Case for Diagnosis: Acquired Epidermolysis Bullosa? Sun-Sensitivity Eruption? Dermatitis Herpetiformis? Presented by Eugene F. Traub, M.D.
A 54-year-old salesman first noticed blisters on his hands, forearms, arms, neck, face, ears, and scalp beginning about six to eight years ago. The blisters have appeared nowhere else and follow minor bruises. A true Nikolsky sign has not been elicited. The lesions are extremely pruritic. There is no history of drug ingestion. The eruption is somewhat seasonal, clearing up to a large extent in the winter months, although, as you can see, it is present now, almost on the first of December. He has, since the question of sun sensitivity was raised, avoided direct sun exposure as much as possible. I should like to draw attention to the patient's color which is suggestive of either a mild jaundice, pernicious anemia, or malignancy. He has never had gallbladder disease.