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Fölster-Holst R, Pasmans S, Volc-Platzer B, Christophers E, Çetinarslan T. Netherton syndrome and papillomatous lesions-Should we perform human papilloma virus vaccination? J Eur Acad Dermatol Venereol 2024; 38:e625-e628. [PMID: 38362846 DOI: 10.1111/jdv.19839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Suzanne Pasmans
- Department of Dermatology, Venereology and Allergology, Erasmus MC University Medical Centre Rotterdam-Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Beatrix Volc-Platzer
- Department of Dermatology and Venereology, Medical University of Vienna, Vienna, Austria
| | - Enno Christophers
- Department of Dermatology, Venereology and Allergology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tubanur Çetinarslan
- Department of Dermatology and Venereology, Manisa Celal Bayar University, Manisa, Turkey
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2
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Biglari S, Moghaddam AS, Tabatabaiefar MA, Sherkat R, Youssefian L, Saeidian AH, Vahidnezhad F, Tsoi LC, Gudjonsson JE, Hakonarson H, Casanova JL, Béziat V, Jouanguy E, Vahidnezhad H. Monogenic etiologies of persistent human papillomavirus infections: A comprehensive systematic review. Genet Med 2024; 26:101028. [PMID: 37978863 PMCID: PMC10922824 DOI: 10.1016/j.gim.2023.101028] [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: 06/25/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Persistent human papillomavirus infection (PHPVI) causes cutaneous, anogenital, and mucosal warts. Cutaneous warts include common warts, Treeman syndrome, and epidermodysplasia verruciformis, among others. Although more reports of monogenic predisposition to PHPVI have been published with the development of genomic technologies, genetic testing is rarely incorporated into clinical assessments. To encourage broader molecular testing, we compiled a list of the various monogenic etiologies of PHPVI. METHODS We conducted a systematic literature review to determine the genetic, immunological, and clinical characteristics of patients with PHPVI. RESULTS The inclusion criteria were met by 261 of 40,687 articles. In 842 patients, 83 PHPVI-associated genes were identified, including 42, 6, and 35 genes with strong, moderate, and weak evidence for causality, respectively. Autosomal recessive inheritance predominated (69%). PHPVI onset age was 10.8 ± 8.6 years, with an interquartile range of 5 to 14 years. GATA2,IL2RG,DOCK8, CXCR4, TMC6, TMC8, and CIB1 are the most frequently reported PHPVI-associated genes with strong causality. Most genes (74 out of 83) belong to a catalog of 485 inborn errors of immunity-related genes, and 40 genes (54%) are represented in the nonsyndromic and syndromic combined immunodeficiency categories. CONCLUSION PHPVI has at least 83 monogenic etiologies and a genetic diagnosis is essential for effective management.
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Affiliation(s)
- Sajjad Biglari
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Mohammad Amin Tabatabaiefar
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Sherkat
- Immunodeficiency Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Youssefian
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amir Hossein Saeidian
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, MI
| | | | - Hakon Hakonarson
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Jean-Laurent Casanova
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY; Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Inserm U1163, Necker Hospital for Sick Children, Paris, France; Imagine Institute, Paris Cité University, France; Department of Pediatrics, Necker Hospital for Sick Children, Paris, France, EU; Howard Hughes Medical Institute, Chevy Chase, MD
| | - Vivien Béziat
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY; Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Inserm U1163, Necker Hospital for Sick Children, Paris, France; Imagine Institute, Paris Cité University, France
| | - Emmanuelle Jouanguy
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY; Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Inserm U1163, Necker Hospital for Sick Children, Paris, France; Imagine Institute, Paris Cité University, France
| | - Hassan Vahidnezhad
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
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3
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Di Nora A, Consentino M, Messina G, Timpanaro T, Smilari P, Pavone P. Severe Hypernatremia as Presentation of Netherton Syndrome. Glob Med Genet 2023; 10:335-338. [PMID: 38025195 PMCID: PMC10665120 DOI: 10.1055/s-0043-1776983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Netherton syndrome is a rare, multisystem, autosomal recessive genodermatosis characterized by a triad of manifestations: congenital ichthyosis, immune dysregulation, and scalp anomalies. We report the case of a 1-month-old male infant evaluated for failure to thrive and feeding difficulties. At birth, the infant was admitted to intensive care for severe hypernatremia (natremia 186 mg/dL). Upon entering the ward, the general conditions were poor. He presented with diffuse erythrodermia. A dermatological evaluation showed evidence of "invaginated trichuriasis," a typical sign of Netherton syndrome. Netherton syndrome is caused by a genetic mutation causing loss of function of the SPINK5 gene it encodes for the LEKTI protein, normally expressed in epithelia. Loss of LEKTI induces severe skin barrier defect. The history of the disease is characterized by serious potential complications in the first months of life, such as the risk of hypernatremic dehydration induced by high skin permeability, recurrent and/or severe infections, and growth retardation.
