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Raja Rajeswari K, Almansour R, Alrajhi F, Fahad Binmeqren A, Shayan Albaqami M, abdullah Albarrak R. Papillon-Lefèvre syndrome in dental pediatric patient: A comprehensive review. Saudi Dent J 2024; 36:682-687. [PMID: 38766300 PMCID: PMC11096607 DOI: 10.1016/j.sdentj.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Papillon-Lefèvre syndrome (PLS) is an autosomal recessive genetic disorder characterized by the presence of palmoplantar hyperkeratosis on the hands and feet, as well as severe periodontal disease affecting both the primary and permanent teeth, which can lead to premature tooth loss. Aims This review aimed to characterize the etiology, clinical manifestations, diagnosis, and recent dental management strategies of pediatric patients with PLS. Material and Methods A comprehensive search of the electronic literature was conducted using specific keywords such as "Papillon-Lefèvre syndrome in dentistry," "Etiology of Papillon-Lefèvre syndrome," "Oral manifestations of Papillon-Lefèvre syndrome," "Management of Papillon-Lefèvre syndrome," and "Papillon-Lefèvre syndrome." A total of 47 publications that provided relevant information and discussed the various aspects of PLS were identified. Conclusion The management of PLS necessitates a multidisciplinary approach, including the active involvement of a dental surgeon, dermatologist, and pediatrician to ensure comprehensive care. Extraction of primary teeth and administration of antibiotics is a successful treatment strategy, while placement of removable partial denture is the best option for pediatric patients.
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Affiliation(s)
- Kaminedi Raja Rajeswari
- Department of pediatric dentistry, college of dentistry, king Saud university, Riyadh, Saudi Arabia
| | - Rahaf Almansour
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Farah Alrajhi
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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2
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Wu Y, Zhao L, Xu C, Wu Y. CTSC compound heterozygous mutations in two Chinese patients with Papillon-Lefèvre syndrome. Oral Dis 2019; 25:1394-1402. [PMID: 30908832 DOI: 10.1111/odi.13095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify the molecular basis of Papillon-Lefèvre syndrome in two Chinese families. METHODS Peripheral blood and mouth swab samples were obtained, from which genomic DNA and RNA were isolated. Sanger sequencing was employed to identify the mutations. mRNA expression was tested by real-time quantitative PCR. Evolutionary conservation, pathogenicity prediction and impact of protein structures of the mutations were conducted with bioinformatics tools and homology modelling. HEK293 cells were transfected with plasmids expressing wild-type or mutated CTSC. CTSC protein expression level and enzyme activity were explored. RESULTS Mutation analysis revealed two novel compound heterozygous mutations, the c.190-191insA and c.1211-1212delA in patient 1 and the c.716A>G and c.757+1G>A in patient 2. In both patients, the levels of CTSC mRNA were significantly lower than in their relatives. Homology modelling analysis predicted that the mutations affect the structure and stability of the protein, and in vitro study showed that the CTSC proteins containing the mutations c.190-191insA and c.1211-1212delA, which result in truncated versions of protein, display impaired enzyme activity. The protein containing c.716A>G mutation showed quite similar enzyme activity compared to wild-type CTSC. CONCLUSION Our data support the molecular mechanism of PLS and enlarge the scope of CTSC gene mutations related to PLS.
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Affiliation(s)
- Yuelin Wu
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Centre for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Zhao
- National Clinical Research Centre for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunmei Xu
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Centre for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yafei Wu
- National Clinical Research Centre for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
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AIBarrak ZM, Alqarni AS, Chalisserry EP, Anil S. Papillon-Lefèvre syndrome: a series of five cases among siblings. J Med Case Rep 2016; 10:260. [PMID: 27658951 PMCID: PMC5034476 DOI: 10.1186/s13256-016-1051-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 09/01/2016] [Indexed: 11/12/2022] Open
Abstract
Background Papillon–Lefèvre syndrome is a rare autosomal recessive disorder characterized by palmoplantar hyperkeratosis and aggressively progressing periodontitis leading to premature loss of deciduous and permanent dentition. The etiopathogenesis of the syndrome is relatively obscure, and immunologic, genetic, or possible bacterial etiologies have been proposed. Case presentation A series of five cases of Papillon–Lefèvre syndrome among the siblings in a family is presented here: a 3-year-old Arab girl, a 4-year-old Arab boy, a 11-year-old Arab boy, a 12-year-old Arab boy, and a 14-year-old Arab boy. The patients presented with severe gingival inflammation and mobility of teeth. The clinical manifestations were typical of Papillon–Lefèvre syndrome and the degree of involvement of the oral and skin conditions varied among them. Conclusions This case series stresses the consanguinity in the family as an etiologic factor. All siblings in the family were affected with Papillon–Lefèvre syndrome which makes this a rare case. A multidisciplinary approach with the active participation of a dental surgeon, dermatologist, and pediatrician is essential for the management of cases of Papillon–Lefèvre syndrome.
