1
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He M, Liu M, Tao X. A Case of Verruciform Xanthoma of Labia in a Child. Clin Cosmet Investig Dermatol 2024; 17:785-789. [PMID: 38616885 PMCID: PMC11011726 DOI: 10.2147/ccid.s432399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/24/2024] [Indexed: 04/16/2024]
Abstract
Purpose Verruciform xanthoma (VX) is a rare, chronic, and benign lesion affecting the skin and mucous membranes. We reported a case of VX in the vulva of a female child. Patients and Methods A 12-year-old female had vulvar lesions for over 10 years without any discomfort. Physical examination revealed red lobulated patches on the left labia majora with a few scales attached to the surface. Histopathological examination indicated excessive and incomplete keratinization, hypertrophic spinous layer hyperplasia, neutrophil infiltration in the epidermis, and foam-like tissue could be seen in the dermal papilla. Lymphocyte-dominated inflammatory cell infiltration was scattered around the blood vessels. Immunohistochemical results showed positive CD68. Results The final diagnosis confirmed the presence of VX. Conclusion Surgical intervention proved successful in achieving favorable outcomes for the patient.
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Affiliation(s)
- Meihua He
- Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China
- Jiangxi Provincial Clinical Research Center For Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
- Dermatology Institute of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China
- The Affiliated Dermatology Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Mingqiang Liu
- Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China
- Jiangxi Provincial Clinical Research Center For Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
- Dermatology Institute of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China
- The Affiliated Dermatology Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Xiaohua Tao
- Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China
- Jiangxi Provincial Clinical Research Center For Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
- Dermatology Institute of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China
- The Affiliated Dermatology Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
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2
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Martínez R, Peña C, Quiroga-Carrillo M, Ordóñez-Reyes C, Rincón J, Suárez-Obando F, Nossa S, García MF. Musculoskeletal abnormalities and a novel genomic variant in an adult patient with CHILD syndrome: a case report. Clin Dysmorphol 2022; 31:162-166. [PMID: 35394469 DOI: 10.1097/mcd.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rafael Martínez
- Fellow at the Pediatric Orthopaedics Fellowship Program, Pontificia Universidad Javeriana
| | - Camilo Peña
- Resident at the Orthopaedics Residency Program, Universidad Militar Nueva Granada
| | | | - Camila Ordóñez-Reyes
- Fellow at the Pediatric Orthopaedics Fellowship Program, Pontificia Universidad Javeriana
| | - Julián Rincón
- Fellow at the Pediatric Orthopaedics Fellowship Program, Pontificia Universidad Javeriana
| | - Fernando Suárez-Obando
- Fellow at the Pediatric Orthopaedics Fellowship Program, Pontificia Universidad Javeriana
| | - Sergio Nossa
- Fellow at the Pediatric Orthopaedics Fellowship Program, Pontificia Universidad Javeriana
| | - María Fernanda García
- Fellow at the Pediatric Orthopaedics Fellowship Program, Pontificia Universidad Javeriana
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3
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Ellis KT, Ovejero D, Choate KA. Cutaneous mosaicism: Special considerations for women. Int J Womens Dermatol 2022; 7:539-544. [PMID: 35024410 PMCID: PMC8721131 DOI: 10.1016/j.ijwd.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022] Open
Abstract
Genetic mosaicism results from postzygotic mutations during embryogenesis. Cells harboring pathogenic mutations distribute throughout the developing embryo and can cause clinical disease in the tissues they populate. Cutaneous mosaicism is readily visualized since affected tissue often follows predetermined patterns, such as lines of Blaschko. Due to its clinical accessibility, cutaneous mosaicism is well suited for genetic analysis. An individual's unaffected tissue can be used as an intrapatient genetic control, a technique that has yielded insight into the genetic etiologies of many disorders, several of which bear mutations in genes that would otherwise be embryonic-lethal. Particular mosaic diseases can also disproportionally impact women. Two such diseases, incontinentia pigmenti (IP) and congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome, arise from mutations on the X chromosome. Both diseases result in fetal demise in males in most cases, thus making the two diseases largely specific to women. Women with McCune–Albright Syndrome, caused by somatic mutations in GNAS, often experience precocious puberty and infertility as a result of uncontrolled cAMP regulation in affected tissue. Women with cutaneous mosaicism carry a risk of transmission to offspring when gonosomal mosaicism is present, yet cutaneous disease burden does not correlate with germline transmission risk. Cutaneous mosaic disease represents a biologically unique set of disorders that can warrant special clinical attention in women.
