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Special Feature
June 2, 2008

Picture of the Month—Diagnosis

Author Affiliations
 

SAMIR S.SHAHMDALBERT C.YANMD

Arch Pediatr Adolesc Med. 2008;162(6):582. doi:10.1001/archpedi.162.6.582

The physical finding of blisters arranged in the cluster of jewels pattern is highly suggestive of chronic bullous dermatosis of childhood (CBDC). With this presumed diagnosis, the patient's home medications were withheld and an empirical regimen of dapsone, 50 mg/d, and oral prednisone, 40 mg/d, was initiated. The patient was admitted for 48 hours for observation and wound care to denuded areas. Histopathologic examination of an intact vesicle demonstrated subepidermal cleft formation with a superficial perivascular, predominantly neutrophilic, infiltrate. Direct immunofluorescence performed on perilesional skin demonstrated linear staining along the basement membrane zone with IgA and C3, and minimally with IgG. These histopathologic findings confirmed the diagnosis of linear IgA bullous dermatosis/CBDC.

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