Abstract
Dermatitis herpetiformis Duhring (DH) is an autoimmune skin disorder that manifests in pruritic papules and vesicles predominantly on the forearms, knees, scalp, and buttocks. Most patients with DH also have gluten-sensitive enteropathy (celiac disease), which is often asymptomatic.
Histologically, DH is characterized by the presence of subepidermal vesicles with neutrophil-rich inflammatory infiltrate-forming papillary microabscesses. Direct immunofluorescence (DIF) shows granular depositions of immunoglobulin A (IgA) along the basal membrane, predominantly in the tips of the dermal papillae.
Flame figures, distinctive structures composed of collagen bundles encrusted by granular eosinophilic material, were first described in 1971 as a component of histomorphological manifestations of eosinophilic cellulitis (Wells syndrome), an uncommon cutaneous condition presenting with pruritic erythematous plaques or nodules. Rarely, annular plaques, vesicles, or bullae have been reported.
Eosinophilic cellulitis may be idiopathic, drug-related, or associated with various myeloproliferative, immunologic, or infectious disorders. We describe the case of a 40-year-old female Caucasian patient admitted to the dermatology unit with recurrent crops of severely pruritic vesicles, predominantly on her forearms, buttocks, and proximal thighs.
Except for skin problems, the patient was otherwise healthy. She was unaware of any allergies or gastrointestinal symptoms, was not taking any medication, and her personal and family history was unremarkable.