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?

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Case Number : Case 2175 - 10 October 2018 Posted By: Dr. Hafeez Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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78 year-old female with bullae.

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Anil Patki

Posted

Subepidermal clevage with lots of eosinophils.  Cell-rich type of bullous pemphigoid. 

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Basically agree with Anil. The unusual features of this bullous disease are the pseudoepitheliomatous hyperplasia and dermal fibrosis or scar (vertically oriented blood vessels in the dermis). So I would like to add cicatricial pemphigoid in the differential diagnosis.

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vincenzo

Posted (edited)

Yes. There are eccrine ducts, so this is skin; but CP ( aka MMP ) can hit skin also.

Edited by vincenzo

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Dr. Hafeez Diwan

Posted

There is no mucosal membrane involvement.  Clinically this was BP.  Given the scarring/pseudoepitheliomatous hyperplasia, I called this pemphigoid nodularis (BP).

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Dr. Richard Carr

Posted

Nice case! Don't think I've seen this variant in practice.

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