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Affiliation(s)
- Katharine T Ellis
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.,Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Diana Ovejero
- Musculoskeletal Research Group, Hospital del Mar Medical Research Institute, Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable, Barcelona, Spain
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.,Department of Genetics, Yale University School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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4
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Samara A, Gusman M, Aker L, Parsons MS, Mian AY, Eldaya RW. The Forgotten Phacomatoses: A Neuroimaging Review of Rare Neurocutaneous Disorders. Curr Probl Diagn Radiol 2021; 51:747-758. [PMID: 34607749 DOI: 10.1067/j.cpradiol.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 01/05/2023]
Abstract
Phakomatoses, or neurocutaneous syndromes, are a heterogeneous group of rare genetic disorders that predominantly affect structures arising from the embryonic ectoderm, namely the skin, eye globe, retina, tooth enamel, and central nervous system. Other organs are also involved in some syndromes, mainly cardiovascular, pulmonary, renal, and musculoskeletal systems. Currently, more than sixty distinct entities belonging to this category have been described in the literature. Common phakomatoses include conditions like Neurofibromatosis and Tuberous sclerosis. Several review papers have focused on various aspects of these common conditions, including clinical presentation, genetic and molecular basis, and neuroimaging features. In this review, we focus on rare neurocutaneous syndromes: Melanophakomatoses (Ie, Neurocutaneous Melanosis, and Incontinentia Pigmenti), Vascular Phakomatoses (Ie, Ataxia Telangiectasia and PHACE Syndrome), and other conditions such as Cowden Syndrome, Basal Nevus Syndrome, Schwannomatosis, Progressive Facial Hemiatrophy, Gomez-Lopez-Hernandez Syndrome, Wyburn-Mason Syndrome, CHILD Syndrome, and Proteus Syndrome. We also review the neuroradiologic manifestations of these conditions as a guide for neurologists and neuroradiologists in their daily practice.
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Affiliation(s)
- Amjad Samara
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO..
| | - Mariya Gusman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Loai Aker
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Matthew S Parsons
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Ali Y Mian
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Rami W Eldaya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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5
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Tang MM, Tan WC, Surana U, Leong KF, Pramano ZAD. CHILD syndrome in a Malaysian adult with identification of a novel heterozygous missense mutation NSDHL c.602A>G. Int J Dermatol 2020; 60:e154-e156. [PMID: 33169834 DOI: 10.1111/ijd.15296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/09/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Min Moon Tang
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Wooi Chiang Tan
- Department of Dermatology, Hospital Pulau Pinang, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Uttam Surana
- Singapore Bioprocessing Technology Institute, Singapore, Singapore.,National Skin Centre, Singapore, Singapore
| | - Kin Fon Leong
- Paediatric Dermatology Unit, Women and Children Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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6
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Maceda EBG, Kratz LE, Ramos VME, Abacan MAR. Novel NSDHL gene variant for congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome. BMJ Case Rep 2020; 13:13/11/e236859. [DOI: 10.1136/bcr-2020-236859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 1-year and 2-month-old girl with clinical features consistent with congenital hemidysplasia with ichthyosis and limb defects syndrome. Sterol analysis from skin flakes revealed increased levels of a mono 4-alpha methyl sterol also seen in plasma as well as the presence of 4-alpha-carboxy-4-methyl-cholest-8(9)-en-3beta-ol and several keto-sterols, which are usually below the limit of detection. This sterol pattern is consistent with abnormal function of the 4-alpha-methylsterol-4-demethylase complex. NSDHL gene testing revealed the presence of a variant of uncertain significance, c.130G>A (p.Gly44Ser). This missense mutation currently is not included in population databases (ExAC no frequency) and has not been reported in individuals with an NSDHL-related condition. Parental studies showed that neither parent carries the NSDHL variant. On this basis, this variant has been reclassified as likely pathogenic. Symptomatic treatment with keratolytic agents, emollients and ketoconazole was initiated.
