To report recurrent conjunctivitis and scleritis secondary to coexistent conjunctival pemiphigus vulgaris and cryptic herpes simplex infection.

Although the clinical findings of pityriasis rubra pilaris (PRP) are striking, the microscopic diagnosis can be difficult because changes can be subtle and can overlap with other skin diseases. Suprabasal acantholysis can be seen in PRP, mimicking pemphigus vulgaris. We report a patient with PRP whose initial biopsies demonstrated subcorneal acantholysis mimicking pemiphigus foliaceus.

Although immunofluorescent tests have been demonstrated to be of value in the diagnosis of many oral and skin lesions, the use of this technique has until recently been cumbersome because of the requirement for frozen tissue specimens. This has been circumvented by the development of a solution in which tissue can be transported to the testing laboratory at ambient temperatures. To verify that the immunofluorescent findings in gingiva and skin kept in this solution are not artifactual, ultrastructural studies were performed on such tissue. These revealed that over-all tissue architecture, individual cells, and the epidermal-connective tissue interface remain intact. Since the majority of oral lesions submitted for immunofluorescent testing are suspected of being pemiphigus or pemphigoid, the finding that these tissue features remain intact indicates that the distribution of immunofluorescence is related to definite morphologic structures and provides additional evidence for the validity of using the transport solution.