Multiple pustules with keratolysis

Over a three-week period, a 49-year-old woman developed progressive erythema over her trunk and limbs associated with fever and malaise. There were miliary pustules linked to areas of keratolysis that produced a crinkled, opaque, cellophane-like sheet (Figure 1). Skin biopsy from the pustular area showed collections of neutrophils below the stratum corneum, forming microabscesses (Figure 2). Bacterial cultures were negative.