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Generalized Acquired Cutis Laxa Associated with Monoclonal Gammopathy of Dermatological Significance. Case Rep Dermatol Med 2020; 2020:7480607. [PMID: 32099688 PMCID: PMC7037480 DOI: 10.1155/2020/7480607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 01/11/2023] Open
Abstract
Background Cutis laxa is a rare dermatosis that is inherited or acquired and clinically features loose, wrinkled, and redundant skin with decreased elasticity. This heterogeneous connective tissue disorder may be localized or generalized, with or without internal manifestations. Generalized cutis laxa often has a cephalocaudal progression and is attributed to inflammatory cutaneous eruptions, medications, and infections. Cutis laxa is also associated with several other conditions including rheumatoid arthritis, systemic lupus erythematosus, and plasma-cell dyscrasias. Case Presentation. We report an unusual case of a 35-year-old male with progression of generalized acquired cutis laxa and vasculitis that occurred over a period of one year. No cutaneous inflammatory eruption preceded or accompanied his decreased skin elasticity, and a biopsy of the skin showed elastolysis. His cutaneous manifestation led to systemic evaluation and an eventual diagnosis of smoldering multiple myeloma accompanied by aortitis and anemia. His myeloma and vasculitis were successfully treated with cyclophosphamide, bortezomib, and dexamethasone and high-dose prednisone, respectively, with no improvement to his cutis laxa. Conclusions The presence of monoclonal gammopathy is strongly associated with several dermatological entities such as acquired cutis laxa. We propose a new term for the dermatological manifestations caused by paraproteinemia: monoclonal gammopathy of dermatological significance, or MGODS, and stress the evaluation of an underlying gammopathy in the setting of certain dermatologic conditions, including scleromyxedema and amyloidosis. We present a case of a newly acquired cutis laxa secondary to plasma-cell dyscrasias that exemplifies MGODS, alongside a brief literature review, and underscore the clinical relevance of monoclonal gammopathies of dermatological significance.
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Wetzel M, Owen CE, Callen JP. Paraneoplastic Syndromes for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00277-y] [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]
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Tan S, Pon K, Bargman J, Ghazarian D. Generalized Cutis Laxa Associated with Heavy Chain Deposition Disease. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Cutis laxa is a heterogeneous group of inherited and acquired disorders characterized clinically by loose skin and histologically by altered elastic tissue. Heavy chain deposition disease is a very rare monoclonal immunoglobulin disorder, distinct from multiple myeloma, in which there is production and deposition of defective immunoglobulin heavy chains without light chain deposition. Objective: We describe a case of acquired cutis laxa associated with heavy chain deposition disease. Results: A 50-year-old male presented with acute renal failure, IgG4 heavy chain deposition in the kidneys, and no evidence of multiple myeloma. Four years later, he developed generalized acquired cutis laxa, emphysema, and a peripheral polyneuropathy. On pathology, there was destruction of elastic fibers within the dermis. Conclusion: This case describes a previously unreported association between acquired cutis laxa and heavy chain deposition disease. Antécédents: Cutis laxa est un groupe hétérogène de troubles héréditaires et acquis qui se caractérise cliniquement par un relâchement de la peau et histologiquement par l'altération du tissu élastique. La maladie des chaînes lourdes est un trouble très rare de l'immunoglobuline monoclonale, différent du myélome multiple où il y a production et dépôt de chaînes lourdes, sans chaînes légères, de l'immunoglobuline déficiente. Objectif: Description d'un cas non conventionnel de cutis laxa acquise associée à une maladie des chaînes légères. Méthodes: Description du cas et aperçu de cutis laxa. Observation: Un homme de 50 ans présente une insuffisance rénale, des dépêts dans les reins de chaînes lourdes IgG4 et aucune preuve de myélome multiple. Quatre ans plus tard, il développe une cutis laxa généralisée acquise, un emphysème et une Polyneuropathie périphérique. La pathologie a montré une destruction des fibres élastiques du derme. Conclusion: Ce cas décrit une association jamais établie auparavant entre cutis laxa et une maladie des chaînes lourdes.
