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Weinberg RL, Kim S, Pang Z, Awad S, Hanback T, Pan B, Bettin L, Chang D, Polydefkis MJ, Qu L, Caterina MJ. Pain Hypersensitivity in SLURP1 and SLURP2 Knock-out Mouse Models of Hereditary Palmoplantar Keratoderma. J Neurosci 2024; 44:e0260232024. [PMID: 38866482 PMCID: PMC11236581 DOI: 10.1523/jneurosci.0260-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/30/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
SLURP1 and SLURP2 are both small secreted members of the Ly6/u-PAR family of proteins and are highly expressed in keratinocytes. Loss-of-function mutations in SLURP1 lead to a rare autosomal recessive palmoplantar keratoderma (PPK), Mal de Meleda (MdM), which is characterized by diffuse, yellowish palmoplantar hyperkeratosis. Some individuals with MdM experience pain in conjunction with the hyperkeratosis that has been attributed to fissures or microbial superinfection within the affected skin. By comparison, other hereditary PPKs such as pachyonychia congenita and Olmsted syndrome show prevalent pain in PPK lesions. Two mouse models of MdM, Slurp1 knock-out and Slurp2X knock-out, exhibit robust PPK in all four paws. However, whether the sensory experience of these animals includes augmented pain sensitivity remains unexplored. In this study, we demonstrate that both models exhibit hypersensitivity to mechanical and thermal stimuli as well as spontaneous pain behaviors in males and females. Anatomical analysis revealed slightly reduced glabrous skin epidermal innervation and substantial alterations in palmoplantar skin immune composition in Slurp2X knock-out mice. Primary sensory neurons innervating hindpaw glabrous skin from Slurp2X knock-out mice exhibit increased incidence of spontaneous activity and mechanical hypersensitivity both in vitro and in vivo. Thus, Slurp knock-out mice exhibit polymodal PPK-associated pain that is associated with both immune alterations and neuronal hyperexcitability and might therefore be useful for the identification of therapeutic targets to treat PPK-associated pain.
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Affiliation(s)
- Rachel L Weinberg
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Suyeon Kim
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
- Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Zixuan Pang
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
- Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Sandy Awad
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Tyger Hanback
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
- Department of Biochemistry and Molecular Biology, Johns Hopkins School of Public Health, Baltimore, Maryland 21205
| | - Baohan Pan
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Leonie Bettin
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Dennis Chang
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Michael J Polydefkis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Lintao Qu
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Michael J Caterina
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
- Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
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Sudduth JD, Clinker C, Holdaway M, Marquez JL, Veith J, Wright T, Rockwell WB. Surgical Management of Pachyonychia Congenita in a 3-Year-Old. Arch Plast Surg 2023; 50:573-577. [PMID: 38143838 PMCID: PMC10736205 DOI: 10.1055/s-0043-1771520] [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] [Received: 11/03/2022] [Accepted: 06/15/2023] [Indexed: 12/26/2023] Open
Abstract
Pachyonychia congenita is a rare genetic disorder characterized by hypertrophic nail plates, hyperkeratotic nail beds, and thickened hyponychium of the fingers and toes, impairing manual dexterity and resulting in poor aesthetics. The current body of literature describes various treatment modalities, but no singular approach has been defined as the gold standard. In this case, the authors employed different surgical techniques for treating pachyonychia congenita to evaluate the most effective approach. A 3-year-old boy presented with hypertrophic nail growth involving all digits of both hands and feet. Three surgical procedures were performed on the patient's fingers and toes using germinal matrix excision (GME) alone, GME plus partial sterile matrix excision (pSME), or GME plus complete sterile matrix excision (cSME). The digits treated with GME + cSME exhibited no recurrence of nail growth. Those treated with GME alone exhibited recurrence of hypertrophic nail growth, although their growth slowed. Excision of GME + cSME prevented recurrence of hypertrophic nails, while GME alone or with pSME led to slower-growing hypertrophic nails. Complete excision of the germinal and sterile matrices with skin graft closure may be a definitive treatment for pachyonychia congenita, but further studies are needed to validate these findings.
