Recurrent palmar blister

A woman aged 34 years, who had no notable medical history, presented with a 2-day history of a painful and tender blister on her right hand but no associated symptoms. She had a history of recurrent episodes in the past 6 years that were preceded by localised pain, tenderness and burning, and resolved spontaneously. There had been no local trauma, recent exercise or use of medicines. Physical examination revealed a tense palmar blister with discrete perilesional erythema and painful lymphangitis of the right upper limb. She was afebrile. Laboratory tests for inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) showed no abnormal findings.