<prompt> Intra-epidermal intercellular deposition of IgG on immunofluorescence is seen in :PemphigusBullous pemphigoidEpidermolysis bullosa acquisitaSubcorneal pustular dermatosis  <response>: Ans. a. Pemphigus Ref: Fitzpatrick 7ep432-441; Rooks 8ep40.27, 13.19, 10.12-10.28Granular deposition of IgA at dermal papillae on immunofluorescence is seen in pemphigus.A 30-year-old male presents with flaccid bullae on an erythematous base and erosions over the oral mucous membrane. The blisters developed painful erosions rupture. The clinical features point towards a diagnosis of pemphigus vulgaris, which is characterized by a fishnet pattern of intraepidermal IgG deposition on immunofluorescence.DisorderImmunofluorescencePatternTarget antigenPemphigus vulgarisIntercellular, intraepidermalIgG, fish netQDesmoglein 3QPemphigus foliaceusIntercellular, intraepidermalIgG, fish netQDesmoglein 1QParaneoplastic pemphigusIntercellular and subepidermalIgG, fish netQPlakins desmoplakin, envoplakin, periplakin, BP 230Bullous pemphigoidBasement membrane zoneIgG, linearBP230 BP180Herpes gestationalisBasement membrane zoneIgG, linearBP230 BP 180Dermatitis herpetiformisDermal papillaeIgA, granular? Epidermal tissue trnasgl utam inaseQLinear IgA diseaseBasement membrane zoneIgA, linearBP180PemphigusAn autoimmune disease characterized by acantholysis induced by deposition of lgG antibodies in the intercellular area of epidermisThe commonest variant is Pemphigus vulgaris, seen in adults mainlyMainly involving the upper part of the bodyCharacterized by cutaneous thin-walled, delicate and flaccid bullaeQ and mucosal blistersMucosal lesions are present in all patients, oral mucosa most frequently involved, painful erosions extend peripherally with the shedding of the mucosa.Erosions are frequently secondarily infected by bacteria in skin and Candida in mucosa, extensive lesions are associated with water and electrolyte imbalance.Associated with Nikolsky sign and Bulla spread sign or Asboe Hansen sign.Histology Biopsy is best taken from the edge, from perilesional skinBulla is intra-epidermal, the split being suprabasalPresence of acantholytic cells rounded keratinocytes present in the blister cavity and at the edge of the blisterA row of tombstone appearanceDirect Immunofluorescence DIF:Done on the skin, shows intercellular deposits of IgG and C3 giving a fishnet appearanceTreatment:Systemic steroids and immunosuppressants. 