Figure 1: Figure 1a through 1c, clinical lesions of excoriated plaques, papules, and plaques in the knees, thighs and lower back, some of them hyperpigmented and some manifesting crusts (black arrows). 1d and e, we tested our patient's serum utilizing monkey esophagus for any reactivity. An IIF using FITC conjugated anti human IgE showed strong positivity against the monkey esophagus ductal epithelium (white arrows). 1f shows an H & E stained section revealing a spongiform dermatitis in the epidermis. Note 1g through ll represent IHC stains. In 1g, 1h and 1i, positive staining is noted against IgE (blue arrows). In 1i, positive staining is also present with HLA DR DP and DQ is present in the upper dermal infiltrate (black arrows). In 1j and 1k, note the positive staining against Complement/C3, at the blue arrows (lower and higher amplification respectively). In 1l, note the positive staining with IgD inside some small vessels in the upper and intermediate dermis.