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7
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Christen M, Austel M, Banovic F, Jagannathan V, Leeb T. NSDHL Frameshift Deletion in a Mixed Breed Dog with Progressive Epidermal Nevi. Genes (Basel) 2020; 11:genes11111297. [PMID: 33143176 PMCID: PMC7716214 DOI: 10.3390/genes11111297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022] Open
Abstract
Loss-of-function variants in the NSDHL gene have been associated with epidermal nevi in humans with congenital hemidysplasia, ichthyosiform nevi, and limb defects (CHILD) syndrome and in companion animals. The NSDHL gene codes for the NAD(P)-dependent steroid dehydrogenase-like protein, which is involved in cholesterol biosynthesis. In this study, a female Chihuahua cross with a clinical and histological phenotype consistent with progressive epidermal nevi is presented. All exons of the NSDHL candidate gene were amplified by PCR and analyzed by Sanger sequencing. A heterozygous frameshift variant, c.718_722delGAACA, was identified in the affected dog. In lesional skin, the vast majority of NSDHL transcripts lacked the five deleted bases. The variant is predicted to produce a premature stop codon truncating 34% of the encoded protein, p.Glu240Profs*17. The mutant allele was absent from 22 additionally genotyped Chihuahuas, as well as from 647 control dogs of diverse breeds and eight wolves. The available experimental data together with current knowledge about NSDHL variants and their functional impact in humans, dogs, and other species prompted us to classify this variant as pathogenic according to the ACMG guidelines that were previously established for human sequence variants. Therefore, we propose the c.718_722delGAACA variant as causative variant for the observed skin lesions in this dog.
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Affiliation(s)
- Matthias Christen
- Institute of Genetics, Vetsuisse Faculty, University of Bern, 3001 Bern, Switzerland; (M.C.); (V.J.)
- Dermfocus, University of Bern, 3001 Bern, Switzerland
| | - Michaela Austel
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (M.A.); (F.B.)
| | - Frane Banovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (M.A.); (F.B.)
| | - Vidhya Jagannathan
- Institute of Genetics, Vetsuisse Faculty, University of Bern, 3001 Bern, Switzerland; (M.C.); (V.J.)
- Dermfocus, University of Bern, 3001 Bern, Switzerland
| | - Tosso Leeb
- Institute of Genetics, Vetsuisse Faculty, University of Bern, 3001 Bern, Switzerland; (M.C.); (V.J.)
- Dermfocus, University of Bern, 3001 Bern, Switzerland
- Correspondence: ; Tel.: +41-31-631-2326
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8
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Mucke HA. Drug Repurposing Patent Applications January–March 2020. Assay Drug Dev Technol 2020; 18:341-346. [DOI: 10.1089/adt.2020.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Molecular Mechanism of Epidermal Barrier Dysfunction as Primary Abnormalities. Int J Mol Sci 2020; 21:ijms21041194. [PMID: 32054030 PMCID: PMC7072774 DOI: 10.3390/ijms21041194] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/08/2020] [Accepted: 02/09/2020] [Indexed: 02/07/2023] Open
Abstract
Epidermal barrier integrity could be influenced by various factors involved in epidermal cell differentiation and proliferation, cell–cell adhesion, and skin lipids. Dysfunction of this barrier can cause skin disorders, including eczema. Inversely, eczema can also damage the epidermal barrier. These interactions through vicious cycles make the mechanism complicated in connection with other mechanisms, particularly immunologic responses. In this article, the molecular mechanisms concerning epidermal barrier abnormalities are reviewed in terms of the following categories: epidermal calcium gradients, filaggrin, cornified envelopes, desquamation, and skin lipids. Mechanisms linked to ichthyoses, atopic dermatitis without exacerbation or lesion, and early time of experimental irritation were included. On the other hand, the mechanism associated with epidermal barrier abnormalities resulting from preceding skin disorders was excluded. The molecular mechanism involved in epidermal barrier dysfunction has been mostly episodic. Some mechanisms have been identified in cultured cells or animal models. Nonetheless, research into the relationship between the causative molecules has been gradually increasing. Further evidence-based systematic data of target molecules and their interactions would probably be helpful for a better understanding of the molecular mechanism underlying the dysfunction of the epidermal barrier.
