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Difficult diagnoses in an austere environment: a clinical vignette ?the presentation, diagnosis, and management of ichthyosis.
[lamellar ichthyosis]
Lamellar
ichthyosis
(
LI
)
is
a
rare
inherited
skin
disorder
of
cornification
,
with
an
incidence
of
approximately
1
in
200
,
000
births
.
It
is
one
of
three
types
of
autosomal
recessive
congenital
ichthyosis
(
ARCI
)
,
a
collective
term
for
the
spectrum
of
nonsyndromic
ichthyoses
caused
by
a
number
of
well-described
genetic
mutations
.
We
describe
the
case
of
LI
diagnosed
in
a
10
-
day
-old
child
of
a
Somali
refugee
at
a
free
clinic
in
downtown
Djibouti
.
Initial
concern
was
for
staphylococcal
infection
versus
congenital
disease
.
With
the
use
of
digital
photographs
,
consultation
with
experts
accessed
through
the
Army
Teledermatology
Consultation
Service
supported
a
diagnosis
of
ARCI
.
Providing
care
to
patients
in
austere
environments
can
present
numerous
medical
challenges
.
A
provider
can
not
be
expected
to
be
able
to
diagnose
and
treat
every
disease
and
disorder
alone
,
especially
if
there
is
a
language
barrier
.
Telemedicine
can
help
close
the
gap
in
knowledge
,
particularly
when
presented
with
a
challenging
case
.
With
a
novel
presentation
,
simply
taking
a
photograph
and
e-mailing
a
consultant
can
quickly
augment
one
?
s
medical
acumen
,
ensuring
appropriate
diagnosis
and
treatment
.
Diseases
Validation
Diseases presenting
"with an incidence of approximately 1 in 200"
symptom
lamellar ichthyosis
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