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Peralta-Amaro AL, Quintal-Ramírez MDJ, Esteban-Prado A, Chávez-Sánchez IN, Vera-Lastra OL, López-Velasco A, Acosta-Jiménez E, Cano-Viveros MI. Type I acquired cutis laxa: Report of a unique progressive case and short review. Am J Med Sci 2024; 367:268-273. [PMID: 38278360 DOI: 10.1016/j.amjms.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 11/09/2023] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
Cutis laxa is a rare connective tissue disorder, characterized by a reduced number and abnormal properties of elastic fibers throughout the dermis, creating a clinical appearance of premature aging. It can be subdivided into inherited and acquired, the latter rarer than the former, and skin involvement may be localized or generalized. The etiology of acquired cutis laxa (ACL) remains unknown and there is no definitive treatment. We present the case of a 30-year-old man diagnosed with type I ACL with progressive systemic involvement at the renal, pulmonary, and digestive levels. Histological analysis of the skin revealed reduction and fragmentation of elastic fibers. Immunosuppressive treatment was started with prednisone, cyclophosphamide, and rituximab, with which a complete response to proteinuria was achieved and the progression of lung damage was limited. Autoimmune, infectious, and neoplastic diseases were ruled out.
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Affiliation(s)
- Ana Lilia Peralta-Amaro
- Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico; Division of Postgraduate Studies, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Marissa de Jesús Quintal-Ramírez
- Pathology Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Alejandro Esteban-Prado
- Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico; Division of Postgraduate Studies, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Iliana Nelly Chávez-Sánchez
- Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico; Division of Postgraduate Studies, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Olga Lidia Vera-Lastra
- Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico; Division of Postgraduate Studies, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Anel López-Velasco
- Division of Postgraduate Studies, Universidad Nacional Autónoma de México, Mexico City, Mexico; Plastic Surgery Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elsa Acosta-Jiménez
- Division of Postgraduate Studies, Universidad Nacional Autónoma de México, Mexico City, Mexico; Pathology Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Mayra Itzel Cano-Viveros
- Division of Postgraduate Studies, Universidad Nacional Autónoma de México, Mexico City, Mexico; Dermatology Department, Hospital de Especialidades Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Reddy GP, Mishra B, Upadhyaya DN. Acquired Localized Cutis Laxa: A Case Report and the Role of Plastic Surgery. Indian J Dermatol 2019; 64:55-58. [PMID: 30745636 PMCID: PMC6340237 DOI: 10.4103/ijd.ijd_14_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cutis laxa is an uncommon connective tissue disorder affecting the elastin fibers leading to lax and pendulous skin and in generalized form can present with systemic involvement. Congenital cutis laxa is common in comparison to acquired cutis laxa and has varied inheritance patterns. Treatment is chiefly observation in congenital cutis laxa, and there is a paucity of literature on surgical management in acquired cutis laxa. We report a rare case of acquired localized cutis laxa with a review of literature on the role of plastic surgery in this condition.
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Affiliation(s)
- Guru Prasad Reddy
- Department of Plastic and Reconstructive Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Brijesh Mishra
- Department of Plastic and Reconstructive Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Divya Narain Upadhyaya
- Department of Plastic and Reconstructive Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
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Abstract
Cutis laxa is a rare connective tissue disease involving damage to dermal elastic fibers creating a clinical appearance of loose, sagging skin. The condition can be either acquired or genetic. Autoimmune diseases, neoplasms, infections, and medications have been proposed as the cause of, or in association with, the acquired form. In nearly 50% of cases, erythematous plaques present before the onset of cutis laxa. Separately, urticarial vasculitis and systemic lupus erythematosus have been linked to cutis laxa acquisita. Our case is the first in the literature documenting a coexistence of cutis laxa acquisita, hypocomplementemic urticarial vasculitis, and systemic lupus erythematosus.
