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April 2006

Bullae on the Wrists of an 11-Year-Old Boy—Quiz Case

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Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006

Arch Dermatol. 2006;142(4):515-520. doi:10.1001/archderm.142.4.515-g

An 11-year-old boy presented with a 6-day history of tense bullae, vesicles, and erosions over the dorsum of both hands and on the helixes of both ears. His symptoms had appeared 2 days after he had been swimming outdoors. He denied any ophthalmologic symptoms. The lesions formed crusts over a few days and healed with scarring.

Three months later, and 3 days after playing basketball in the sun, the patient developed multiple erythematous papules and tense vesicles on the same areas, with a crusted erosion on the right helix. There was no family history of photosensitivity, and no exposure to photosensitizers was recorded during this period. On examination, there were numerous lesions in various stages of development. Active lesions included flaccid, tense, umbilicated bullae and vesicles (Figure 1 and Figure 2). Each bulla ruptured within a few days. A biopsy was performed on a bulla (Figure 3).