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Baklan E, Duman N, Yaman B, Ceylan C. Childhood-onset progressive skin fibrosis and joint immobility. Clin Exp Dermatol 2024; 49:944-946. [PMID: 38468187 DOI: 10.1093/ced/llae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 03/13/2024]
Abstract
A 28-year-old woman presented with generalized hardening of the skin, joint immobility, shortness of breath and lower back pain since the age of 7 years.
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Affiliation(s)
- Ecem Baklan
- Department of Dermatology and Venereal Diseases, Ege University, Faculty of Medicine, İzmir, Türkiye
| | - Nilay Duman
- Department of Dermatology and Venereal Diseases, Ege University, Faculty of Medicine, İzmir, Türkiye
| | - Banu Yaman
- Department of Pathology, Ege University, Faculty of Medicine, İzmir, Türkiye
| | - Can Ceylan
- Department of Dermatology and Venereal Diseases, Ege University, Faculty of Medicine, İzmir, Türkiye
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2
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Baka JLCES, Rocha TOCD, Pincelli MS, Samorano LP, Rivitti-Machado MCDM, Oliveira ZNPD. Stiff skin syndrome: long-term follow-up. An Bras Dermatol 2024; 99:597-600. [PMID: 38664099 PMCID: PMC11221244 DOI: 10.1016/j.abd.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/22/2023] [Accepted: 07/09/2023] [Indexed: 06/12/2024] Open
Affiliation(s)
| | - Tauana Ogata Coelho da Rocha
- Pediatric Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcella Soares Pincelli
- Dermatopathology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luciana Paula Samorano
- Pediatric Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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3
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Zhao Q, Chu Z, Li L, Feng C, Zhou H, Hu J, Zhao L, Che D, Zhang X, Peng B, Han Y, Geng S. New clinical classification of stiff skin syndrome. Arch Dermatol Res 2024; 316:333. [PMID: 38844593 DOI: 10.1007/s00403-024-03090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 11/29/2023] [Accepted: 04/26/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Stiff skin syndrome (SSS) is a rare disease characterized by thickened, indurated skin and limited joint movement. Multiple diverse phenotypes have been reported, and the correlation of severity with the clinical heterogeneity and histopathological findings of SSS needs to be refined. OBJECTIVE To define subtypes based on clinical features and predict the prognosis of a new SSS classification. METHODS Eighty-three patients with SSS were retrospectively reviewed for clinicopathological manifestations and routine laboratory workup, including 59 cases obtained from a PubMed search between 1971 and 2022 and 24 cases diagnosed in our department between 2003 and 2022. RESULTS Among the 83 patients, 27.7, 41, and 31.3% had classic widespread, generalized segmental, and localized SSS, respectively. Joint immobility was present in 100, 71, and 20% of classic, generalized, and localized cases, respectively. Histopathologic findings were common among the 3 groups, and based on that, we further found a difference in the distribution of proliferative collagen. 54.5% of classic and 50% of generalized cases occurred throughout the dermis or the subcutis, whereas 76% of localized cases were mainly involved in the reticular dermis or subcutis. In patients with incipient localized SSS, 42% (21/50) developed generalized SSS, and only 6% (3/50) progressed to classic SSS, whereas more than half of the incipient generalized SSS cases (60.6%, 20/33) developed classic SSS. LIMITATIONS This retrospective study was limited to previously published cases with limited data. CONCLUSIONS We propose a distinct clinical classification characterized by lesion distribution, including classic widespread, generalized segmental, and localized SSS, associated with disease severity and prognosis.
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Affiliation(s)
- Qiang Zhao
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Zhaowei Chu
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Li Li
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Cheng Feng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Hongmei Zhou
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Jiahui Hu
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Lihong Zhao
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Delu Che
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Xinyue Zhang
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Bin Peng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Yichen Han
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, 710049, People's Republic of China.