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10
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Yu X, Chen L, Yang Z, Gu Y, Zheng W, Wu Z, Li M, Yao Z. An excellent response to topical therapy of four congenital hemidysplasia with ichthyosiform erythroderma and limb defects syndrome patients with an increased concentration of simvastatin ointment. J Eur Acad Dermatol Venereol 2019; 34:e8-e11. [PMID: 31374135 DOI: 10.1111/jdv.15838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- X. Yu
- Department of Dermatology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - L. Chen
- Department of Dermatology, Huashan Hospital Fudan University Shanghai China
| | - Z. Yang
- Department of Dermatology, Beijing Children’s Hospital Capital Medical University Beijing China
| | - Y. Gu
- Department of Dermatology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - W. Zheng
- Key Laboratory of the Public Health Safety, Ministry of Education, Department of Environmental Health, School of Public Health Fudan University Shanghai China
| | - Z. Wu
- Department of Dermatology, Shanghai First People’s Hospital Shanghai Jiaotong University of Medicine Shanghai China
| | - M. Li
- Department of Dermatology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Z. Yao
- Department of Dermatology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
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11
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Metabolism and Biological Activities of 4-Methyl-Sterols. Molecules 2019; 24:molecules24030451. [PMID: 30691248 PMCID: PMC6385002 DOI: 10.3390/molecules24030451] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 12/12/2022] Open
Abstract
4,4-Dimethylsterols and 4-methylsterols are sterol biosynthetic intermediates (C4-SBIs) acting as precursors of cholesterol, ergosterol, and phytosterols. Their accumulation caused by genetic lesions or biochemical inhibition causes severe cellular and developmental phenotypes in all organisms. Functional evidence supports their role as meiosis activators or as signaling molecules in mammals or plants. Oxygenated C4-SBIs like 4-carboxysterols act in major biological processes like auxin signaling in plants and immune system development in mammals. It is the purpose of this article to point out important milestones and significant advances in the understanding of the biogenesis and biological activities of C4-SBIs.
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12
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Bergqvist C, Abdallah B, Hasbani DJ, Abbas O, Kibbi AG, Hamie L, Kurban M, Rubeiz N. CHILD syndrome: A modified pathogenesis-targeted therapeutic approach. Am J Med Genet A 2018; 176:733-738. [PMID: 29392821 DOI: 10.1002/ajmg.a.38619] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/07/2022]
Abstract
Congenital Hemidysplasia with Ichthyosiform nevus and Limb Defects (CHILD syndrome) is a rare X-linked dominant genodermatosis caused by mutations in the NAD(P) dependent steroid dehydrogenase-like protein gene. Its defect leads to accumulation of toxic metabolic intermediates upstream from the pathway block and to the deficiency of bulk cholesterol, probably leading to altered keratinocyte membrane function, resulting in the phenotype seen in CHILD syndrome. Symptomatic treatment using emollients and retinoids to reduce scaling has long been used until recently, whereby new therapeutic means based on the pathogenesis-targeted therapy have been developed. We subsequently chose to use the same pathogenesis-based therapy using a 2% cholesterol and 2% lovastatin cream with or without glycolic acid in two of our patients. Improvement in CHILD skin lesions was seen as early as 4 weeks after initiation. The addition of glycolic acid helped improve the penetrance of the cholesterol and lovastatin cream into the thick waxy scales. Our study confirms the efficacy of the pathogenesis-targeted therapy and introduces the possibility of modifying its formula by adding glycolic acid in order to improve the treatment.
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Affiliation(s)
| | | | | | - Ossama Abbas
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - Abdul Ghani Kibbi
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - Lamiaa Hamie
- Faculty of Medicine, Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon.,Department of Dermatology, Columbia University, New York, New York
| | - Nelly Rubeiz
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
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13
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Yu X, Zhang J, Gu Y, Deng D, Wu Z, Bao L, Li M, Yao Z. CHILD syndrome mimicking verrucous nevus in a Chinese patient responded well to the topical therapy of compound of simvastatin and cholesterol. J Eur Acad Dermatol Venereol 2018; 32:1209-1213. [PMID: 29341259 DOI: 10.1111/jdv.14788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- X. Yu
- Department of Dermatology; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - J. Zhang
- Department of Dermatology; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Y. Gu
- Department of Dermatology; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - D. Deng
- Department of Dermatology; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Z. Wu
- Department of Dermatology; Shanghai First People s Hospital; Shanghai Jiaotong University of Medicine; Shanghai China
| | - L. Bao
- Department of Radiology; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - M. Li
- Department of Dermatology; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Z. Yao
- Department of Dermatology; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
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14
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Abstract
Knowledge of the molecular underpinnings of many epidermal nevi and epidermal nevus syndrome has expanded rapidly in recent years. In this review and update on epidermal nevus syndrome, we will cover recent genetic discoveries involving epidermal nevi, including nevus sebaceus, keratinocytic epidermal nevus, nevus comedonicus, congenital hemidysplasia with ichthyosiform nevus and limb defects syndrome, phakomatosis pigmentokeratotica, Becker's nevus, porokeratotic adnexal ostial nevus, inflammatory linear verrucous epidermal nevi, and cutaneous-skeletal hypophosphatemia syndrome. We will discuss how newly defined mutations relate to the biology reflected in the cutaneous patterns seen in these mosaic disorders and how new molecular data has informed our understanding of these diseases and shaped management decisions.
