Patient presents with the following signs.

1. Hyperkeratotic papules present over the seborrheic area of the body.

2. V - shaped nicking present at the tip of the nails.

3. Red and white longitudinal nail lines.

Primary diagnosis usually starts off with a thorough physical exam and evaluation of medical history. To further investigate, a dermoscope, a diagnostic tool, is used by the dermatologist to examine the skin using a magnified lens. A complete blood count (CBC) along with other blood tests can also be done to rule out any sort of other infections. Lastly, a skin biopsy test may be ordered to arrive at a definitive diagnosis. This pathological examination of the skin biopsy helps to arrive at the correct diagnosis via a fungal culture(mycology). The biopsy is put together with clinical and microscope findings and study of the special tissues if need be. The signs and symptoms of MG are similar to many other clinical conditions and therefore it is necessary to perform all of the additional tests in order for a physician to correctly rule out all other possible diagnoses.

The exact cause of Majocchi's granuloma is not well established however a dysfunctinoal immune system may be a causative factor. The first form of MG, the superficial perifollicular form occurs predominately on the legs of otherwise healthy young women who repeatedly shave their legs and develop hair follicle occlusions that directly or indirectly disrupt the follicle and allow for passive introduction of the organism into the dermis. Hence, the physical barrier of the skin is important because it prevents the penetration of microorganisms. Physical factors that play a major role in inhibiting dermal invasion include the interaction among keratin production, the rate of epidermal turnover, the degree of hydration and lipid composition of the stratum corneum, CO levels, and the presence or absence of hair. Keratin and/or necrotic material can also be introduced into the dermis with an infectious organism to further enhance the problem. In immunocompromised individuals, the use of topical corticosteroids may lead to a dermatophyte infection due to local immunosuppression.

It is self limiting condition

1.reassurence

2.steriod cream for local application

3.moisterizer lotion

Because granuloma annulare is usually asymptomatic and self-limiting with a course of about 2 years, initial treatment is generally topical steroid creams, followed by oral steroids and finally intradermal injections at the site of each ring. Treatment success varies widely, with most patients finding only brief success with the above-mentioned treatments. New research out of India suggests that the combination of rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) once monthly, or ROM therapy, produces promising results. Most lesions of granuloma annulare disappear in pre-pubertal patients with no treatment within two years while older patients (50+) have rings for upwards of 20 years. The appearance of new rings years later is not uncommon.

Granuloma annulare, microscopically, consists of dermal epithelioid histiocytes around a central zone of mucin - a so-called palisaded granuloma.

A 1992 study of 163 affected persons found that most patients had no other medical problems and most manage to lead a relatively normal life.

Generally, lichen nitidus is asymptomatic and self-limited; therefore, no treatment is required. However, if persistent pruritus is present, or the appearance “...interferes with daily activities or outlook...” topical glucocorticoids may be tried. If the disease process is symptomatic, generalized and extensive, oral glucocorticoids may be indicated. Other reported treatments include PUVA, UVA/UVB phototherapy, astemizole, acitretin, and etretinate.

When appears with sun/humidity; air conditioning (cool dry air) reduces swelling and discomfort.

Due to the rarity of different types of vascular conditions, angiokeratomas may be misdiagnosed. A biopsy of the lesion can produce a more accurate diagnosis.

CGPD is known to be a temporary skin disease with a benign course. The skin papules typically resolve after a few months to a few years. After CGPD resolves, the skin may return to normal without scarring or may have small atrophic depressions with collagen loss, milia, or small pit-like scars.

Oral antibiotics of the tetracycline class such as minocycline, doxycycline, and tetracycline have been recommended for CGPD. However, their use is limited by side effects such as nausea, vomiting, and sensitivity of the skin to sunlight. Tetracycline antibiotics are not recommended for children under the age of 8 since tetracyclines are known to deposit in teeth (thereby staining them) and impair bone growth in children. The use of calcineurin inhibitor creams such as tacrolimus or pimecrolimus on the skin is controversial and results have been mixed. Certain studies have found the use of topical calcineurin inhibitors led to resolution of CGPD whereas others found incomplete resolution or prolonged symptoms. Topical azelaic acid has also been used successfully to treat CGPD.

Angiokeratoma may be classified as:

- "Angiokeratoma of Mibelli" (also known as "Mibelli's angiokeratoma," "Telangiectatic warts") consists of 1- to 5-mm red vascular papules, the surfaces of which become hyperkeratotic in the course of time. The disease is named after Italian dermatologist Vittorio Mibelli (1860-1910).

- "Angiokeratoma of Fordyce" (also known as "Angiokeratoma of the scrotum and vulva," though not to be confused with Fordyce's spots) is a skin condition characterized by red to blue papules on the scrotum or vulva.

- "Solitary angiokeratoma" is a small, bluish-black, warty papule that occurs predominantly on the lower extremities.

- "Verrucous vascular malformation" (also known as "Angiokeratoma circumscriptum naeviforme") is a malformation of dermal and subcutaneous capillaries and veins, a congenital vascular malformation, which, over time, a verrucous component appears.

