UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Carol Roper MD, and Drazen Jukic, MD
JANUARY 2004 CASE OF THE MONTH
CLINICAL FINDINGS
CLINICAL HISTORY:A 37 year-old white male presented
to an outpatient dermatology clinic with a persistent arm rash. It was present
for several months and was painful. He noted that his skin was easily injured,
that he broke out in blisters and “sores” that were slow to heal.
Both forearms were involved. He denied pruritus or any prior treatment. He worked
as an outdoor laborer and repairman and his skin rash was worsened by sun exposure
such that he wore long sleeves and gloves even during the summer.
History was significant for alcohol abuse, although he stated that he currently
drinks only rarely. He noted that his beard is increasing in size. He denied
any past or family history of skin disorders, medication use, or allergies.
Physical examination was significant for the presence of bullae, erosions, scarring,
milia, and dyspigmentation on the dorsal surface of both hands and forearms.
Hypertrichosis was present over both malar eminences. A 6 mm punch biopsy of
skin on the left dorsal hand was performed. (see fig3 & fig4)
Biopsy of the blister revealed a subepidermal bullae. It was noninflammatory,
and its base appeared to festoon into the bullae. Blood vessel walls in the
upper dermis appeared thickened with hyalinized, PAS-positive, diastase resistant
material.
The patient tested positive for Hepatitis C. HIV testing was refused.
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