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May 1, 2008

Extensive Flaccid Bullae With Milia—Quiz Case

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Arch Dermatol. 2008;144(5):673-678. doi:10.1001/archderm.144.5.673-a

A 75-year-old woman with a history of multiple myeloma presented with extensive bullae. For 4 years, she had experienced generalized pruritus and occasional blister formation. She had recently noted easy bruising with extensive blistering of the skin in areas of friction, particularly the axillae and groin. With rubbing, these blisters became large, painful erosions, with subsequent scarring and milia formation. Physical examination revealed skin laxity and fragility with large, flaccid bullae in the axillae, groin (Figure 1), and inframammary folds. There were multiple brown plaques studded with milia in these areas, as seen in the axilla (Figure 2). On the trunk and extremities she had diffuse petechiae and ecchymoses. She had periorbital edema and purpura with yellow-brown waxy plaques around the eyelids. No macroglossia or lymphadenopathy was noted. A punch biopsy specimen of a bullous area on the left upper thigh was obtained (Figure 3).

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