PMC9441388_01
Oral mucosal lesions (a) and scalp erosion (b) due to pemphigus and hyperpigmented macules on ear (c) and cheek (d) due to lichen planus pigmentosus following COVID-19 vaccination.
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Upon examination, residual PV erosions were found on oral palatal mucosa and scalp (Figures 1(a) and 1(b)). We also noticed multiple well-defined grey-brown hyperpigmented macules on the ears, cheeks, and chin (Figures 1(c) and 1(d)).
Suprabasal epidermal acantholysis and cleft containing inflammatory cells and rounded acantholytic cells with intensely eosinophilic cytoplasm and a perinuclear halo. DIF shows intercellular deposition throughout the epidermis compatible with diagnosis of PV (a, b). Hyperkeratosis, atrophic epidermis with vacuolar alteration of the basal cell layer, and pigmentary incontinence and negative. DIF, compatible with diagnosis of LP pigmentosus (c, d)
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Since the nature of this pigmentation was unclear, we performed a punch biopsy of a representative chin lesion which showed typical findings of lichen planus (LP) pigmentosus (Figure 2).
The exact time points of events.
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 Figure 3 shows the exact time points regarding the history of the patient.