Erythrokeratodermia Variabilis in a 4-Year-Old Girl with Erythematous, Hyperkeratotic Skin Lesions

A 4-year-old girl with erythematous, hyperkeratotic skin lesions unresponsive to various treatments, including topical antibiotics, emollients, steroids, and systemic antihistamines, was diagnosed with erythrokeratodermia variabilis. The lesions, which began a few months after birth and worsened over time, were located on her cheeks, forearms, and knees, with variable exacerbations and remissions. The patient's palms, soles, nails, and teeth were normal, but she experienced marginal hair loss on the scalp. Despite normal blood count, serum zinc, ferritin levels, and urine examination, the skin biopsy showed nonspecific hyperkeratosis, papillomatosis, and acanthosis. Treatment with emollients did not significantly improve her condition. There was no family history of similar issues, although her brother had marginal hair loss without skin lesions.