A 20-year-old white man was referred to the dermatology department for recalcitrant bilateral tinea pedis. He had been treated several times by his primary care physician, without success. He presented with significant bilateral pedal intertriginous erythema with severe fissuring and exfoliation. A potassium hydroxide scraping of his feet was positive for hyphae.
During the initial evaluation, the patient was noted to have thickened, ridged skin overlying his elbows, wrists, and knees (Figure 1). He reported a lifelong history of thick, gray, scaling skin localized to the flexural regions of his elbows, wrists, knees, and ankles. On further questioning, he also admitted to having an associated formation of bullous lesions on his upper and lower extremities as a child. These bullous lesions typically occurred at areas of minor skin trauma. Although he had not experienced any bullae during his adolescent years, his examination revealed two 2.0-cm healing bullae on his right forearm and left ankle that had developed after minor trauma to these areas (Figure 2). He stated that bullous lesions would occur in areas of friction or after mild pressure was applied to his skin.
Guardiano RA, Ryan M, Liotta EA. Bullae in a 20-Year-Old Man. Arch Dermatol. 2001;137(11):1521–1526. doi: