Mal de Meleda is a rare inherited skin condition that usually begins in infancy or early childhood. It causes thick, hard skin on the palms and soles, and the skin can spread onto the backs of the hands and feet over time. The early symptoms of Mal de Meleda may include redness, sweating, cracks, pain, and trouble with walking or using the hands. Not everyone will have the same experience, but Mal de Meleda is usually lifelong and it does not usually affect life expectancy. Treatment focuses on symptom relief and often includes moisturizers, gentle skin care, and medicines that reduce skin thickening.
How many people live with Mal de meleda?
Mal de Meleda is extremely rare: Orphanet lists it as affecting fewer than 1 in 1 million people (Orphanet, 2024), which suggests fewer than about 8,200 people worldwide based on current global population totals (United Nations, 2024). Using that same very rough rate, fewer than about 340 people may be living with it in the United States, although there is no single national count and the true number could be lower (Orphanet, 2024; U.S. Census Bureau, 2024).
Overview
Mal de meledaSymptoms
Mal de Meleda causes thick, waxy skin on the palms and soles, often starting in infancy or early childhood. Many living with Mal de Meleda also have redness, sweating, cracking, pain, and skin changes that can spread onto the backs of the hands and feet.
Outlook and prognosis
Mal de Meleda is lifelong, but many people live well with regular skin care and treatment of painful cracking, sweating, and infections. Symptoms often start in infancy and can slowly thicken over time, so ongoing follow-up helps protect comfort and mobility.
Causes and risk factors
Mal de Meleda is caused by changes in the SLURP1 gene, usually inherited when both parents pass on a changed copy. Risk is highest with a family history or related parents. Lifestyle and environment do not cause it, but friction and heat can worsen symptoms.
Genetic influences
Genetics are central to Mal de Meleda. It is usually caused by inherited changes in the SLURP1 gene, and different genetic variations can influence how early symptoms of Mal de Meleda begin and how severe they become.
Diagnosis
Diagnosis of Mal de Meleda usually starts with the skin changes and family history. A dermatologist looks for typical clinical features on the hands and feet. Genetic tests can confirm the diagnosis.
Treatment and drugs
Mal de Meleda is managed by softening thick skin with moisturizers and peeling creams, often with urea or salicylic acid. Some people also use retinoid medicines. Doctors treat skin cracks, sweating, and infections early to ease walking and hand use.
Symptoms
Everyday tasks like walking, gripping a pen, or buttoning clothes can be harder when the skin on the palms and soles becomes unusually thick and tender. In Mal de Meleda, these changes usually begin in infancy or early childhood and can affect comfort, movement, and hand use. Features vary from person to person and can change over time. The early features of Mal de Meleda often include thickened skin on the hands and feet, sweating, and painful cracks.
The skin on the palms and soles usually becomes very thick, rough, and sometimes yellowish. For many people with Mal de Meleda, this can make standing, walking, or holding objects less comfortable.
The thickened skin can spread beyond the palms and soles onto the backs of the hands and feet, and sometimes toward the wrists or ankles. This wider pattern is one of the more recognizable features of Mal de Meleda.
Deep splits can form in the thick skin, especially with friction, dry weather, or long periods on the feet. These cracks may sting, bleed, and make daily routines more difficult.
Hands and feet often sweat more than usual, and trapped moisture can lead to a strong odor. The skin may also feel soggy, peel more easily, or become sore after time in shoes or gloves.
How people usually first notice Mal de meleda?
Mal de Meleda is usually first noticed in infancy or early childhood, when a baby or young child develops thick, waxy, yellowish skin on the palms of the hands and soles of the feet that does not fade and often slowly spreads. For many families, the first signs of Mal de Meleda are skin that becomes unusually rough, red, or sweaty, along with painful cracks, a strong odor, or trouble with walking, crawling, or using the hands comfortably. Doctors often recognize how Mal de Meleda is first noticed by this early pattern of palm-and-sole thickening that can extend onto the backs of the hands and feet over time.
Types of Mal de meleda
No distinct types of Mal de meleda are widely recognized.
Can I slow down the onset of symptoms?
