On examination, he has normal vital signs. He is in no distress, comfortable appearing, but acting shy and withdrawn (appropriate for age). His eyes and conjunctiva are normal, but the eyelids are ectropic. He has moist and otherwise normal oral mucosa. The left otic canal is filled with keratinitic debris and once cleared reveals a normal tympanic membrane. The right ear is normal. The remainder of his skin examination reveals diffuse, whole-body brown plaques which are anchored at the center and peeling at the edges…

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