Question

A young girl presented to the OPD with rough surfaced lesions over her elbows and knees. She also complained of diminished vision in the night. What is the most likely diagnosis?

• A. Keratosis pilaris
• B. Phrynoderma
• C. Folliculitis
• D. Pyoderma

Hint:

Think of a nutritional deficiency that causes both follicular hyperkeratosis and night blindness.

Answer 1

The Correct Option is B

Step 1: Identify the key clinical features. The patient has rough surfaced lesions over elbows and knees (follicular hyperkeratosis) combined with night blindness (diminished vision in the night). This combination points to a nutritional deficiency disorder.

Step 2: Analyse each option.

• Keratosis pilaris: A genetic condition causing rough patches and tiny bumps; not associated with night blindness.
• Phrynoderma (toad skin): Follicular hyperkeratosis caused by deficiencies of vitamins A, B complex, C, and E. Night blindness is a hallmark feature of Vitamin A deficiency, which is the predominant deficiency in Phrynoderma. Endemic to poor populations and rare in developed countries.
• Folliculitis: Infection or inflammation of hair follicles presenting as pustules; does not cause night blindness.
• Pyoderma: A purulent bacterial skin infection; not associated with night blindness or nutritional deficiency.

Step 3: Conclusion. Phrynoderma was coined by Nicholls in 1933 to describe the toad-like appearance of the skin of undernourished labourers. Adjunctive symptoms such as night blindness, cheilitis, glossitis, blepharitis, diarrhea, muscle weakness, and neuritis may develop when hypovitaminosis A is predominant. Treatment is with vitamin supplementation. Answer: Phrynoderma.