An annular pruritic eruption

Abstract

A 36-year-old female patient presented with a 3-month history of a pruritic eruption on the trunk and extremities. She had no past medical history. Clinical examination revealed erythematous gyrate annular and edematous lesions with clusters of small vesicles arranged in a herpetiform pattern affecting the anterior and posterior skin of the trunk and the upper and lower limbs. There were multiple papules, vesicles, and crusted excoriations on an erythematous background on the trunk (Fig. 1a, b). Besides, there was no mucosal involvement. Histopathological findingsSkin biopsy revealed suprabasal bullae containing some acantholytic cells, neutrophils, and eosinophils. There was also eosinophilic spongiosis with intraepidermal vesicles filled with neutrophils and eosinophils ( Fig. 2a,b). Direct immunofluorescence of a perilesional skin biopsy revealed epidermal IgG in an intercellular pattern. Antibodies to desmoglein 1 but not desmoglein 3 were demonstrated by enzyme-linked immunosorbent assay. (a) (b) Figure 2 (a) Suprabasal bullae containing some acantholytic cells, neutrophils and eosinophils (Hematoxylin and eosin, 940); (b) Eosinophilic spongiosis with intraepidermal vesicles filled with neutrophils and eosinophils (Hematoxylin and eosin, 9100) (a) (b) Figure 1 (a) Erythematous gyrate annular and edematous lesions with clusters of small vesicles arranged in a herpetiform pattern affecting the lower limbs; (b) Multiple papules, vesicles, and crusted excoriations on an erythematous background on the trunk ª