“…Their observations have been amply confirmed, and many descriptions of similar lesions seen in this country are now on record. [48][49][50][51][52][53] The early change is one of simple dryness (xeroderma).48,53 When more severe, according to Markowitz,54 the normal skin epithelium atrophies and is replaced by proliferating basal cells that become keratinized. A similar process in the skin glands and ducts causes accumulation of keratinized epithelium, which by protruding from the pilosebaceous follicular orifices results in the hyperkeratotic papules (hyperkeratosis follicularis) so characteristic of this disorder.…”