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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 2162 - 21 September 2018 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F30. Recurrent blistering of light exposed skin & lips following sun exposure. Non itchy. ?Polymorphic light eruption. ??LE


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Although the upper dermal edema favours PMLE,  the epidermal atrophy,  subtle hydropic degeneration of basal cells and a fuzzy dermo-epidermal junction favour LE.  Stain for mucin and clinical picture will settle the issue. 

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Alice Roberts

Posted

Agree with above.  DIF and ancillary studies may help, depending upon clinical correlation.

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Krishnakumar subramanian

Posted

PLE, there are no necrotic keratinocytes , so I will go for PLE 

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vincenzo

Posted (edited)

Neutrophils at the interface are more in keeping with acute LE.  But this is a difficult case. 

Edited by vincenzo

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vincenzo

Posted (edited)

10 minutes ago, vincenzo said:

And there is some vacuolar degeneration  

 

Edited by vincenzo

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But without any dermal mucin and with this impressive edema in papillary dermis PLE maybe is a better option...Waiting for the final diagnosis. 

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Saman Fatah

Posted

There is reasonable number of neutrophils in the infiltrate including at DEJ. I would consider Non-bullous Neutrophilic LE in DDx (other names may include Sweet Syndrome like eruption in the context of SLE and Neutrophilic Urticarial Dermatosis, they all share many histological features).Clinical correlation is essential here to differentiate from PLE.

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Dr. Richard Carr

Posted

Thanks. I think I bowled a straight delivery again. Case came from a very experienced dermatologist. I thought it showed text-book features for polymorphous light eruption and did not do any special stains. Not sure I'm seeing a true interface pattern, dermal mucin or dermal neutrophils. 

I think Spot Diagnosis is a bit artificial especially as you're expecting something with a catch but occasionally there is no catch. In exams this can be a real issue as you want to know sometimes the candidate can deal with a straight forward bench case without equivocation. I did find that I had very few cases in my slide collection so for me at least my diagnosis is mainly based on "text-book" knowledge not personal experience.

 

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