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Affiliation(s)
- Jack D. Sudduth
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Christopher Clinker
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Matthew Holdaway
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Jessica L. Marquez
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Jacob Veith
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Thomas Wright
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - W. Bradford Rockwell
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
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Chu HT, Dinh Duong TA, Le DH, Le TV, Nguyen BB, Dang CV, Vu QV. Phenotype and genotype features of Vietnamese children with pachyonychia congenita. Pediatr Neonatol 2023; 64:405-410. [PMID: 36658016 DOI: 10.1016/j.pedneo.2022.09.018] [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: 05/20/2022] [Revised: 07/04/2022] [Accepted: 09/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pachyonychia congenita (PC) is a group of autosomal dominant disorders caused by mutations in one of five keratin genes (KRT6A, KRT6B, KRT6C, KRT16, or KRT17). PC is an extremely rare condition. To our knowledge, this is the largest genotype-phenotype study of PC in a Vietnamese population to date. MATERIALS AND METHODS We investigated keratin gene mutations and clinical features of seven Vietnamese children with PC. RESULTS The seven Vietnamese patients were from six different families (two patients in the same family) from across Northern, Central, and Southern Vietnam. All children displayed PC symptoms before 1 year of age, but diagnosis was delayed in 4/7 patients. Thick fingernails, thick toenails, oral leukokeratosis, and follicular hyperkeratosis were the most common features recorded by all seven patients. Plantar keratoderma and thick fingernails were the clinical features associated with the most significant effect on daily function. All patients had mutations in KRT6A (PC-K6a) focused on the 1A and 2B domains. We found three distinct types of mutations (K6a R466P, K6a N171K, and K6a N172del). One mutation (N172del) was common to 5/7 (71.4%) of the patients. CONCLUSIONS Individuals displaying nail dystrophy, oral leukokeratosis, follicular hyperkeratosis, and plantar keratoderma should be referred for genetic testing given the high likelihood of a PC-K6a-related mutation in patients with this constellation of clinical signs.
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Affiliation(s)
- Ha Thi Chu
- Department of Pediatrics, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Tung Anh Dinh Duong
- Department of Pediatrics, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Doanh Huu Le
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Thieu Van Le
- Endoscopy and Exploration Functional Department, Viettiep Friendship Hospital, Haiphong, Vietnam
| | - Binh Bui Nguyen
- Department of Pediatrics, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Chuc Van Dang
- Department of Pediatrics, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Quang Van Vu
- Department of Pediatrics, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam; Pediatric Department, Green International Hospital, Haiphong, Vietnam.
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Paul JM, Orlovich DS, Patton JW, Qian X. Intravenous Ketamine as an Adjunct for Pachyonychia Congenita-Associated Pain: A Case Report. A A Pract 2019; 13:319-321. [PMID: 31343433 DOI: 10.1213/xaa.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pachyonychia congenita (PC) is a rare, inherited disorder of keratin filaments characterized by palmoplantar hyperkeratosis, keratoderma, and extreme pain. Management is largely symptomatic and typically involves multimodal pain control strategies. Here, we report the treatment of one 21-year-old man's refractory neuropathic PC pain with a 4-day inpatient ketamine infusion. Within 1 night of beginning treatment, his pain diminished to a 0/10 without any adverse effects, with effects lasting 2 weeks. No reported PC pain regimens have made use of intravenous ketamine; thus, we suggest recurrent ketamine infusions as an additional option in the multimodal pain regimen for patients with PC.
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Affiliation(s)
- Jed M Paul
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
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DeKlotz CMC, Schwartz ME, Milstone LM. Nail removal in pachyonychia congenita: Patient-reported survey outcomes. J Am Acad Dermatol 2017; 76:990-992. [PMID: 28411774 DOI: 10.1016/j.jaad.2016.08.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Cynthia Marie Carver DeKlotz
- MedStar Washington Hospital Center/Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC.
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Tariq S, Schmitz ML, Kanjia MK. Chronic Foot Pain due to Pachyonychia Congenita in a Pediatric Patient: A Successful Management Strategy. ACTA ACUST UNITED AC 2017; 6:305-7. [PMID: 27182712 DOI: 10.1213/xaa.0000000000000301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of an 11-year-old girl who presented to our multidisciplinary pain center with the chief complaint of chronic bilateral foot pain because of a rare congenital keratin disorder. This patient had been diagnosed with pachyonychia congenita, an extremely rare genetic disorder primarily affecting the skin and nails. The child had bilateral foot pain for years because of the characteristic blisters and calluses on the soles of her feet. Chronic pain was negatively impacting her quality of life; she was severely limited in her activities of daily living secondary to pain. Furthermore, she reported absenteeism from school, lack of social activities, and frequent nighttime awakenings. We discuss the successful management of her chronic foot pain using a multimodal, multidisciplinary approach.
