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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 4079 - 08 September 2022 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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"34F, punch biopsy right breast, 7-year history of sore, itchy areas developing into blisters
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Subtle acantholysis with no dyskeratosis, somewhat lichenified - goes with history of pruritis; thinking Hailey-Hailey disease.

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Anil Patki

Posted

Agree with the above comment. Grover's is a differential.

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vincenzo

Posted

My impression at a glance is of a PV, but it's an odd site and other clinical findings don't fit well. 

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Eman El-Nabarawy

Posted

Itching..Blisters..Goes PV.. For DIF..

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Saleem Taibjee

Posted

I have shown the initial level above. As you have all well-spotted, there is very subtle intra-epidermal clefting suggesting an acantholytic disorder.

The main point is to request further levels when the clinician is indicating a blistering disorder and the initial levels show only subtle features. The additional levels are shown below, and in contrast show a more dramatic acantholytic blistering process.

There is also dyskeratosis including corps ronds, suggesting an acantholytic dyskeratosis disorder. The clinical was suspecting Hailey-Hailey disease which seems to fit. There was no separate biopsy sent for immunofluorescence, but ideally this should be sent in such cases to rule out an immunobullous disorder. However, the genuine dyskeratosis would seem to make pemphigus unlikely here.

BW, Saleem

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vincenzo

Posted

"..However, the genuine dyskeratosis would seem to make pemphigus unlikely here". Yes! totally agree!

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