No. For Mal de Meleda, there is no good evidence that lifestyle changes or medical treatment can meaningfully delay when symptoms begin, because this inherited skin condition usually starts in infancy or early childhood. Gentle skin care, lowering rubbing or pressure on the hands and feet, and treating cracks or skin infections may help with comfort and daily life, but they have not been shown to postpone the start of the condition, and helping symptoms is not the same as preventing it. There is no proven preventive medicine to stop it from appearing, but early care from a skin doctor can still make a real difference in managing symptoms once they begin.
What genetics can tell you about symptoms
In Mal de Meleda, genetic testing can often confirm the diagnosis because this condition is usually linked to changes in a gene called SLURP1. These genetic changes are known to affect the skin barrier and can help explain why many people develop thick, red, peeling skin on the palms and soles, often starting in infancy or early childhood, but they do not reliably predict exactly how severe symptoms will be or which extra features, such as sweating, odor, or spread to the backs of the hands and feet, someone will have. In other words, genetics can tell you the underlying cause, but day-to-day symptoms can still vary from one person or family to another.
Causes and risk factors
Mal de Meleda is caused by changes in a gene called SLURP1, and this disrupts normal skin growth on the palms and soles. It usually happens when a child inherits two changed copies of SLURP1, one from each parent. The risk is higher when there is a family history of Mal de Meleda, and it can also be higher when the parents are related by blood. Heat, sweating, tight shoes, and repeated friction do not cause the condition, but they can make symptoms worse. Genetic testing for Mal de Meleda can sometimes clarify your personal risk.
What are the most common causes or risk factors?
Mal de Meleda is mainly caused by an inherited change in a gene called SLURP1, so the biggest risk factor is being born to two parents who each carry the changed gene. A family history of the condition raises the chance, and it is also more likely when parents are related by blood, because both may pass down the same changed gene. There are no known lifestyle or environmental causes, although heat, sweating, and rubbing can make the skin problems worse once someone has the condition.
Environmental and biological risk factors
Mal de Meleda is a rare condition that is usually present from birth or very early infancy. Doctors often group risks into internal (biological) and external (environmental). For Mal de Meleda, there are no well-established environmental or non-genetic biological risk factors known to increase the chance of it occurring, and no pregnancy exposure, infection, or parental health factor has been clearly shown to cause it.
Genetic risk factors
Mal de Meleda is mainly linked to inherited changes in a gene called SLURP1, which helps the outer layer of skin work properly. In most families, the condition develops only when a child inherits two changed copies of this gene, one from each parent. That is why the main inherited risks are having carrier parents, having an affected relative, or coming from a family or community where the same gene change has been passed down for generations. In some cases, genetic testing can give a clearer picture of your personal risk.
SLURP1 gene: Most known cases of Mal de Meleda are caused by changes in SLURP1. This gene helps skin cells mature and hold together in a healthy way, especially on the palms and soles.
Recessive inheritance: Mal de Meleda is usually inherited in an autosomal recessive pattern, which means two changed copies are needed for the condition to develop. A child typically inherits one changed copy from each parent.
Carrier parents: If both parents carry one changed SLURP1 copy, each pregnancy has a 1 in 4, or 25%, chance of Mal de Meleda. Carrying a genetic change does not mean the condition will appear, and most carriers do not have symptoms.
Family history: Having a brother, sister, or other close relative with Mal de Meleda raises the chance that the same gene change runs in the family. This is one of the clearest inherited clues when doctors look into the genetic causes of Mal de Meleda.
Founder variants: Some families or communities have a higher chance of Mal de Meleda because the same SLURP1 change has been passed down through many generations. This is sometimes called a founder effect, and it can make the condition cluster in one region or extended family.
Related parents: The chance of Mal de Meleda is higher when parents are biologically related, such as cousins, because they are more likely to carry the same rare SLURP1 change. This does not create the gene change itself, but it increases the chance that a child inherits two changed copies.
Lifestyle risk factors
Lifestyle habits do not cause Mal de Meleda, but they can make thickened skin, fissures, pain, odor, and infections easier or harder to control. When people ask how lifestyle affects Mal de Meleda, the biggest issues are friction, moisture, skin care routines, and day-to-day pressure on the hands and feet. Careful habit changes may reduce symptom flares and lower the chance of complications such as cracking and secondary infection.
