PMC10285345_01
Appearance of the hands showing extensive erosions and intact blisters.
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Examination revealed intact blisters alongside numerous erosions over the hands and elbows and milia on inspection of the left hand ( Figure 1).
Punch biopsy of right hand demonstrating a sub-epidermal blister with festooning of dermal papilla and with adjacent epidermal hyperplasia with hypergranulosis.. In the superficial dermis there are some thick-walled blood vessels, which stain for Periodic acid-Schiff (PAS). In the upper dermis there is a sparse lymphocytic infiltrate.
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Histopathology revealed an intact sub-epidermal blister with minimal dermal inflammation ( Figure 2).