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Blistering, Scarring, and Photosensitivity in a Male Teenager—Quiz Case

Blistering, Scarring, and Photosensitivity in a Male Teenager—Quiz Case Report of a case A 15-year-old white boy had been experiencing itchy papules and blisters on sun-exposed areas since he was 18 months old, primarily during the spring and summer. Sometimes, the red papules evolved into painful blisters that oozed clear fluid, became crusted, and healed with scars. Frequently, the lesions also became infected. The patient's mother observed that the eruptions flared several days after sun exposure, but also reported that multiple sunblocks were of no benefit. Over the last 5 years, the frequency of these blistering episodes markedly decreased. The patient's medical history was significant for a bout of iritis with keratitis, occasional oral blisters, and episodes of gastritis. He had no atopic diathesis, and his family history was unremarkable. On physical examination, there were extensive pigmentary changes on the face (Figure 1), as well as numerous "pocklike" scars left by the primary lesions, especially on the arms. The results of the following laboratory tests and determinations were normal: complete blood cell count, liver function tests, and iron, uric acid, antinuclear antibody, serum Ro/La, porphyrin (serum, urine, and fecal samples), and quantitative urinary amino acid levels. Multiple Tzanck smears were negative, as were viral and bacterial cultures. The findings of screening light tests were unremarkable with a UV-B minimal erythema dose of 30 to 40 mJ/cm2 and a broad-band UV-A minimal erythema dose greater than 20 J/cm2. Photo-patch tests were nonreactive. The results of direct and indirect immunofluorescence studies were negative. A biopsy specimen of an acute blistering lesion was obtained for routine hematoxylin-eosin staining (Figure 2 and Figure 3). View LargeDownload Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. What is your diagnosis? SECTION EDITOR: MICHAEL MING, MD http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Blistering, Scarring, and Photosensitivity in a Male Teenager—Quiz Case

Archives of Dermatology , Volume 135 (10) – Oct 1, 1999

Blistering, Scarring, and Photosensitivity in a Male Teenager—Quiz Case

Abstract

Report of a case A 15-year-old white boy had been experiencing itchy papules and blisters on sun-exposed areas since he was 18 months old, primarily during the spring and summer. Sometimes, the red papules evolved into painful blisters that oozed clear fluid, became crusted, and healed with scars. Frequently, the lesions also became infected. The patient's mother observed that the eruptions flared several days after sun exposure, but also reported that multiple sunblocks were of no...
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Publisher
American Medical Association
Copyright
Copyright © 1999 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.135.10.1267
Publisher site
See Article on Publisher Site

Abstract

Report of a case A 15-year-old white boy had been experiencing itchy papules and blisters on sun-exposed areas since he was 18 months old, primarily during the spring and summer. Sometimes, the red papules evolved into painful blisters that oozed clear fluid, became crusted, and healed with scars. Frequently, the lesions also became infected. The patient's mother observed that the eruptions flared several days after sun exposure, but also reported that multiple sunblocks were of no benefit. Over the last 5 years, the frequency of these blistering episodes markedly decreased. The patient's medical history was significant for a bout of iritis with keratitis, occasional oral blisters, and episodes of gastritis. He had no atopic diathesis, and his family history was unremarkable. On physical examination, there were extensive pigmentary changes on the face (Figure 1), as well as numerous "pocklike" scars left by the primary lesions, especially on the arms. The results of the following laboratory tests and determinations were normal: complete blood cell count, liver function tests, and iron, uric acid, antinuclear antibody, serum Ro/La, porphyrin (serum, urine, and fecal samples), and quantitative urinary amino acid levels. Multiple Tzanck smears were negative, as were viral and bacterial cultures. The findings of screening light tests were unremarkable with a UV-B minimal erythema dose of 30 to 40 mJ/cm2 and a broad-band UV-A minimal erythema dose greater than 20 J/cm2. Photo-patch tests were nonreactive. The results of direct and indirect immunofluorescence studies were negative. A biopsy specimen of an acute blistering lesion was obtained for routine hematoxylin-eosin staining (Figure 2 and Figure 3). View LargeDownload Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. What is your diagnosis? SECTION EDITOR: MICHAEL MING, MD

Journal

Archives of DermatologyAmerican Medical Association

Published: Oct 1, 1999

Keywords: adolescent,cicatrix,blister,photosensitivity

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