A middle-aged male with bullous lesions and co-morbidities

Abstract

Epidermolysis bullosa acquisita (EBA) is a rare acquired type of mechano bullous disease affecting the dermal-epidermal junction (DEJ) of trauma prone acral surfaces. It manifests as tense vesicles, bullae, and milia and typically heals as atrophic hypo or hyperpigmented scars. Classic noninflammatory mechano bullous EBA typically presents at a mean age of 48 years. A 57 years old male patient, presented with itchy fluid filled lesions over the face since, 2 months. On cutaneous examination, discrete and grouped papulo-vesicles on an erythematous base and areas of erosions present over both eyelids, erythematous annular plaque with vesicles at the border present over the left cheek. Blood investigations revealed an increased total blood count, total bilirubin, direct bilirubin, and positive HCV antibodies. Histopathology showed a sub-epidermal blister and surrounding dermis shows inflammatory infiltrate composed of eosinophils and neutrophils. Direct immunofluorescence revealed linear deposits of IgG and C3 at the DEJ. The patient was started on dapsone.