119 4. Collins P, Ferguson J, Narrow-band UVB J. (TL-01) phototherapy: an effective preventative treatment for the photodermatoses. Br J Dermatol 1995; 132: 956-63. 5. Beissert S, Ständer H, Schwarz T. UVA rush hardening for the treatment of solar urticaria. J Am Acad Dermatol 2000; 42: 1030-2. 6. Masuoka E, Fukunaga A, Kishigami K, et al. Successful and longlasting treatment of solar urticaria with ultraviolet A rush hardening therapy.A 58-year-old woman was hospitalized for a bullous eruption evolving for 2 months. The eruption had started in the right chest, where it was predominant. After 2 weeks, dispersed blisters appeared on the rest of the body. Three months earlier, the patient had been treated for cancer of the right breast (low-grade infiltrating ductal carcinoma), by tumorectomy and right axillary node curettage (1 of 10 lymph nodes involved), then oral hormone therapy (letrozol 2.5 mg/day). Radiotherapy had been performed on the tumor area (65 Gy in 30 sessions), subclavicular area (46 Gy) and right internal mammary node chain (50 Gy). The patient showed no distant metastasis. The bullous eruption began on the irradiated area 21 days after the last sequence of radiotherapy (i.e., 71 days after the first irradiation). Treatment with oral antibiotics (pristinamycin) and silver sulfadiazine ointment was begun, assuming bullous impetigo, with no effect. On hospitalization of the patient, physical examination showed superficial blisters and post-bullous erosions on the trunk and appendages, which were accentuated in the area of the right breast ( figure 1A). The remaining skin showed no lesions. Examination of mucous membranes revealed post-bullous gingival erosion. No signs were on the genital area. Results of the usual biological tests were normal. The ratio of circulating antibodies to intercellular anti-substance was high (1/800). The presence of anti-desmoglein antibody 3 was detected by ELISA (scanning range 230). Electron microscopy of a skin sample with serum anti-IgA, IgG, IgG, and anti-C3 antibodies highlighted a fine and continuous marking of the epidermal membranes on desmosomes as well as inter-desmosomes. On histopathologic examination of a cutaneous blister, pemphigus vulgaris was diagnosed (figures 1B-C). Direct immunofluorescence showed inter-cellular deposits of IgG and C3 in suprabasal epidermal layers. Immunostaining with the monoclonal antibody to desmoglein 1, 32-2B, revealed fine dots along cytoplasmic membranes, without granules ( figure 1D). The technique was performed on samples fixed in 10% formaldehyde, then embedded in paraffin, with 20-min incubation with 32-2B diluted 1/50. The patient was started on oral corticosteroids (prednisone, 2 mg/kg/day) and immunosuppressive treatment (mycophe-
