Interactive Case Study - November 2019

45-year-old female with multiple papular lesions on the vulva

Amy Austin, MD; Robert Kitz, MD; John Childs, MD

The patient is a 45-year-old woman who presents with multiple scaly papules and plaques on her vulva bilaterally. She endorses mild pruritus in the area, but review of systems is otherwise negative. Further skin examination is unremarkable. She is otherwise healthy and has no known family history. Biopsy of one of the lesions reveals the following histopathology (Figure 1-3):

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Figure 1.

Figure 2.

Figure 3.

What is the best diagnosis?

A.	Darier Disease (Keratosis Follicularis)

B.	Hailey-Hailey Disease (Benign Familial Pemphigus)

C.	Herpes simplex virus infection

D.	Papular acantholytic dyskeratosis

E.	Pemphigus vulgaris