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Affiliation(s)
- Sarah Asch
- Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St. Paul, MN, USA
| | - Jeffrey L Sugarman
- Department of Dermatology, University of California, San Francisco, Santa Rosa, CA, USA.,Department of Community and Family Medicine, University of California, San Francisco, Santa Rosa, CA, USA
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15
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Reimer A, He Y, Has C. Update on Genetic Conditions Affecting the Skin and the Kidneys. Front Pediatr 2018; 6:43. [PMID: 29552546 PMCID: PMC5840143 DOI: 10.3389/fped.2018.00043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/14/2018] [Indexed: 01/01/2023] Open
Abstract
Genetic conditions affecting the skin and kidney are clinically and genetically heterogeneous, and target molecular components present in both organs. The molecular pathology involves defects of cell-matrix adhesion, metabolic or signaling pathways, as well as tumor suppressor genes. This article gives a clinically oriented overview of this group of disorders, highlighting entities which have been recently described, as well as the progress made in understanding well-known entities. The genetic bases as well as molecular cell biological mechanisms are described, with therapeutic applications.
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Affiliation(s)
- Antonia Reimer
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yinghong He
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Cristina Has
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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16
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Mi XB, Luo MX, Guo LL, Zhang TD, Qiu XW. CHILD Syndrome: Case Report of a Chinese Patient and Literature Review of the NAD[P]H Steroid Dehydrogenase-Like Protein Gene Mutation. Pediatr Dermatol 2015; 32:e277-82. [PMID: 26459993 DOI: 10.1111/pde.12701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Congenital hemidysplasia with ichthyosiform nevus and limb defects (CHILD) syndrome is an X-linked autosomal dominant disorder characterized by unilateral congenital hemidysplasia with ichthyosiform erythroderma and ipsilateral limb defects caused by a mutation in the gene encoding NAD[P]H steroid dehydrogenase-like protein (NSDHL) at Xq28. The histopathologic hallmark of skin lesions in CHILD syndrome is psoriasiform epidermis with hyperkeratosis and parakeratosis, and its most striking feature affecting the upper dermis is filling of the papillary dermis with foam cells. Here we present the case of a 9-year-old Chinese girl born with the typical clinical features of CHILD syndrome. Histologic and immunohistochemical evaluation of the skin lesions confirmed the diagnosis and led to identification of a heterozygous point mutation in exon 8 of the NSDHL gene. In addition, we provide a literature review of 26 unrelated CHILD syndrome patients from different countries, caused by 20 unique gene mutations occurring throughout the entire NSDHL gene, to promote understanding and provide a more comprehensive description of this unusual disorder.
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Affiliation(s)
- Xiang-bin Mi
- Department of Dermatology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Miao-xuan Luo
- Department of Dermatology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Lin-lang Guo
- Department of Pathology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Tang-de Zhang
- Department of Dermatology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xian-wen Qiu
- Department of Dermatology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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17
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Porter TD. Electron Transfer Pathways in Cholesterol Synthesis. Lipids 2015; 50:927-36. [PMID: 26344922 DOI: 10.1007/s11745-015-4065-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/21/2015] [Indexed: 12/17/2022]
Abstract
Cholesterol synthesis in the endoplasmic reticulum requires electron input at multiple steps and utilizes both NADH and NADPH as the electron source. Four enzymes catalyzing five steps in the pathway require electron input: squalene monooxygenase, lanosterol demethylase, sterol 4α-methyl oxidase, and sterol C5-desaturase. The electron-donor proteins for these enzymes include cytochrome P450 reductase and the cytochrome b5 pathway. Here I review the evidence for electron donor protein requirements with these enzymes, the evidence for additional electron donor pathways, and the effect of deletion of these redox enzymes on cholesterol and lipid metabolism.
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Affiliation(s)
- Todd D Porter
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, 40536-0596, USA.
