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This quiz tests your diagnostic skills for leg ulceration.
For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.
Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.
When you finish the quiz, you can download a certificate.
What is the diagnosis?
This is a primary bullous eruption, and the precise diagnosis cannot be made from the images. The differential diagnosis includes thermal injury, bullous drug eruption and bullous pemphigoid. In this case the blistering appeared to have been provoked by the prescription of frusemide to a diabetic with chronic renal failure. An irregular shape is characteristic of diabetic bullae.
How would you manage this condition?
A biopsy should be taken for histology. The most suitable site would be excising a new fresh blister, failing that, from the edge of the recent lesion. A second adjacent biopsy should be processed for direct immunofluorescence (negative in this case).