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QUIZ SECTION ActaDV ActaDV
Advances in dermatology and venereology Acta Dermato-Venereologica
Pigmented Intertriginous Lesions and Bullous Plaques: A Quiz
Magdalena ZYCHOWSKA, Aleksandra BATYCKA-BARAN *, Joanna MAJ, Jacek C. SZEPIETOWSKI and Wojciech BARAN Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368, Wroclaw, Poland. * E-mail: ola. batycka @ interia. pl
An 82-year-old woman presented with extensive, nonpruritic skin lesions, which had developed gradually over 10 years( Fig. 1a). Clinical examination also revealed shiny erythematous-violaceous plaques with several tense bullae on the forearms, thighs, dorsal aspects of the hands and feet( Fig. 1b) and extensive reticular white striae on the buccal mucosa. No hair or nail abnormalities were seen. A basic laboratory work-up was normal with the exception of dyslipidaemia. Histological examinations of hyperpigmented lesions in the right groin and a bullous plaque were performed( Fig. 1c, d). Direct immunofluorescence revealed numerous cytoid bodies at the dermoepidermal junction composed of IgM, IgA and C3c in both tissue samples. No circulating anti-basement membrane zone( anti-BMZ) antibodies were found.
What is your diagnosis? See next page for answer.
Fig. 1.( a) Reticular, hyperpigmented lesions in the axillae and submammary regions.( b) Tense bullae over an erythematous-violaceous plaque on the right thigh.( c) Histopathology( reticular lesion in the right groin): hyperkeratosis, hypergranulosis, vacuolar degeneration of the basal layer, band-like infiltration composed of lymphocytes and melanophages, prominent pigment incontinence( haematoxylin and eosin( H & E), original magnification × 100).( d) Histopathology( bullous plaque on the right thigh): hyperkeratosis, acanthosis, hypergranulosis, extensive bulla, band-like lymphocytic infiltration in the upper dermis( H & E, original magnification × 100).
doi: 10.2340 / 00015555-2532 Acta Derm Venereol 2017; 97: 548 – 549
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica.