Fig. 1

Patient physical characteristics. a Generalized erythema with scaling, a marked presence of periorificial wrinkles. b Side view of the head where scaly areas on the scalp with ophiasis pattern of alopecia. c Poor eyebrow hair and the bilateral ectropion that does not allow closing his eyes completely. d Palm view of the right hand, showing the hypoplasia and contractures of the hands with intense scaling. There is an easy development of fissures in hand folds. e Back view of the right hand, with a notable deformity in distal bones of the hand with visible microcirculation disturbances due to the contractures in the joints and the skin pressure. f Equinovarus feet, erythema, scaling, and onychorrhexis, are observed