Dermpath Diagnosis

Pruritic Papules in the Perianal and Gluteal Cleft Regions

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A 66-year-old man presented to the dermatology clinic with pruritus of the gluteal cleft and perianal region of several months’ duration. He had been prescribed permethrin by an outside physician, as well as oral acyclovir, triamcinolone-nystatin combination ointment, and topical zinc oxide prescribed by dermatology, without improvement. Physical examination showed several papules and erosions (<1 mm) in the perianal and gluteal cleft regions (inset). Hyperpigmented macules also were noted in the inguinal folds. A shave biopsy of a lesion from the perianal region was performed.

H&E, original magnification ×20.

H&E, original magnification ×20.

The best diagnosis is:

Darier disease

Grover disease

Hailey-Hailey disease

papular acantholytic dyskeratosis

pemphigus vulgaris

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