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Visual Treats in Dermatology
2023
:3;
73
doi:
10.25259/CSDM_83_2023

Mal de Meleda

Department of Dermatology, JIPMER, Puducherry, India
Corresponding author: Aravind Sivakumar, Department of Dermatology, JIPMER, Puducherry, India. aravinddermat@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Elango S, Sivakumar A. Mal de Meleda. CosmoDerma 2023;3:73.

A 23-year-old male presented with a history of reddish raised scaly plaques involving bilateral palms and soles from the early childhood. He gave a history of painful fissuring with difficulty in walking and carrying out daily activities. He did not give any other systemic complaints or have other comorbid illnesses. A family history of similar lesions was not present. He had taken topical therapies including phototherapy without much benefit. Examination revealed the presence of waxy yellowish scaly palmoplantar keratoderma involving the bilateral palms and soles diffusely with extension onto the dorsum [Figure 1a and b]. The nails were dystrophic with transverse ridging, increased curvature, and subungual hyperkeratosis. Thus, considering the possibility of hereditary palmoplantar keratoderma genetic testing for clinical exome was done which revealed a mutation in the SLURP1 gene (Exon 3, c.212G>A, [p.Arg71His]), thus confirming the diagnosis of Mal de Meleda.

Figure 1:
(a) Diffuse waxy keratoderma involving the palms in a glove shaped fashion. (b) Presence of transgradiens with nail dystrophy.

Mal de Meleda is a rare autosomal recessive palmoplantar keratoderma due to a mutation of the SLURP1 gene. First described in the Croatian island of Mljet, it is characterized by diffuse yellowish waxy palmoplantar keratoderma, nail dystrophy, periorificial plaques, and psoriasiform lesions, along with transgradiens and progradiens. Complications include superadded fungal infections causing malodor, mutilation with pseudoainhum formation, melanoma, and squamous cell carcinoma. Treatment options include topical keratolytic such as urea, lactic acid, and salicylic acid, systemic agents such as acitretin and alitretinoin have also been used.[1]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

References

  1. , . Mal de Meleda: A focused review. Am J Clin Dermatol. 2016;17:63-70.
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