Extensive hydroa vacciniforme
An 18-year-old female student reported that since the age of 5 she has been suffering\nfrom necrotic lesions and vesicles in exposed areas that leave asymptomatic\nvarioliform scars, which worsen in summer.\nSkin examination showed that the nose and ears were covered with hemorrhagic/yellow\ncrusts and erosions (). The dorsal\nsurfaces of hands were also strongly involved with hemorrhagic crusts and vesicles\n(). There were also lesions on other\nareas that were unprotected from the sunlight, such as the ankles and the presternal\nregion ().\nLight microscopy showed epidermal necrosis with lymphocytic infiltration (). Laboratory tests for lupus erythematosus\n(ANA) and uroporphyrines were normal. There are no similar cases in her family. There\nwas little improvement with the use of highly protective sunscreens (SPF 45), with onset\nof new lesions. Topical antibiotics were prescribed for secondary infection.