1
|
Zhao Q, Chu Z, Li L, Feng C, Zhou H, Hu J, Zhao L, Che D, Zhang X, Peng B, Han Y, Geng S. New clinical classification of stiff skin syndrome. Arch Dermatol Res 2024; 316:333. [PMID: 38844593 DOI: 10.1007/s00403-024-03090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 11/29/2023] [Accepted: 04/26/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Stiff skin syndrome (SSS) is a rare disease characterized by thickened, indurated skin and limited joint movement. Multiple diverse phenotypes have been reported, and the correlation of severity with the clinical heterogeneity and histopathological findings of SSS needs to be refined. OBJECTIVE To define subtypes based on clinical features and predict the prognosis of a new SSS classification. METHODS Eighty-three patients with SSS were retrospectively reviewed for clinicopathological manifestations and routine laboratory workup, including 59 cases obtained from a PubMed search between 1971 and 2022 and 24 cases diagnosed in our department between 2003 and 2022. RESULTS Among the 83 patients, 27.7, 41, and 31.3% had classic widespread, generalized segmental, and localized SSS, respectively. Joint immobility was present in 100, 71, and 20% of classic, generalized, and localized cases, respectively. Histopathologic findings were common among the 3 groups, and based on that, we further found a difference in the distribution of proliferative collagen. 54.5% of classic and 50% of generalized cases occurred throughout the dermis or the subcutis, whereas 76% of localized cases were mainly involved in the reticular dermis or subcutis. In patients with incipient localized SSS, 42% (21/50) developed generalized SSS, and only 6% (3/50) progressed to classic SSS, whereas more than half of the incipient generalized SSS cases (60.6%, 20/33) developed classic SSS. LIMITATIONS This retrospective study was limited to previously published cases with limited data. CONCLUSIONS We propose a distinct clinical classification characterized by lesion distribution, including classic widespread, generalized segmental, and localized SSS, associated with disease severity and prognosis.
Collapse
Affiliation(s)
- Qiang Zhao
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Zhaowei Chu
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Li Li
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Cheng Feng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Hongmei Zhou
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Jiahui Hu
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Lihong Zhao
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Delu Che
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Xinyue Zhang
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Bin Peng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Yichen Han
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China.
| |
Collapse
|
2
|
Lin Z, Pei Y, Tang X, Rong L, Chen L, Jiang X. Classification and rising medication therapy in stiff skin syndrome: A case report and literature review. Dermatol Ther 2022; 35:e15633. [PMID: 35686816 DOI: 10.1111/dth.15633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
Stiff skin syndrome (SSS) is a rare disorder characterized by skin induration and limited joint mobility in the absence of visceral, musculoskeletal, vascular, or immunologic abnormalities. Distinctive subsets of SSS could be distinguished by various manifestation and mechanism, which accounts for the high heterogeneity in SSS cases. Although rehabilitation training remains the mainstay of management, rising medications has drawn awareness in recent years, owing to the potential efficacy. Nevertheless, experience was limited, especially in widespread SSS. We report on a 5-year-old girl with widespread SSS, whose lesion stopped progressing after combination therapy by mycophenolic acid (MPA) and losartan (LST) in addition to rehabilitation exercise. Despite limited experience, a combined therapy of MPA and LST seems to be effective in retarding progression of widespread SSS.
Collapse
Affiliation(s)
- Zhilang Lin
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuxin Pei
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuhua Tang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liping Rong
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lizhi Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoyun Jiang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
3
|
Ventéjou S, Schwieger-Briel A, Nicolai R, Christen-Zaech S, Schnider C, Hofer M, Bogiatzi S, Hohl D, De Benedetti F, Morren MA. Case Report: Pansclerotic Morphea-Clinical Features, Differential Diagnoses and Modern Treatment Concepts. Front Immunol 2021; 12:656407. [PMID: 33767715 PMCID: PMC7985437 DOI: 10.3389/fimmu.2021.656407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 01/17/2023] Open
Abstract
Pansclerotic morphea (PSM) is a rare skin disease characterized by progressive stiffening of the skin with or without the typical superficial skin changes usually seen in morphea (localized scleroderma). Standard therapy, consisting of a combination of systemic glucocorticoids and methotrexate or mycophenolate mofetil, does rarely stop disease progression, which may lead to severe cutaneous sclerosis and secondary contractures. Little is known about the efficacy of newer biologicals such as abatacept, a fusion protein antibody against CTLA-4, or tocilizumab, a fully humanized IL-6R antibody, in the treatment of this pathology. We present the case of an 8 years old girl with an unusual, progressive stiffening of the skin, which was eventually diagnosed as pansclerotic morphea. A treatment with systemic glucocorticoids and methotrexate combined with tocilizumab led to a good clinical response within 2 months after initiation. In this paper, we discuss differential diagnoses to be considered and this new promising treatment option based on a case review of the literature.
