The hot, humid days of summer can exacerbate many skin
diseases but probably none so much as Darier’s disease. Friction increases in
flexural areas with excess sweating leading to epidermal thickening and skin splitting
with superimposed candida and often staph infection. You can see this under the
breasts in this case with the surrounding satellitosis of candida
superinfection. Dariers is also prominent in other mainly sebaceous areas such
as behind the ears and on the anterior chest presenting as greasy brown scaly
papules. The condition is inherited as an autosomal dominant so it is seen
equally in males and females. The most effective therapy we have is acitretin,
an oral retinoid which reduces the
excessive skin thickening but you still need topical steroids, topical
antibiotics and anti yeast creams to suppress the inflammation and infection. Acitretin
cannot be used in menstruating females who may fall pregnant as the drug is
teratogenic and can remain in the system for 18 months after being stopped.
Always check the nails of someone suspected of having Dariers as they often
show longitudinal red streaks with a notch at the nail edge. This condition can
clear remarkably in the winter months and patients are always better in cooler
climates.