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18
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Bellezza I, Gatticchi L, del Sordo R, Peirce MJ, Sidoni A, Roberti R, Minelli A. The loss of Tm7sf gene accelerates skin papilloma formation in mice. Sci Rep 2015; 5:9471. [PMID: 25804527 PMCID: PMC4372794 DOI: 10.1038/srep09471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/16/2015] [Indexed: 01/04/2023] Open
Abstract
The 3β-hydroxysterol Δ14-reductase, encoded by the Tm7sf2 gene, is an enzyme involved in cholesterol biosynthesis. Cholesterol and its derivatives control epidermal barrier integrity and are protective against environmental insults. To determine the role of the gene in skin cholesterol homeostasis, we applied 12-o-tetradecanoylphorbol-13-acetate (TPA) to the skin of Tm7sf2+/+ and Tm7sf2-/- mice. TPA increased skin cholesterol levels by inducing de novo synthesis and up-take only in Tm7sf2+/+ mouse, confirming that the gene maintains cholesterol homeostasis under stress conditions. Cholesterol sulfate, one of the major players in skin permeability, was doubled by TPA treatment in the skin of wild-type animals but this response was lost in Tm7sf2-/- mice. The expression of markers of epidermal differentiation concomitant with farnesoid-X-receptor and p38 MAPK activation were also disrupted in Tm7sf2-/- mice. We then subjected Tm7sf2+/+ and Tm7sf2-/- mice to a classical two-stage skin carcinogenesis protocol. We found that the loss of Tm7sf2 increased incidence and multiplicity of skin papillomas. Interestingly, the null genotype showed reduced expression of nur77, a gene associated with resistance to neoplastic transformation. In conclusion, the loss of Tm7sf2 alters the expression of proteins involved in epidermal differentiation by reducing the levels of cholesterol sulfate.
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Affiliation(s)
- I Bellezza
- Dipartimento di Medicina Sperimentale, Università di Perugia, Polo Unico Sant'Andrea delle Fratte, p.le Gambuli, Perugia, 06132; Italia
| | - L Gatticchi
- Dipartimento di Medicina Sperimentale, Università di Perugia, Polo Unico Sant'Andrea delle Fratte, p.le Gambuli, Perugia, 06132; Italia
| | - R del Sordo
- Dipartimento di Medicina Sperimentale, Università di Perugia, Polo Unico Sant'Andrea delle Fratte, p.le Gambuli, Perugia, 06132; Italia
| | - M J Peirce
- Dipartimento di Medicina Sperimentale, Università di Perugia, Polo Unico Sant'Andrea delle Fratte, p.le Gambuli, Perugia, 06132; Italia
| | - A Sidoni
- Dipartimento di Medicina Sperimentale, Università di Perugia, Polo Unico Sant'Andrea delle Fratte, p.le Gambuli, Perugia, 06132; Italia
| | - R Roberti
- Dipartimento di Medicina Sperimentale, Università di Perugia, Polo Unico Sant'Andrea delle Fratte, p.le Gambuli, Perugia, 06132; Italia
| | - A Minelli
- Dipartimento di Medicina Sperimentale, Università di Perugia, Polo Unico Sant'Andrea delle Fratte, p.le Gambuli, Perugia, 06132; Italia
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Abstract
The term epidermal nevus syndrome (ENS) has been used to describe the association of epidermal hamartomas and extracutaneous abnormalities. Although many continue to use the term "ENS," it is now understood that this is not one disease, but rather a heterogeneous group with distinct genetic profiles defined by a common cutaneous phenotype: the presence of epidermal and adnexal hamartomas that are associated with other organ system involvement. One commonality is that epidermal nevi often follow the lines of Blaschko and it appears the more widespread the cutaneous manifestations, the greater the risk for extracutaneous manifestations. The majority of the extracutaneous manifestations involve the brain, eye, and skeletal systems. The CNS involvement is wide ranging and involves both clinical manifestations such as intellectual disability and seizures, as well as structural anomalies. Several subsets of ENS with characteristic features have been delineated including the nevus sebaceus syndrome, Proteus syndrome, CHILD syndrome, Becker's nevus syndrome, nevus comedonicus syndrome, and phakomatosis pigmentokeratotica. Advances in molecular biology have revealed that the manifestations of ENS are due to genomic mosaicism. It is likely that the varied clinical manifestations of ENS are due in great part to the functional effects of specific genetic defects. Optimal management of the patient with ENS involves an interdisciplinary approach given the potential for multisystem involvement. Of note, epidermal nevi have been associated with both benign and malignant neoplasms, and thus ongoing clinical follow-up is required.
