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The variable numbers of necrotic keratinocytes revealed by histopathology suggest that blister formation may be the result of a phototoxic reaction,7,8 while the near exclusive location of the lesions on the lower limbs suggests that friction and trauma may trigger lesion formation.8 Heidbreder and Henseler5 demonstrated that PUVA treatment inhibits the synthesis of connective tissue and increases collagen fractionation, resulting in a loss of dermoepidermal cohesion

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