55 year old male presents with diffuse dry skin since childhood

    55 year old otherwise healthy male presents with diffuse dry skin since childhood characterized by dark brown plate-like scales over the bilateral arms, legs and trunk and thickened rough skin and scale on the palms and soles with hyperlinear palms, and fingernails and toenails thickened with subungal hyperkeratosis. The patient reported that he sometimes experiences pruritis but is most bothered by the dryness and cosmesis of his skin. Patient reported that his sister and father experience similar symptoms. The patient received treatment with topical steroids 1 month prior to presentation, which initially improved but then worsened his symptoms. The patient denied any eye dryness or trouble with his vision, and endorsed that he may have been a "red baby" at birth. Patient was treated with urea 40 % cream to the affected areas twice a day, halobetasol propionate 0.05 % ointment to the affected area twice a day, and fluconazole 200 mg once a day, which improved the texture and moisture of his skin.