Repeated rubbing from manual tasks, long walking, running, or poorly fitting shoes can worsen thick callus buildup and painful splitting. Reducing pressure points with cushioning, pacing, and activity modification may help limit skin breakdown.
Warm environments, heavy sweating, and occlusive gloves or shoes can leave the palms and soles wetter and more irritated. This can increase odor, soften damaged skin, and make fissures or infection more likely.
Tight shoes, rough seams, and nonbreathable materials can aggravate plantar pain and trigger more rubbing over already thick skin. Soft, well-fitted, breathable footwear and socks may improve comfort and reduce cracking.
Frequent wet work, detergents, and abrasive hand use can irritate affected skin and deepen painful fissures. Using protective gloves appropriately and avoiding prolonged moisture inside gloves may help balance protection with skin comfort.
Risk prevention
Because Mal de Meleda is an inherited skin condition, there is usually no way to prevent the condition itself from developing in someone who carries the changed gene. For many living with Mal de Meleda, prevention means protecting the thickened skin on the hands and feet, lowering the chance of cracks and infections, and easing day-to-day discomfort. Prevention is about lowering risk, not eliminating it completely. If Mal de Meleda runs in your family, genetic counseling may help clarify the chance of passing it on to children.
Thick creams or ointments can help soften the hard skin of Mal de Meleda and lower the risk of painful splitting. Putting them on after bathing and again before bed often works best.
Well-cushioned shoes, soft socks, and protective gloves can limit rubbing that makes Mal de Meleda skin thicker or more sore. Some may find that breaking in new shoes slowly helps prevent blisters and cracks.
Sweat trapped on the hands or feet can make skin more fragile and raise the chance of odor or infection. Keeping skin clean and dry, changing socks, and using sweat-control products if a doctor recommends them may help.
Small fissures can turn into deeper, painful breaks that make walking or using your hands harder. Preventing skin infections in Mal de Meleda often starts with early care for any split skin and quick medical advice if redness, warmth, or drainage appears.
Can you prevent Mal de meleda?
Mal de Meleda cannot usually be prevented because it is an inherited condition that someone is born with. If it runs in your family, meeting with a genetics specialist can help you understand the chance of passing it on and talk through testing options. Good skin care may help reduce irritation and other skin problems, but it does not prevent the condition itself.
Transmission
Mal de Meleda is not infectious, so it does not spread through touch, kissing, sex, shared food, or being near someone who has it. Instead, the genetic transmission of Mal de Meleda happens from parent to child.
Many living with Mal de Meleda were born with the condition because they inherited two changed copies of the same gene, usually one from each parent. In most families, both parents are healthy carriers, which means they have one changed copy but do not have symptoms; when both parents are carriers, each pregnancy has a 1 in 4 chance of resulting in a child with Mal de Meleda.
When to test your genes
Consider genetic testing if thickened skin on the palms and soles begins in infancy or early childhood, especially if it spreads, runs in your family, or your parents are related by blood. Testing can confirm Mal de Meleda, guide dermatology care, and support family planning.
Diagnosis
Mal de Meleda is usually diagnosed by looking at the skin changes over time and then confirming the cause with specific tests. People with Mal de Meleda often develop thickened skin on the palms and soles early in life, and doctors also look for whether it spreads to the backs of the hands, feet, or other areas. Getting a diagnosis is often a turning point toward answers and support.
Doctors examine the palms, soles, nails, and nearby skin for the typical pattern of thick, scaly skin that often begins in infancy or early childhood. The age when symptoms started and how the skin changes have spread can give important clues.
A detailed health history helps doctors understand when symptoms began, whether walking or hand use has become painful, and whether there have been repeated skin infections or cracking. This is often an early part of the diagnosis of Mal de Meleda.
Because Mal de Meleda is an inherited condition, doctors ask whether relatives have had similar palm and sole skin changes, even if they were never formally diagnosed. Family history can also suggest the chance that both parents carry a nonworking copy of the same gene.
