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JAMA Dermatology Clinicopathological Challenge
April 2014

Vesicles and Targetoid Lesions in a Postpartum Woman

Author Affiliations
  • 1Department of Dermatology, Henry Ford Medical Center, Detroit, Michigan
JAMA Dermatol. 2014;150(4):445-446. doi:10.1001/jamadermatol.2013.7581

A woman in her 20s was seen with a widespread, intensely pruritic eruption that had started 4 days postpartum. The patient had had an uneventful pregnancy and did not have pruritus during her third trimester. Her child was born full-term, with no cutaneous lesions. Physical examination of the patient revealed an extensive cutaneous eruption involving all 4 extremities and most of her trunk, including the periumbilical area. There was no involvement of the ocular, oral, or external genital mucous membranes. Her skin lesions had multiple morphologies, including polycyclic vesicles overlying erythematous plaques on the lateral chest (Figure, A) and targetoid erythematous plaques with dusky centers on the abdomen (Figure, B). Punch biopsy specimens were obtained from a vesicle and perilesional skin and were submitted for histologic examination with routine hematoxylin-eosin staining (Figure, C) and direct immunofluorescence, respectively.

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