Case Number : Case 2292 - 27 March 2019 Posted By: Dr. Hafeez Diwan

Subepidermal paucicellular vesicular dermatitis with post-inflammatory hyperpigmentation. There are also scattered necrotic keratinocytes. Differential diagnosis includes porphyria, cell poor BP, EBA, erythema multiforme and fixed drug eruption. I kind of favor porphyria because of the paucicellular nature, the caterpillar bodies and the location of dorsal hand. With DIF and clinical correlation the diagnosis should be more obvious.

cell poor sub epidermal bulla

Fixed drug eruption is the first thing that comes to my mind. Inherited porphyria is unlikely as at the age of 55, the patient will have a lot of scarring in the dermis because of recurring blisters. Other possibilities are cell-poor pemphigoid and pseudoporphyria induced by photosensitizing drugs like frusimide. 

Thought the same as John. Porphyria Cutanea Tarda. 

Agree with the excelents differentials, but i favor Fixed Drug Eruption

21 hours ago, John Zhang said:

Subepidermal paucicellular vesicular dermatitis with post-inflammatory hyperpigmentation. There are also scattered necrotic keratinocytes. Differential diagnosis includes porphyria, cell poor BP, EBA, erythema multiforme and fixed drug eruption. I kind of favor porphyria because of the paucicellular nature, the caterpillar bodies and the location of dorsal hand. With DIF and clinical correlation the diagnosis should be more obvious.

 well said, agree with PCT, need DIF.

Fixed drug eruption.  This is what they were thinking clinically as well.

Beautiful images. It is definitely a setting were CPC is mandatory.