A genetic test can look for changes in the SLURP1 gene, which is the most common known cause of Mal de Meleda. Finding the gene change can confirm the genetic diagnosis of Mal de Meleda and help with family counseling.
How is Mal de meleda diagnosed?
Mal de Meleda is usually diagnosed by a skin doctor based on the pattern of skin changes, especially thick, red, rough skin on the palms and soles that starts early in life and can spread onto the backs of the hands and feet. The doctor will also ask when the symptoms began and whether others in the family have had similar skin problems. A blood or saliva test can look for a change in the SLURP1 gene to help confirm the diagnosis, especially if the condition looks similar to other skin disorders passed down in families.
Stages of Mal de meleda
Mal de Meleda does not have defined progression stages. That is because it is usually a lifelong inherited skin condition that begins early in life and tends to persist, rather than moving through clear step-by-step phases. Often the process begins when you notice changes in daily life, such as thick skin on the palms and soles, sweating, cracking, or discomfort with walking and hand use; these are often part of the early symptoms of Mal de Meleda. Diagnosis is usually based on the pattern of skin changes, when they started, family history, and sometimes genetic testing to confirm the cause.
Outlook and prognosis
The outlook for people with Mal de Meleda is generally favorable in terms of survival, because it is a chronic skin disorder that does not usually affect life expectancy. Symptoms typically begin in infancy or early childhood and tend to persist lifelong, often progressing to thicker palm and sole skin, painful fissures, sweating, odor, and recurrent skin infections if not well managed. Although the condition is not usually life-threatening, it can significantly affect comfort, mobility, hand function, and quality of life. Severity varies from person to person, and regular dermatologic care can help reduce complications and improve daily functioning. There is no strong evidence that Mal de Meleda increases mortality, and most affected individuals are expected to have a normal lifespan.
Long-term effects
For many living with Mal de Meleda, the main long-term effects involve the skin on the hands and feet, especially with walking, gripping, and daily comfort. The condition usually lasts throughout life and often changes slowly rather than going away. It’s important to remember that long-term doesn’t always mean progressive, but the long-term effects of Mal de Meleda can still build up over time and affect day-to-day function.
The most lasting feature of Mal de Meleda is marked thickening of the skin on the palms and soles. This often begins in early childhood and tends to persist into adult life. In many people, the skin can become hard, waxy, or deeply ridged over time.
Unlike some other palm and sole skin conditions, Mal de Meleda often extends onto the backs of the hands and feet, and sometimes toward the wrists and ankles. Over the years, many people notice small adjustments—like avoiding long walks or tasks that need a firm grip—as this wider skin involvement affects comfort and movement.
The thick skin can split, leading to painful cracks, tenderness, and trouble with walking or using the hands for longer periods. These breaks in the skin may also make infection more likely, especially when the skin stays moist or irritated.
Many people with Mal de Meleda have heavy sweating of the hands and feet, which can soften the skin and make fissures worse. A strong foot odor can also become a persistent issue, especially when sweat and thickened skin build up together.
How is it to live with Mal de meleda?
Living with Mal de Meleda often means dealing every day with very thick, red skin on the palms and soles that can crack, hurt, and make walking, writing, gripping objects, or other routine tasks much harder than they look from the outside. Many people also cope with sweating, odor, and frequent skin infections, which can be uncomfortable physically and socially, especially at school, work, or in close relationships. For family members and other close people, the condition can mean helping with skin care routines, shoes, bandages, and emotional support, but with steady treatment and practical adjustments, many living with Mal de Meleda find ways to protect their skin and stay active.
Treatment and drugs
Mal de Meleda is usually treated by easing the thick, hard skin on the palms and soles and helping prevent pain, cracks, and skin infections, since there is no cure that fixes the underlying genetic change. Treatment plans often combine several approaches. Many people with Mal de Meleda use thick moisturizers every day, along with creams or ointments that soften and thin the extra skin, such as products containing urea, salicylic acid, or lactic acid. If symptoms are more severe, a skin specialist may prescribe vitamin A-like medicines called retinoids, but these need careful monitoring because side effects can happen and they are not safe for everyone. For many living with Mal de Meleda, care also includes gentle removal of thick skin, treatment for sweating or infection when needed, and practical steps like cushioned shoes and regular foot care to make walking and daily tasks easier.
