Friday Pop Quiz #249

The correct answer is B. Topical retinoids.

The condition shown is erythrokeratodermia variabilis (EKV), a genetic skin disorder characterized by the autosomal dominant inheritance pattern of mutations in GJB3, GJB4, and GJA1 genes which encode connexins, the component parts of gap junctions. Patients present with stable hyperkeratosis and transient patches of erythema. Goals of treatment are to attenuate hyperkeratosis and minimize discomfort.

First line treatment involves emollients, keratolytics such as urea and salicyclic acid, and topical retinoids such as tretinoin or tazarotene. Systemic retinoids may be used for more severe or generalized disease. Antihistamines are used for pruritus, but would not be first line in treatment of EKV.

This is not a fungal or bacterial infection, so topical azoles and antibacterials would not be appropriate.


Karadag AS, Bilgili SG, Calka O, Bayram I. Erythrokeratodermia variabilis: Two case reports. Indian Dermatol Online J. 2013 Oct;4(4):340-3. doi: 10.4103/2229-5178.120674. PMID: 24350021; PMCID: PMC3853906.