Mucosal manifestation
White cobblestone pattern of small papules
Overgrowth of gums
Usually affects the mouth, esophagus, rectum, vulva, vagina
Oral symptoms  can be diagnosed by a routine dental examination
Other symptoms and their overall prevalence in the affected population:In 80 to 90% of patients
Acrokeratosis verruciformisAcrokeratosis is characterized by several small wart-like and flat-topped bumps that line the skin on typically the hand and feet. Hypermelanotic macule
Patches on the skin that contain excess pigment, they often appear as dark patches in the skin. Pruritus
Itching
Subungual hyperkeratotic fragments
Thickened skin that is often discolored, under nails, on either hands or feet. Palmar pits
Usually red in color, they are pits or depressions in the palms or soles of the hands and feet. In 30 to 79% of patients
Abnormal hair morphology
Acne conglobata
Typically described as cystic acne

Genetics
Mutations in a single gene, ATP2A2, are responsible for the development of Dariers disease. ATP2A2 encodes the SERCA2 protein, which is a calcium pump localized to the membranes of the endoplasmic reticulum (ER) in nearly all cells and the sarcoplasmic reticulum (SR) in muscle cells. The ER is where protein processing and transport begins for proteins targeted for secretion. The SR is a specialized form of ER found in muscle cells that sequesters calcium, the regulated efflux of which into the cytosol stimulates muscle fiber contraction. Calcium acts as a second messenger in many cellular signal transduction pathways. SERCA2 is required for Ca2+ signaling in cells by removing nearly all Ca2+ ions from the cytoplasm and storing them in the ER/SR compartments.
Mild cases present clinically are minor rashes (without odor) that can become exacerbated by heat, humidity, stress, and sunlight. The symptoms of the disease are thought to be caused by an abnormality in the desmosome-keratin filament complex leading to a breakdown in cell adhesion. Dariers disease is an incommunicable disorder that is seen in males and females equally. Symptoms typically arise between the ages of 15 and 30. One study of 100 British individuals diagnosed with Dariers disease reported that affected individuals display elevated frequencies of neuropsychiatric conditions. There were high lifetime rates for mood disorders (50%), including depression (30%), bipolar disorder (4%), suicidal thoughts (31%), and suicide attempts (13%), suggesting a possible common genetic link. Several case studies have suggested affected populations display elevated frequencies of learning disorders, but this has yet to be confirmed. Treatment
Treatment of Darier disease depends on the severity of the presented clinical symptoms. In most minor cases, the disorder can be managed using sunscreen, moisturizing lotions, avoidance of non-breathable clothing, and excessive perspiration. In more severe cases of Dariers disease, hospitalisation may be required to heal affected individuals who display frequent relapse and remit patterns. In less severe cases, signs and symptoms may clear up completely through hygienic interventions. Most patients with Dariers disease live normal, healthy lives. Rapid resolution of rash symptoms can be complicated due to the increased vulnerability of affected skin surfaces by secondary bacterial or viral infections. Epidermal Staphylococcus aureus, human papillomavirus (HPV) and herpes simplex virus (HSV) infections have been reported.