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Affiliation(s)
- A. Di Nora
- Department of Clinical and Experimental Medicine, University of Catania, Catania CT, Italy
| | - M.C. Consentino
- Department of Clinical and Experimental Medicine, University of Catania, Catania CT, Italy
| | - G. Messina
- Department of Clinical and Experimental Medicine, University of Catania, Catania CT, Italy
| | - T. Timpanaro
- Department of Clinical and Experimental Medicine, University of Catania, Catania CT, Italy
| | - P. Smilari
- Department of Clinical and Experimental Medicine, University of Catania, Catania CT, Italy
| | - P. Pavone
- Department of Clinical and Experimental Medicine, University of Catania, Catania CT, Italy
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4
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Liao C, Wang Q, An J, Zhang M, Chen J, Li X, Xiao L, Wang J, Long Q, Liu J, Guan X. SPINKs in Tumors: Potential Therapeutic Targets. Front Oncol 2022; 12:833741. [PMID: 35223512 PMCID: PMC8873584 DOI: 10.3389/fonc.2022.833741] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/14/2022] [Indexed: 12/14/2022] Open
Abstract
The serine protease inhibitor Kazal type (SPINK) family includes SPINK1-14 and is the largest branch in the serine protease inhibitor family. SPINKs play an important role in pancreatic physiology and disease, sperm maturation and capacitation, Nager syndrome, inflammation and the skin barrier. Evidence shows that the unregulated expression of SPINK1, 2, 4, 5, 6, 7, and 13 is closely related to human tumors. Different SPINKs exhibit various regulatory modes in different tumors and can be used as tumor prognostic markers. This article reviews the role of SPINK1, 2, 4, 5, 6, 7, and 13 in different human cancer processes and helps to identify new cancer treatment targets.
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Affiliation(s)
- Chengcheng Liao
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
| | - Qian Wang
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- Microbial Resources and Drug Development Key Laboratory of Guizhou Tertiary Institution, Life Sciences Institute, Zunyi Medical University, Zunyi, China
| | - Jiaxing An
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Minglin Zhang
- Department of Gastroenterology, Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, China
| | - Jie Chen
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaolan Li
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- Microbial Resources and Drug Development Key Laboratory of Guizhou Tertiary Institution, Life Sciences Institute, Zunyi Medical University, Zunyi, China
| | - Linlin Xiao
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
| | - Jiajia Wang
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
| | - Qian Long
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- *Correspondence: Qian Long, ; Xiaoyan Guan, ; Jianguo Liu,
| | - Jianguo Liu
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- *Correspondence: Qian Long, ; Xiaoyan Guan, ; Jianguo Liu,
| | - Xiaoyan Guan
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- *Correspondence: Qian Long, ; Xiaoyan Guan, ; Jianguo Liu,
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5
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Human inborn errors of immunity to oncogenic viruses. Curr Opin Immunol 2021; 72:277-285. [PMID: 34364035 DOI: 10.1016/j.coi.2021.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
Oncoviruses are viruses that can cause tumors. Seven viruses are currently recognized as oncogenic in humans: Epstein Barr virus (EBV), Kaposi sarcoma-associated herpesvirus (KSHV, also known as HHV8), human papillomaviruses (HPVs), hepatitis B virus (HBV), hepatitis C virus (HCV), human T-lymphotropic virus-1 (HTLV-1), and Merkel cell polyomavirus (MCPyV). The clinical phenotypes resulting from infection with these oncoviruses range from asymptomatic infection to invasive cancers. Patients with inborn errors of immunity (IEI) are prone to the development of infectious diseases caused by a narrow or broad spectrum of pathogens, including oncoviruses in some cases. Studies of patients with IEI have deepened our understanding of the non-redundant mechanisms underlying the control of EBV, HHV8 and HPV infections. The human genetic factors conferring predisposition to oncogenic HBV, HCV, HTLV-1 and MCPyV manifestations remain elusive. We briefly review here what is currently known about the IEI conferring predisposition to severe infection with oncoviruses.
