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[Clinical Picture] Generalised nodules in pemphigoid nodularis

An 82-year-old woman presented to the department of dermatology at our hospital in February, 2016, with a 6-month history of widespread pruritic nodules on her neck, trunk, arms, and legs (figure), which were easily eroded by scratching. She had been diagnosed with prurigo nodularis in a local clinic and treated with triamcinolone acetonide acetate ointment and oral antihistamines without improvement. We took a biopsy sample from one of the lesions on her back. Haematoxylin and eosin staining showed hyperkeratosis, epidermal hyperplasia, acanthosis, papillomatosis, subepidermal blisters, and the infiltration of lymphocytes and eosinophils in the upper dermis (appendix).