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4
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Yang Y, Zhang L, Li JH. Segmental Skin Induration in a Boy. JAMA Dermatol 2024; 160:354-355. [PMID: 38198132 DOI: 10.1001/jamadermatol.2023.4235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
An 11-year-old boy presented with progressive unilateral skin hardening on his right thigh and buttock for 7 years. What is your diagnosis?
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Affiliation(s)
- Yang Yang
- Department of Dermatology, The First Hospital of China Medical University, Shenyang China
- Key Laboratory of Immunodermatology, Ministry of Education and NHC, Shenyang, China
- National Joint Engineering Research Center for Theranostics of Immunological Skin Diseases, Shenyang, China
| | - Lan Zhang
- Department of Dermatology, The First Hospital of China Medical University, Shenyang China
- Key Laboratory of Immunodermatology, Ministry of Education and NHC, Shenyang, China
- National Joint Engineering Research Center for Theranostics of Immunological Skin Diseases, Shenyang, China
| | - Jiu-Hong Li
- Department of Dermatology, The First Hospital of China Medical University, Shenyang China
- Key Laboratory of Immunodermatology, Ministry of Education and NHC, Shenyang, China
- National Joint Engineering Research Center for Theranostics of Immunological Skin Diseases, Shenyang, China
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5
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Sanchez-Espino LF, Sibbald C, Stimec J, Laxer RM, Pope E. Characteristics and onset of presentation of pediatric stiff skin syndrome: A retrospective cohort study of 11 patients in a tertiary care center. Pediatr Dermatol 2024; 41:16-22. [PMID: 37864376 DOI: 10.1111/pde.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND/OBJECTIVE Stiff skin syndrome (SSS) is a rare disorder characterized by "rock hard" indurated skin affecting different body parts. The localized variant poses a diagnostic challenge, as it is frequently mistaken for other inflammatory connective tissue disorders. The aim of this study is to provide insightful clinical, radiologic and diagnostic data that might prove useful for the evaluation, management and treatment of pediatric patients with segmental SS. METHODS This single-center cohort study included patients ≤18 years diagnosed with localized SSS from 1988 to 2021 in a quaternary pediatric healthcare center in Toronto, Canada. Data included demographics, clinical, histopathologic and radiologic features, treatments, and clinical course. Data were summarized with descriptive statistics (mean, standard deviation, medians, interquartile ranges [IQRs]) and frequencies. RESULTS A total of 11 patients were included. The sclerotic changes were measured clinically and radiologically, by a total of 16 imaging studies: 13 magnetic resonance imaging (MRI) and 3 ultrasound. MRI readings showed abnormal high signal intensity of the affected tissue correlating with the anatomical site of involvement in all cases, specifically, in the shoulder/pelvic girdle with limb extension. Shear wave ultrasound elastography (SWE) demonstrated higher values within the dermis compared to the control site. CONCLUSION The presence of segmental sclerotic changes that affects the pelvic/shoulder girdle with extension to the extremities, in the absence of inflammation on biopsy and abnormal signaling intensity on imaging is suggestive of SSS. Skin SWE is a feasible, noninvasive, and objective instrument to evaluate and monitor sclerotic changes overtime, it could be potentially extrapolated to other pediatric skin sclerotic conditions.
