LAUSR

dermatosis on the lower legs, arms, and back of 1 month’s duration. He had an 8-year history of lichen planus, and the lesions recently had worsened despite the addition of UVB phototherapy. His medical history was remarkable for hepatitis B treated with entecavir and the addition of hydrochlorothiazide for essential hypertension 2 weeks prior to the dramatic worsening of the rash. Physical examination revealed multiple bullae on the lower legs associated with violaceous and hyperpigmented papules and patches. He also had violaceous papules on the lower back and eroded lesions on the oral mucosa. Shave biopsies were obtained from the right thigh and mid back, and histopathologic analysis was performed for both routine histology and direct immunofluorescence.