Bullous Lesions on a Chronic Cutaneous Plaque

Abstract

In March 2011, a 51-year-old man was referred to our department for his generalized mucocutaneous lesions. The onset of lesions was after an episode of a common cold 3 months earlier. He had an asymptomatic, erythematous plaque on the upper chest since childhood, and after his recent cold, the plaque became irritated, tender and multiple erosions and crusts appeared on it. Later the satellite lesions spread beyond the edge and 2 weeks before the referral, the eruptions became generalized. He had no history of similar lesions. Clinical examination revealed multiple erosions and loose blisters mostly on the left upper chest, erythematous plaque and scattered erosions on the scalp, face, trunk, limbs and oral mucosa (Fig. 8.1a). Sensation on the chest plaque appeared normal? The results of all laboratory tests were within normal ranges, except purified protein derivative (PPD)-tuberculin skin test that was positive with a 15 mm of induration. Histologic examination of a skin biopsy from the erosions on the old erythematous plaque of the chest, revealed focal suprabasal acantholysis within the epidermis, with bullae formation, while dense granulomatous aggregations of tuberculoid and foreign body type granulomas were seen in the upper and mid dermis. Areas of effacement of dermo-epidermal junction (DEJ) and interface pattern were also noted (Fig. 8.2).