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July 2009

Vesiculobullous Lesions on the Dorsum of the Foot—Diagnosis

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Arch Dermatol. 2009;145(7):829-834. doi:10.1001/archdermatol.2009.144-b

Histopathological examination revealed multiple intraepidermal blisters and a predominantly eosinophilic infiltration within the vesicles and in the upper dermis (Figure 2). The vesicles containing a moderate number of eosinophils were separated by strands of necrotic eosinophilic keratinocytes and surrounded by necrotic epidermis with marked ballooning and pale keratinocytes (Figure 3). The diagnosis of ADE was confirmed by a very low blood zinc level of 21 μg/dL (reference range, 70-121 μg/dL) (to convert to micromoles per liter, multiply by 0.153). The level of serum glucagon was within the normal range (81 pg/mL; reference range, 59-177 pg/mL) (to convert to nanograms per liter, multiply by 1.0). Treatment with zinc sulfate (100 mg twice daily) was commenced, and the cutaneous findings resolved completely over 12 days.

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