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Localized Facial Macules and Vesicles—Quiz Case

Localized Facial Macules and Vesicles—Quiz Case Report of a case A 37-year-old white woman presented with a 1-year history of an intensely pruritic, burning eruption that was limited to her face. She stated that theitching and burning sensation would occur 1 or 2 days before the appearance of erythematous macules and small vesicles on her face. The vesicles wouldquickly rupture and crusts would form. She had been treated for presumed acne, but the use of topical and systemic antibiotics and topical retinoids onlyworsened the burning and erythema. Her medical history was notable for type 1 diabetes mellitus and iron deficiency anemia, which did not improve withoral iron supplementation. Also, a small-bowel biopsy specimen that had been obtained 2 months before presentation revealed mucosal inflammation that wasconsistent with gluten-sensitive enteropathy. The patient denied having current symptoms of diarrhea, bloating, cramping, abdominal discomfort, or other systemiccomplaints. On further questioning, however, she did recall a remote history of a similar eruption on her buttocks, as well as focal areas of pruritusand burning on her shoulders and upper back area. Physical examination revealed numerous discrete 2- to 6-mm erythematous macules and erosions, some with overlying hemorrhagic or serous scale-crust,on the patient's forehead, nose, cheeks, and chin (Figure 1). A rare vesicle with an erythematous base was also evident on the glabella. Focal areas of hypopigmented scarring were noted across theupper back area. No erythema or erosions were seen on the oral, ocular, or nasal mucosa. A biopsy specimen from normal-appearing skin of the left innerarm was obtained for direct immunofluorescence (Figure 2, IgA antibody pattern shown). No biopsy specimen was obtained for hematoxylin-eosin staining. Figure 1. View LargeDownload Figure 2. View LargeDownload What is your diagnosis? http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Localized Facial Macules and Vesicles—Quiz Case

Localized Facial Macules and Vesicles—Quiz Case

Abstract

Report of a case A 37-year-old white woman presented with a 1-year history of an intensely pruritic, burning eruption that was limited to her face. She stated that theitching and burning sensation would occur 1 or 2 days before the appearance of erythematous macules and small vesicles on her face. The vesicles wouldquickly rupture and crusts would form. She had been treated for presumed acne, but the use of topical and systemic antibiotics and topical retinoids onlyworsened the burning and...
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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.140.3.353-g
Publisher site
See Article on Publisher Site

Abstract

Report of a case A 37-year-old white woman presented with a 1-year history of an intensely pruritic, burning eruption that was limited to her face. She stated that theitching and burning sensation would occur 1 or 2 days before the appearance of erythematous macules and small vesicles on her face. The vesicles wouldquickly rupture and crusts would form. She had been treated for presumed acne, but the use of topical and systemic antibiotics and topical retinoids onlyworsened the burning and erythema. Her medical history was notable for type 1 diabetes mellitus and iron deficiency anemia, which did not improve withoral iron supplementation. Also, a small-bowel biopsy specimen that had been obtained 2 months before presentation revealed mucosal inflammation that wasconsistent with gluten-sensitive enteropathy. The patient denied having current symptoms of diarrhea, bloating, cramping, abdominal discomfort, or other systemiccomplaints. On further questioning, however, she did recall a remote history of a similar eruption on her buttocks, as well as focal areas of pruritusand burning on her shoulders and upper back area. Physical examination revealed numerous discrete 2- to 6-mm erythematous macules and erosions, some with overlying hemorrhagic or serous scale-crust,on the patient's forehead, nose, cheeks, and chin (Figure 1). A rare vesicle with an erythematous base was also evident on the glabella. Focal areas of hypopigmented scarring were noted across theupper back area. No erythema or erosions were seen on the oral, ocular, or nasal mucosa. A biopsy specimen from normal-appearing skin of the left innerarm was obtained for direct immunofluorescence (Figure 2, IgA antibody pattern shown). No biopsy specimen was obtained for hematoxylin-eosin staining. Figure 1. View LargeDownload Figure 2. View LargeDownload What is your diagnosis?

Journal

Archives of DermatologyAmerican Medical Association

Published: Mar 1, 2004

Keywords: face,vesicle,macule

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