PMC9039429_01
Erythematous annular plaques with vesicles in a string-of-pearls configuration on the right forearm.
10.1177_2050313X221093128-fig1.jpg
PMC9039429_01_10.1177_2050313X221093128-fig1.jpg
fig1-2050313X221093128
On physical examination, tense bullae and vesicles were clustered in an annular string-of-pearls arrangement on an erythematous base on both forearms (Figure 1).
Lichenified erythematous plaques with vesicles and crusted lesions on dorsal hands and fingers.
10.1177_2050313X221093128-fig2.jpg
PMC9039429_01_10.1177_2050313X221093128-fig2.jpg
fig2-2050313X221093128
Lichenified erythematous plaques with overlying vesicles and some bullae were distributed acrally on dorsal hands and feet (Figure 2).
Subepidermal blister rich in eosinophils with perivascular eosinophilic inflammatory infiltrates on hematoxylin-eosin staining (magnification x10).
10.1177_2050313X221093128-fig3.jpg
PMC9039429_01_10.1177_2050313X221093128-fig3.jpg
fig3-2050313X221093128
Histopathology with hematoxylin and eosin staining showed subepithelial bullous dermatitis with numerous eosinophils as well as perivascular chronic inflammation rich in eosinophils (Figure 3).
IgG and C3 deposits on both epidermal and dermal sides on the salt-split technique of direct immunofluorescence study (magnification x40).
10.1177_2050313X221093128-fig4.jpg
PMC9039429_01_10.1177_2050313X221093128-fig4.jpg
fig4-2050313X221093128
Salt-split skin study revealed IgG and C3 deposits along both epidermal and dermal sides of the split (Figure 4).