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Affiliation(s)
- Zyad M AIBarrak
- King Abdulaziz Medical City, Ministry of Health, Riyadh, Saudi Arabia.
| | - Adel S Alqarni
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, 153, AIkharj, 11942, Riyadh, Saudi Arabia
| | - Elna P Chalisserry
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, 82943, Saudi Arabia
| | - Sukumaran Anil
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, 153, AIkharj, 11942, Riyadh, Saudi Arabia
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Song H, Wang L, Zhang L, Wang Z. A novel nonsense mutation in CTSC causes Papillon–Lefèvre syndrome with uronephrosis. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Soliman H, Eldeen HG, Mustafa MI. A novel nonsense mutation in cathepsin C gene in an Egyptian patient presenting with Papillon–Lefèvre syndrome. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2015. [DOI: 10.1016/j.ejmhg.2015.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sreeramulu B, Shyam NDVN, Ajay P, Suman P. Papillon-Lefèvre syndrome: clinical presentation and management options. Clin Cosmet Investig Dent 2015; 7:75-81. [PMID: 26203280 PMCID: PMC4507741 DOI: 10.2147/ccide.s76080] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder, characterized by diffuse palmoplantar keratoderma and precocious aggressive periodontitis, leading to premature loss of deciduous and permanent dentition at a very young age. Various etiopathogenic factors are associated with the syndrome, like immunologic alterations, genetic mutations, and the role of bacteria. Dentists play a significant role in the diagnosis and management of PLS as there are characteristic manifestations like periodontal destruction at an early age and an early eruption of permanent teeth. Here, we are presenting an elaborate review of PLS, its etiopathogenesis, clinical presentation, and management options.
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Affiliation(s)
- Basapogu Sreeramulu
- Department of Prosthodontics, Government Dental College and Hospital, Hyderabad, Telangana State, India
| | - Naragani DVN Shyam
- Department of Oral Pathology, Government Dental College and Hospital, Hyderabad, Telangana State, India
| | - Pilla Ajay
- Department of Prosthodontics, Government Dental College and Hospital, Hyderabad, Telangana State, India
| | - Pathipaka Suman
- Department of Prosthodontics, Government Dental College and Hospital, Hyderabad, Telangana State, India
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Jose J, Bartlett K, Salgado C, Gutierrez NM. Papillon-Lefèvre syndrome: review of imaging findings and current literature. Foot Ankle Spec 2015; 8:139-42. [PMID: 25421448 DOI: 10.1177/1938640014560164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive condition that causes palmoplantar keratoderma and premature exfoliation of primary and secondary dentition. There are several diseases that can mimic PLS, and it is estimated that the disease is far more prevalent than documented but may either be misdiagnosed or not acknowledged. Radiological exams can provide important clues to differentiate between these syndromes and make an accurate diagnosis.
