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Outer-corner crease sign on dermoscopy may help to rule out other differentials in its early presentation. Periorbital ADMH should be considered as a differential diagnosis of periorbital hyperpigmentation in children and young adults. Outer-corner crease sign on dermoscopy may help to rule out other differentials in its early presentation. Lepra reactions if not managed promptly are an important cause of sudden onset nerve palsy and disability due to leprosy. To evaluate the usefulness of histology in predicting type 1 lepra reaction.