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Bar-Ilan E, Mashiah J, Alkalay R, Ingber A, Zahavi K, Bar J, Zeeli T, Gat A, Samuelov L, Sprecher E, Goldberg I. Superimposed type 2 segmental atopic dermatitis: a case series and review of the literature. Clin Exp Dermatol 2022; 47:1703-1706. [PMID: 35340038 PMCID: PMC9544281 DOI: 10.1111/ced.15196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Generalized acquired dermatoses can seldom manifest more prominently or exclusively along the lines of Blaschko. Six individuals with segmental atopic dermatitis (AD) have been reported to date. We present three additional cases of segmental cutaneous manifestations superimposed on generalized AD, and review the relevant literature.
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Affiliation(s)
- Efract Bar-Ilan
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Jacob Mashiah
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Pediatric Dermatology clinic, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronen Alkalay
- Department of Dermatology, Hadassah University Hospital, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Arieh Ingber
- Department of Dermatology, Hadassah University Hospital, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Keren Zahavi
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Jonathan Bar
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tal Zeeli
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Andrea Gat
- Department of Pathology, Sourasky Medical Center Tel-Aviv, Tel Aviv, Israel
| | - Liat Samuelov
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Pediatric Dermatology clinic, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Goldberg
- Division of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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2
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Kang HJ, Kim HJ, Han JH, Bang CH, Kim TY. A Case of Linear Exacerbation of Atopic Dermatitis with Secondary Prurigo Nodularis. Ann Dermatol 2022; 34:297-300. [PMID: 35948333 PMCID: PMC9365657 DOI: 10.5021/ad.20.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/15/2020] [Accepted: 10/09/2020] [Indexed: 12/02/2022] Open
Abstract
Inflammatory acquired Blaschko-linear dermatoses (IABLD) are a continuous concept involving diseases such as lichen striatus, blaschkitis, and atopic dermatitis. However, atopic dermatitis that showed increase in severity along Blaschko lines is rarely reported on its own. Herein, we report a rare case of atopic dermatitis with secondary prurigo nodularis along Blaschko lines, which may be valuable in broadening the concept of IABLD. A 28-year-old male presented with multiple, pruritic, brownish nodules on the left lower extremity along Blaschko lines for 3 to 4 years. The patient had atopic dermatitis since childhood. Histopathologic findings revealed compact orthohyperkeratosis, hypergranulosis, spongiosis, and irregular acanthosis in the epidermis. Fibrosis with vertically arranged collagen fibers and perivascular lymphohistiocytic infiltration were shown in the upper dermis. We diagnosed the case as secondary prurigo nodularis along Blaschko lines, accompanied by the preceding atopic dermatitis. We hypothesized that the patient’s underlying atopic dermatitis increased in severity along Blaschko lines, and prurigo nodularis occurred due to frequent scratching. The lesions improved with topical methylprednisolone cream, oral antihistamines and intralesional triamcinolone injection.
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Affiliation(s)
- Hyun Jin Kang
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Jung Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Hee Han
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Hwan Bang
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yoon Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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3
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Leszczynska MA, Trainor MA, Henkel E, Keeling BH, Diaz LZ. Superimposed linear atopic dermatitis treated with dupilumab. Pediatr Dermatol 2021; 38:1377-1378. [PMID: 34272754 DOI: 10.1111/pde.14695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Common polygenic skin disorders, such as atopic dermatitis, may rarely present in a segmental or linear distribution due to cutaneous mosaicism. Only seven cases of superimposed linear atopic dermatitis have been reported to date. Here, we present a child with severe superimposed linear atopic dermatitis and highlight the first successful use of dupilumab in its treatment.
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Affiliation(s)
- Maria A Leszczynska
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at The University of Texas, Austin, TX, USA
| | - Megan A Trainor
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at The University of Texas, Austin, TX, USA
| | - Emily Henkel
- Transitional Year Program, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Brett H Keeling
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at The University of Texas, Austin, TX, USA
| | - Lucia Z Diaz
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at The University of Texas, Austin, TX, USA.,Dell Children's Medical Center, Austin, TX, USA
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Abstract
Genodermatoses are inherited disorders presenting with cutaneous manifestations with or without the involvement of other systems. The majority of these disorders, particularly in cases that present with a cutaneous patterning, may be explained in the context of genetic mosaicism. Despite the barriers to the genetic analysis of mosaic disorders, next-generation sequencing has led to a substantial progress in understanding their pathogenesis, which has significant implications for the clinical management and genetic counseling. Advances in paired and deep sequencing technologies in particular have made the study of mosaic disorders more feasible. In this review, we provide an overview of genetic mosaicism as well as mosaic cutaneous disorders and the techniques required to study them.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Young Lim
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Keith A Choate
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA.
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5
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Van Gysel J, Grimalt R. A linear lesion in a child with atopic dermatitis: Not a coincidence. Clin Case Rep 2019; 7:1667-1669. [PMID: 31534723 PMCID: PMC6745366 DOI: 10.1002/ccr3.2322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 11/16/2022] Open
Abstract
A blaschkolinear lesion in a patient with atopic dermatitis can be a superimposed segmental manifestation of this polygenic disorder. Knowledge of this phenomenon, presence of less severe, disseminated, symmetrically distributed lesions of the same disorder and, if necessary, histology are helpful in the differential diagnosis from other linear inflammatory diseases.
