case_images: PMC3937492_01
case_images: Skin of the shoulder spared of erythroderma showing discrete, horny, follicular papules
case_images: IDOJ-5-63-g001.jpg
case_images: PMC3937492_01_IDOJ-5-63-g001.jpg
case_images: F1
case_images: 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].
case_images: Tightening of skin of the face resulting in bilateral ectropion and furrows at the nasolabial area
case_images: IDOJ-5-63-g002.jpg
case_images: PMC3937492_01_IDOJ-5-63-g002.jpg
case_images: F2
case_images: 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].
case_images: Thickened nail with subungual hyperkeratosis
case_images: IDOJ-5-63-g003.jpg
case_images: PMC3937492_01_IDOJ-5-63-g003.jpg
case_images: F3
case_images: Palmoplantar hyperkeratosis was present and associated with thick, lusterless nails with subungual hyperkeratosis, and longitudinal ridging [Figure 3].
case_images: Enlarged knees with bilateral genu valgum
case_images: IDOJ-5-63-g004.jpg
case_images: PMC3937492_01_IDOJ-5-63-g004.jpg
case_images: F4
case_images: The joints of both the knees were widened with bilateral genu valgum [Figure 4].
case_images: Histology of the follicular lesions (H and E,x100) showing parakeratosis, follicular plugging and ostial parakeratosis
case_images: IDOJ-5-63-g005.jpg
case_images: PMC3937492_01_IDOJ-5-63-g005.jpg
case_images: F5
case_images: 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.