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Affiliation(s)
- Luis Fernando Sanchez-Espino
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Stimec
- Division of Radiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ronald M Laxer
- Division of Rheumatology, Departments of Paediatrics and Medicine, The Hospital for Sick Children Ontario, University of Toronto, Toronto, Canada
| | - Elena Pope
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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6
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Marelli S, Micaglio E, Taurino J, Salvi P, Rurali E, Perrucci GL, Dolci C, Udugampolage NS, Caruso R, Gentilini D, Trifiro' G, Callus E, Frigiola A, De Vincentiis C, Pappone C, Parati G, Pini A. Marfan Syndrome: Enhanced Diagnostic Tools and Follow-up Management Strategies. Diagnostics (Basel) 2023; 13:2284. [PMID: 37443678 DOI: 10.3390/diagnostics13132284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Marfan syndrome (MFS) is a rare inherited autosomic disorder, which encompasses a variety of systemic manifestations caused by mutations in the Fibrillin-1 encoding gene (FBN1). Cardinal clinical phenotypes of MFS are highly variable in terms of severity, and commonly involve cardiovascular, ocular, and musculoskeletal systems with a wide range of manifestations, such as ascending aorta aneurysms and dissection, mitral valve prolapse, ectopia lentis and long bone overgrowth, respectively. Of note, an accurate and prompt diagnosis is pivotal in order to provide the best treatment to the patients as early as possible. To date, the diagnosis of the syndrome has relied upon a systemic score calculation as well as DNA mutation identification. The aim of this review is to summarize the latest MFS evidence regarding the definition, differences and similarities with other connective tissue pathologies with severe systemic phenotypes (e.g., Autosomal dominant Weill-Marchesani syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome) and clinical assessment. In this regard, the management of MFS requires a multidisciplinary team in order to accurately control the evolution of the most severe and potentially life-threatening complications. Based on recent findings in the literature and our clinical experience, we propose a multidisciplinary approach involving specialists in different clinical fields (i.e., cardiologists, surgeons, ophthalmologists, orthopedics, pneumologists, neurologists, endocrinologists, geneticists, and psychologists) to comprehensively characterize, treat, and manage MFS patients with a personalized medicine approach.
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Affiliation(s)
- Susan Marelli
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Emanuele Micaglio
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Jacopo Taurino
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, Cardiology Unit, IRCCS, 20133 Milan, Italy
| | - Erica Rurali
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Gianluca L Perrucci
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Claudia Dolci
- Laboratory of Functional Anatomy of the Stomatognathic System (LAFAS), Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | | | - Rosario Caruso
- Clinical Research Service, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, Cusano Milanino, University of Milano-Bicocca, 20095 Milan, Italy
| | - Giuliana Trifiro'
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Edward Callus
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Clinical Psychology Service, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
- Association "Bambini Cardiopatici nel Mondo" Non-Governmental Organization (NGO), 20123 Milan, Italy
| | - Carlo De Vincentiis
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Carlo Pappone
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Institute of Molecular and Translational Cardiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, Cardiology Unit, IRCCS, 20133 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alessandro Pini
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
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7
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Frecentese GI, Roche AD, Cederna PS. Chronic Exertional Compartment Syndrome Requiring Bilateral Fasciotomy: An Atypical Complication of Familial Stiff Skin Syndrome in a Father and Son. Ann Plast Surg 2023; 90:631-635. [PMID: 37115944 DOI: 10.1097/sap.0000000000003529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
ABSTRACT Stiff skin syndrome (SSS) is a rare cutaneous disorder characterized by cutaneous fibrosis resulting in the early onset of thickened and indurated skin, joint mobility restrictions, and contractures. We describe a father and son with familial SSS who presented with bilateral exertional pain and a confirmed diagnosis of chronic exertional compartment syndrome on 4-compartment pressure testing. Patients experienced restored functionality with bilateral 4-compartment fasciotomy. Chronic exertional compartment syndrome should be considered in the differential diagnosis of patients with SSS and chronic pain of the lower limbs.
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Affiliation(s)
| | | | - Paul S Cederna
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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8
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Fernandez-Flores A, Cassarino DS. Type 2 Dermal Dendrocytes Are Telocytes and So Should They Be Called. Am J Dermatopathol 2023; 45:351-353. [PMID: 36939132 DOI: 10.1097/dad.0000000000002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain
- Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain
- Department of Research, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain
| | - David S Cassarino
- Departments of Pathology and Dermatology, Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Los Angeles, CA
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9
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Modesti CA, Alves JP, Leopoldo LR, Bonamigo RR, Heck R. Segmental stiff skin syndrome: report of a rare disease. Int J Dermatol 2023; 62:e248-e249. [PMID: 36628973 DOI: 10.1111/ijd.16577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/08/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Cláudia A Modesti
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
| | - Juliana P Alves
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
| | - Larissa R Leopoldo
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
| | - Renan R Bonamigo
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
| | - Renata Heck
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
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10
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Gelinas A, Powell J, Lapointe C, Coulombe J. Segmental stiff skin syndrome treated with secukinumab. Pediatr Dermatol 2023. [PMID: 36825671 DOI: 10.1111/pde.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
Segmental stiff skin syndrome is a rare fibrosing scleroderma-like disorder characterized by progressive indurations of the skin leading to joint contractures, decreased mobility, and pain. Treatment options are limited; we report a patient that showed improvement with anti-IL17 biologic therapy.