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Lin CJ, Lin CY, Stitziel NO. Genetics of the extracellular matrix in aortic aneurysmal diseases. Matrix Biol 2018; 71-72:128-143. [PMID: 29656146 DOI: 10.1016/j.matbio.2018.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 12/17/2022]
Abstract
Aortic aneurysms are morbid conditions that can lead to rupture or dissection and are categorized as thoracic (TAA) or abdominal aortic aneurysms (AAA) depending on their location. While AAA shares overlapping risk factors with atherosclerotic cardiovascular disease, TAA exhibits strong heritability. Human genetic studies in the past two decades have successfully identified numerous genes involved in both familial and sporadic forms of aortic aneurysm. In this review we will discuss the genetic basis of aortic aneurysm, focusing on the extracellular matrix and how insights from these studies have informed our understanding of human biology and disease pathogenesis.
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Affiliation(s)
- Chien-Jung Lin
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Chieh-Yu Lin
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan O Stitziel
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA; McDonell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA.
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Tan S, Pon K, Bargman J, Ghazarian D. Generalized Cutis Laxa Associated with Heavy Chain Deposition Disease. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Cutis laxa is a heterogeneous group of inherited and acquired disorders characterized clinically by loose skin and histologically by altered elastic tissue. Heavy chain deposition disease is a very rare monoclonal immunoglobulin disorder, distinct from multiple myeloma, in which there is production and deposition of defective immunoglobulin heavy chains without light chain deposition. Objective: We describe a case of acquired cutis laxa associated with heavy chain deposition disease. Results: A 50-year-old male presented with acute renal failure, IgG4 heavy chain deposition in the kidneys, and no evidence of multiple myeloma. Four years later, he developed generalized acquired cutis laxa, emphysema, and a peripheral polyneuropathy. On pathology, there was destruction of elastic fibers within the dermis. Conclusion: This case describes a previously unreported association between acquired cutis laxa and heavy chain deposition disease. Antécédents: Cutis laxa est un groupe hétérogène de troubles héréditaires et acquis qui se caractérise cliniquement par un relâchement de la peau et histologiquement par l'altération du tissu élastique. La maladie des chaînes lourdes est un trouble très rare de l'immunoglobuline monoclonale, différent du myélome multiple où il y a production et dépôt de chaînes lourdes, sans chaînes légères, de l'immunoglobuline déficiente. Objectif: Description d'un cas non conventionnel de cutis laxa acquise associée à une maladie des chaînes légères. Méthodes: Description du cas et aperçu de cutis laxa. Observation: Un homme de 50 ans présente une insuffisance rénale, des dépêts dans les reins de chaînes lourdes IgG4 et aucune preuve de myélome multiple. Quatre ans plus tard, il développe une cutis laxa généralisée acquise, un emphysème et une Polyneuropathie périphérique. La pathologie a montré une destruction des fibres élastiques du derme. Conclusion: Ce cas décrit une association jamais établie auparavant entre cutis laxa et une maladie des chaînes lourdes.
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Affiliation(s)
- Stephen Tan
- University Hospital, Indianapolis, Indiana, USA
| | - Kucy Pon
- University Hospital, Indianapolis, Indiana, USA
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Nygaard RH, Maynard S, Schjerling P, Kjaer M, Qvortrup K, Bohr VA, Rasmussen LJ, Jemec GBE, Heidenheim M. Acquired Localized Cutis Laxa due to Increased Elastin Turnover. Case Rep Dermatol 2016; 8:42-51. [PMID: 27293393 PMCID: PMC4899661 DOI: 10.1159/000443696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cutis laxa is a rare disease characterized by abnormal skin wrinkling and laxity, due to decreased elastin synthesis or structural extracellular matrix defects. We have explored elastin metabolism in a case of adult onset cutis laxa localized to the upper body of a woman. For this purpose, we obtained skin biopsies from affected and unaffected skin areas of the patient and analyzed these with microscopy, polymerase chain reaction, western blotting and cell culture experiments. Skin from the affected area lacked elastin fibers in electron microscopy but had higher mRNA expression of elastin and total RNA. Levels of an apparent tropoelastin degradation product were higher in the affected area. Fibroblast cultures from the affected area were able to produce elastin and showed higher proliferation and survival after oxidative and UVB stress compared to fibroblasts from the unaffected area. In conclusion, we report a case of acquired localized cutis laxa with a lack of elastic fibers in the skin of the patient's upper body. The lack of elastic fibers in the affected skin was combined with increased mRNA expression and protein levels of elastin. These findings indicate that elastin synthesis was increased but did not lead to deposited elastic fibers in the tissue.
