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However, this proposed role of complement in blister development is at odds with the absence of immunoglobulins and other immunoreactants and the paucity of inflammatory infiltrate.8 Three main conditions should be included in the differential diagnosis: blisters secondary to phototoxic reactions, pseudoporphyria, and PUVA-induced bullous pemphigoid.10 The main characteristics of each of these conditions are listed in Table 2

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However, the rise in smokeless tobacco and e-cigarette use and lack of change in cigar use suggest that tobacco control approaches are not universally successful

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