Brownish-Black Crusts and Erosions all Over the Body

A 6-year-old female child presented with generalized brownish-black, moderately adherent scales forming hyperkeratotic, corrugated, rippled ridges mainly on the flexures and lichenification on the knee and elbow joints, along with multiple erosions on the trunk and extremities [Figure 1]. History of fluid-filled lesions during birth and aggravation during summer was present. Histopathology revealed marked hyperkeratosis with granular and vacuolar degeneration in stratum granulosum and spinosum respectively [Figure 2]. Genetic test revealed a missense mutation of keratin 10, located on exon 1. Based on clinico-histopathological and genetic study, a diagnosis of a sporadic case of epidermolytic ichthyosis (EI) due to keratin 10 mutation was made, and the patient was started on oral isotretinoin 0.5 mg/kg once daily, along with emollients and antihistamines. The parents were counseled about the disease, and genetic counseling was done. Management of EI includes frequent bathing, moisturization, antiseptics, and wound care. Low-dose retinoids can be used in cases of severe hyperkeratosis.[1]Figure 1: Generalized brownish-black, moderately adherent scales forming hyperkeratotic, corrugated, rippled ridges along with multiple erosions on the trunk and extremitiesFigure 2: Marked hyperkeratosis with granular and vacuolar degeneration in stratum granulosum and spinosum respectively [H and E, X100]Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the parent(s) has/ have given their consent for the patient’s and other clinical information to be reported in the journal. The parent(s) understand that the patient’s name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.