A 16-year-old male patient presented with skin lesions of 10 years duration.
She did not report any relevant personal or family history.
On physical examination, polygonal folded papules were found covered by a retro-parduque bedding, which was grouped into plaques located on the forehead, scalp, and lateral neck.
The oral mucosa showed whitish papules with central umbilication in the upper gums.
At the nail level, he had indentation in "V "on the free edge of the right thumb, longitudinal grooves and white and red lines, parallel to the major axis of the nail of the left middle finger.
A skin biopsy showed focal parakeratosis, dyskeratotic cells and sectors of acantholysis supraglottis.
Quarter infiltrates, grains and mild perivascular infiltrates in superficial dermis.
He had previously received treatment with topical adapalene and emollients, with little response.
Given the magnitude of cutaneous manifestations, and taking into account the deterioration in their quality of life, it was decided to perform systemic treatment with isotretinoin.
Oral treatment was initiated for 6 months.
Initially at a dose of 20 mg/d (0.4 mg/kg/d), which was rapidly increased to 40 mg/d (0.7 mg/kg/d).
Clinical and laboratory controls were performed, with good tolerance and no complications.
The etiology was favorable with improvement of symptoms and reduction of the size of the skin lesions.