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Affiliation(s)
- Alexa Gelinas
- Faculty of Medecine, Universite de Montreal, Montreal, Canada
| | - Julie Powell
- Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Universite de Montreal, Montreal, Canada
| | - Chantal Lapointe
- Department of Pediatrics, CHU Sainte-Justine, Universite de Montreal, Montreal, Canada
| | - Jerome Coulombe
- Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Universite de Montreal, Montreal, Canada
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11
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Lin Z, Pei Y, Tang X, Rong L, Chen L, Jiang X. Classification and rising medication therapy in stiff skin syndrome: A case report and literature review. Dermatol Ther 2022; 35:e15633. [PMID: 35686816 DOI: 10.1111/dth.15633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
Stiff skin syndrome (SSS) is a rare disorder characterized by skin induration and limited joint mobility in the absence of visceral, musculoskeletal, vascular, or immunologic abnormalities. Distinctive subsets of SSS could be distinguished by various manifestation and mechanism, which accounts for the high heterogeneity in SSS cases. Although rehabilitation training remains the mainstay of management, rising medications has drawn awareness in recent years, owing to the potential efficacy. Nevertheless, experience was limited, especially in widespread SSS. We report on a 5-year-old girl with widespread SSS, whose lesion stopped progressing after combination therapy by mycophenolic acid (MPA) and losartan (LST) in addition to rehabilitation exercise. Despite limited experience, a combined therapy of MPA and LST seems to be effective in retarding progression of widespread SSS.
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Affiliation(s)
- Zhilang Lin
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuxin Pei
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuhua Tang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liping Rong
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lizhi Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoyun Jiang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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12
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Raef HS, Nassim JS, Fedeles F. Indurated plaques on the back: distinguishing stiff skin syndrome from scleredema and morphea. Int J Dermatol 2021; 61:e393-e394. [PMID: 34411278 DOI: 10.1111/ijd.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Haya S Raef
- Tufts University School of Medicine, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Janelle S Nassim
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Flavia Fedeles
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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13
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Baréa P, Hoffmann Guarda N, Bonamigo RR, Heck R. Generalized thickening of the skin and hypertrichosis in a child. Pediatr Dermatol 2021; 38:683-685. [PMID: 34224625 DOI: 10.1111/pde.14545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paula Baréa
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
| | - Nathalia Hoffmann Guarda
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
| | - Renan Rangel Bonamigo
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil.,Faculty of Medicine, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Renata Heck
- Sanitary Dermatology Outpatient Clinic, Health Department of Rio Grande do Sul State - SES/RS, Porto Alegre, Brazil
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14
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Cerejeira D, Bonito F, António AM, Cunha H. Segmental stiff skin syndrome (SSS): Clinical case and a brief review. Australas J Dermatol 2021; 62:380-382. [PMID: 33769553 DOI: 10.1111/ajd.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 01/25/2023]
Abstract
Stiff skin syndrome (SSS) is a rare, scleroderma-like condition that is commonly characterised by stony hard skin and limited joint mobility, in the absence of visceral involvement or immunologic abnormalities. Depending on the distribution of the disease, this disorder can be further categorised into classic (widespread) SSS or its newly described segmental variant. Additional features of this syndrome may include hypertrichosis, lipodystrophy, dysmetria and scoliosis. In this report, we present the case of a patient with segmental SSS and we briefly review the current literature about the topic.