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Affiliation(s)
- Sarah Tariq
- From the *Department of Anesthesiology and Pain Medicine, UT Houston, Texas Medical Center, Houston, Texas; †Arkansas Children's Hospital, Little Rock, Arkansas; and ‡Texas Children's Hospital, Houston, Texas
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Fatiha EAI, Abdeljalil C, Ilham K, Nawal B, Yassamine B, Nada Z, Nafissa B, Intissar H. [Pachyonychia congenita associated with renal artery stenosis and bronchiectasis]. Pan Afr Med J 2016; 24:183. [PMID: 27795780 PMCID: PMC5072884 DOI: 10.11604/pamj.2016.24.183.9284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/15/2016] [Indexed: 11/11/2022] Open
Abstract
Pachyonychia congenita (PC) is a rare hereditary disease, mainly characterized by a painful palmoplantar keratoderma, thickened nails, cysts and white lesions of the oral mucosa. Its clinical manifestations are very variable, it may appear from birth to adulthood. This study report the case of a child with pachyonychia congenita associated with bronchiectasis and renal artery stenosis. The diagnosis of pachyonychia congenita was retained based on clinical and histological data. However the presence of renal artery stenosis and bronchiectasis suggests a possible association as part of a particular syndromic group.
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Affiliation(s)
- El Alaoui Ismaili Fatiha
- Service de Néphrologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
| | - Chemlal Abdeljalil
- Service de Néphrologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
| | - Karimi Ilham
- Service de Néphrologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
| | - Benabdellah Nawal
- Service de Néphrologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
| | - Bentata Yassamine
- Service de Néphrologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
| | - Zizi Nada
- Service de Dermatologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
| | - Benajiba Nafissa
- Service de Néphrologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
| | - Haddiya Intissar
- Service de Néphrologie, CHU Mohamed VI, Faculté de Médecine, Université Mohamed Premier, Oujda, Maroc
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Kerns ML, Hakim JMC, Lu RG, Guo Y, Berroth A, Kaspar RL, Coulombe PA. Oxidative stress and dysfunctional NRF2 underlie pachyonychia congenita phenotypes. J Clin Invest 2016; 126:2356-66. [PMID: 27183391 DOI: 10.1172/jci84870] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/24/2016] [Indexed: 12/27/2022] Open
Abstract
Palmoplantar keratoderma (PPK) are debilitating lesions that arise in individuals with pachyonychia congenita (PC) and feature upregulation of danger-associated molecular patterns and skin barrier regulators. The defining features of PC-associated PPK are reproduced in mice null for keratin 16 (Krt16), which is commonly mutated in PC patients. Here, we have shown that PPK onset is preceded by oxidative stress in footpad skin of Krt16-/- mice and correlates with an inability of keratinocytes to sustain nuclear factor erythroid-derived 2 related factor 2-dependent (NRF2-dependent) synthesis of the cellular antioxidant glutathione (GSH). Additionally, examination of plantar skin biopsies from individuals with PC confirmed the presence of high levels of hypophosphorylated NRF2 in lesional tissue. In Krt16-/- mice, genetic ablation of Nrf2 worsened spontaneous skin lesions and accelerated PPK development in footpad skin. Hypoactivity of NRF2 in Krt16-/- footpad skin correlated with decreased levels or activity of upstream NRF2 activators, including PKCδ, receptor for activated C kinase 1 (RACK1), and p21. Topical application of the NRF2 activator sulforaphane to the footpad of Krt16-/- mice prevented the development of PPK and normalized redox balance via regeneration of GSH from existing cellular pools. Together, these findings point to oxidative stress and dysfunctional NRF2 as contributors to PPK pathogenesis, identify K16 as a regulator of NRF2 activation, and suggest that pharmacological activation of NRF2 should be further explored for PC treatment.
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Keratin 16 regulates innate immunity in response to epidermal barrier breach. Proc Natl Acad Sci U S A 2013; 110:19537-42. [PMID: 24218583 DOI: 10.1073/pnas.1309576110] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Mutations in the type I keratin 16 (Krt16) and its partner type II keratin 6 (Krt6a, Krt6b) cause pachyonychia congenita (PC), a disorder typified by dystrophic nails, painful hyperkeratotic calluses in glabrous skin, and lesions involving other epithelial appendages. The pathophysiology of these symptoms and its relationship to settings in which Krt16 and Krt6 are induced in response to epidermal barrier stress are poorly understood. We report that hyperkeratotic calluses arising in the glabrous skin of individuals with PC and Krt16 null mice share a gene expression signature enriched in genes involved in inflammation and innate immunity, in particular damage-associated molecular patterns. Transcriptional hyper-activation of damage-associated molecular pattern genes occurs following de novo chemical or mechanical irritation to ear skin and in spontaneously arising skin lesions in Krt16 null mice. Genome-wide expression analysis of normal mouse tail skin and benign proliferative lesions reveals a tight, context-dependent coregulation of Krt16 and Krt6 with genes involved in skin barrier maintenance and innate immunity. Our results uncover a role for Krt16 in regulating epithelial inflammation that is relevant to genodermatoses, psoriasis, and cancer and suggest a avenue for the therapeutic management of PC and related disorders.
