More Than Skin Deep: A Cutaneous Photo Essay
Allergic contact dermatitis, drug-induced hypersensitivity syndrome, Stevens-Johnson syndrome, metastases to the skin, tinea versicolor, lichen spinulosus—a look at cutaneous conditions and their underlying causes.
An intensely itchy rash developed diffusely over the body of a 63-year-old man. Physical examination revealed edematous, red plaques on the back, abdomen, thighs, and legs along with many fluid-filled vesicles and bullae with surrounding erythema on both feet.
Biopsy revealed parakeratosis; a spongiotic epidermis with lymphocyte, eosinophil, and neutrophil exocytosis; and profound papillary dermal edema with subepidermal bulla and a superficial to mid-dermal infiltrate of lymphocytes and eosinophils.
Given the morphology and distribution of the rash and the biopsy results, the best diagnosis was acute contact dermatitis with bulla formation.
Allergic contact dermatitis is a common, possibly debilitating dermatosis. The allergens most often responsible are nickel; fragrances; topical antibiotics; and preservatives, including both formaldehyde- and non–formaldehyde-releasing preservatives.
Acute allergic contact dermatitis may produce urticaria and bullae, mimicking other dermatoses. Biopsy and culture should be performed to exclude bullous pemphigoid and impetigo.
Case and photo courtesy of Alok Vij, MD and Kenneth J Tomecki, MD