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Affiliation(s)
- Diogo Cerejeira
- Dermatology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Frederico Bonito
- Dermatology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Henriqueta Cunha
- Dermatology Department, Hospital Garcia de Orta, Almada, Portugal
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15
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Ventéjou S, Schwieger-Briel A, Nicolai R, Christen-Zaech S, Schnider C, Hofer M, Bogiatzi S, Hohl D, De Benedetti F, Morren MA. Case Report: Pansclerotic Morphea-Clinical Features, Differential Diagnoses and Modern Treatment Concepts. Front Immunol 2021; 12:656407. [PMID: 33767715 PMCID: PMC7985437 DOI: 10.3389/fimmu.2021.656407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 01/17/2023] Open
Abstract
Pansclerotic morphea (PSM) is a rare skin disease characterized by progressive stiffening of the skin with or without the typical superficial skin changes usually seen in morphea (localized scleroderma). Standard therapy, consisting of a combination of systemic glucocorticoids and methotrexate or mycophenolate mofetil, does rarely stop disease progression, which may lead to severe cutaneous sclerosis and secondary contractures. Little is known about the efficacy of newer biologicals such as abatacept, a fusion protein antibody against CTLA-4, or tocilizumab, a fully humanized IL-6R antibody, in the treatment of this pathology. We present the case of an 8 years old girl with an unusual, progressive stiffening of the skin, which was eventually diagnosed as pansclerotic morphea. A treatment with systemic glucocorticoids and methotrexate combined with tocilizumab led to a good clinical response within 2 months after initiation. In this paper, we discuss differential diagnoses to be considered and this new promising treatment option based on a case review of the literature.
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Affiliation(s)
- Sarah Ventéjou
- Pediatric Dermatology Unit, Department of Pediatrics and Dermatology and Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Agnes Schwieger-Briel
- Department of Dermatology, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Rebecca Nicolai
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattera Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Stephanie Christen-Zaech
- Pediatric Dermatology Unit, Department of Pediatrics and Dermatology and Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Caroline Schnider
- Department of Pediatric Rheumatology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Michael Hofer
- Department of Pediatric Rheumatology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Sofia Bogiatzi
- Laboratory of Dermato-Histopathology, Department of Dermato-Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Daniel Hohl
- Laboratory of Dermato-Histopathology, Department of Dermato-Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Fabrizio De Benedetti
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattera Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Marie-Anne Morren
- Pediatric Dermatology Unit, Department of Pediatrics and Dermatology and Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
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16
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Quintana Castanedo L, Rodríguez Bandera AI, Feito Rodríguez M, González García MC, Stewart N, de Lucas Laguna R. Clinical presentation, sonographic features and treatment options of segmental stiff skin syndrome. Clin Exp Dermatol 2020; 46:135-141. [PMID: 32697852 DOI: 10.1111/ced.14394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/22/2020] [Accepted: 07/18/2020] [Indexed: 01/20/2023]
Abstract
Segmental stiff skin syndrome is a rare genetic connective tissue disease, which is often misdiagnosed. High-frequency ultrasonography can represent a useful clinical adjunct in the differential diagnosis of this condition, in conjunction with the clinical and histopathological findings. Treatment options are limited and evidence is scarce. We present the clinical, sonographic and histological features of five paediatric patients diagnosed at our institution and discuss their response to treatment.
