Figure 1.

Clinical and laboratory features of patients with pemphigus living near the wastewater treatment plant. A – Pemphigus foliaceus crusted erosion on erythematous base located on the nose of patient no. 1. B – Direct immunofluorescence on perilesional skin showing IgG4 pemphigus deposits in patient no. 1. C – Initial pemphigus foliaceus erosions and erythematous patches on the chest of female patient no. 2. D – Indirect immunofluorescence on monkey esophagus revealing IgG4 pemphigus antibodies in patient no. 2. E – Pemphigus vulgaris crusted erosions with massive impetiginisation on the scalp in patient no. 3. F – Pemphigus vulgaris lesions affecting interdigital spaces imitating fungal infection in patient no. 3