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Affiliation(s)
- Rie Harboe Nygaard
- Institute of Sports Medicine, Department of Orthopedic Surgery, Bispebjerg Hospital, Copenhagen, Denmark; Center for Healthy Aging, Copenhagen, Denmark
| | - Scott Maynard
- Center for Healthy Aging, Copenhagen, Denmark; Department of Cellular and Molecular Medicine, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schjerling
- Institute of Sports Medicine, Department of Orthopedic Surgery, Bispebjerg Hospital, Copenhagen, Denmark; Center for Healthy Aging, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine, Department of Orthopedic Surgery, Bispebjerg Hospital, Copenhagen, Denmark; Center for Healthy Aging, Copenhagen, Denmark
| | - Klaus Qvortrup
- Core Facility for Integrated Microscopy, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vilhelm A Bohr
- Center for Healthy Aging, Copenhagen, Denmark; Department of Cellular and Molecular Medicine, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Laboratory of Molecular Gerontology, National Institute on Aging, National Institutes of Health, Baltimore, Md., USA
| | - Lene J Rasmussen
- Center for Healthy Aging, Copenhagen, Denmark; Department of Cellular and Molecular Medicine, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Heidenheim
- Department of Dermatology, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Turner RB, Haynes HA, Granter SR, Miller DM. Acquired cutis laxa following urticarial vasculitis associated with IgA myeloma. J Am Acad Dermatol 2009; 60:1052-7. [PMID: 19467378 DOI: 10.1016/j.jaad.2008.09.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 09/12/2008] [Accepted: 09/24/2008] [Indexed: 11/19/2022]
Abstract
Cutis laxa (CL) is an inherited or acquired connective tissue disorder characterized clinically by loosely hanging skin folds. There is often preceding cutaneous inflammatory eruption (ie, urticaria, eczema, erythema multiforme), and there is frequently internal organ involvement of the gastrointestinal, urogenital, pulmonary, and cardiovascular systems. Histologically, there are degenerative changes in the dermal elastic fibers. Of the few reports on this rare disorder, authors have speculated about an immune-mediated destruction of elastic fibers, and monoclonal gammopathies, such as multiple myeloma or heavy chain deposition disease, have a recognized association with CL. We report an unusual case of rapidly progressing acquired CL associated with leukocytoclastic vasculitis, IgA myeloma, and an immune complex-mediated glomerulonephritis. Light microscopy of the lax skin revealed complete absence of elastic fibers in areas of vasculitis.
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Affiliation(s)
- Ryan B Turner
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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GARCÍA-PATOS V, PUJOL R, BARNADAS M, PÉREZ M, MORENO A, CONDOMINES J, GELPI C, RODRÍGUEZ J, DE MORAGAS J. Generalized acquired cutis laxa associated with coeliac disease: evidence of immunoglobulin A deposits on the dermal elastic fibres. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-950.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Aguilar CR, Gontijo B, Vale ECSD. Elastólise pós-inflamatória e cutis laxa (doença de James Marshall): estudo de casos. An Bras Dermatol 2007. [DOI: 10.1590/s0365-05962007000400004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: Elastólise pós-inflamatória e cutis laxa são doenças raras, porém só o Estado de Minas Gerais responde por quase um terço dos casos relatados em todo o mundo. Também são escassos os trabalhos com seguimento dos pacientes. OBJETIVOS: Relatar nove casos observados no período de 1981 a 2004, confrontando seus achados com os 20 casos da literatura. MÉTODOS: Foram analisadas variáveis epidemiológicas, clínicas, histopatológicas e terapêuticas. RESULTADOS: Foram observados o predomínio na raça negra (8:1), no sexo feminino (4:1) e nos trópicos (9:1); idade de início até os quatro anos (93%); deficiência de alfa 1-antitripsina (7%); aortite (7%); dermatoses relacionadas (62%); aspecto facial envelhecido (97%), fase atrófica estável na infância após período variável de meses a anos com lesões inflamatórias (97%). A histopatologia das lesões recentes mostrou infiltrado mais intenso e perda elástica menor do que nas lesões tardias. A cirurgia de reconstrução deu bons resultados na fase atrófica, enquanto o ácido retinóico tópico a 0,05% não foi efetivo. CONCLUSÕES: A elastólise pós-inflamatória e cutis laxa na fase aguda correlacionaram-se com diversas dermatoses inflamatórias, que promoveram elastólise (62%). A abordagem adequada dessas doenças pode diminuir a extensão do quadro atrófico final, que tem como boa opção terapêutica a cirurgia reconstrutora. Sugere-se pesquisar a deficiência de alfa 1-antitripsina.
