Multiple painful vesicles in a patient with erythroderma

Abstract

A 50-year-old male with a history of alcoholism was evaluated for a 4-week history of painful vesicles and hemorrhagic erosions on the face without any previous treatment (Figs 1 and 2). He had a 15-year history of eczematous plaques on flexural surfaces with periods of remission and relapse. Over the last year, the patient developed widespread erythema with diffuse scaling and lower-limb edema. Laboratory tests revealed mild normochromic normocytic anemia (Hb 11.8 g/dL, MCV 94.3 fL, MCH 33.5 pg) with eosinophilia (13%), and abnormal liver function tests (ALT 15.1 U/L, AST 67 U/L, AST/ALT ratio 4.4).