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admin 18.09.2015

Pt has a known history of Churg-Strauss which is currently being managed with prednisone 2.5 mg and 5 mg alternating daily. Examination of the skin reveals multiple tense bullae with surrounding erythema on the volar wrists bilaterally and extensor forearms.
Direct IF- thick meshy linear IgG and much weaker C3 deposition along the epidermal basement membrane zone.
Epidermolysis Bullosa Acquisita (EBA) is a rare, acquired, chronic, autoimmune blistering disease.
Our patient was treated with a higher dose of prednisone and started on mycophenolate mofetil with improvement of her symptoms. Busch JO, Sticherling M.Epidermolysis bullosa acquisita and neuroendocrine pancreatic cancer - Coincidence or patho-genetic relationship?J Dtsch Dermatol Ges. Atopic dermatitis is particularly prevalent in children; in infants it frequently affects the feet and ankles, and in older children and adults it is often prominent behind both knees (the popliteal fossae).
Discoid eczema, also called nummular dermatitis, arises at any age and results in round or oval plaques. Varicose eczema refers to a discoid eczema that follows the line of varicose veins on one or both legs. Gravitational dermatitis, also called venous eczema, is due to valvular damage in leg veins and is due to past deep venous thrombosis (blood clot) or cellulitis (deep skin infection). Contact dermatitis can be due to irritants, such as excessive bathing, soaps and tight socks, or to a specific allergic reaction.
Lichen simplex is a solitary well-demarcated plaque of chronic eczema and most often arises on the lateral lower leg, due to a long-standing habit of rubbing.


Skin cancers are relatively asymptomatic slowly growing red dry patches that tend to bleed (basal cell carcinoma, Bowen disease), or faster-growing scaly lumps (invasive squamous cell carcinoma).
Cellulitis is bacterial infection resulting in fevers, chills, sepsis and painful, hot, redness and swelling.
Folliculitis are itchy or non-itchy pustules affecting hair follicles, often resulting from shaving or waxing.
Tinea corporis (fungal infection) results in irregular plaque(s) usually affecting only one leg, with spreading and more prominent edge, often originating from tinea pedis (look for a scaly foot) or tinea unguium (discoloured and crumbling toenails). Minimise swelling – avoid standing for prolonged periods, take regular walks, elevate the feet when sitting or overnight and wear special graduated compression stockings long term.
Prescription treatments may include oral antibiotics for secondary infection and topical steroids of varying potency – weak products can be used long term if necessary but potent topical steroids should be used once or twice daily for short courses of one to four weeks. Avoid topical antibiotics, topical antihistamines and multi-ingredient fragranced or herb-containing emollients because of the risk of provoking contact allergy.
After salt splitting this specimen the thick linear IgG and Ce deposition was located only at the dermal side of artificially induced blister.
The eventual goal for our patient was to taper her off the prednisone and ameliorate symptoms using steroid sparing medications. For unknown reasons, certain medicaments and cosmetics containing topical antibiotics, fragrances and preservatives are more likely to sensitise when applied to the lower leg than on other sites. Surgical removal is usual, but options for treatment may include cryotherapy, photodynamic therapy or imiquimod cream. Diagnosis should be confirmed by mycology of skin scrapings prior to use of topical or oral antifungal agents.


The result is a blistering eruption precisely corresponding to the site of application of the topical agent. They most often appear on the lower legs of atopic subjects and can be extremely debilitating. Chronic dermatitis accompanied by rubbing and scratching results in darkened (hyperpigmented), and thickened (lichenified) plaques. It is often triggered by an injury to the skin (insect bite, thermal burn, cut, surgical wound), and colonised or infected by Staphylococcus aureus. If the cause is uncertain, a dermatologist may be able to identify the specific allergens by patch testing.
Discoid eczema starts with a single patch on one leg, but soon multiple lesions appear on both lower legs and may later affect the trunk and arms. Surrounding skin may be irregularly discoloured from red blood cells that have leaked from the blood vessels because of the high venous pressure. Atrophie blanche is the term used for white scarred areas surrounded by tiny red spots (enlarged capillaries).
Complications of gravitational dermatitis include secondary infection (impetigo and cellulitis), lipodermatosclerosis (hard deep tissues), autosensitisation (generalised rash) and ulceration.



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