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Riveros CJP, Gavilán MFB, França LFS, Sotto MN, Takahashi MDF. Acquired localized cutis laxa confined to the face: case report and review of the literature. Int J Dermatol 2004; 43:931-5. [PMID: 15569023 DOI: 10.1111/j.1365-4632.2004.01946.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutis laxa is an uncommon entity characterized by laxity of the skin, which hangs in loose folds, producing the appearance of premature aging. It can be subdivided into congenital and acquired. This latter variant is rare and the skin involvement varies from generalized to localized. We report a case of a localized acquired cutis laxa confined to the face, without preceding inflammatory lesions or systemic compromise. Four similar cases have been reported to date. The etiology remains unknown and there is no definitive treatment. METHODS A 27-year-old White woman came to our hospital with a wrinkled face, pendulous earlobes and drop eyelids. Changes began 5 years prior, and she appeared much older than her age. RESULTS Histological analysis and ultrastructural examination of skin biopsy revealed reduction and fragmentation of elastic fibers, confirming the diagnosis of cutis laxa. No systemic involvement was diagnosed. The patient was submitted to plastic surgery for repair, with satisfactory results to date. CONCLUSIONS Acquired localized cutis laxa confined to the face without preceding inflammatory lesions is extremely rare. The etiology remains unknown. Clinical features and histopathologic findings confirm the diagnosis. Surgical repair seems to be the only therapeutic choice, but the results are variable and temporary.
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12
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Lewis KG, Bercovitch L, Dill SW, Robinson-Bostom L. Acquired disorders of elastic tissue: Part II. decreased elastic tissue. J Am Acad Dermatol 2004; 51:165-85; quiz 186-8. [PMID: 15280835 DOI: 10.1016/j.jaad.2004.03.016] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Elastic fibers in the extracellular matrix are integral components of dermal connective tissue. The resilience and elasticity required for normal structure and function of the skin are attributable to the network of elastic tissue. Advances in our understanding of elastic tissue physiology provide a foundation for studying the pathogenesis of elastic tissue disorders. Many acquired disorders are nevertheless poorly understood owing to the paucity of reported cases. Several acquired disorders in which loss of dermal elastic tissue produces prominent clinical and histopathologic features have recently been described, including middermal elastolysis, papular elastorrhexis, and pseudoxanthoma-like papillary dermal elastolysis, which must be differentiated from more well-known disorders such as anetoderma, acquired cutis laxa, and acrokeratoelastoidosis. Learning objective At the conclusion of this learning activity, participants should have an understanding of the similarities and differences between acquired disorders of elastic tissue that are characterized by a loss of elastic tissue.
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Affiliation(s)
- Kevan G Lewis
- Department of Dermatology, Brown Medical School-Rhode Island Hospital, Providence, RI 02903, USA
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Manuel Guía Torrent J, Castro García F, Cuenca Gómez M, Gracián Gómez M. Alteraciones cardiovasculares en el síndrome de cutis laxa congénita. Rev Esp Cardiol 1999. [DOI: 10.1016/s0300-8932(99)74897-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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GARCÍA-PATOS V, PUJOL R, BARNADAS M, PÉREZ M, MORENO A, CONDOMINES J, GELPI C, RODRÍGUEZ J, MORAGAS J. Generalized acquired cutis laxa associated with coeliac disease: evidence of immunoglobulin A deposits on the dermal elastic fibres. Br J Dermatol 1996. [DOI: 10.1111/j.1365-2133.1996.tb03625.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A 31-year-old man had cutis laxa after an urticarial eruption. He had no systemic manifestations. In urticarial lesions, elastolysis occurred only within the inflammatory infiltrate of neutrophils around the vessels and between the collagen bundles. In lax skin, elastolysis occurred throughout the entire dermis. Electron microscopic study showed a markedly decreased number of elastic fibers, with elastolysis most predominant near the inflammatory cells. These findings suggest that the neutrophil plays a significant role in the destruction of elastic fibers and subsequent development of cutis laxa.
