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Intraepidermal IgA pustulosis IgA paraproteinemia HIV infection Dr. José M de Moragas, Department of Dermatology, Hospital de la Sta. Creu i St. Pau, C/St. Antoni M Claret, 167, E-08025 Barcelona (Spain) Intraepidermal IgA pustulosis (IEAP) is a term coined by Wallach [1] characterized by a pustular eruption similar to the subcorneal pustulosis of Sneddon and Wilkinson, but it differs from this entity in that the direct immunofluorescence test shows deposits of IgA in the epidermis, at the intercellular level in most of the cases. Clinicopatholog-ically there seem to be two distinct types: (1) resembling subcorneal pustular dermatosis (SPD type) and (2) intraepidermal neutrophilic IgA dermatosis (IEN type) [2]. As this entity has recently been associated with HIV infection [2], we would like to report another case of an HIV-infected patient who developed an IEAP and who presented an associated IgA λ paraprotein. In November 1994, a 35-year-old-male came to our Department because of a generalized vesiculopustular eruption of 1 month of duration. The patient had a history of HIV antibody positi vity diagnosed in April 1993 in a routine blood test and had been following therapy with zidovudine since July 1993. Physical examination revealed the presence of papules, vesicles and pustules arranged in a circinate pattern that were spreading cen-trifugally. They involved the trunk and, upper limbs, with a predominant involvement of the axillae and groins (fig. 1). A bacteriological culture revealed the presence of Staphylococcus aureus and Streptococcus group A, both sensitive to ciprofloxacin. Systemic therapy with ciprofloxacin (500 mg b.i.d.) was initiated and topical antibiotics (neomycin, bacitracin and polymyxin B) were applied. Although some improvement was observed, control of the disorder 1.5 months later was only partial. Topical betamethasone dipropionate 0.05% associated with topical gentamycin 0.1% was then given, and the disorder completely resolved in 3 weeks. The histopathological study showed a subcorneal pustule containing some isolated acantholytic cells. A direct immunofluorescence test using perilesional skin revealed intercellular IgA in the