Collapse
Affiliation(s)
- Sarah Ventéjou
- Pediatric Dermatology Unit, Department of Pediatrics and Dermatology and Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Agnes Schwieger-Briel
- Department of Dermatology, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Rebecca Nicolai
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattera Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Stephanie Christen-Zaech
- Pediatric Dermatology Unit, Department of Pediatrics and Dermatology and Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Caroline Schnider
- Department of Pediatric Rheumatology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Michael Hofer
- Department of Pediatric Rheumatology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Sofia Bogiatzi
- Laboratory of Dermato-Histopathology, Department of Dermato-Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Daniel Hohl
- Laboratory of Dermato-Histopathology, Department of Dermato-Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Fabrizio De Benedetti
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattera Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Marie-Anne Morren
- Pediatric Dermatology Unit, Department of Pediatrics and Dermatology and Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
4
|
Varjú C, Kumánovics G, Czirják L, Matucci-Cerinic M, Minier T. Sclerodermalike syndromes: Great imitators. Clin Dermatol 2019; 38:235-249. [PMID: 32513403 DOI: 10.1016/j.clindermatol.2019.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sclerodermalike syndromes (SLSs) comprise diseases with mucin deposition (eg, scleromyxedema, scleredema), with eosinophilia (eg, eosinophilic fasciitis), metabolic or biochemical abnormalities (eg, nephrogenic systemic fibrosis), or endocrine disorders (eg, POEMS syndrome, or polyneuropathy, organomegaly, endocrinopathy, monoclonal lymphoproliferative disorder, and hypothyroidism). Chronic graft-versus-host disease may also show sclerodermalike skin changes. Inherited progeria syndromes with early aging (eg, Werner syndrome) and a heterogeneous group of hereditary disorders with either skin thickening (eg, stiff skin syndrome) or atrophy and tightening (eg, acrogeria) can also imitate classic systemic sclerosis (SSc). In addition, SLSs can be provoked by several drugs, chemicals, or even physical injury (eg, trauma, vibration stress, radiation). In SLSs, the distribution of skin involvement seems to be atypical compared with SSc. The acral skin involvement is usually missing, and lack of Raynaud phenomenon, scleroderma-specific antinuclear antibodies, the absence of scleroderma capillary pattern, and internal organ manifestations indicate the presence of an SLS. Skin involvement is sometimes nodular, and the underlying tissues can also be affected. For the differential diagnosis, a skin biopsy of the deeper layers including fascia and muscle is required. Histology does not always allow differentiation between SSc and SLSs; therefore, the diagnosis is often based on the distribution, quality of cutaneous involvement, and other accompanying clinical features.
Collapse
Affiliation(s)
- Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Florence, Italy
| | - Tünde Minier
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary.
| |
Collapse
|
5
|
Sezer E, Lehman JS, Dasgin E. Congenital Indurated Skin Lesions with Impaired Joint Mobility. Pediatr Dermatol 2017; 34:365-366. [PMID: 28523897 DOI: 10.1111/pde.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Engin Sezer
- Department of Dermatology, School of Medicine, Acıbadem University, Istanbul, Turkey
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Emel Dasgin
- Department of Pathology, School of Medicine, Acıbadem University, Istanbul, Turkey
| |
Collapse
|
6
|
Rolim A, Silvany C, Freitas J. SÍNDROME STIFF SKIN X ESCLERODERMIA SISTÊMICA: A RESPEITO DE UM CASO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
7
|
Myers KL, Mir A, Schaffer JV, Meehan SA, Orlow SJ, Brinster NK. Segmental stiff skin syndrome (SSS): A distinct clinical entity. J Am Acad Dermatol 2016; 75:163-8. [DOI: 10.1016/j.jaad.2016.01.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 11/17/2022]
|
8
|
Chamney S, Cartmill B, Earley O, McConnell V, Willoughby CE. The ocular phenotype of stiff-skin syndrome. Eye (Lond) 2015; 30:156-9. [PMID: 26471116 DOI: 10.1038/eye.2015.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 05/08/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Stiff skin syndrome (SSS; MIM#184900) is a rare autosomal dominantly inherited Mendelian disorder characterised by thickened and stone-hard indurations of the skin, mild hypertrichosis, and limitation of joint mobility with flexion contractures. It is autosomal dominant with high penetrance and results from mutations in the fibrillin 1 (FBN1; MIM*134797) gene. Here we present the associated ocular phenotype in a two generation nonconsanguineous Northern Irish family.METHODS The affected patients underwent complete ophthalmic and orthoptic assessment and genetic testing.RESULTS All three patients had ophthalmoplegia of varying degrees. Direct sequencing of the FBN1 gene detected a heterozygous pathogenic mutation (c.4710G>C; p.Trp1570Cys) in all affected patients.CONCLUSIONS This is the first report of ophthalmoplegia in association with SSS.
