(3) Acquired ichthyosis and unclassified lymphoma

D.P., female, aged 5 years. Hospital case no. 63862. History. She was first seen in September 1976 complaining of recurrent blisters of 2-3 months duration. These were probably due to papular urticaria and did not reappear when they got rid of their dog. Ichthyosis had been present since birth but there were no previous episodes of blistering. Past illnesses. Nil relevant. Family history. Her mother (who accompanies her today) is similarly affected as is her maternal grandfather. A brother, who died as a cot death, had eczema and a living boy is unaffected. Examination. She has a verrucose pigmented ichthyosis most marked around her waist and on the flexor and extensor aspects of her joints. There are no blisters. Treatment. Her mother's lesions respond extremely well to 10",, salicylic acid in soft paraffin applied on alternate days. Investigations. Skin biopsy (8763/76) taken from her mother's antecubital fossa: ^The epidermis shows papillomatosis with marked hyperkeratosis. Small focal areas of the upper prickle cell layer show loss of cell wall boundaries but there are no microvesicles. The upper dermis has a scanty, mainly perivascular infiltrate. The overall appearances are similar to naevus verrucosus' (Dr P.J. Smith). Comment. The autosomal dominant inheritance, clinical picture and histology fit with a diagnosis of ichthyosis hystrix.