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June 1, 2008

Bullous Lesions Arising After a Skin Prick Test—Quiz Case

Author Affiliations


Arch Dermatol. 2008;144(6):795-800. doi:10.1001/archderm.144.6.795-d

A 41-year-old Turkish woman who was referred to the dermatology department at the Medical University of Graz (Austria) had bullous skin lesions that were located on both arms and that had arisen 48 hours after a skin prick test for common food and airborne allergens (Figure 1). She stated that during the first 30 minutes after needle inoculation no cutaneous signs were observed and that a negative finding for the skin prick test report was made. However, within the next 24 hours, progressively enlarging and painful bullous lesions appeared in the same areas as the skin prick test. Physical examination showed multiple bullous lesions on both arms, almost 1 cm in diameter, surrounded by erythema, as well as few pustules on her face and painful ulcers on her tongue and genital area (Figure 2). The patient reported oral and genital ulcers a few months prior to the skin prick test. She was seen by an otorhinolaryngologist and gynecologist, who respectively diagnosed her as having a nonspecific stomatitis aphthosa and genital candidiasis. A punch biopsy specimen was obtained for microscopic evaluation from a bullous lesion on her left arm that resulted after the skin prick test (Figure 3).

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