The biopsy specimen showed a subepidermal vesicle, beneath which was a dense infiltrate of mast cells with monomorphous ovoid nuclei and fine granular cytoplasm. The patient's condition worsened during her outside hospitalization after she received codeine, a mast cell degranulator, for pain control. Treatment with mast cell degranulators was discontinued, and the patient is currently being treated with oral cromolyn sodium, cimetidine, and hydroxyzine hydrochloride. She remains healthy, with only the intermittent development of localized bullae and no signs or symptoms of systemic involvement. No c-kit mutations were identified.
Generalized Bullae in an Infant. Arch Dermatol. 2002;138(6):831–836. doi:10.1001/archderm.138.6.831