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June 1, 2008

Bullous Lesions Arising After a Skin Prick Test—Diagnosis

Author Affiliations

Carrie Ann R.CusackMDSenait W.DysonMDJacqueline M.Junkins-HopkinsMDVincentLiuMDKarla S.RosenmanMD

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

Histopathologic examination revealed a widespread necrosis of the epidermis with blister formation and a massive neutrophilic infiltrate in the upper part of the dermis. Fibrin deposits in the vessel walls with intraluminal thrombi were present, as well as focal nuclear dust and hemorrhages (Figure 3). Findings from complete blood cell count and blood chemistry analysis and levels of antinuclear antibodies and antiphospholipid antibodies were within reference range. The patient expressed the HLA-B51 antigen. Findings from ocular examination as well as neurologic workup were within reference range. Our patient received a topical steroid to treat the lesions on the arms and dapsone systemically. The lesions on her arms resolved within a few days, whereas the oral and genital ulcers healed within a few months. At her 18-month follow-up visit, the patient was free of cutaneous and mucosal lesions while receiving dapsone, 50 mg, every other day.