case_images: PMC9304631_01
case_images: Clinical features of the patient. (A) At the admission time, the inguinal and scrotal scabs were accompanied by severe exudation. (B) After 6 days of treatment, the skin lesions basically subsided. (C-F) Red papules began to appear on both feet, and blisters gradually spread all over the body, except the head, face, and soles of the feet. (G, H) The patient was discharged with improved skin lesions, remaining milium and post-inflammatory hyperpigmentation.
case_images: CCID-15-1371-g0001.jpg
case_images: PMC9304631_01_CCID-15-1371-g0001.jpg
case_images: f0001
case_images: Initially, except for the arms, below the knees, and above the collarbone, the rest of the skin had densely or scattered red papules, some of which were pustules, incrustation, and pus-like exudate of the groin and scrotum (Figure 1A). Severe itching was the only symptom; after treatment for five days, the skin lesions quickly improved (Figure 1B). After that, red papules began to appear on both feet (Figure 1C). In a short time, skin lesions are all over the body, except the head, face, and soles of the feet (Figure 1D and E). Thus, we did a second biopsy (Figure 1F). On the tenth day after use minocycline and methotrexate, the patient's skin lesions subsided, improved, and was discharged (Figure 1D and G).
case_images: Histopathological characteristics of the lesions. (A, C, D) Skin biopsy of right thigh showed intra-epidermal blisters which could be seen on the basal cells and under the stratum corneum; acantholytic cells, hyperplasia of stratum spinosum, basal vacuolization. A few scattered eosinophils can be seen in the shallow depth of the dermis (haematoxylin and eosin stain, original magnification x200). (B) Figure 2A enlarged to x400, the acantholytic cells could be observed in the blister. (E) Type IV collagen immunohistochemistry suggested intra-epidermal blisters (original magnification x40). (F) Original magnification x100.
case_images: CCID-15-1371-g0002.jpg
case_images: PMC9304631_01_CCID-15-1371-g0002.jpg
case_images: f0002
case_images: Pathological skin biopsy of right thigh showed acantholysis, as well as intraepidermal blisters and the presence of blisters on the basal cells as well as under the stratum corneum can be observed on the same pathological section (Figure 2A-D). Type IV collagen immunohistochemistry suggested intra-epidermal blisters (Figure 2E and F).