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Moger G, Shashikanth MC, Chandrashekar KT, Kurein S. Pachyonychia congenita tarda: A rare case report. Contemp Clin Dent 2013; 4:409-11. [PMID: 24124319 PMCID: PMC3793574 DOI: 10.4103/0976-237x.118374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pachyonychia congenita is a rare, but well-characterized autosomal dominant disorder of keratinization. It usually begins within the first few months of life. Here, we are presenting a rare case, which started at the age of 10 years of life and is known as pachyonychia congenita tarda. The case is being reported for its rarer occurrence as the patient had oral leukokeratosis and angular cheilosis present in the same type of the syndrome (Jadassohn-Lewandowsky syndrome), which is still uncommon.
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Affiliation(s)
- Ganapathi Moger
- Department of Oral Medicine and Radiology, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
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Abstract
Management of ichthyoses is a complex and continuously dynamic process. Primary treatments of ichthyosis are by means of topical moisturizers and topical medications. Patients and families need to have reasonable and realistic expectations when it comes to topical therapy. Topical medications cannot cure the scaling, but can gradually reduce it and thus improve their condition. No one treatment regimen works for everyone, and the best topical therapy for each patient may be the result of months (or years) of painstaking effort on both the physician's and the patient's behalf. As patients get older and their activities and lifestyles change, so should their topical treatment regimen. Bear in mind that the more complex the skin care regimen and costly the topical treatments, the less likely a patient and their family will be compliant.
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Affiliation(s)
- Philip Fleckman
- Dermatology, University of Washington, Seattle, WA 98105, USA.
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Goldberg I, Fruchter D, Meilick A, Schwartz ME, Sprecher E. Best treatment practices for pachyonychia congenita. J Eur Acad Dermatol Venereol 2013; 28:279-85. [PMID: 23363249 DOI: 10.1111/jdv.12098] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous therapeutic modalities have been proposed to treat the manifestations of pachyonychia congenita (PC). While research hopes lie with molecular therapies, patients are in need of answers regarding the efficacy of conventional treatments. AIM OF THE STUDY To determine patients' experience and preferences regarding conventional treatments for PC. METHODS The study population included 120 PC patients from 20 countries. The study was based on a patient survey developed by physicians and researchers from the International Pachyonychia Congenita Consortium and conducted via the internet. Using an effectiveness scale of 1 to 5, the patients were asked to grade treatments for different manifestations, including keratoderma, cysts, follicular hyperkeratosis, fingernail and toenail involvement. RESULTS Patients reported surgical treatments being most effective for cysts and mechanical treatments the most effective conventional therapeutic approach for all other investigated manifestations. The other conventional medical treatments were found to be non-effective to only slightly effective. Among patients with keratoderma, older people were more likely to report beneficial effect from mechanical treatments (P = 0.04), topical retinoids (P = 0.04) and topical steroids (P = 0.02). Likewise, females were more inclined to report filing and grinding beneficial than males (P = 0.02). Finally, carriers of KRT16 and KRT6a were more likely to benefit from keratolytics than carriers of mutations in KRT17 (P = 0.04). CONCLUSIONS None of the currently available therapeutic options for PC are ideal, although they provide some relief, with mechanical/surgical options being preferred over medical therapies. These results emphasize the need for more efficient and targeted therapies.
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Affiliation(s)
- I Goldberg
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Abstract
Increased thickness of the epithelium imparts a white appearance to the oral mucosa by increasing the distance to the underlying blood vessels. Usually this thickening is a result of the increased formation of keratin. Some other less common causes of white lesions are acanthosis or a thickening of the spinous cell layer, edema of the epithelium, or increased fibrosis of the connective tissue thereby reducing blood vessels. Occasionally the surface of an ulcer may appear white, due to collection of fibrin on the surface. In this article the authors discuss white lesions based on putative etiology, that is, hereditary, reactive, inflammation related, immunologic, traumatic, infection related, and idiopathic.
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Affiliation(s)
- Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, Oral & Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL 32610, USA.
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Pedraz J, Peñas PF, Garcia-Diez A. Pachyonychia congenita and hidradenitis suppurativa: no response to infliximab therapy. J Eur Acad Dermatol Venereol 2008; 22:1500-1. [PMID: 18482325 DOI: 10.1111/j.1468-3083.2008.02691.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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