An intertriginous blistering eruption

Abstract

A 66-year-old man presented with a 10-month history of erythematous blistering lesions in his axillae and groin. This eruption had begun when he was on holiday in the Caribbean, where he developed purpuric patches in the intertriginous areas. These then blistered within hours, leaving 'tissue paper-like' skin. The lesions were otherwise asymptomatic. His only longterm medication was co-tenidone for hypertension. He had no prior history of photosensitivity, excess alcohol intake, liver or autoimmune disease, or any relevant family history.On physical examination, macerated erythematous blistered areas were seen in the groin and axillae, with signs of atrophic wrinkled skin in the perinatal cleft, back and posterior legs. Nikolsky sign was negative ( Fig. 1a-d). There were no clinical changes noted on the oral and genital mucosae. The hair and nails were normal. Swabs, fungal cultures and Borrelia serology were negative. Figure 2 (a) Skin biopsy from affected skin of the patient showing hyperkeratosis, focal interface change and a subepidermal split. (b,c) Dermal hyalinization with subjacent perivascular lymphoid infiltrate. Haematoxylin and eosin; original magnification (a) 9 20; (b) 9 200; (c) 9 400. Clinicopathological case ª