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6
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Petrova E, Hovnanian A. Advances in understanding of Netherton syndrome and therapeutic implications. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1857724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Evgeniya Petrova
- Laboratory of genetic skin diseases, Université de Paris, Imagine Institute, INSERM UMR1163, Paris, France
| | - Alain Hovnanian
- Laboratory of genetic skin diseases, Université de Paris, Imagine Institute, INSERM UMR1163, Paris, France
- Departement of Genetics, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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7
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Eczematous dermatitis in primary immunodeficiencies: A review of cutaneous clues to diagnosis. Clin Immunol 2020; 211:108330. [DOI: 10.1016/j.clim.2019.108330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 11/23/2022]
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8
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Mazereeuw-Hautier J, Hernández-Martín A, O'Toole EA, Bygum A, Amaro C, Aldwin M, Audouze A, Bodemer C, Bourrat E, Diociaiuti A, Dolenc-Voljč M, Dreyfus I, El Hachem M, Fischer J, Ganemo A, Gouveia C, Gruber R, Hadj-Rabia S, Hohl D, Jonca N, Ezzedine K, Maier D, Malhotra R, Rodriguez M, Ott H, Paige DG, Pietrzak A, Poot F, Schmuth M, Sitek JC, Steijlen P, Wehr G, Moreen M, Vahlquist A, Traupe H, Oji V. Management of congenital ichthyoses: European guidelines of care, part two. Br J Dermatol 2018; 180:484-495. [PMID: 29897631 DOI: 10.1111/bjd.16882] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 01/03/2023]
Abstract
These guidelines for the management of congenital ichthyoses have been developed by a multidisciplinary group of European experts following a systematic review of the current literature, an expert conference held in Toulouse in 2016, and a consensus on the discussions. These guidelines summarize evidence and expert-based recommendations and intend to help clinicians with the management of these rare and often complex diseases. These guidelines comprise two sections. This is part two, covering the management of complications and the particularities of some forms of congenital ichthyosis.
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Affiliation(s)
- J Mazereeuw-Hautier
- Reference Centre for Rare Skin Diseases, Dermatology Department, Larrey Hospital, Toulouse, France
| | | | - E A O'Toole
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - A Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - C Amaro
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - M Aldwin
- Ichthyosis Support Group, PO Box 1242, Yateley, GU47 7FL, U.K
| | - A Audouze
- Association Ichtyose France, Bellerive sur Allier, France
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Saint-Louis, Paris, France.,Institut Imagine, Université Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - E Bourrat
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Saint-Louis, Paris, France
| | - A Diociaiuti
- Dermatology Division, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - M Dolenc-Voljč
- Department of Dermatovenereology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - I Dreyfus
- Reference Centre for Rare Skin Diseases, Dermatology Department, Larrey Hospital, Toulouse, France
| | - M El Hachem
- Dermatology Division, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Ganemo
- Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Gouveia
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Gruber
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - S Hadj-Rabia
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Saint-Louis, Paris, France.,Institut Imagine, Université Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - D Hohl
- Department of Dermatology, Hôpital de Beaumont, Lausanne, Switzerland
| | - N Jonca
- Epithelial Differentiation and Rheumatoid Autoimmunity Unit (UDEAR), UMR 1056 Inserm - Toulouse 3 University, Purpan Hospital, Toulouse, France
| | - K Ezzedine
- Depatment of Dermatology, Hôpital Henri Mondor, EA EpiDerm, UPEC-Université Paris-Est Créteil, 94010, Créteil, France
| | - D Maier
- Dermatology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, U.K
| | - M Rodriguez
- Department of Ear, Nose and Throat, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - H Ott
- Division of Pediatric Dermatology and Allergology, Auf Der Bult Children's Hospital, Hanover, Germany
| | - D G Paige
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, U.K
| | - A Pietrzak
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - F Poot
- ULB-Erasme Hospital, Department of Dermatology, Brussels, Belgium
| | - M Schmuth
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - J C Sitek
- Department of Dermatology and Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - P Steijlen
- Department of Dermatology, Maastricht University Medical Centre, GROW Research School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - G Wehr
