Hyperkeratosis with visual and hearing disturbances

A 66-year-old woman presented with multiple lifelong skin complaints. The physical examination revealed nonscarring alopecia with diffuse generalized erythema and rough scale, prominent over the face (Fig 1). Erythema and rough scale covered the hands (Fig 2, A and B), with thick yellow hyperkeratotic plaques on the soles (Fig 3, B). Erythema and scale extended to the dorsal surfaces of her feet with hyperkeratotic yellow nail dystrophy (Fig 3, A). Findings included significant hearing loss and visual impairment.

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