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Affiliation(s)
- Stephen Tan
- University Hospital, Indianapolis, Indiana, USA
| | - Kucy Pon
- University Hospital, Indianapolis, Indiana, USA
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Slingerland NWR, Sonneveld P, Hollander JCD, Bleyen I. Marked bilateral lower eyelid ectropion in cutis laxa: a paraneoplastic process in multiple myeloma. Orbit 2012; 31:174-176. [PMID: 22551370 DOI: 10.3109/01676830.2011.648808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To describe a bilateral involutional lower eyelid ectropion in a patient with cutis laxa, a paraneoplastic process in multiple myeloma. DESIGN Case report. RESULTS A 60-year-old male presented with a marked involutional left lower eyelid ectropion. Systemic history included cutis laxa, a paraneoplastic feature of multiple myeloma. After surgical treatment, the ectropion recurred; furthermore, a right lower eyelid ectropion developed. In addition, a distinct dermatochalasis of both upper eyelids was present. CONCLUSIONS This case is the first description of a marked bilateral involutional ectropion in cutis laxa acquisita.
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Affiliation(s)
- N W R Slingerland
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Berk DR, Bentley DD, Bayliss SJ, Lind A, Urban Z. Cutis laxa: A review. J Am Acad Dermatol 2012; 66:842.e1-17. [DOI: 10.1016/j.jaad.2011.01.004] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 12/05/2010] [Accepted: 01/03/2011] [Indexed: 12/17/2022]
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Sun XK, Chen JF. No mutation of elastin and fibulin-5 genes in a patient with acquired cutis laxa associated with chronic urticaria. Br J Dermatol 2010; 164:215-7. [DOI: 10.1111/j.1365-2133.2010.10049.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Turner RB, Haynes HA, Granter SR, Miller DM. Acquired cutis laxa following urticarial vasculitis associated with IgA myeloma. J Am Acad Dermatol 2009; 60:1052-7. [PMID: 19467378 DOI: 10.1016/j.jaad.2008.09.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 09/12/2008] [Accepted: 09/24/2008] [Indexed: 11/19/2022]
Abstract
Cutis laxa (CL) is an inherited or acquired connective tissue disorder characterized clinically by loosely hanging skin folds. There is often preceding cutaneous inflammatory eruption (ie, urticaria, eczema, erythema multiforme), and there is frequently internal organ involvement of the gastrointestinal, urogenital, pulmonary, and cardiovascular systems. Histologically, there are degenerative changes in the dermal elastic fibers. Of the few reports on this rare disorder, authors have speculated about an immune-mediated destruction of elastic fibers, and monoclonal gammopathies, such as multiple myeloma or heavy chain deposition disease, have a recognized association with CL. We report an unusual case of rapidly progressing acquired CL associated with leukocytoclastic vasculitis, IgA myeloma, and an immune complex-mediated glomerulonephritis. Light microscopy of the lax skin revealed complete absence of elastic fibers in areas of vasculitis.