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Affiliation(s)
- Sarah Asch
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey L Sugarman
- Departments of Dermatology and Community and Family Medicine, University of California San Francisco, Santa Rosa, CA, USA.
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20
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Kiritsi D, Schauer F, Wölfle U, Valari M, Bruckner-Tuderman L, Has C, Happle R. Targeting epidermal lipids for treatment of Mendelian disorders of cornification. Orphanet J Rare Dis 2014; 9:33. [PMID: 24607067 PMCID: PMC3975448 DOI: 10.1186/1750-1172-9-33] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inherited ichthyoses or Mendelian disorders of cornification (MeDOC) are clinically heterogeneous disorders with high unmet therapeutic needs, which are characterized by skin hyperkeratosis and scaling. Some MeDOC types are associated with defects of the epidermal lipid metabolism, resulting in perturbed barrier permeability and subsequent epidermal hyperplasia, hyperkeratosis and inflammation. An example is the CHILD (congenital hemidysplasia with ichthyosiform nevus and limb defects) syndrome, an X-linked dominant multisystem MeDOC caused by mutations in the NSDHL (NAD(P)H steroid dehydrogenase-like protein) gene, which is involved in the distal cholesterol biosynthetic pathway. The skin manifestations of the CHILD syndrome have been attributed to two major mechanisms: deficiency of cholesterol, probably influencing the proper corneocyte membrane formation, and toxic accumulation of aberrant steroid precursors. METHODS Here we addressed the efficacy of an ointment containing cholesterol and simvastatin, an agent inhibiting endogenous cholesterol synthesis in a compassionate-use treatment of three patients with CHILD syndrome. To test the specificity of this therapeutic approach, we applied the same topical treatment to two patients with other types of MeDOC with disturbed skin lipid metabolism. RESULTS The therapy with simvastatin and cholesterol was highly effective and well-tolerated by the CHILD syndrome patients; only lesions in the body folds represented a therapeutic challenge. No improvement was noted in the patients with other types of MeDOC. CONCLUSIONS This therapy is inexpensive and accessible to every patient with CHILD syndrome, because both simvastatin and cholesterol are available worldwide. Our data provide initial evidence of the specificity of the therapeutic effect of the simvastatin-cholesterol ointment in CHILD syndrome in comparison to other types of MeDOC.
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Affiliation(s)
| | | | | | | | | | - Cristina Has
- Department of Dermatology, Medical Center-University of Freiburg, 79104 Freiburg, Germany.
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21
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Feingold KR, Elias PM. Role of lipids in the formation and maintenance of the cutaneous permeability barrier. Biochim Biophys Acta Mol Cell Biol Lipids 2013; 1841:280-94. [PMID: 24262790 DOI: 10.1016/j.bbalip.2013.11.007] [Citation(s) in RCA: 245] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 12/18/2022]
Abstract
The major function of the skin is to form a barrier between the internal milieu and the hostile external environment. A permeability barrier that prevents the loss of water and electrolytes is essential for life on land. The permeability barrier is mediated primarily by lipid enriched lamellar membranes that are localized to the extracellular spaces of the stratum corneum. These lipid enriched membranes have a unique structure and contain approximately 50% ceramides, 25% cholesterol, and 15% free fatty acids with very little phospholipid. Lamellar bodies, which are formed during the differentiation of keratinocytes, play a key role in delivering the lipids from the stratum granulosum cells into the extracellular spaces of the stratum corneum. Lamellar bodies contain predominantly glucosylceramides, phospholipids, and cholesterol and following the exocytosis of lamellar lipids into the extracellular space of the stratum corneum these precursor lipids are converted by beta glucocerebrosidase and phospholipases into the ceramides and fatty acids, which comprise the lamellar membranes. The lipids required for lamellar body formation are derived from de novo synthesis by keratinocytes and from extra-cutaneous sources. The lipid synthetic pathways and the regulation of these pathways are described in this review. In addition, the pathways for the uptake of extra-cutaneous lipids into keratinocytes are discussed. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. Guest Editors: Kenneth R. Feingold and Peter Elias.
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Affiliation(s)
- Kenneth R Feingold
- Metabolism Section, Medicine Service and Dermatology Service, Department of Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA 94121, USA.
| | - Peter M Elias
- Metabolism Section, Medicine Service and Dermatology Service, Department of Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA 94121, USA
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