LAUSR

Fig 2. Loricrin keratoderma. Constriction band at the proximal aspect of the interphalangeal joint of the right little finger. CASE REPORT A 5-year-old boy with a known diagnosis of loricrin keratoderma presented to the clinic for evaluation of a painful right fifth toe, with associated color changes. His mother had noted generalized dry skin prone to fissuring despite the use of several topical therapies. Physical examination showed fine scale on all areas of the body. A faint hourglass constriction of approximately 5 mm was present over the proximal aspect of the phalanx of the right fifth toe (Fig 1). The toe was noted to have slight congestion distal to the site of constriction, with capillary refill of 1 second. Additional constriction bands were present at the proximal aspect of the interphalangeal joint of the fourth and fifth digits of the hands bilaterally (Fig 2). Constrictions on the left hand were asymptomatic. Radiographs of the foot revealed no bony abnormalities. Initially, conservative management with topical emollients (petrolatum, 12% ammonium lactate lotion, and pumice bar) was pursued. However, the constriction progressed. At the site of the constriction band on the right fifth toe, the patient developed a local infection, resolved with oral antibiotics. Surgical intervention was pursued to prevent further