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A 29 year old woman was admitted to the medical ward feeling generally unwell with a one week history of bilateral leg weakness, increased anxiety, and labile mood. She also described a five month history of blistering on the face, chest, and dorsum of her hands, without a confirmed diagnosis. She had previously seen her general practitioner and also attended the emergency department complaining of abdominal and back pain, sometimes associated with vomiting, but no diagnosis had been made and she had not been referred to dermatology. Her medical history included bipolar disease diagnosed five years ago, which was controlled with sodium valproate, and bulimia. On examination, there were multiple angulated erosions on her face and upper chest (fig 1A⇓). A single large irregularly shaped tense bulla was present on the dorsum of the right hand surrounded by a few smaller erosions on both hands. Scarring and milia were also noted at sites of previous blisters (fig 1B⇓). Systemic examination was unremarkable. Blood testing showed a normal full blood count and liver and renal function. Sodium level was low at 130 mEq/L. (normal range 133-146), C reactive protein was

A 74 year-old woman presented with a 9 month history of a slowly enlarging exophytic lesion over her left nasal alar. Examination revealed a firm, cystic mass fixed to underlying skin. It was pedunculated with occasional superficial telangiectasia and a violaceous hue. A differential diagnosis of dermoid or sebaceous cyst, dermatofibroma, and neurofibroma was considered. Histopathological examination confirmed the rare diagnosis of chondroid syringoma (CS), which has a reported incidence of 0.01- 0.098% of excised skin tumors. It is unusual for CS to present in an elderly woman, as these benign primary skin tumors normally present in adult males. Dermoscopy does not reveal any specific features and the diagnosis is difficult to make based on clinical examination alone.