An 81 years old female patient has a history of hypertension treated by calcium channel blockers. She complained of painful erosions around the lips for the last 9 months. She also developed umbilical and groin lesions treated with local and oral antibiotic without any improvement. There was no history of any fluid filled lesion or any genital ulcer in the past. Physical examination showed an erosive cheilitis. There was also a well-defined, irregular and hypertrophic plaque located on the umbilical and inguinal areas (Figure 1). There were no other systemic findings. VDRL in serial dilutions was non-reactive and TPHA was negative. A biopsy taken from the umbilical region showed suprabasal epidermal acantholysis, clefting and blister formation (Figure 2). Direct immunofluorescence showed intercellular immunoglobulin G throughout the epidermis and intercellular substance antibodies were detected by indirect immunofluorescence. The diagnosis of pemphigus vegetans of Hallopeau was established. The patient was put on oral corticosteroids (2mg/kg per day). She had complete healing of the cheilitis and intertriginous areas within 8 weeks (Figure 2).