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Affiliation(s)
| | - Ramon Grimalt
- Facultat de Medicina i Ciències de la SalutUniversitat Internacional de CatalunyaBarcelonaSpain
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López-Cedeño A, Noguera-Morel L, Hernández-Martín A, Happle R, Torrelo A. Superimposed linear atopic dermatitis. Pediatr Dermatol 2018; 35:e393-e395. [PMID: 30152545 DOI: 10.1111/pde.13611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Superimposed linear atopic dermatitis is rarely manifested in polygenic disease as a counterpart to type 2 segmental mosaicism of monogenic skin diseases. Linear arrangement following Blaschko lines represents more severe disease on a generalized background of atopic dermatitis, perhaps reflecting clonal loss of heterozygosity. Only three cases of superimposed linear atopic dermatitis have been reported; we describe three additional cases.
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Affiliation(s)
| | | | | | - Rudolf Happle
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil del Niño Jesús, Madrid, Spain
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Johnson M, Walker D, Galloway W, Gardner JM, Shalin SC. Interface dermatitis along Blaschko's lines. J Cutan Pathol 2014; 41:950-4. [PMID: 25353350 DOI: 10.1111/cup.12412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 06/17/2014] [Accepted: 07/20/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Mariah Johnson
- Department of Dermatology; University of Oklahoma Health Sciences Center; Oklahoma City OK USA
| | - Daniel Walker
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | | | - Jerad M. Gardner
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Sara C. Shalin
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
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Abstract
The skin gives us an opportunity to study pathologies unapparent in other systems such as patterned disorders. Among the best-identified patterns of skin disorders are the well-known lines of Blaschko, but other types of skin-patterned lesions have also been recognized. This short review will describe and discuss these different patterns and their pathophysiologic mechanisms, such as somatic mosaicism and X-chromosome associated mosaicism. Cutaneous patterned disorders are thought to be associated usually with inherited diseases per se, but in fact they are also reported in so-called acquired diseases. These cases suggest the existence of an underlying defect in a gene closely associated with the disease pathogenesis. The study of these acquired patterned disorders in the future may help us to understand the biologic foundations and pathogenesis of common human diseases.
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Lofgren S, Mann J, White C, Krol A. Juvenile dermatomyositis presenting as an acquired inflammatory Blaschko-linear dermatosis. J Am Acad Dermatol 2011; 65:e134-e135. [DOI: 10.1016/j.jaad.2011.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 05/14/2011] [Accepted: 05/27/2011] [Indexed: 10/17/2022]
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11
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Abstract
The discovery that null mutations in the filaggrin gene (FLG) are associated with atopic eczema represents the single most significant breakthrough in understanding the genetic basis of this complex disorder. The association has been replicated in multiple independent studies during the past 2 years with the use of various methodologies, from populations in Europe, the United States, and Japan. Filaggrin plays a key role in epidermal barrier function, and its association with atopic eczema emphasizes the importance of barrier dysfunction in eczema pathogenesis. This review aims to summarize the current state of knowledge regarding the role of FLG mutations in ichthyosis vulgaris, atopic eczema, and other skin disorders, with an emphasis on potential clinical applications. Further research is needed to clarify the precise role of filaggrin in skin and systemic atopic disease, to pave the way for novel therapeutic interventions.
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Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. "Pediatric blaschkitis": expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol 2007; 24:621-7. [PMID: 18035983 DOI: 10.1111/j.1525-1470.2007.00550.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe two young children who developed relapsing, pruritic, papulovesicular eruptions in multiple bands along Blaschko lines on the neck, trunk, and extremities. Skin specimens in both revealed spongiotic dermatitis. This represents the first report of "blaschkitis" in children, providing further evidence that lichen striatus and blaschkitis are related acquired Blaschko-linear dermatoses that exist on a spectrum rather than as the childhood and adult form of a single disease entity. We highlight the features that differentiate blaschkitis from lichen striatus, review the potential roles of cutaneous mosaicism, environmental triggers, and background immunologic state in their pathogenesis, and discuss the spectrum of inflammatory dermatoses that can follow Blaschko lines.
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Affiliation(s)
- Brian R Keegan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York City, New York 10016, USA
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Happle R. Superimposed segmental manifestation of polygenic skin disorders. J Am Acad Dermatol 2007; 57:690-9. [PMID: 17870433 DOI: 10.1016/j.jaad.2007.06.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 05/01/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
Abstract
In common acquired skin disorders with a polygenic background such as psoriasis, a linear or otherwise segmental arrangement may sometimes be noted. The segmental involvement tends to be rather severe and may be associated with milder, nonsegmental lesions of the same disorder. Such cases may be best explained by an early postzygotic event in the form of loss of heterozygosity involving one of the genes that predispose to the disorder. The following pertinent examples are reviewed in this article: psoriasis vulgaris, pustular psoriasis, atopic dermatitis, lichen planus, systemic lupus erythematosus, pemphigus vulgaris, vitiligo, graft-versus-host disease, granuloma annulare, erythema multiforme, and drug eruption to ibuprofen. Such cases should not be categorized as a "type 2 segmental manifestation" because this term exclusively applies to monogenic traits, whereas in polygenic disorders the more descriptive term "superimposed segmental manifestation" seems appropriate. The concept of early loss of heterozygosity offers a plausible explanation as to why: the segmental involvement tends to appear at a rather young age and often precedes the development of milder, nonsegmental lesions of the same disorder; the segmental lesions are notoriously difficult to treat; and family members may show the disorder in its nonsegmental form. On the other hand, the theory of isolated versus superimposed segmental manifestation may help to elucidate the origin of polygenic skin disorders at the molecular level.
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Affiliation(s)
- Rudolf Happle
- Department of Dermatology, Philipp University of Marburg, Marburg, Germany.
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