Clinicopathologic challenge Papules and vesicles on the ears of a young boy Eduardo Rozas-Mu ~ noz 1 , MD, Cristina L  opez-S  anchez 2 , MD, Jaime Piquero-Casals 3 , MD, Esther Ro  e 2 , MD and Juan F. Mir-Bonaf  e 4 , MD 1 Department of Dermatology, Hospital San Pablo, Coquimbo, Chile, 2 Department of Dermatology, Hospital Sant Pau, Barcelona, Spain, 3 Department of Dermatology, Cl  ınica Dermatol  ogica Multidisciplinar Dermik, Barcelona, Spain, and 4 Department of Dermatology, Hospital Son Ll atzer, Palma de Mallorca, Spain Correspondence Eduardo Rozas-Mu~ noz, MD Department of Dermatology Hospital San Pablo Avenida Videla S/N 1780000 –Coquimbo Chile E-mail: docrozas@yahoo.com Conflict of interest: None. Funding source: None. doi: 10.1111/ijd.15336 What is your diagnosis? Case presentation An 11-year-old Caucasian boy presented with a slightly pruritic rash involving his ears and face that appeared 1 day after play- ing soccer outdoors. Physical examination revealed erythema- tous papules and vesicles involving the helix of his ears bilaterally. Additionally, erythematous confluent papules and small vesicles were located on the lips, cheeks, neck, periauric- ular area, and dorsum of the arms (Fig. 1). The patient had a similar, but less severe and self-limited, eruption 1 year ago. Parents denied the use of any topical or systemic photosensi- tive medication. Results of laboratory investigations, including a serum chemistry panel, liver function tests, complete blood cell count, and erythrocyte sedimentation rate, revealed no abnor- malities. Serologic tests were negative for herpes virus 1 infec- tion, and antinuclear and anti-Ro antibodies. A 4 mm punch biopsy was taken from one of the lesions (Fig. 2). Figure 1 (a) Vesicles and crusts on the lips. Erythema on the neck. (b) Erythematous plaques and small vesicles on the neck and auricular and periauricular area. (c) Erythema and vesicles on the left helix Figure 2 (a) Biopsy specimen showing spongiosis and intraepidermal vesiculation with marked papillary dermal edema. A mild perivascular infiltrate of lymphocytes without atypia was seen in the upper dermis. (c) High power image showing intraepidermal vesiculation and papillary dermal edema. (Hematoxylin and eosin, (a) 94; (b) 910; (c) 920) ª 2020 the International Society of Dermatology International Journal of Dermatology 2020 1