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Abstract
Genetic mosaicism arises when a zygote harbors two or more distinct genotypes, typically due to de novo, somatic mutation during embryogenesis. The clinical manifestations largely depend on the differentiation status of the mutated cell; earlier mutations target pluripotent cells and generate more widespread disease affecting multiple organ systems. If gonadal tissue is spared-as in somatic genomic mosaicism-the mutation and its effects are limited to the proband, whereas mosaicism also affecting the gametes, such as germline or gonosomal mosaicism, is transmissible. Mosaicism is easily appreciated in cutaneous disorders, as phenotypically distinct mutant cells often give rise to lesions in patterns determined by the affected cell type. Genetic investigation of cutaneous mosaic disorders has identified pathways central to disease pathogenesis, revealing novel therapeutic targets. In this review, we discuss examples of cutaneous mosaicism, approaches to gene discovery in these disorders, and insights into molecular pathobiology that have potential for clinical translation.
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Affiliation(s)
- Young H Lim
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA; .,Departments of Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Zoe Moscato
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA;
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA; .,Departments of Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Abstract
PURPOSE To describe the ophthalmic manifestations in a series of children with congenital lamellar ichthyosis. These cases presented with varying types of eyelid abnormality associated with the systemic disease. The clinical features and ophthalmic management were studied. METHODS The case histories of three children presenting to the oculoplastic clinic were reviewed. All were diagnosed with congenital lamellar ichthyosis and under the care of the Dermatology department. Family history and pedigree analysis was performed to determine mode of genetic inheritance. Ocular examination for visual acuity, eyelid and eyelash malposition, lid function and closure were carried out. Corneal examination including tests for exposure was also done. RESULTS All three patients had eyelid position abnormalities from the systemic disease. There was no clinical evidence of conjunctival involvement. One patient required full thickness skin grafts to treat corneal exposure secondary to lower lid ectropion. One had mild lower lid ectropion but without corneal exposure. The third case had the unusual finding of inward turning of the anterior lamella of the upper eyelid with a marked lash ptosis and only mild ectropion of the lower lid. CONCLUSIONS Congenital lamellar ichthyosis is a heterogeneous disorder with phenotypic variability. The most common eyelid abnormality is cicatricial ectropion of the upper and mainly lower eyelids. Most cases are managed conservatively although in severe cases secondary corneal exposure may require surgical correction. In this condition, to the best of our knowledge, the tendency for the eyelids to turn inwards has not previously been described.
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Affiliation(s)
- A J Singh
- Department of Ofhthalmology, Leeds General Infirmary, Leeds, England.
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Muto Y, Fujimura T, Kakizaki A, Tono H, Tsuchiyama K, Aiba S. Acral lentigenous melanoma developing from the skin of bullous congenital ichthyosiform erythroderma. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Schmuth M, Martinz V, Janecke AR, Fauth C, Schossig A, Zschocke J, Gruber R. Inherited ichthyoses/generalized Mendelian disorders of cornification. Eur J Hum Genet 2013; 21:123-33. [PMID: 22739337 PMCID: PMC3548255 DOI: 10.1038/ejhg.2012.121] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/08/2022] Open
Abstract
Inherited ichthyoses, defined as the generalized form of Mendelian disorders of cornification, are characterized by visible scaling and/or hyperkeratosis of most or all of the skin. This etiologically and phenotypically heterogenous group of conditions is caused by mutations in various different genes important for keratinocyte differentiation and epidermal barrier function. Diagnosing a specific entity is a particular challenge for the nonspecialist presented with the common clinical scaling. For the clinician, this review outlines an algorithmic approach for utilizing diagnostic clues to narrow down the differential diagnosis and to guide further testing and treatment options.
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Affiliation(s)
- Matthias Schmuth
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
| | - Verena Martinz
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
| | - Andreas R Janecke
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
- Department of Pediatrics II, Innsbruck Medical University, Innsbruck, Austria
| | - Christine Fauth
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Schossig
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
| | - Johannes Zschocke
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
| | - Robert Gruber
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
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Descargues P, Deraison C, Bonnart C, Kreft M, Kishibe M, Ishida-Yamamoto A, Elias P, Barrandon Y, Zambruno G, Sonnenberg A, Hovnanian A. Spink5-deficient mice mimic Netherton syndrome through degradation of desmoglein 1 by epidermal protease hyperactivity. Nat Genet 2004; 37:56-65. [PMID: 15619623 DOI: 10.1038/ng1493] [Citation(s) in RCA: 269] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 11/23/2004] [Indexed: 11/09/2022]
Abstract
Mutations in SPINK5, encoding the serine protease inhibitor LEKTI, cause Netherton syndrome, a severe autosomal recessive genodermatosis. Spink5(-/-) mice faithfully replicate key features of Netherton syndrome, including altered desquamation, impaired keratinization, hair malformation and a skin barrier defect. LEKTI deficiency causes abnormal desmosome cleavage in the upper granular layer through degradation of desmoglein 1 due to stratum corneum tryptic enzyme and stratum corneum chymotryptic enzyme-like hyperactivity. This leads to defective stratum corneum adhesion and resultant loss of skin barrier function. Profilaggrin processing is increased and implicates LEKTI in the cornification process. This work identifies LEKTI as a key regulator of epidermal protease activity and degradation of desmoglein 1 as the primary pathogenic event in Netherton syndrome.
