Case: A 6-year-old male patient was brought to the clinic. Patient had been well till one month of age after which he developed progressive jaundice. At the age of one-and-a-half, he developed multiple raised non-itchy lesions over the knuckles, followed by similar lesions on the eyelids, hands, and the body folds. The early lesions were slowly growing and yellowish, but later they coalesced and became skin-colored.
There was associated pruritus that was generalized, moderate to severe in intensity with no diurnal variation and not relieved by treatment with oral antihistamines and topical calamine lotion and steroids. The child’s developmental milestones were delayed. His social smile had appeared at the age of 4 months and he was not able to walk or talk till he was one-and-a-half years old. Cutaneous examination revealed asymptomatic well defined painless, indurated papules and…
