Diagnosis: Epidermolysis Bullosa Acquisita (Tardive) ? Presented by Dr. Jesse A. Tolmach.
A Negro woman, aged 39, complains of an eruption which has been present on her hands for about two years. The eruption was preceded by painful swelling of the finger joints, which was diagnosed as rheumatoid arthritis. It is difficult to obtain an accurate history of the appearance of the initial eruption, but on two occasions a small bulla was noted on two of the sites of eruption, allegedly after trauma. The patient imbibes a moderate amount of alcohol.
The skin over all of the metacarpophalangeal joints and, with the exception of the thumbs, over all of the proximal interphalangeal joints is involved. On these sites, there are small, yellowish waxy irregular-shaped patches consisting of milia-like conglomerations and scarring.
Microscopic examination showed a thickening of the epidermis with an irregularity of the surface contour.
Sobel N, Kesten B. NEW YORK ACADEMY OF MEDICINE, SECTION OF DERMATOLOGY AND SYPHILOLOGY. Arch Dermatol. 1960;82(3):464–468. doi:10.1001/archderm.1960.01580030158035
Artificial Intelligence Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.