Dr. Pai is from the Department of Dermatology, Goa Medical College, India. Drs. Gupta, Athanikar, Naveen, Sori, and Shastry are from Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad, India. Drs. Gupta, Athanikar, Naveen, and Sori are from the Department of Dermatology, and Dr. Shastry is from the Department of Pathology.
The authors report no conflict of interest.
Correspondence: Varadraj V. Pai, MD, Department of Dermatology, Goa Medical College, Goa 403202, India (docpai@rediffmail.com).
Figure 3. Polymorphonuclear neutrophilic infiltrate with multilobulated nucleus without leukocytoclasia (H&E, original magnification ×100).
Bullous-type SS has been reported, but all the known cases were secondary to malignancy or were drug induced8,10; they did not present in a classic or idiopathic variant. Our case is unique in that it is a report of the classic SS variant with lesions including bullae over photoexposed areas, possibly indicating a causal association of sun exposure and the development of SS.
Figure 4. Intravenous dexamethasone resulted in improvement within 4 to 5 days of treatment.
The diagnostic histopathologic features of SS include a dense, predominantly neutrophilic infiltrate located in the superficial dermis as well as prominent papillary dermal edema, which occasionally may lead to subepidermal vesiculation.11,12 The epidermis often is normal but spongiosis may be present, and rarely neutrophils may extend into the epidermis to form subcorneal pustules.13 Severe edema in the papillary dermis may cause subepidermal blistering and bullous lesions.10 Systemic steroids are the therapeutic mainstay in SS. Other treatment options include methylprednisolone, potassium iodide, colchicine, indomethacin, cyclosporine, and dapsone.