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Off-Center Fold
June 2010

Painful Vesicles on the Wrist—Diagnosis

Author Affiliations


Arch Dermatol. 2010;146(6):667-672. doi:10.1001/archdermatol.2010.117-b

Histologic evaluation revealed an acanthotic epidermis marked by ghosts of necrotic keratinocytes that exhibited reticular and balloon degeneration. The viable keratinocytes were enlarged with increased eosinophilic cytoplasm and prominent amphophilic perinuclear inclusions. The superficial aspect of the dermis was homogeneous, and a perivascular mononuclear infiltrate was present. A monoclonal antibody directed against Vacciniavirus strongly stained the perinuclear inclusions (Figure 3). The patient revealed that 10 days prior to presentation, he wrestled with a fellow marine who had recently been vaccinated against smallpox. The lesion spontaneously regressed within a few weeks, leaving a residual scar.

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