9-year-old girl with a 4-...

A 9-year-old girl with a 4-week H/o progressive skin desquamation visited the clinic. The child was febrile, in moderate distress and had signs of mild dehydration and severe malnutrition. She also had H/o plague psoriasis three months back. Upon examination, generalized skin desquamation was seen over her entire body, accompanied by blepharitis, conjunctivitis and madarosis. In addition, advanced onychodystrophy in her toenails and fingernails was noted bilaterally, as shown in the figure. The physician also identified Swelling, pain, and rigidity in her knees and elbows.

She had no pathological birth or related family history. Her parents also denied having experienced trauma, drugs, infections, or similar triggers for her condition. The reports of a histopathological study showed the presence of parakeratosis, hyperkeratosis, elongation of rete ridges, and neutrophil infiltration, which led to the diagnosis.