Row of tombstone is seen in which skin disorder:
**Core Concept**
Pemphigus vulgaris is an autoimmune disorder characterized by the formation of intraepithelial blisters, resulting from the breakdown of epidermal cell-cell adhesion. This is due to autoantibodies against desmoglein 3, a component of desmosomes, which are crucial for maintaining the integrity of the epidermis.
**Why the Correct Answer is Right**
In pemphigus vulgaris, the autoantibodies target desmoglein 3, causing a loss of cell-cell adhesion within the epidermis. This leads to the formation of suprabasal blisters, which eventually rupture to form crusted erosions. The "row of tombstones" appearance is classically seen in pemphigus vulgaris due to the presence of basal keratinocytes that have lost their overlying epidermal cells, resembling tombstones.
**Why Each Wrong Option is Incorrect**
**Option A:** Paraneoplastic pemphigus is a rare, autoimmune disorder associated with underlying neoplasms, and it targets multiple proteins, including desmoglein 3, but it is not the primary condition associated with the "row of tombstones" appearance.
**Option B:** Pemphigus foliaceous is a variant of pemphigus vulgaris that primarily affects the superficial epidermis, and it is characterized by the loss of desmoglein 1, not desmoglein 3.
**Option D:** Bullous pemphigoid is an autoimmune disorder that targets the basement membrane zone, leading to the formation of subepidermal blisters, which is distinct from the intraepidermal blisters seen in pemphigus vulgaris.
**Clinical Pearl / High-Yield Fact**
The "row of tombstones" appearance is a classic histopathological feature of pemphigus vulgaris, and it is essential to recognize this pattern to differentiate it from other autoimmune skin disorders.
✓ Correct Answer: A. Pemphigus vulgaris