title: Vulvo-cervico-vaginal manifestations and evaluation of Papanicolaou smears in pemphigus vulgaris and pemphigus foliaceus.
abstract: BACKGROUND
  Vulvo-cervico-vaginal involvement has rarely been reported in pemphigus vulgaris (PV) and has not been reported in pemphigus foliaceus (PF).
  
  
  OBJECTIVE
  We sought to evaluate genital lesions and Papanicolaou (Pap) smears in female patients with PV and PF.
  
  
  METHODS
  This prospective study includes all consecutive cases of female patients with PV and PF seen from May 2009 to February 2010. Gynecologic examination was performed and Pap smears were collected for cytologic analysis from each patient.
  
  
  RESULTS
  A total of 56 patients were given a diagnosis of pemphigus (41 PV and 15 PF). Genital involvement was observed in 9 patients with PV (22%) and the vulva was the most common genital site of involvement. Of these 9 patients, 8 presented with active skin/mucous lesions. Four of 15 patients with PF had genital lesions and vulva was the exclusive site of involvement. Three of 4 patients with PF and genital involvement also showed active cutaneous lesions. Six of 56 patients (5 PV and 1 PF) presented with atypical squamous cells of undetermined significance in Pap smear analysis. Upon further pathologic review, acantholytic cells were seen, confirming the diagnosis of pemphigus.
  
  
  CONCLUSIONS
  A small number of PF cases were studied.
  
  
  CONCLUSIONS
  Vulvar lesions were the second most frequent site of mucous membrane PV. Herein we report the first case to our knowledge of symptomatic genital lesions in a patient with PF. Moreover, acantholytic cells in Pap smears were found in a patient with PF who was in complete remission off therapy with no clinical genital lesions and no circulating anti-desmoglein-1 and anti-desmoglein-3 autoantibodies. Gynecologic evaluation in patients with pemphigus, including a careful evaluation of Pap smears, should be recommended.
authors.affiliation: Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil. natashadamasio@gmail.com
authors.forename: Natasha D
authors.initials: ND
authors.lastname: Fairbanks Barbosa
authors.forename: Lana M
authors.initials: LM
authors.lastname: de Aguiar
authors.forename: Celina W
authors.initials: CW
authors.lastname: Maruta
authors.forename: Valéria
authors.initials: V
authors.lastname: Aoki
authors.forename: Miriam N
authors.initials: MN
authors.lastname: Sotto
authors.forename: Glaucia H O
authors.initials: GH
authors.lastname: Labinas
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Perigo
authors.forename: Claudia Giuli
authors.initials: CG
authors.lastname: Santi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005831:Genital Diseases, Female / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D010392:Pemphigus / Q000150:complications* / Q000473:pathology; D011446:Prospective Studies; D002577:Uterine Cervical Diseases / Q000209:etiology; D014623:Vaginal Diseases / Q000209:etiology; D014626:Vaginal Smears; D014845:Vulvar Diseases / Q000209:etiology; D055815:Young Adult