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Affiliation(s)
- S I Chun
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
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Karnes PS, Shamban AT, Olsen DR, Fazio MJ, Falk RE. De Barsy syndrome: report of a case, literature review, and elastin gene expression studies of the skin. AMERICAN JOURNAL OF MEDICAL GENETICS 1992; 42:29-34. [PMID: 1308362 DOI: 10.1002/ajmg.1320420108] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Several "progeroid" syndromes have now been identified. The De Barsy syndrome is an autosomal recessive syndrome of dwarfism, mental deficiency, an "aged" appearance at birth, abnormal elastic fibers on skin biopsy, and lax skin, large helices, eye abnormalities, lax joints, hypotonia, and athetoid posturing. We report one case and review 11 cases from the literature. To understand the abnormal appearance of the elastic fibers on biopsy, we performed elastin gene expression studies on fibroblasts cultured from our patient's skin. Molecular hybridization studies revealed reduced elastin mRNA steady-state levels as compared with age matched control individuals. Assuming normal rates of mRNA translation, reduced elastin synthesis would occur. Diminished dermal elastin content could explain the altered cutaneous elasticity, decreased elastic fibers in the skin, and many clinical manifestations of individuals with this condition.
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Affiliation(s)
- P S Karnes
- Children's Hospital Los Angeles, Division of Medical Genetics, Calif 90027
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Ghigliotti G, Parodi A, Borgiani L, Gambini C, Rebora A. Acquired cutis laxa confined to the face. J Am Acad Dermatol 1991; 24:504-5. [PMID: 2061455 DOI: 10.1016/s0190-9622(08)80080-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G Ghigliotti
- Department of Dermatology, University of Genoa, Italy
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Affiliation(s)
- S S Greenbaum
- Department of Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107
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Abstract
We report the first case of acral localized acquired cutis laxa. The skin laxity was preceded by swelling of the fingers and toes and by the appearance of papular urticaria. Dapsone therapy was effective in controlling the swelling. Examination of skin biopsy specimens showed fragmentation and almost total loss of elastic fibers in the areas of cutis laxa. Electron microscopy showed no abnormalities in elastic structure and function in unaffected skin. In addition, electron microscopic examination of an urticarial lesion showed a neutrophilic dermatosis with polymorphonuclear leukocytes attached to the surface of either normal elastic fibers or fibers showing early degenerative changes. These findings suggest that there is no primary defect in the elastic fibers and that the polymorphonuclear leukocytes play a significant role in the destruction of the elastic fibers and the subsequent development of cutis laxa in this case.
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Affiliation(s)
- B K Fisher
- Division of Dermatology, Wellesley Hospital, Toronto, Ontario, Canada
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Cutis laxa: reduced elastin gene expression in skin fibroblast cultures as determined by hybridizations with a homologous cDNA and an exon 1-specific oligonucleotide. J Biol Chem 1988. [DOI: 10.1016/s0021-9258(18)68662-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
A 10-year-old boy developed cutis laxa while receiving isoniazid therapy; no systemic manifestations occurred. There are several well-documented cases of acquired cutis laxa. We propose a classification of the elastolysis syndromes, including inherited, neonatal, and acquired forms of cutis laxa.
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Kornberg RL, Hendler SS, Oikarinen AI, Matsuoka LY, Uitto J. Elastoderma--disease of elastin accumulation within the skin. N Engl J Med 1985; 312:771-4. [PMID: 3974652 DOI: 10.1056/nejm198503213121207] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Hospital case notes and chest radiographs of 100 patients with Marfan syndrome were investigated for evidence of pulmonary disease. The criteria for inclusion of details of a given patient in the study were the occurrence of Marfan abnormalities in at least two separate body systems (skeletal, cardiovascular, ocular) or in one body system where there was a family history of a classically affected first degree relative. Selection of cases was biased towards those with cardiorespiratory problems by virtue of the hospitals from which the patients were drawn. Forty eight patients underwent cardiac surgery. Eleven patients had a history of spontaneous pneumothorax, which had been recurrent in 10 cases and bilateral in six. Eight had had pneumonia or excessively frequent respiratory infections and two had bronchiectasis. Chest radiographs showed emphysematous bullae in five, upper lobe fibrosis in four, and aspergilloma in two. The cases reviewed together with other published evidence suggest that spontaneous pneumothorax and bullae are causally related to Marfan syndrome. The presence of idiopathic upper lobe fibrosis in four Marfan patients is interesting but provides insufficient evidence to assess possible causality.
