PMC3937492_01
Skin of the shoulder spared of erythroderma showing discrete, horny, follicular papules
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F1
Small areas of skin (spared of erythema and scaling) with these horny papules were still visible over the shoulders and flanks at the time of admission [Figure 1].
Tightening of skin of the face resulting in bilateral ectropion and furrows at the nasolabial area
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F2
The face showed tightening of skin, bilateral ectropion of lower eyelids, furrowing of skin of the nasolabial area, and fissuring at the angle of the mouth [Figure 2].
Thickened nail with subungual hyperkeratosis
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F3
Palmoplantar hyperkeratosis was present and associated with thick, lusterless nails with subungual hyperkeratosis, and longitudinal ridging [Figure 3].
Enlarged knees with bilateral genu valgum
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F4
The joints of both the knees were widened with bilateral genu valgum [Figure 4].
Histology of the follicular lesions (H and E,x100) showing parakeratosis, follicular plugging and ostial parakeratosis
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F5
This was confirmed by histopathology [Figure 5] which showed parakeratosis, hypogranulosis, elongated rete ridges with corresponding dermal papillary hyperplasia, suprapapillary thinning of epidermis, and neutrophilic infiltrate in the dermis.