Tense Bullae on the Palms and Soles: What could it be?
A man in his 70s presented with a 2-week history of a bullous eruption localized to the hands and feet. He denied having pruritus or spontaneous bleeding but reported discomfort from the pressure of intact bullae. His medical history was notable for diabetes mellitus and hypertension, which was well controlled with a stable regimen of lisinopril and atenolol for several years.

He denied using any new medications or supplements or making recent dose adjustments in existing medications. There was no history of a prior bullous eruption. Physical examination revealed numerous small intact bullae and large erosions on the lateral feet, soles, and toes (Figure, A).

The extent of the bullae led to difficulty with ambulation.
There were also intact vesicles on the lateral palms along with erosions demonstrating evidence of previous bullae formation. There were no vesicular or bullous lesions on the trunk, arms, legs, or mucosal surfaces. Hematoxylin-eosin staining of a biopsy specimen obtained from a bulla on the foot was performed (Figure, B).

Histopathological examination revealed a sub-epidermal bulla with numerous dermal eosinophils and degranulation of eosinophils at the dermal-epidermal junction (Figure,B). Direct immunofluorescence revealed strong linear staining of C3 at the dermal-epidermal junction. Salt-split skin analysis demonstrated deposits ofIgGandC3 on the epidermal roof. The patient’s serum was strongly positive for antibodies to BP180 and BP230. Clinicopathologic correlation supported the diagnosis of dyshidrosiform pemphigoid (DP).

Read more here: https://jamanetwork.com/journals/jamadermatology/article-abstract/1936089