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April 2010

Bullae, Scaly Papules, and Plaques—Diagnosis

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Arch Dermatol. 2010;146(4):439-444. doi:10.1001/archdermatol.2010.37-b

The punch biopsy specimen of the patient's upper back showed lichenoid interface dermatitis composed of lymphocytes with rare eosinophils and plasma cells. There were numerous necrotic keratinocytes in the epidermis and pigment-laden melanophages in the superficial dermis. The punch biopsy specimen from the left lower extremity showed a subepidermal bulla with superficial dermal lichenoid inflammation composed of lymphocytes, rare eosinophils, and numerous pigment-laden melanophages (Figure 3). Direct immunofluorescence using cryostat sections with antisera to IgG, IgA, IgM, C3, and fibrinogen showed linear IgG and C3 deposition (Figure 4, anti IgG immunoreactant) at the basement membrane zone. Test results for IgA, IgM, and fibrinogen were negative.

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