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Affiliation(s)
- Jean Jose
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida (JJ, NMG)University of Miami Miller School of Medicine, Miami, Florida (KB)Department of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida (CS)Department of Radiology, Jackson Memorial Medical Center, Miami, Florida (NMG)
| | - Kyle Bartlett
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida (JJ, NMG)University of Miami Miller School of Medicine, Miami, Florida (KB)Department of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida (CS)Department of Radiology, Jackson Memorial Medical Center, Miami, Florida (NMG)
| | - Christopher Salgado
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida (JJ, NMG)University of Miami Miller School of Medicine, Miami, Florida (KB)Department of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida (CS)Department of Radiology, Jackson Memorial Medical Center, Miami, Florida (NMG)
| | - Nicholas M Gutierrez
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida (JJ, NMG)University of Miami Miller School of Medicine, Miami, Florida (KB)Department of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida (CS)Department of Radiology, Jackson Memorial Medical Center, Miami, Florida (NMG)
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Shah AF, Tangade P, Agarwal S. Papillon-Lefevre syndrome: Reporting consanguinity as a risk factor. Saudi Dent J 2014; 26:126-31. [PMID: 25057233 DOI: 10.1016/j.sdentj.2014.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/31/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022] Open
Abstract
Papillon-Lefevre syndrome (PLS) is an autosomal recessive genetic disorder characterized by palmoplantar hyperkeratosis associated with severe early-onset periodontitis and premature loss of primary and permanent teeth. This report describes two cases of PLS in 28-year-old female and 16-year-old male siblings with consanguineously married parents. The patients presented to the Department of Public Health Dentistry of a dental education and research institute in India with thickening, flaking, and scaling of the skin on the palms and soles of the feet. On oral examination, the female patient presented completely resorbed maxillary and mandibular alveolar ridges with retention of only the third molars. The male patient retained only teeth 18, 13, 28, 38, and 45. Based on complete histories and clinical examination findings, a final diagnosis of PLS was made and treatment was initiated using an interdisciplinary dental approach in both cases.
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Affiliation(s)
- Aasim Farooq Shah
- Department of Public Health Dentistry, Kothiwal Dental College & Research Centre, Kanth Road, Moradabad 244001, Uttar Pradesh, India
| | - Pradeep Tangade
- Department of Public Health Dentistry, Kothiwal Dental College & Research Centre, Kanth Road, Moradabad 244001, Uttar Pradesh, India
| | - Swatantra Agarwal
- Department of Prosthodontics, Kothiwal Dental College & Research Centre, Kanth Road, Moradabad 244001, Uttar Pradesh, India
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Khan FY, Jan SM, Mushtaq M. Papillon-Lefevre syndrome (PLS) without cathepsin C mutation: A rare early onset partially penetrant variant of PLS. Saudi Dent J 2014; 26:25-8. [PMID: 24526825 PMCID: PMC3923170 DOI: 10.1016/j.sdentj.2013.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/11/2013] [Accepted: 12/03/2013] [Indexed: 11/27/2022] Open
Abstract
Papillon-Lefevre syndrome (PLS) is a very rare, autosomal recessive syndrome characterized by palmar-plantar hyperkeratosis and severe destructive periodontitis. Most patients present with PLS harbor mutations in the cathepsin C gene, but recent studies have identified individuals with classic PLS symptoms without such mutations. This suggests more genetic heterogeneity for PLS than previously thought. Here we present an individual's manifesting characteristic clinical features of PLS with no mutations in the coding sequence of cathepsin C. We suggest there must be alternative genetic causes for such forms of PLS.
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Affiliation(s)
- Fayiza Yaqoob Khan
- Department of Periodontics and Oral Implantology, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
| | - Suhail Majid Jan
- Department of Periodontics and Oral Implantology, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
| | - Mubashir Mushtaq
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
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Bhavsar MV, Brahmbhatt NA, Sahayata VN, Bhavsar NV. Papillon-lefevre syndrome: Case series and review of literature. J Indian Soc Periodontol 2013; 17:806-11. [PMID: 24554896 PMCID: PMC3917216 DOI: 10.4103/0972-124x.124530] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/04/2013] [Indexed: 11/21/2022] Open
Abstract
Papillon-lefevre syndrome (PLS) belongs to a heterogeneous group of skin diseases that are characterized by hyperkeratosis of palms and soles. It is a type IV palmoplantar keratosis (PPK) while the palmoplantar keratodermas share some features of PPK, they are etiologically heterogeneous. PLS differs from other types of PPK by the presence of severe and early onset periodontitis. Genetic studies have shown that mutation in the major gene locus of chromosome 11q14 with the loss of function of cathepsin-C (CTSC) gene is responsible for PLS. CTSC gene mutations are causative for PLS. The resultant loss of CTSC function is responsible for the severe periodontal destruction seen clinically. This report represents two siblings with classical signs and symptoms of PLS.
