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benign familial pemphigus (figure 53) Typically begins as a painful erosive skin rash on areas exposed to friction such as the neck, axilla, under the breasts, the groins and in between the buttocks Lesions extend peripherally, healing in the centre without scars If the lesions are present for some time they may become thickened and malodorous with soft vegetations, and fissures Refer to the chapter Hailey-Hailey disease Pemphigus vulgaris Can have flexural involvement Pemphigus vegetans (figure 54) The principle finding is vegetating lesions in the flexures, although any site can be affected Refer to the related chapter Pemphigus vulgaris and pemphigus vegetans Oral lesions Chronic erosions and ulcers, which can be the endpoint of bullae, are seen more commonly than the bullae themselves

From shades of purple and blue to deep browns or blacks, their appearance often depends on factors like skin tone and underlying issues

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Gallstones are the most common cause of blocked bile ducts