History: 20 yo AAF with a history of primary familial intrahepatic cholestasis status post orthotopic liver transplant in 2006, followed by acute rejection in 2007, now on tacrolimus for immunosuppression, presents with complaint of hair loss for 1 year and dry bumpy skin. She had not received any treatment for her hair loss and had been using over the counter emollients for her skin.
Past Medical History: end stage liver disease s/p transplant per HPI, iron deficiency anemia
Allergies: no known drug allergies
Social History: denied alcohol, tobacco or illicit drug use
Family History: non-contributory
ROS: poor night vision
Physical Exam: Alopecia in band around scalp with hyperkeratotic scaly plaques and follicular plugging (Figs. 1,2). Hyperkeratotic scaly plaques and follicular plugging on the trunk and extremeties (Fifs.3-5).
Retinol 173 mcg/L (nl: 325-780)
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