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Anderson CE, Finklestein JZ, Nussbaum E, Larson EJ, Halpern R, Uitto J, Tanaka KR. Association of hemolytic anemia and early-onset pulmonary emphysema in three siblings. J Pediatr 1984; 105:247-51. [PMID: 6747755 DOI: 10.1016/s0022-3476(84)80121-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Three of four siblings born to nonconsanguineous parents of Italian origin were affected with severe congenital hemolytic anemia of unknown cause, and early-onset pulmonary emphysema. Two of the three affected siblings died of septic shock after splenectomy, at the ages of 7 and 3 1/2 years, respectively. The remaining affected sibling was shown to have cutis laxa and severe pulmonary emphysema at 15 years of age. Assay of serum components indicated that alpha 1-antitrypsin and alpha 2-macroglobulin levels were normal or slightly elevated. However, there was markedly elevated activity of an elastase-like serum enzyme. The relation of the hemolytic anemia to the pulmonary findings in this family is not clear; pedigree analysis suggests a recessively inherited defect.
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Abstract
We report a patient with acquired cutis laxa and multiple myeloma, and the possible association between the two conditions is discussed.
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Abstract
A case of a congenital, autosomal recessive form of generalized cutis laxa with pulmonary emphysema was histologically and ultrastructurally investigated. The cutaneous abnormalities observed seem to result mainly from a developmental defect of the elastic network which is absent in the papillary dermis and blocked at an early state of its formation in the upper and mid-reticular dermis. The union between the two elastic fibre components appears to be defective; the vectorial synthesis is non-existent and the elastic fibres remain in the state of dystrophic elastic units. Evidence is given to suggest that cutis laxa, presenting several described structural patterns, should be considered as a syndrome.
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Christensen CC, Gonzalez-Crussi F. Postinflammatory elastolysis and cutis laxa: report of a case with aortitis. PEDIATRIC PATHOLOGY 1983; 1:199-210. [PMID: 6387674 DOI: 10.3109/15513818309040658] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A 17-month-old black female manifested an acute febrile dermatosis followed by the development of cutis laxa and aortitis. The neutrophilic, acute inflammatory nature of the disease is emphasized. Pathologically, both the skin and the aorta were affected by a lesional process that shared common morphologic attributes and resulted in extensive elastolysis. However, the disease appears to differ from other entities characterized by generalized degradation of elastic fibers.
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Clark JG, Kuhn C, McDonald JA, Mecham RP. Lung connective tissue. INTERNATIONAL REVIEW OF CONNECTIVE TISSUE RESEARCH 1983; 10:249-331. [PMID: 6358098 DOI: 10.1016/b978-0-12-363710-9.50011-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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O'Brien JP. Solar and radiant damage to elastic tissue as a cause of internal vascular disease. Protective aspects relating to the skin, temporal artery and eye. Australas J Dermatol 1980; 21:1-9. [PMID: 7406783 DOI: 10.1111/j.1440-0960.1980.tb00131.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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36
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Kossard S, Kronman KR, Dicken CH, Schroeter AL. Inflammatory macular atrophy: immunofluorescent and ultrastructural findings. J Am Acad Dermatol 1979; 1:325-34. [PMID: 389963 DOI: 10.1016/s0190-9622(79)70025-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In a patient with primary inflammatory macular atrophy, immunofluorescence studies disclosed both C'3 and IgM in a granular and fibrillar pattern in the dermis between the coagen fibers and at the basement membrane zone. Localization of C'3 to autofluorescent elastic fibers was demonstrated. Ultrastructural examination showed the presence of activated macrophages enveloping fragmented elastic fibers. Immunologic mechanisms may play a participatory role in some forms of macular atrophy.
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