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June 2007

Recurrent, Pruritic Dermal Plaques and Bullae—Quiz Case

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Arch Dermatol. 2007;143(6):791-796. doi:10.1001/archderm.143.6.791-b

A 91-year-old woman with a 6-month history of recurrent, itchy, erythematous plaques and bullae presented with her third eruption of lesions. The initial lesions had started 6 months earlier as itchy, erythematous plaques with central areas of necrosis that resolved after a few weeks of topical therapy with 0.05% fluocinonide. The second eruption of lesions, which appeared several weeks later as erythematous bullae on both arms, developed and fully resolved within a 2-week period. The patient denied any recent history of trauma, arthropod bites, or medication changes. Physical examination revealed an afebrile woman with tense bullae arising from a rosy, irregular, edematous plaque measuring 6 cm in diameter on her right pretibial area that was not warm on palpation (Figure 1). A 4-mm biopsy specimen was obtained from the lesion (Figure 2 and Figure 3). Laboratory work revealed a slight leukocytosis (white blood cell count, 11.1×103/μL; reference range, 4.8-10.8×103/μL) with 16% eosinophils (1800/μL; reference range, 0-500/μL).

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