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A bullous rash
  1. Vanessa Migliarino1,
  2. Alberto Di Mascio1,
  3. Irene Berti2,
  4. Andrea Taddio1,2,
  5. Egidio Barbi1,2
  1. 1 Pediatric Department, University of Trieste, Trieste, Italy
  2. 2 Pediatric Department, Institute of Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
  1. Correspondence to Dr Vanessa Migliarino, Pediatrics, University of Trieste, Trieste, Friuli-Venezia Giulia, Italy; v.migliarino{at}


­A 3-year-old boy presented with a 5-day history of bullous skin lesions localised mainly in the upper and lower limbs and in the genital region (figure 1). Lesions were not pruritic nor painful and showed a central crust. There was no family history of skin disorders or autoimmune diseases. The child never had fever and his physical examination was otherwise unremarkable.

Figure 1

Bullous skin lesions forming around a central crust, localised in the upper and lower limbs.


  1. What is the most likely diagnosis based on this clinical presentation?

    1. Bullous impetigo.

    2. Bullous pemphigoid.

    3. Linear IgA bullous dermatosis.

    4. Dermatitis herpetiformis.

  2. What would be the next step in the investigation to confirm your diagnosis?

    1. Skin biopsy.

    2. Swab test for bacterial culture with an antibiogram.

    3. Anti-transglutaminase antibody detection.

  3. What is the mainstay of management?

    1. Dapsone.

    2. Systemic steroids.

    3. Topical steroids.

    4. All of the above answers are correct, according to the severity of the disease.

Questions Answers can be found on page 02 .

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  • Contributors VM and ADM wrote the manuscript. IB clinically followed the patient. EB and AT reviewed the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.