Can you cure Mal de meleda?
No, Mal de Meleda cannot currently be cured. Treatment can still help by softening and thinning the thick skin on the hands and feet, easing pain, and lowering the chance of cracks and skin infections. Many people living with Mal de Meleda do best with regular skin care and ongoing follow-up with a skin doctor.
Non-drug treatment
Living with Mal de Meleda often means planning around sore, thick skin on the hands and feet, trouble with gripping, and pain when walking. Non-drug care focuses on softening built-up skin, lowering friction, and protecting cracks so everyday tasks are easier. Managing this condition often starts with steady skin care at home and a few practical changes to shoes, work, or school routines. Because symptoms can vary, the best plan is usually tailored to how much thickening, sweating, pain, or infection risk you have.
Thick, frequent use of bland moisturizers can soften rough skin and help reduce splitting. Many people with Mal de Meleda do best when cream or ointment is applied after bathing and again before bed.
Warm soaks followed by careful filing of loose surface scale can make hands and feet feel less tight. Skin should not be cut or scraped aggressively, because this can worsen pain, cracks, and irritation.
Soft, well-cushioned shoes and moisture-wicking socks can reduce rubbing and make walking more comfortable. For many, treatment begins not at the pharmacy, but with reducing pressure points during work, exercise, and time on your feet.
Gloves for cleaning, cold weather, or repetitive manual tasks can lower friction and help protect tender skin. People living with Mal de Meleda may also find padded grips useful for pens, tools, or kitchen items.
Your genes may have an impact on how drugs work for you
For people living with Mal de Meleda, treatment usually focuses on softening and thinning the thick skin, often with moisturizers, peeling creams, and sometimes vitamin A-like medicines taken by mouth. Right now, there is no well-established evidence that inherited differences are routinely used to predict how well these treatments will work or which side effects someone will have. In everyday care, doctors usually choose and adjust treatment based on how severe the skin changes are, how well the treatment is helping, and whether side effects like dryness or irritation show up.
Pharmacological treatments
Living with Mal de Meleda often means dealing with very thick skin on the hands and feet, painful cracks, and sometimes odor or repeated skin infections that make walking or using your hands harder. There is no medicine that cures Mal de Meleda itself, so treatment usually focuses on softening thick skin, easing discomfort, and treating complications when they happen. Not everyone responds to the same medication in the same way. In practice, medications for Mal de Meleda often include skin-softening creams, peeling agents, retinoid medicines, and drugs for infection if needed.
Urea creams or ointments are often used first to soften thick, rough skin and help it hold on to moisture. They can make scaling and cracking less severe over time, especially when used regularly.
Salicylic acid helps loosen and shed built-up skin on the palms and soles. It is often combined with moisturizers, but skin can sting if cracks are deep or the strength is too high.
Topical retinoids and oral retinoids such as acitretin or isotretinoin may reduce severe thickening by slowing excess skin buildup. These drugs can help some people with Mal de Meleda, but they need medical supervision because side effects can be significant.
Antibiotic or antifungal medicines may be used if Mal de Meleda leads to skin infection, odor, or maceration in damaged areas. The exact drug depends on whether bacteria or fungus is the cause.
Genetic influences
When Mal de meleda shows up early in life, with thickened skin on the hands and feet that may slowly spread, it is usually caused by an inherited gene change rather than something you did or did not do. This condition is most often linked to changes in a gene called SLURP1, which helps the outer layer of skin develop and work properly. Mal de meleda is typically inherited in an autosomal recessive pattern, meaning a child has to receive a nonworking copy of the gene from both parents; parents who carry one copy usually do not have symptoms. Many people feel relieved to learn more about the role of genetics. If both parents are carriers, each pregnancy has a 1 in 4, or 25%, chance of resulting in a child with Mal de meleda. Understanding how Mal de meleda is inherited can help families decide whether genetic counseling or testing would be useful, especially if more than one relative has similar skin changes.
Is Mal de meleda genetic?
Genetics are central to Mal de Meleda. It is usually caused by inherited changes in the SLURP1 gene, and different genetic variations can influence how early symptoms of Mal de Meleda begin and how severe they become.
