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A 17-year-old male presents with a one-year history of a recurrent pruritic rash on his back, shoulders, hands, and axillae. He mentions that the rash is typically worse in the summer months and similar in appearance to one his mother has. Examination reveals numerous brown keratotic papules with a greasy texture and multiple cobblestone lesions in the mouth. A skin biopsy demonstrates a dermal inflammatory process, with acantholysis at all epidermal levels, as well as significant dyskeratosis. Which of the following other clinical features is consistent with this patient’s most likely diagnosis? Image credit: @chingiz.