A 12-year-old female with seven weeks H/o well-defined darkening and thickening of the hands, feet, ankles, neck, and the upper trunk region, including upper chest and back, visited the hospital. The lesions progressively increased in size, accompanied by itching & burning sensations following exposure to the sun. Her dietary history revealed a constant intake of corn which is the primary meal in the household. She also complains of recurrent episodes of the passage of loose, watery stools. There was no history of tuberculosis treatment.
On examination, a depressed young girl with a well-demarcated symmetrical hyperpigmented and thickened burn-like eruptions with erythematous margins as shown in the figure. These hyper-keratinized and thickened hyperpigmentation lesions also appeared symmetrically over the dorsum of the feet, the ankles, the upper part of the legs, the hands, wrist, arms, forearms and milder forms on the lips as shown in the figure. She also had koilonychia. The patient could not afford to conduct requested laboratory investigations. Based on physical and clinical symptoms, a final diagnosis was made. She was then placed on nicotinamide with multivitamin supplements. The patient improved symptoms rapidly.
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