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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

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

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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33 year old female with bullous and lichenoid papules on legs.

Case Posted by Dr Uma Sundram

Edited by Admin_Dermpath


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Admin_Dermpath

Posted

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

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Raul Perret

Posted

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

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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.

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Robledo F. Rocha

Posted

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.

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Robledo F. Rocha

Posted

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

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Dr. Mona Abdel-Halim

Posted

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.

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Eman El-Nabarawy

Posted

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. 

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vincenzo polizzi

Posted

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 ).

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Nitin Khirwadkar

Posted

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

Many congratulations Uma.

Vincenzo I hope things settle down soon. 

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Uma Sundram

Posted

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.

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Uma Sundram

Posted

Great to be on board helping this wonderful forum!

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Dr. Mona Abdel-Halim

Posted

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 .

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Arti Bakshi

Posted

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.

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vincenzo polizzi

Posted

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

Congrats to Uma also from me. 

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