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Affiliation(s)
- L Quintana Castanedo
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
| | - A I Rodríguez Bandera
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
| | - M Feito Rodríguez
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
| | | | - N Stewart
- The Skin Hospital, Sydney, NSW, Australia
| | - R de Lucas Laguna
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
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17
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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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18
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Rangu S, Rubin AI, Li D, Castelo-Soccio L. Segmental stiff skin syndrome: a novel case with an interleukin-17C mutation successfully treated with secukinumab. Clin Exp Dermatol 2020; 45:658-660. [PMID: 32212274 DOI: 10.1111/ced.14205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 01/30/2023]
Affiliation(s)
- S Rangu
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A I Rubin
- Department of Pathology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D Li
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - L Castelo-Soccio
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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19
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Ko CJ, Atzmony L, Lim Y, McNiff JM, Craiglow BG, Antaya RJ, Choate KA. Review of genodermatoses with characteristic histopathology and potential diagnostic delay. J Cutan Pathol 2019; 46:756-765. [DOI: 10.1111/cup.13520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/16/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Christine J. Ko
- Department of DermatologyYale University Medical School New Haven Connecticut
| | - Lihi Atzmony
- Department of DermatologyYale University Medical School New Haven Connecticut
| | - Young Lim
- Department of DermatologyYale University Medical School New Haven Connecticut
| | - Jennifer M. McNiff
- Department of DermatologyYale University Medical School New Haven Connecticut
| | | | - Richard J. Antaya
- Department of DermatologyYale University Medical School New Haven Connecticut
| | - Keith A. Choate
- Department of DermatologyYale University Medical School New Haven Connecticut
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20
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Middle-Aged Female Diagnosed With Widespread Stiff Skin Syndrome. Arch Rheumatol 2019; 33:491-493. [PMID: 30874234 DOI: 10.5606/archrheumatol.2018.6805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/28/2018] [Indexed: 11/21/2022] Open
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21
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Abstract
Stiff skin syndrome is a rare disease causing stony hard induration of skin usually in early childhood. We report a case of 12 years old boy who presented to our clinic with biopsy showing adipocyte entrapment which we believe is an unrecognized key pathological finding in diagnosis of this entity.
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22
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Oral rigidity and xerostomia in a 46-year-old man. J Am Dent Assoc 2018; 149:214-219. [DOI: 10.1016/j.adaj.2017.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/26/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022]
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23
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Maillet-Lebel N, Kokta V, Coulombe J, Powell J. A case of segmental stiff skin syndrome treated with systemic losartan. Pediatr Dermatol 2018; 35:e66-e67. [PMID: 29110325 DOI: 10.1111/pde.13330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Stiff skin syndrome (SSS) is a rare, autosomal dominant cutaneous disorder with progressive, symmetric, sclerotic skin changes of the shoulders, hips, and thighs. In a recent publication, a distinct segmental variant of SSS was proposed. In this report we discuss the case of a boy with segmental SSS and review the current literature.
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Affiliation(s)
| | - Victor Kokta
- Department of Pathology, CHU Sainte Justine, Montreal, QC, Canada
| | - Jerome Coulombe
- Department of Dermatology, CHU Sainte Justine, Montreal, QC, Canada
| | - Julie Powell
- Department of Dermatology, CHU Sainte Justine, Montreal, QC, Canada
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24
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Therapies for genetic extracellular matrix diseases of the skin. Matrix Biol 2017; 71-72:330-347. [PMID: 29274938 DOI: 10.1016/j.matbio.2017.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 12/26/2022]
Abstract
A specialized, highly developed dermal extracellular matrix (ECM) provides the skin with its unique mechano-resilient properties and is vital for organ function. Accordingly, genetically acquired deficiency of dermal ECM proteins or proteins essential for the post-translational modification and homeostasis of the dermal ECM, results in diseases affecting the skin. Some of these diseases are lethal or lead to severe complications for the affected individuals. At present limited efficient and evidence-based treatment options exist for genetic ECM diseases of the skin. There is thus a high unmet medical need, creating an urgent demand to develop improved care for these diseases. Here, by drawing examples from the wealth of research on epidermolysis bullosa, we present the current status of biological and small molecule therapies for genetic ECM diseases with skin manifestations. We discuss challenges, and using existing data to propose strategies and future directions allowing development of more efficacious therapies and advancement of them into clinical practice.
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25
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Kurtzman DJ, Wright NA, Patel M, Vleugels RA. Segmental stiff skin syndrome (SSS): Two additional cases with a positive response to mycophenolate mofetil and physical therapy. J Am Acad Dermatol 2016; 75:e237-e239. [DOI: 10.1016/j.jaad.2016.05.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 10/20/2022]
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