CRP and Hyperkeratosis: There was an elevated erythrocyte sedimentation rate (ESR) of 18 mm/h (normal: 0–15 mm/h); C-reactive protein (CRP) level was 28.1 mg/L (normal 0–3 mg/L); circulating antibodies to BP180 NC16A and BP230-gC were positive in the peripheral blood serum.Histopathological biopsy taken from the left forearm showed hyperkeratosis, parakeratosis, Munro’s microabscess, hypogranulosis, and acanthosis with regular rete elongation, and congested and dilated blood vessels in the superficial dermis (Figure 2a).