case_images: PMC4763581_01
case_images: Pedigree chart
case_images: IDOJ-7-46-g001.jpg
case_images: PMC4763581_01_IDOJ-7-46-g001.jpg
case_images: F1
case_images: There was a family history of similar lesions; they had appeared around the age of 12 years in her mother, two older sisters, maternal uncle, and the patient's 14-year-old son and 9-year-old daughter [Figure 1].
case_images: (a) Showing multiple, deep, pock-like scars with comedones over nose and cheek (b) Multiple comedones with pigmented papular lesions over flexor aspect of arm (c) Multiple comedones and pigmented papules on the upper back
case_images: IDOJ-7-46-g002.jpg
case_images: PMC4763581_01_IDOJ-7-46-g002.jpg
case_images: F2
case_images: Cutaneous examination showed numerous, widespread, hyperkeratotic papules and comedones varying in size from 0.5 to 1 cm over all areas of the body, especially the face, back, flexor aspects of arms along with multiple pock-like scars on the face and prominently over the nose [Figure 2].
case_images: (a) Microphotograph showing massive hyperkeratosis, parakeratosis, and epidermal invagination with keratinous material (H and E; original magnification x40) (b) Showing enlarged view of marked portion in Figure 2a) showing dyskeratotic cells shown by arrows (H and E; original magnification x100)
case_images: IDOJ-7-46-g003.jpg
case_images: PMC4763581_01_IDOJ-7-46-g003.jpg
case_images: F3
case_images: There was irregular thinning of the epidermis and dyskeratosis was observed at places [Figure 3].
case_images: (a) Multiple comedones with pigmented papular lesions more clustered over Elbows and facial sparing (b and c) multiple comedonal papules over lower limbs
case_images: IDOJ-7-46-g004.jpg
case_images: PMC4763581_01_IDOJ-7-46-g004.jpg
case_images: F4
case_images: Her daughter showed numerous, widespread, hyperkeratotic papules, and comedones with a predisposition for the limbs [Figure 4].