Having a genetic risk is not necessarily a diagnosis
Genetic variants are a usual part of human biology and are common throughout the general population. Most do not have a direct impact on health and simply make up part of normal human diversity. For many genes, carrying a variant associated with a condition suggests a possible link rather than a certain diagnosis, especially when more than one gene and environmental factors are involved. In some situations, though, a single well-studied variant in a particular gene can be enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
When thick, painful skin on the hands and feet makes walking, gripping a pen, or opening a jar harder, treatment usually focuses on easing that build-up and soreness. In Mal de meleda, the underlying genetic change is most often in a gene called SLURP1, and that matters because genetic testing can help confirm the diagnosis and tell it apart from other inherited skin conditions that can look similar. Right now, those genetic results usually do not point to one specific medicine or a standard drug dose for Mal de meleda, so care is still based mainly on symptoms, with moisturizers, skin-softening treatments such as urea or salicylic acid, and sometimes oral retinoids in more severe cases. Genetics is only one factor, because age, how extensive the skin changes are, irritation from daily activities, and side effects all affect which treatment plan is most practical. For many living with Mal de meleda, this means some trial and adjustment is still needed, even after the gene change is known. As research moves forward, the gene cause of Mal de meleda may help doctors develop more targeted treatments, but current care is aimed at control rather than cure.
Interactions with other conditions
People living with Mal de Meleda mainly deal with thick, often painful skin on the palms and soles, but that can also affect other parts of health. Cracked skin can make it easier for bacteria or fungi to get in, so skin infections around the hands and feet may happen more often, especially when walking, sports, or hand use causes friction. Some may also develop nail changes or irritation around the fingers and toes, which can add to discomfort and make everyday tasks like buttoning clothes or standing for long periods harder. Another important aspect is how it may link with other diseases: ongoing pain, sweating, and visible skin changes can overlap with anxiety, low mood, or stress, even though Mal de Meleda itself is not a mental health disorder. In some people, the thick skin can also be confused with other inherited skin conditions or with eczema, psoriasis, or fungal infections, so getting the right diagnosis matters. If early symptoms of Mal de Meleda seem to be changing or new problems appear, it is worth asking a dermatologist whether there is an infection, another skin condition, or a treatment side effect involved.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Mal de meleda?
Other conditions that can look like Mal de Meleda include other inherited disorders that cause very thick skin on the palms and soles, as well as psoriasis, eczema, fungal infections such as athlete's foot, and heavy calluses from repeated rubbing. Doctors usually tell them apart by looking at when the skin changes started, where they spread, whether nails or sweating are affected, and whether similar problems run in the family.
History
For people living with Mal de Meleda, the condition can shape everyday life from an early age. Thickened skin on the palms and soles may make walking uncomfortable, turning a long school day, a work shift, or time spent on your feet into something tiring and painful. That very visible pattern is one reason the condition was recognized and described by doctors relatively early compared with many other rare skin disorders.
Mal de Meleda was first reported in the medical literature in the 1800s, after doctors noticed families from the Adriatic island of Mljet, historically called Meleda, with a striking form of palm and sole skin thickening. Over time, descriptions became more detailed, and physicians realized this was not simply ordinary callusing from friction or labor. The skin changes often started in infancy or early childhood, tended to worsen over time, and could spread beyond the palms and soles, which helped set Mal de Meleda apart from other conditions.
As medical knowledge improved in the 20th century, researchers grouped Mal de Meleda with inherited disorders that cause thick skin on the hands and feet. Early reports were sometimes incomplete, and the condition was occasionally confused with related disorders that can look similar at first glance. Even so, those observations helped doctors recognize the early symptoms of Mal de Meleda more reliably, including the way the skin changes often begin young and can gradually extend onto the backs of the hands and feet.
In more recent decades, better skin microscopy and later genetic research confirmed that Mal de Meleda is a distinct rare condition rather than a variation of a more common problem. This has made diagnosis more accurate and has helped families get clearer answers, even though the condition itself remains uncommon. Knowing this history also helps explain why older records may use slightly different names or descriptions for what is now understood as Mal de Meleda.