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Affiliation(s)
- Margi V. Bhavsar
- Department of Periodontology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Nilam A. Brahmbhatt
- Department of Periodontology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Vishal N. Sahayata
- Department of Periodontology, Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat, India
| | - Neeta V. Bhavsar
- Department of Periodontology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
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Abstract
The goal of periodontal therapy has always been regeneration of the lost tissues. However, conventional periodontal therapy has not always been successful in achieving regeneration, especially when it is part of a syndrome. This case report involves a 13-year old male patient with the chief complaint of mobile teeth for over 3 months. His dental history revealed early loss of primary dentition, around 3–4 years of age and that he noticed mobility of permanent incisors and molars at 9–10 years. Keratotic skin lesions on the palms and soles were present since the age of 3 years. Full mouth intra-oral periapical radiographs showed extensive bone loss upto apical thirds of the teeth and an orthopantamograph showed “floating in air” appearance. Further, a lateral cephalogram was taken to rule out any calcifications of the duramater. The case was provisionally diagnosed to be Papillon Lefévre syndrome. A conventional polymerase chain reaction assay was also done to assess the virulence genes in aggressive periodontitis. Though the management of PLS involves the regular phases of periodontal therapy, namely, etiotropic, surgical, restorative and maintenance phases, the complete esthetic and functional rehabilitation also involves other specialities especially prosthodontic and dermatologic and later an implantologist. After appropriate periodontal and prosthodontic management, the patient has been followed up for over a year and is maintaining in a stable condition.
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Muppa R, Prameela B, Duddu M, Dandempally A. Papillon-lefevre syndrome: a combined approach from the dermatologist and dentist - a clinical presentation. Indian J Dermatol 2012; 56:740-3. [PMID: 22345785 PMCID: PMC3276911 DOI: 10.4103/0019-5154.91843] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Papillon–Lefevre syndrome (PLS) is a rare disease characterized by skin lesions, which includes palmar-plantar hyperkeratosis and hyperhidrosis with severe periodontal destruction involving both the primary and the permanent dentitions. It is transmitted as an autosomal-recessive condition, and consanguinity of parents is evident in about one-third of the cases. This paper describes a 13-year-old male patient who presented to the department of pedodontics, with rapidly progressing periodontitis. A general physical examination revealed scaling on the hands and feet, which had been medically diagnosed as PLS. The incidence of this rare entity is increasing in the recent times, which is associated with irreparable periodontal destruction at an early age, with not so prominent skin lesions in some cases. In such instances, the dentist has a more important role in diagnosing, treatment planning and preservation of the periodontal tissues and, at the same time, referring for the treatment of the skin lesions. This paper emphasizes the combined effort of the two specialities in order to maintain skin as well as dental conditions in health by early intervention and a synergistic treatment approach.
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Affiliation(s)
- Radhika Muppa
- Department of Pedodontics with Preventive Dentistry, Panineeya Dental College, Hyderabad, India
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Pavankumar K. Papillon-Lefevre syndrome: A case report. Saudi Dent J 2010; 22:95-8. [PMID: 24151407 PMCID: PMC3804957 DOI: 10.1016/j.sdentj.2010.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 07/08/2009] [Accepted: 09/07/2009] [Indexed: 12/01/2022] Open
Abstract
Papillon-Lefevre syndrome (PLS) is a rare autosomal recessive disorder of keratinization, characterized by palmoplantar hyperkeratosis, periodontal involvement and precocious loss of dentition. The purpose of this report was to describe the case of an 18-year-old girl who presented to the out patient department of Navodaya Dental College and Hospital, Raichur, Karnataka, India, with the chief complaint of multiple loss of teeth. Her gingiva appeared erythematous, edematous and bled readily on probing, and the teeth were mobile. Hyperkeratosis of palms and soles were found. These findings are consistent with Papillon-Lefèvre syndrome. The clinical presentation, differential diagnosis, complications and management of this syndrome are discussed.
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Affiliation(s)
- Kalwa Pavankumar
- Department of Periodontics, Navodaya Dental College and Hospital, Navodaya Nagar, Raichur 584103, Karnataka, India
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Yazdanfar A, Farahnaki S. Late-onset Papillon-Lefevre syndrome with pyogenic liver abscesses: report of one case. Int J Dermatol 2009; 48:76-8. [PMID: 19126057 DOI: 10.1111/j.1365-4632.2009.03797.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ameneh Yazdanfar
- Department of Dermatology, Farshchian Hospital, Hamedan University of Medical Sciences, Hamedan, Iran.
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