Custom-compounded glycine-proline jelly for ulcers in prolidase deficiency

Custom-compounded glycine-proline jelly for ulcers in prolidase deficiencyDear Editor, A 26-year-old hypertensive male, born of a third-degree consanguineous marriage, presented with a 1-year history of itchy and oozy painful ulcers on his right lower leg.Family history was significant due to the death of an elder brother due to unspecified renal disease.On examination, the patient exhibited dysmorphic features [Figure 1a], including ocular hypertelorism, exophthalmos, low-set ears, and clinodactyly of the fifth finger.Cutaneous examination revealed multiple shallow crusted ulcers measuring 2 cm × 1 cm to 2 cm × 2 cm, containing yellowish slough, healing with atrophic scars on the lower limbs [Figures 1b and c].Laboratory tests revealed iron deficiency anaemia, and abdominal ultrasound revealed splenomegaly.Serological tests for antinuclear antibodies, rheumatoid factor and C-reactive protein were negative.Urine investigations and renal function tests were normal.Venous doppler of bilateral lower limbs revealed no varicosities.A skin biopsy from the ulcer edge showed hyperkeratotic squamous epithelium, vascular proliferation and dermal vessel wall thickening with fibrinoid deposits.Considering the clinical features, family history and consanguinity, genetic testing was performed.Whole exome sequencing from the How to cite this article: