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May 2009

Periorbital Papulovesicular Eruption in an Elderly Man—Diagnosis

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Arch Dermatol. 2009;145(5):589-594. doi:10.1001/archdermatol.2009.91-b

Histologic examination revealed a subepidermal vesicle filled with neutrophils and a few eosinophils and a moderate, perivascular, lymphocytic infiltrate. Direct immunofluorescence of perilesional skin revealed an intense linear deposition of IgG and slightly less intense IgA and C3 along the basement membrane. Direct immunofluorescence of the specimen following incubation with 2M of sodium chloride that resulted in a subepidermal cleft revealed the deposition of IgG and IgA to be limited to the dermal side of the subepidermal cleft. Indirect immunofluorescence of the patient's serum using normal human salt-split skin as substrate revealed circulating IgG and IgA antibodies against the dermal side. The combination of clinical, histologic, and immunofluorescence findings is characteristic of localized inflammatory EBA. The patient was treated with fluocinonide ointment, twice daily for 4 weeks, and the eruption cleared completely. He was then lost to follow-up.

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