| • | AKA hyalinosis cutis et mucosae  |  
 | • | very rare, autosomal recessive |  
 | • | characterized by infiltration of hyaline material into the skin, oral cavity, larynx, and internal organs |  
 | • | usually presents in infancy with hoarseness |  
 | • | increased in South Africa |  
 | • | characteristic “beaded” papules present along margins of the eyelids |  
   
diagnosis: 
| • | hoarseness from early childhood, thickening and stiffening of the tongue, and characteristic cutaneous verrucous nodules on elbows knees, and hands makes the diagnosis relatively easy |  
   
ddx: 
| • | EPP – solar sensitivity; and scarred areas confined to exposed skin  |  
 | • | histologically:  xanthomatosis, amyloidosis |  
 | • | in adults:  lichen myxedematosus, myxedema with hoarseness |  
 | • | waxy lesions of the skin: EPP |  
   
not ddx (but one symptom overlap) 
| • | hoarse voice: Dowling-Meara |  
   
prognosis: 
| • | chronic and benign course with normal life span |  
  
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