A bullous dermatosis in an infant

Abstract

Conflict of interest: there are no conflicts of interest. A 7‐month‐old Indian girl was referred by her general practitioner with a 4‐month history of blistering lesions on her trunk and scalp. These were intensely itchy, keeping the infant awake at night. Resolution occurred with healing of superficial erosions leaving postinflammatory hypopigmented patches, which repigmented slowly. The infant also exhibited frequent facial flushing. Examination of the skin revealed numerous intact and ruptured vesicles and bullae arising on an urticated base on the trunk, on a background of Fitzpatrick type V skin (Fig. 1). There was also extensive involvement of the scalp with weeping vesicles and associated crusting. Darier's sign was negative. The skin was not thickened or lichenified at any site, and had no pachydermia or skin folding. ... Skin biopsy from an affected area of the lower back revealed a moderately dense perivascular and interstitial infiltrate of mast cells filling the papillary dermis and marked oedema of the dermal papillae (Fig 2). There were scattered eosinophils and a few neutrophils. The overlying epidermis showed mild elongation of the rete ridges, basal pigmentation and serum in the stratum corneum.