{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:59:46Z","timestamp":1780477186392,"version":"3.54.1"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Pemphigus vulgaris (PV) is a rare immunobullous disease. Although it classically presents as generalized flaccid blisters affecting the skin and mucosae, atypical cases of PV can be diagnostically challenging. Herein, we report an underrecognized non-blistering manifestation of pemphigus vulgaris, which we call mounded and refractory keratoses (MARK). MARK presents as exuberant scaling plaques on the scalp, often in the skin of color. When MARK features are present, pemphigus vulgaris is prone to misdiagnosis, clinically and histopathologically, leading to delays in appropriate treatment. Specifically, biopsies from these patients may resemble acantholytic dyskeratosis, resulting in initial misdiagnosis. Thus, recognizing this presentation may aid physicians in diagnosing and monitoring the recurrence of pemphigus vulgaris.<\/jats:p>","DOI":"10.3389\/fmed.2022.1087382","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T20:29:33Z","timestamp":1673382573000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case report: Mounded and refractory keratoses (MARK), a novel presentation of pemphigus vulgaris"],"prefix":"10.3389","volume":"9","author":[{"given":"Stephanie T.","family":"Le","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atrin M.","family":"Toussi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan E.","family":"Nava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A.","family":"Downing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell A.","family":"Fung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/j.jaad.2018.02.021","article-title":"Diagnosis and management of pemphigus: recommendations of an international panel of experts.","volume":"82","author":"Murrell","year":"2020","journal-title":"J Am Acad Dermatol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1007\/s12016-010-8248-5","article-title":"The etiology of paraneoplastic autoimmunity.","volume":"42","author":"Maverakis","year":"2012","journal-title":"Clin Rev Allergy Immunol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/S0140-6736(19)31778-7","article-title":"Pemphigus.","volume":"394","author":"Schmidt","year":"2019","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S0140-6736(05)66829-8","article-title":"Pemphigus.","volume":"366","author":"Bystryn","year":"2005","journal-title":"Lancet."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a180","article-title":"Bullous pemphigoid and pemphigus vulgaris\u2013incidence and mortality in the UK: population based cohort study.","volume":"337","author":"Langan","year":"2008","journal-title":"BMJ."},{"key":"B6","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.jaad.2005.10.068","article-title":"Disparities in dermatology educational resources.","volume":"55","author":"Ebede","year":"2006","journal-title":"J Am Acad Dermatol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1016\/j.jaad.2022.08.003","article-title":"Skin of color representation in dermatology atlases.","volume":"87","author":"Hereford","year":"2022","journal-title":"J Am Acad Dermatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/cup.13356","article-title":"Distinguishing histopathologic features of acantholytic dermatoses and the pattern of acantholytic hypergranulosis.","volume":"46","author":"See","year":"2019","journal-title":"J Cutan Pathol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1097\/00004347-198303000-00006","article-title":"Warty dyskeratoma of the vulva.","volume":"2","author":"Duray","year":"1983","journal-title":"Int J Gynecol Pathol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"87","DOI":"10.4103\/idoj.IDOJ_83_19","article-title":"A rare case of extensive pemphigus vegetans.","volume":"11","author":"Verma","year":"2020","journal-title":"Indian Dermatol Online J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1590\/abd1806-4841.20198285","article-title":"Pemphigus vegetans with isolated involvement of the nose and chest: rare variant of pemphigus vulgaris.","volume":"94","author":"Feitoza","year":"2019","journal-title":"An Bras Dermatol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1111\/j.1468-3083.2010.03939.x","article-title":"Pemphigus vegetans: a clinical, histological, immunopathological and prognostic study.","volume":"25","author":"Zaraa","year":"2011","journal-title":"J Eur Acad Dermatol Venereol."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.127712","article-title":"Localized pemphigus vegetans without mucosal involvement.","volume":"59","author":"Jain","year":"2014","journal-title":"Indian J Dermatol."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/6154397","article-title":"The significance of scalp involvement in pemphigus: a literature review.","volume":"2018","author":"Sar-Pomian","year":"2018","journal-title":"Biomed Res Int."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1001\/jamainternmed.2015.5768","article-title":"The value of the history and physical examination\u2013sailing through medicine with modern tools: a teachable moment.","volume":"175","author":"Abou Ziki","year":"2015","journal-title":"JAMA Intern Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1087382\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T20:29:36Z","timestamp":1673382576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1087382\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,10]]},"references-count":15,"alternative-id":["10.3389\/fmed.2022.1087382"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.1087382","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,10]]},"article-number":"1087382"}}