A 47-year-old woman with ichthyosis congenita presented with recent onset of pain at the dorsal aspect of the left foot. She suffered from chronic back pain and stiffness beginning at the age of 40. Standard X-ray of the left foot revealed new bone apposition in several sites (Fig. 1). Spine X-ray revealed lumbar and dorsal coarse non-marginal syndesmophytes and osteophytes. MRI showed normal sacroiliac joints, with no signs of bone oedema. SpA was excluded (the classification criteria for axial SpA were not fulfilled), and DISH was unlikely (young age). As the patient had been taking retinoids, namely acitretin, for about 30 years, retinoid-induced diffuse skeletal hyperostosis was our final diagnosis.
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