Urticarial vasculitis presenting as erythema gyratum repens‐like eruption

flare resolved in 2 weeks and disease control was achieved in a month. All pemphigus patients should be advised to avoid unnecessary medications. In particular, immune-stimulating herbal medicinals, such as Astragalus, Echinacea, alfalfa and licorice, as well as vitamin E and zinc may counteract the immunosuppressants used to control the disease. Phellinus linteus has been reported to induce maturation of dendritic cells, which in turn provoke T-cell mediated immune responses. Moreover, Phellinus linteus -sourced proteoglycan preferably activates CD19+ B cells over CD3+ T cells in murine splenic lymphocytes, and concurrently up-regulates co-stimulatory molecules, CD86 and CD80, in B cells. These suggest Phellinus linteus exerts immuno-stimulatory effects via selective B-cell activation. Another study concluded that Phellinus linteus increased antibody production by B cells responding to specific antigens. As pemphigus is an antoantibody-producing disease, we propose cautiously that Phellinus linteus could contribute to pemphigus exacerbation due to its immune-enhancing effects on antibody production. In our patient, the possibility of pemphigus aggravation as part of the natural disease course cannot be completely ruled out. However, the fact that her disease had been controlled with minimal medication for a year, and the fact that the disease flared after taking Phellinus linteus showed resistance to aggressive treatment until Phellinus linteus withdrawal, strongly suggests a correlation between the flare and Phellinus linteus. The patient had no other notable exacerbating factors such as viral infections, dermatitis, emotional and physical stress. Additional studies are necessary to investigate herb-triggered aggravations in pemphigus.