A 66‐year‐old man presented with a 1‐month history of a generalized, pruritic, blistering eruption. His medical history included hypertension, iron‐deficiency anaemia and poorly controlled diabetes mellitus. He had been prescribed subcutaneous insulin, hydrochlorothiazide and losartan 3 years prior to the onset of the rash.Physical examination revealed generalized eczematous patches with crusted erosions scattered over the patient's scalp, face, trunk and limbs, while herpetiform vesicles and pustules were distributed over his arms, legs and abdomen (Fig. a,b). The mucous membranes were unaffected.(a) Coalescent erosions, some of which were crusted, were seen over the patient's abdomen and chest. A few intact vesicles and pustules were seen on closer inspection. (b) Annular urticated plaques with herpetiform vesicles were visible over the right flank.Histological examination of a skin biopsy taken from an erosion on the chest revealed spongiosis with eosinophilic exocytosis and a superficial perivascular infiltrate of eosinophils. A repeat skin biopsy from of a vesicle on the right flank showed an intraepidermal blister with adjacent spongiosis and eosinophilic exocytosis (Fig. a). There were no features of acantholysis seen at either the granular layer or the basal epidermis.(a) Intraepidermal blister containing eosinophils and erythrocytes, with epidermal spongiosis and eosinophilic exocytosis, and a dense upper dermal infiltrate
Clinical & Experimental Dermatology – Wiley
Published: Jan 1, 2018
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