Progressive Palmo Plantar Keratoderma of Greither

Today an old patient of mine came with his brother who had severe palmo plantar keratoderma since childhood which worsened after coming to Gulf. The most striking feature was the transgrediens. They said several members of their family have this problem. With my broken Hindi, I managed to elicit sufficient history to draw a crude pedigree chart. Based on the livid transgrediens, I came to a diagnosis of Progressive PPK (Greither disease or PPK of Sybert). I started him on 50% urea and 0.05% tretinoin. Before leaving my old patient (A in the chart) asked me about the chances of this condition developing in his children. What is your answer?

Polymorphous Light Eruption (PLE / PMLE)

Differentiation of PLE on pigmented skin from Actinic LP can be tricky without a biopsy as the second condition is also fairly common in India and Gulf. On fair skin PLE is described as ‘pink or red raised spots’ [ http://dermnetnz.org/reactions/pmle.html ] but the pink hue is never appreciable on pigmented skin. PLE is generally pruritic and involves photo exposed areas, often sparing the face as in the above case. Actinic LP is non-pruritic and commonly involves the face as the case posted below (http://www.gulfdoctor.net/blog/2006/01/diagnosis.html ).

Follicular Lesions

A 36 year old male patient with these unilateral follicular lesions of 4 months duration over the shin. What is your diagnosis?