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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1437- 25 December Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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Case History: M50. Blistering eruption arm and chest. ?Bullous lichen planus, ?Pemphigus. Case c/o Dr Nitin Khirwadkar

Case posted by Dr Richard Carr
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  Report Record
Go to records December 2015

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vincenzo polizzi

vincenzo polizzi 185

Posted

Follicular plugs, interface lichenoid cell-poor dermatitis, epidermal atrophy, mucin(?)...what about bulls subacute lupus?

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

As Eman said, I am thinking in lichen planus pemphigoides. In lichen planus pemphigoides, blisters may develop away from lichen papules on normal or erythematous skin or may develop in lichen papules. If developing in lichen papules, they will show esinophils in the infiltrate which are not seen in bullous lichen planus. The presence of hypergranulosis, squamatized basal cell layer (fig4) and definite interface change (fig6) may favour blisters of lichen planus pemphigoides developing within lichen papules. Bullous SLE would have shown a neutrophil rich blister with neutrophilic microabscesses.

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Raul Perret

Raul Perret 262

Posted

Agree with lichen planus pemphigoides, hypergranulosis and interface change as well of eosinophils seen on picture 4 made me favor it. Nevertheless, the presence of extravasated red blood cells, interstitial eosinophils and a lymphocytic infiltrate that surrounds in some areas the blood vessels makes me put in the differential a bullous drug reaction. I would like to ask you what do you think is the reason of follicular  plugging in this case.  Greetings!

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IgorSC

I agree with Lichen planus pemphigoides, but clinical picture is essential in this case. As I can see many lymphocytes within the epidermis without proportionate interface changes, I would perform immunostains for MF (bullous MF) even with popsitive DIF, because bullae in MF can be triggered by autoimmune bullous disorders.

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Dr. Richard Carr

Dr. Richard Carr 622

Posted

Apologies for the delay - I was on hols but I am pleased to see you all pretty much nailed it. 

 

This was a case of lichen planus pemphigoides.

 

The follicular hyperkeratosis my reflect the element of lichen planus / lichen planopilaris in this case as some of you thought there was also evidence of LP in the images in addition to the immunobullous process with eosinophils - I would not dissagree.

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