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JAMA Dermatology Clinicopathological Challenge
January 2015

Tense Bullae on the Palms and Soles

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Harvard Combined Dermatology Residency Program, Boston, Massachusetts
  • 3Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2015;151(1):99-100. doi:10.1001/jamadermatol.2014.2702

A man in his 70s presented with a 2-week history of a bullous eruption localized to the hands and feet. He denied having pruritus or spontaneous bleeding but reported discomfort from the pressure of intact bullae. His medical history was notable for diabetes mellitus and hypertension, which was well controlled with a stable regimen of lisinopril and atenolol for several years. He denied using any new medications or supplements or making recent dose adjustments in existing medications. There was no history of a prior bullous eruption. Physical examination revealed numerous small intact bullae and large erosions on the lateral feet, soles, and toes (Figure, A). The extent of the bullae led to difficulty with ambulation. There were also intact vesicles on the lateral palms along with erosions demonstrating evidence of previous bullae formation. There were no vesicular or bullous lesions on the trunk, arms, legs, or mucosal surfaces. Hematoxylin-eosin staining of a biopsy specimen obtained from a bulla on the foot was performed (Figure, B).

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