the patients present with erythematous patches and plaques of dry, scaly, eczematous skin that may evolve into crusted, vesiculobullous, erosive and pustular lesions. The lesions are distributed in a periorificial and acral pattern, on the face, scalp, hands, feet, and anogenital areas. Paronychia as well as loss of scalp hair, eyebrows and eyelashes may occur.