title: Bullous dermatitis artefacta.
abstract: Bullous artefactual dermatoses are rare and may be induced by various techniques, including chemicals, heat, or electrical current. Proving a factitial etiology and identifying the mechanism of injury may be difficult. We describe the clinical features and histopathology of 2 patients with bullous disease induced by electrical current or heat. Physical examination in both patients demonstrated geometrically shaped tense bullae. Skin biopsies revealed epidermal necrosis overlying a pauci-inflammatory subepidermal cleft, with homogenization of underlying superficial dermal collagen. In 1 of the 2 patients, there was prominent vertical elongation of keratinocyte nuclei and also of cytoplasmic processes. Direct immunofluorescence study of skin plus testing of serum by indirect immunofluorescence and enzyme-linked immunosorbent assay for BP180 and BP230 antibodies revealed no evidence for immunobullous disease in either patient. Vertical elongation of keratinocyte nuclei, often attributed to a polarization effect of electrical current, is characteristic of electrical burn but also may be induced by thermal injury. These 2 patients highlight the importance of histopathology in confirming a diagnosis of bullous dermatitis artefacta.
authors: Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
authors: Olayemi
authors: O
authors: Sokumbi
authors: Nneka I
authors: NI
authors: Comfere
authors: Marian T
authors: MT
authors: McEvoy
authors: Margot S
authors: MS
authors: Peters
mesh_terms: D000328:Adult; D001706:Biopsy; D002056:Burns / Q000473:pathology* / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D016728:Self-Injurious Behavior / Q000473:pathology* / Q000523:psychology / Q000628:therapy; D012867:Skin / Q000473:pathology*; D012872:Skin Diseases, Vesiculobullous / Q000473:pathology* / Q000523:psychology / Q000628:therapy; D055815:Young Adult