Lichen planus 5. Pemphigus foliaceous 6. Pemphigus vulgaris 7. A minimal neutrophilic infiltration is noted in the upper dermis. A high power view shows the subcorneal split and acantholytic cells .
Direct immunofluorescence is negative.
However, the negative immunofluorescence is certainly data agains this diagnosis. Subcornel pustular dermatosis of Sneddon-Wilkinson could have an identical clinial morphology, although the lesions typically display multiloculated lakes of pus. This patient was started on hydroxychloroquine with the notion that systemic corticosteroids may be necessary in the near future. The patient is a 25 year old woman with the onset of asymptomatic lesions on the left upper cutaneous lip since age 5 years. Over time, she has developed new lesions at the same site but has has had similar papules elsewhere.