Collapse
Affiliation(s)
- S Chamney
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
| | - B Cartmill
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
| | - O Earley
- Department of Ophthalmology, Mater Hospital, Belfast, UK
| | - V McConnell
- Northern Ireland Regional Genetics Department, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - C E Willoughby
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| |
Collapse
|
9
|
Deng X, Chen F, Song Z, Yan H, You Y, Zhong B, Yang X, Hao F. Four new cases of stiff skin syndrome with unusual presentations. J Eur Acad Dermatol Venereol 2014; 30:163-5. [PMID: 25200307 DOI: 10.1111/jdv.12657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- X. Deng
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - F. Chen
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Z. Song
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - H. Yan
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Y. You
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - B. Zhong
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - X. Yang
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - F. Hao
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| |
Collapse
|
10
|
Halverstam CP, Mercer SE, Harwayne-Gidansky I, Geller L, Phelps RG. Stiff skin syndrome in a newborn infant. Int J Dermatol 2012; 52:993-5. [DOI: 10.1111/j.1365-4632.2012.05478.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Amorim AGDF, Aidé MK, Durães SMB, Rochael MC. Stiff skin syndrome--case report. An Bras Dermatol 2012; 86:S178-81. [PMID: 22068804 DOI: 10.1590/s0365-05962011000700046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 11/01/2010] [Indexed: 11/22/2022] Open
Abstract
Stiff skin syndrome is a rare scleroderma-like disorder of unknown etiology characterized by stone-hard indurations of skin, mild hypertrichosis and limited joint mobility. No effective treatment has yet been found. Exercises and rehabilitative therapy are important in maintaining the patient's quality of life. The authors present a case of a two-year-old boy with progressive skin hardening since he was eight-month old and secondary restricted joint mobility, diagnosed as Stiff skin syndrome.
Collapse
|
12
|
Olivieri J, Smaldone S, Ramirez F. Fibrillin assemblies: extracellular determinants of tissue formation and fibrosis. FIBROGENESIS & TISSUE REPAIR 2010; 3:24. [PMID: 21126338 PMCID: PMC3012016 DOI: 10.1186/1755-1536-3-24] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/02/2010] [Indexed: 11/13/2022]
Abstract
The extracellular matrix (ECM) plays a key role in tissue formation, homeostasis and repair, mutations in ECM components have catastrophic consequences for organ function and therefore, for the fitness and survival of the organism. Collagen, fibrillin and elastin polymers represent the architectural scaffolds that impart specific mechanic properties to tissues and organs. Fibrillin assemblies (microfibrils) have the additional function of distributing, concentrating and modulating local transforming growth factor (TGF)-β and bone morphogenetic protein (BMP) signals that regulate a plethora of cellular activities, including ECM formation and remodeling. Fibrillins also contain binding sites for integrin receptors, which induce adaptive responses to changes in the extracellular microenvironment by reorganizing the cytoskeleton, controlling gene expression, and releasing and activating matrix-bound latent TGF-β complexes. Genetic evidence has indicated that fibrillin-1 and fibrillin-2 contribute differently to the organization and structural properties of non-collagenous architectural scaffolds, which in turn translate into discrete regulatory outcomes of locally released TGF-β and BMP signals. Additionally, the study of congenital dysfunctions of fibrillin-1 has yielded insights into the pathogenesis of acquired connective tissue disorders of the connective tissue, such as scleroderma. On the one hand, mutations that affect the structure or expression of fibrillin-1 perturb microfibril biogenesis, stimulate improper latent TGF-β activation, and give rise to the pleiotropic manifestations in Marfan syndrome (MFS). On the other hand, mutations located around the integrin-binding site of fibrillin-1 perturb cell matrix interactions, architectural matrix assembly and extracellular distribution of latent TGF-β complexes, and lead to the highly restricted fibrotic phenotype of Stiff Skin syndrome. Understanding the molecular similarities and differences between congenital and acquired forms of skin fibrosis may therefore provide new therapeutic tools to mitigate or even prevent disease progression in scleroderma and perhaps other fibrotic conditions.
Collapse
Affiliation(s)
- Jacopo Olivieri
- Scienze Mediche e Chirurgiche, Sezione Clinica Medica, Universita' Politecnica delle Marche, Ancona, Italy
| | - Silvia Smaldone
- Pharmacology and Systems Therapeutics, Mount Sinai School of Medicine, New York, USA
| | - Francesco Ramirez
- Pharmacology and Systems Therapeutics, Mount Sinai School of Medicine, New York, USA
| |
Collapse
|