Punctate palmoplantar keratoderma type 1 with a novel AAGAB frameshift mutation: intrafamilial phenotype variation due to ageing

by local T-cell cytotoxic response, which is developed against the external materials used in the treatment. Another case reported by Kowing et al. is madarosis and facial alopecia secondary to botulinum A toxin injection for orofacial dystonia. They considered this side-effect as an idiosyncratic reaction. They also mentioned that madarosis may be due to oedema occurring at the site of percutaneous injection. Rubegni et al. reported one patient with Meige hereditary lymphoedema presenting with alopecia of the lateral third of eyebrows and conjunctival oedema. Alopecia of the lateral third of the eyebrows is a common sign of obstruction in lymphatic drainage of the periorbital region. Herein, the underlying pathology is a nerve sheath tumour which presumably impairs lymphatic drainage and therefore causes a mild periorbital oedema and milphosis. Physicians have to take into consideration that unilateral milphosis can be a possible sign of intracranial pathologies.