Case Number : Case 1657 - 1 November - Dr Uma Sundram Posted By: Guest

Dr Uma Sundram, our new Editor-in-Chief, gets November off to a great start with an interesting case, what do you think?

Cheer, Geoff

Favor bullous lichen planus over lichen planus pemphigoides (due to the cell poor bullae) but should perform IF and reccomend CPC

I agree with bullous lichen planus x lichen planus pemphigoides ddx. DIF and CPC are needed. Interestingly, there´s a nice pseudomelanocytic nest on picture 5.

I favor lichen planus-like bullous pemphigoid (lichen planus pemphigoid). Lesions are typically located on lower limbs and maybe the bullae appear on both involved and uninvolved skin by pre-existent lichenoid papules. I’m not convinced about the microscopic features of lichen planus, like wedge-shaped hypergranulosis and severe basal cell hydropic degeneration enough to cause subepidermal bulla.

Welcome, Dra. Uma Sundram, as our new Editor-in-Chief.

Congratulations Dr Uma for becoming the new Editor in Chief!! 

Agree with the differentials, slightly favoring bullous LP as no esinophils are seen. Clinical correlation is needed.

Just now, Robledo F. Rocha said:

I favor lichen planus-like bullous pemphigoid (lichen planus pemphigoid). Lesions are typically located on lower limbs and maybe the bullae appear on both involved and uninvolved skin by pre-existent lichenoid papules. I’m not convinced about the microscopic features of lichen planus, like wedge-shaped hypergranulosis and severe basal cell hydropic degeneration enough to cause subepidermal bulla.

Agree. 

I appreciate the above comments, but I'm not able to differentiate BLP from LP pemphigoides in this case. Waiting for the final diagnosis.

I'm late today, but these are days a bit frantic ( a new earthquake 6.5 R. yesterday and another 4.8 today...I live in center Italy, but all is OK with us here ).

Favour bullous LP. Can't see the eosinophils typically present in LPP.

Many congratulations Uma.

Vincenzo I hope things settle down soon. 

Great comments and differential diagnosis; this is what we thought as well. DIF is negative and the clinician favored LP based on clinical distribution of lesions, which was more like typical LP.

Great to be on board helping this wonderful forum!

7 hours ago, vincenzo polizzi said:

I appreciate the above comments, but I'm not able to differentiate BLP from LP pemphigoides in this case. Waiting for the final diagnosis.

I'm late today, but these are days a bit frantic ( a new earthquake 6.5 R. yesterday and another 4.8 today...I live in center Italy, but all is OK with us here ).

Vincenzo, wish everything settles down. Stay safe .

Congrats to Uma on her new position!

Been hearing on the news, Vincenzo. Hope no more damage happens to your lovely country. All our best wishes.

Thanks Mona. All right for now and hopefully for later...

Congrats to Uma also from me. 

Thank you vincenzo and good luck!