Vegetating mucocutaneous plaques

From Lo Fund Conf Repr D A 56-year-old woman presented with a 3-month history of vegetating lesions that began as flaccid bullae. She denied systemic symptoms or ingestion of suspicious drugs. The physical examination revealed well demarcated, symmetric, bilateral, papillomatous plaques with peripheral pustules on the genitocrural and cleft areas (Fig 1). Similar verrucous plaques and papules were located on the right axilla and oral commissure, along with vegetating whitish, erythematous lesions on the lateral surfaces of the tongue (Fig 2A) and buccal mucosa (Fig 2B). The histologic examination revealed acanthosis, papillomatosis, and acantholysis with intraepidermal eosinophilic abscesses. A direct immunofluorescence study revealed the intercellular deposition of immunoglobulin G.