Race for the Case

Race for the Case is a clinical quiz feature published quarterly in Dermatology World Directions in Residency — and right here!

Review the case and photos, and submit your answers to the questions below. If you answer correctly, you'll be entered to win a $25 Starbucks gift card. Free coffee and pastries are on the line — what are you waiting for?


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A 56-year-old man was transferred from an outside hospital for a four-month history of painful and pruritic
skin erosions that started on his back and progressed to involve his extremities, mouth, perianal region, and genitals. Examination revealed hypertrophic papillomatous plaques overlying friable erosions of the oral mucosa and the right side of the neck, many ill-defined pink erosions on the trunk, and a single intact pustule on the chest. He endured worsening oral pain with eating, as well as weight loss and odynophagia.

What would you expect to see on H&E and DIF?
What are the major subtypes of this condition?
What treatment did the FDA recently approve for treatment of this condition, and what is its mechanism of action?
What are at least two other entities on the differential diagnosis of hemorrhagic crusts of the vermilion lips?
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