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focal or extensive parakeratosis and acanthosis Differential diagnosis • Lamellar ichthyosis • Other ichthyoses Treatment • Topical keratolytic agents • Moisturize skin with emollients immediately after • bathing and frequently through the day Increase ambient humidity Figure 20.6 Epidermolytic hyperkeratosis with columnar thick odiferous scales Mallory Chapter 20 374 • • • • • 27/1/05 3:09 pm Page 374 Illustrated Manual of Pediatric Dermatology Prominent keratoderma on the palms and soles No ectropion Heat intolerance Secondary infection common, resulting in malodor Autosomal dominant or sporadic Pathogenesis • Chromosomes 12q and 17q • Gene: keratin 1 and 10 • Increased germinative cell hyperplasia of the basal • cells and increased transit rate through the epidermis Increased transepidermal water loss Diagnosis • Clinical presentation • Histology: characteristic intracellular vacuolar • degeneration of upper spinous/granular cell layers and large clumped keratohyalin granules Prenatal diagnosis by fetal skin biopsy at 20–22 weeks’ gestation Differential diagnosis • Lamellar ichthyosis • Congenital ichthyosiform erythroderma • • • • • • (nonbullous) Epidermolysis bullosa at birth Incontinentia pigmenti at birth Staphylococcal scalded skin syndrome Ichthyosis hystrix Conradi–Hünermann syndrome Other ichthyoses References Nazzaro V, Ermacora E, Santucci B, Caputo R

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147 mM NaCl, 4 mM KCl, 1.2 mM CaCl2 and 1.2 mM MgCl2