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Whitish bullae on the fingers: What is the diagnosis?

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Whitish bullae on the fingers: What is the diagnosis?
Ana Nogueira MD1, Ana F Duarte MD1,2, Paulo Morais MD1,2, Sofia Magina MD1,2, Filomena Azevedo MD1
Dermatology Online Journal 15 (6): 9

1. Department of Dermatology and Venereology, Hospital S. João, EPE, Porto, Portugal.
2. Faculty of Medicine, Oporto University

Case synopsis

Figure 1 Figure 2
Figures 1 & 2: Whitish-yellow soft bullous plaques on finger pads

Figure 3
Figure 3. Fine needle aspiration cytology from a finger pad (x100)

A 56-year-old obese woman, admitted for acute arterial ischemia of the lower limb that required revascularization, presented with whitish bullae of the fingers that had evolved over the past six months with recent worsening. Although she suffered from chronic renal insufficiency and atrial fibrillation, she was not taking any regular medication. She was an alcoholic and did not seek regular medical attention. She displayed painful soft whitish-yellow bullous plaques with an erythematous rim, affecting mainly the finger pads (Figs. 1 & 2). She had no signs of arthritis. On punch biopsy a whitish fluid was extruded, which was examined microscopically (Fig. 3). Lab results revealed normocytic normochromic anemia, normal leukocyte count, low albumin, and renal dysfunction with urea 1.11 g/L and creatinine 26.3 mg/L. Calcium levels were normal, but the uric acid level was 16.2 mg/dL (normal up to 6.1).

What is your diagnosis?


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