Multiple itchy blisters and painful erosions on the hands.

TLDR: A 52-year-old man was referred to us for recurrent, itchy blisters and painful erosions localized on his hands that appeared during summer and persisted despite application of topical corticosteroids and barrier creams.

Abstract: A 52-year-old man was referred to us for recurrent, itchy blisters and painful erosions localized on his hands. He worked as an administrative employee in a company. Comorbidities included hypertension, type 2 diabetes and hepatic steatosis. In addition, the patient was under immunosuppressive therapy with cyclosporine (2 mg/kg/day) and prednisone (25 mg/ day); this started after a heart transplantation performed eight years before. The lesions appeared during summer and persisted despite application of topical corticosteroids and barrier creams. Patch tests with common contact allergens were negative. Physical examination revealed multiple tense vesiculobullae of variable sizes (0.7–3.0 cm in diameter) and erosions on both hands. The lesions involved the palms, interdigital webs and dorsal aspects of the hands (Figure 1). The mucosae and other skin areas were spared. Two punch biopsies were taken from the border of a blister and from perilesional skin for histopathological and direct immunofluorescence examination, respectively. Multiple itchy blisters and painful erosions on the hands Case for Diagnosis