X-linked Ichthyosis (XLI)- XLR, defect in steroid sulfatase (STS, arylsulfatase C)
- Presents around infancy with mild erythroderma and large translucent scales → evolves into adherent brown “dirty” scales over extremities, trunk, neck; variable involvement of flexures, sparing of palms/soles/face
- Mother (with affected fetus): low/absent estrogen in urine/amniotic fluid → labor fails to progress
- Other associations: comma-shaped corneal opacities, cryptorchidism (↑ risk of testicular CA)
- Histology: hyperkeratosis or parakeratosis overlying normal or slightly thickened granular layer
- Tests: serum lipoprotein electrophoresis (detects accumulation of cholesterol sulfate)
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