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Affiliation(s)
- Pascal Descargues
- INSERM U563, Paul Sabatier University, Place du Dr Baylac, 31059 Toulouse, cedex 3, France
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Jakab Z, Szegedi I, Balogh E, Kiss C, Oláh E. Duchenne muscular dystrophy-rhabdomyosarcoma, ichthyosis vulgaris/acute monoblastic leukemia: association of rare genetic disorders and childhood malignant diseases. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 39:66-8. [PMID: 12116087 DOI: 10.1002/mpo.10043] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zsuzsanna Jakab
- Department of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
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Baala L, Hadj-Rabia S, Hamel-Teillac D, Hadchouel M, Prost C, Leal SM, Jacquemin E, Sefiani A, de Prost Y, Courtois G, Munnich A, Lyonnet S, Vabres P. Homozygosity mapping of a locus for a novel syndromic ichthyosis to chromosome 3q27-q28. J Invest Dermatol 2002; 119:70-6. [PMID: 12164927 PMCID: PMC6173186 DOI: 10.1046/j.1523-1747.2002.01809.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ichthyosis is a heterogeneous group of skin disorders characterized by abnormal epidermal scaling. Occasionally, extracutaneous features are associated. A novel autosomal recessive ichthyosis syndrome is described here with scalp hypotrichosis, scarring alopecia, sclerosing cholangitis, and leukocyte vacuolization in two inbred kindreds of Moroccan origin. We also report the mapping of the diseased gene to a 21.2 cM interval of chromosome 3q27-q28. Homo zygosity for polymorphic markers has enabled us to reduce the genetic interval to a 16.2 cM region. Furthermore, comparison of mutant chromosomes in the two families has suggested a common ancestral mutant haplotype. This linkage disequilibrium has reduced the genetic interval encompassing the diseased gene to less than 9.5 cM maximum. Further study of additional families from the same geographic area will hopefully reduce the genetic interval as well as help in the cloning of the gene involved in this rare disorder.
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Affiliation(s)
- Lekbir Baala
- Département de Génétique et Unité de Recherches sur les Handicaps Génétiques de l’Enfant INSERM U-393, Hôpital Necker-Enfants Malades, Paris, France
- Département de Génétique et Biologie moléculaire, INH Rabat et Faculté des Sciences Kénitra, Morocco
| | - Smaïl Hadj-Rabia
- Département de Génétique et Unité de Recherches sur les Handicaps Génétiques de l’Enfant INSERM U-393, Hôpital Necker-Enfants Malades, Paris, France
- Service de Dermatologie, Hôpital Necker-Enfants Malades Paris, France
| | | | - Michelle Hadchouel
- Service d’Hépatologie Infantile et Unité INSERM U-347 Hôpital Kremlin Bicétre, Bicétre, France
| | - Catherine Prost
- Laboratoire d’Histologie et de Thérapie Génique. UFR SBMH, Bobigny France
| | - Suzanne M. Leal
- Laboratory of Statistical Genetics, The Rockefeller University, New York, New York, U.S.A
| | - Emmanuel Jacquemin
- Service d’Hépatologie Infantile et Unité INSERM U-347 Hôpital Kremlin Bicétre, Bicétre, France
| | - Abdelaziz Sefiani
- Département de Génétique et Biologie moléculaire, INH Rabat et Faculté des Sciences Kénitra, Morocco
| | - Yves de Prost
- Service de Dermatologie, Hôpital Necker-Enfants Malades Paris, France
| | - Gilles Courtois
- Unite de Biologie Moleculaire de l’Expression Genique, URA CNRS 1773, Institut Pasteur, Paris, France
| | - Arnold Munnich
- Département de Génétique et Unité de Recherches sur les Handicaps Génétiques de l’Enfant INSERM U-393, Hôpital Necker-Enfants Malades, Paris, France
| | - Stanislas Lyonnet
- Département de Génétique et Unité de Recherches sur les Handicaps Génétiques de l’Enfant INSERM U-393, Hôpital Necker-Enfants Malades, Paris, France
| | - Pierre Vabres
- Département de Génétique et Unité de Recherches sur les Handicaps Génétiques de l’Enfant INSERM U-393, Hôpital Necker-Enfants Malades, Paris, France
- Service de Dermatologie, Hôpital Necker-Enfants Malades Paris, France
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Scheimberg I, Hoeger PH, Harper JI, Lake B, Malone M. Omenn's syndrome: differential diagnosis in infants with erythroderma and immunodeficiency. Pediatr Dev Pathol 2001; 4:237-45. [PMID: 11370261 DOI: 10.1007/s100240010171] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The clinical differential diagnosis of erythroderma plus immunodeficiency and failure to thrive in neonates includes graft-versus-host-disease (GVHD), Omenn's syndrome (OS), and Netherton's syndrome (NS). In addition to immunological investigations, skin biopsy is an important part of the diagnostic work-up. We reviewed biopsies from 25 patients that were retrieved from the archives of the Department of Histopathology at Great Ormond Street, of which 9 were OS, 11 were GVHD, and 5 were NS. Five patients had two biopsy specimens. Both OS and GVHD show dyskeratosis and basal vacuolation. OS always shows acanthosis and almost always parakeratosis. GVHD shows a flat epidermis and rarely parakeratosis. OS and GVHD can be distinguished after immunohistochemistry for LCA and CD68 by the relative proportions of lymphocytes and macrophages in the dermal infiltrate (predominantly lymphocytes in OS, relatively more macrophages in GVHD). Skin biopsy diagnosis of OS is difficult before 6 weeks of age because the features are poorly developed. NS can be distinguished by psoriasiform acanthosis, thickening of the basement membrane, prominent dermal blood vessels, absence of dyskeratosis, and basal layer vacuolation, and a dermal infiltrate in which lymphocytes and macrophages are equally represented. Thus, the main difference between GVHD and OS is in the proportion of lymphocytes and macrophages in the infiltrate on immunohistochemical staining for LCA and CD68, while OS and NS may be distinguished on H&E morphology alone.
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Affiliation(s)
- I Scheimberg
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK
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Affiliation(s)
- P H Hoeger
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
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