- Selbsthilfe Ichthyose, Kürten, Germany
| | - M Moreen
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology KU Leuven, Leuven, Belgium
| | - A Vahlquist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Von-Esmarch-Straße 58, D-48149, Münster, Germany
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Von-Esmarch-Straße 58, D-48149, Münster, Germany.,Hautarztpraxis am Buddenturm, Rudolf-von-Langen-Straße 55, D-48147, Münster, Germany
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9
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Shreberk-Hassidim R, Hassidim A, Adler N, Horev L, Maly A, Zlotogorski A, Ramot Y. Squamous cell carcinoma in situ
in association with HPV 11 in Netherton's syndrome patient: a case report. J Eur Acad Dermatol Venereol 2016; 30:e232-e234. [DOI: 10.1111/jdv.13568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- R. Shreberk-Hassidim
- Department of Dermatology; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - A. Hassidim
- Department of Plastic surgery; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - N. Adler
- Department of Plastic surgery; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - L. Horev
- Department of Dermatology; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - A. Maly
- Department of Pathology; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - A. Zlotogorski
- Department of Dermatology; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - Y. Ramot
- Department of Dermatology; Hadassah - Hebrew University Medical Center; Jerusalem Israel
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10
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Guerra L, Diociaiuti A, El Hachem M, Castiglia D, Zambruno G. Ichthyosis with confetti: clinics, molecular genetics and management. Orphanet J Rare Dis 2015; 10:115. [PMID: 26381864 PMCID: PMC4573700 DOI: 10.1186/s13023-015-0336-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 09/01/2015] [Indexed: 11/10/2022] Open
Abstract
Ichthyosis with confetti (IWC) is an autosomal dominant congenital ichthyosis also known as ichthyosis variegata or congenital reticular ichthyosiform erythroderma. It manifests at birth with generalized ichthyosiform erythroderma or with a collodion baby picture. The erythrodermic and ichthyotic phenotype persists during life and its severity may modify. However, the hallmark of the disease is the appearance, in childhood or later in life, of healthy skin confetti-like spots, which increase in number and size with time. IWC is a very rare genodermatosis, with a prevalence <1/1,000,000 and only 40 cases reported worldwide. The most important associated clinical features include ear deformities, mammillae hypoplasia, palmoplantar keratoderma, hypertrichosis and ectropion. IWC is due to dominant negative mutations in the KRT10 and KRT1 genes, encoding for keratins 10 and keratin 1, respectively. In this context, healthy skin confetti-like spots represent “repaired” skin due to independent events of reversion of keratin gene mutations via mitotic recombination. In most cases, IWC clinical suspicion is delayed until the detection of white skin spots. Clinical features, which may represent hint to the diagnosis of IWC even before appearance of confetti-like spots, include ear and mammillae hypoplasia, the progressive development of hypertrichosis and, in some patients, of adherent verrucous plaques of hyperkeratosis. Altogether the histopathological finding of keratinocyte vacuolization and the nuclear staining for keratin 10 and keratin 1 by immunofluorescence are pathognomonic. Nevertheless, mutational analysis of KRT10 or KRT1 genes is at present the gold standard to confirm the diagnosis. IWC has to be differentiated mainly from congenital ichthyosiform erythroderma. Differential diagnosis also includes syndromic ichthyoses, in particular Netherton syndrome, and the keratinopathic ichthyoses. Most of reported IWC cases are sporadic, but familial cases with autosomal dominant mode of inheritance have been also described. Therefore, knowledge of the mutation is the only way to properly counsel the couples. No specific and satisfactory therapy is currently available for IWC. Like for other congenital ichthyoses, topical treatments (mainly emollients and keratolytics) are symptomatic and offer only temporary relief. Among systemic treatments, retinoids, in particular acitretin, improve disease symptoms in most patients. Although at present there is no curative therapy for ichthyoses, treatments have improved considerably over the years and the best therapy for each patient is always the result of both physician and patient efforts.
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Affiliation(s)
- Liliana Guerra
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy.
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy.
| | - May El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy.
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy.
| | - Giovanna Zambruno
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy.
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