There seems to be beneficial responses to clindamycin therapy as the lesions regress. This leads to the hypothesis that microorganisms may be playing a role in the initial stages of Kyrle disease.

A family with Kyrle disease were examined which their skin lesions were benign. However, when three of the young adult members were closely examined, they had posterior subcapsular cataracts and two of those three developed multiple tiny yellow-brown anterior stromal corneal opacities. In order to determine if there is any correlation between Kyrle disease and the ocular observations, more cases of Kyrle disease are to be analyzed.

All in all, since Kyrle disease is relatively rare, more cases need to be studied and analyzed in order to understand the underlying pathogenesis and to improve the management of the disease.

Morbidity and mortality range from both extremes as the significance correlate with the underlying systemic disease.

Lichen striatus is defined by:

The papules could be smooth, flat topped or scaly. The band of lichen striatus varies from a few millimeters to 1-- 2 cm wide and extends from a few centimeters to the complete length of the extremity. By and big, the papules are unilateral and single on an extremity along the lines of Blaschko.

Most people with rosacea have only mild redness and are never formally diagnosed or treated. No test for rosacea is known.

In many cases, simple visual inspection by a trained health care professional is sufficient for diagnosis. In other cases, particularly when pimples or redness on less-common parts of the face is present, a trial of common treatments is useful for confirming a suspected diagnosis.

The disorder can be confused or co-exist with acne vulgaris or seborrheic dermatitis. The presence of rash on the scalp or ears suggests a different or co-existing diagnosis because rosacea is primarily a facial diagnosis, although it may occasionally appear in these other areas.

Acrokeratoelastoidosis of Costa (also known as "Keratoelastoidosis marginalis") is a familial condition characterized by multiple keratotic papules on the dorsum of the hands and feet, palms, soles, in which electron microscopy shows rarified, abnormal elastic tissue.

It was characterized in 1953.

Treatments such as liquid nitrogen, salicylic acid, tretinoin, and prednisone have been tried, though with limited success.

The histology of lichen nitidus is significant for a "...localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla with thinning of overlying epidermis and downward extension of the ridges at the lateral margin of the infiltrate, producing a typical 'claw clutching a ball' picture..."

There is no effective treatment for this condition. It has been reported that clearance of lesions can be done with melphalan and cyclophosphamide alone or in combination with prednisone. Both isotretinoin and etretinate have also been shown to improve the conditions. All medications listed can cause adverse symptoms, with isotretinoin and etretinate particularly dangerous since they are both teratogens. Other attempted treatments include interferon-alpha, cyclosporine, PUVA photochemotherapy, electron-beam therapy, IVIg, and dermabrasion. However, the overall prognosis for the disease is poor. There are reported instances of remission of the disease when treated with a combination of Revlimid and Dexamethasone over a 24-month period.

There are many skin diseases which develop papules, such as Lichen planus, a skin disease which classically forms polygonal, purple papules.

A papule (/ˈpæpjuːl/) is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1 cm. It can be brown, purple, pink or red in color, and can cluster into a papular rash. Papules may open when scratched and become infected and crusty. Larger non-blisterform elevated lesions may be termed nodules.

Papules may have different shapes and are sometimes associated with other features such as crusts or scales.

With only a small number of case reports, treatment can be difficult and focuses primarily on axillary disease and specific symptoms. First line treatment includes topical and intalesional glucocorticoids. Specific therapies include estrogen hormones and steroid creams. Use of tretinoin reduced pruritic and axillary papules in one study. However, irritation limited drug use to short term only. Clindamycin mixed with pimecrolimus cream and benzoyl peroxide was also effective. Clindamycin is used to inhibit bacterial growth and is used when treating staphylococcal and streptococcal infections.

Granulosis rubra nasi is a rare familial disease of children, occurring on the nose, cheeks, and chin, characterized by diffuse redness, persistent hyperhidrosis, and small dark red papules that disappear on diascopic pressure.

Nevus comedonicus (also known as a "comedo nevus") is characterized by closely arranged, grouped, often linear, slightly elevated papules that have at their center keratinous plugs resembling comedones.

Soothing mild cases during pregnancy consists mainly of the application of topical moisturising creams or aqueous/emollient ointments. Class I or II corticosteroid creams and ointments are used in more aggressive cases, and oral (systemic) corticosteroids can be used to treat very severe cases—although the benefits of a pregnant woman's ingesting high-potency corticosteroids must be weighed carefully against possible (and mostly unknown) risks to the developing fetus or fetuses. Rarely, in unusually persistent and distressing cases, some women have had their labor induced as soon as they are considered to be at term (37 weeks).

Antihistamine tablets may be prescribed to provide relief from the itch, although they are generally considered much less effective than corticosteroid treatments, and may act as little more than a sleep aid.

Pine tar soap/body wash can bring relief as can keeping the skin chilled such as through a cold shower or iced cloths.

In the majority of cases, PUPPP resolves spontaneously within a week of delivery. However, a few women continue to experience symptoms long into the postpartum period.