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Affiliation(s)
- Ryan B Turner
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Harrington CR, Beswick TC, Susa JS, Pandya AG. Acquired cutis laxa associated with heavy chain deposition disease. J Am Acad Dermatol 2008; 59:S99-101. [DOI: 10.1016/j.jaad.2008.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 05/02/2008] [Accepted: 05/04/2008] [Indexed: 11/26/2022]
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GARCÍA-PATOS V, PUJOL R, BARNADAS M, PÉREZ M, MORENO A, CONDOMINES J, GELPI C, RODRÍGUEZ J, DE MORAGAS J. Generalized acquired cutis laxa associated with coeliac disease: evidence of immunoglobulin A deposits on the dermal elastic fibres. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-950.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Frémont G, Kérob D, Prost-Squarcioni C, Lièvre N, Rivet J, Tancrède E, Servant JM, Fermand JP, Morel P, Lebbé C. Cutis laxa acquise généralisée associée à un myélome : découverte de grandes cellules vacuolisées dermiques. Ann Dermatol Venereol 2007; 134:548-51. [PMID: 17657181 DOI: 10.1016/s0151-9638(07)89266-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cutis laxa is a rare disorder characterized by loss of elastic tissue. Several organs are often involved such as the skin, lungs, heart, digestive system or genitourinary tract. It may be inherited or acquired, generalized or localized. Its pathogenesis is unclear. Association of acquired cutis laxa with myeloma or plasma cell dyscrasia is very rare. We report a case of acquired cutis laxa associated with a myeloma. CASE REPORT A 59 year-old woman was admitted for skin hyperlaxity present for a number of years. Light microscopic examination of a skin sample revealed fragmented elastic fibers. Electron microscopic examination of the elastic network demonstrated numerous large vacuolated cells with the appearance of macrophages around abnormal elastic and collagen fibers of the reticular dermis. In addition, a stage-1 IgG lambda myeloma was detected. The patient was treated by thalidomide for one year. After this treatment, electron microscopy examination did not reveal any large vacuolated cells in the dermis, and elastic and collagen fibers were not modified and skin laxity seemed to be stabilized. DISCUSSION Acquired cutis laxa may be associated with many systemic diseases or can appear after inflammatory skin diseases. Seven cases of generalized cutis laxa associated with myeloma and four cases associated with plasma cell dyscrasia have been reported in the literature. In our case, as in 2 previously described cases, large vacuolated cells resembling macrophages were seen in the dermis. They were thought to play a role in cutis laxa.
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Affiliation(s)
- G Frémont
- Service de Dermatologie, Hôpital Saint Louis, Paris
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Riveros CJP, Gavilán MFB, França LFS, Sotto MN, Takahashi MDF. Acquired localized cutis laxa confined to the face: case report and review of the literature. Int J Dermatol 2004; 43:931-5. [PMID: 15569023 DOI: 10.1111/j.1365-4632.2004.01946.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutis laxa is an uncommon entity characterized by laxity of the skin, which hangs in loose folds, producing the appearance of premature aging. It can be subdivided into congenital and acquired. This latter variant is rare and the skin involvement varies from generalized to localized. We report a case of a localized acquired cutis laxa confined to the face, without preceding inflammatory lesions or systemic compromise. Four similar cases have been reported to date. The etiology remains unknown and there is no definitive treatment. METHODS A 27-year-old White woman came to our hospital with a wrinkled face, pendulous earlobes and drop eyelids. Changes began 5 years prior, and she appeared much older than her age. RESULTS Histological analysis and ultrastructural examination of skin biopsy revealed reduction and fragmentation of elastic fibers, confirming the diagnosis of cutis laxa. No systemic involvement was diagnosed. The patient was submitted to plastic surgery for repair, with satisfactory results to date. CONCLUSIONS Acquired localized cutis laxa confined to the face without preceding inflammatory lesions is extremely rare. The etiology remains unknown. Clinical features and histopathologic findings confirm the diagnosis. Surgical repair seems to be the only therapeutic choice, but the results are variable and temporary.
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Lewis KG, Bercovitch L, Dill SW, Robinson-Bostom L. Acquired disorders of elastic tissue: Part II. decreased elastic tissue. J Am Acad Dermatol 2004; 51:165-85; quiz 186-8. [PMID: 15280835 DOI: 10.1016/j.jaad.2004.03.016] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Elastic fibers in the extracellular matrix are integral components of dermal connective tissue. The resilience and elasticity required for normal structure and function of the skin are attributable to the network of elastic tissue. Advances in our understanding of elastic tissue physiology provide a foundation for studying the pathogenesis of elastic tissue disorders. Many acquired disorders are nevertheless poorly understood owing to the paucity of reported cases. Several acquired disorders in which loss of dermal elastic tissue produces prominent clinical and histopathologic features have recently been described, including middermal elastolysis, papular elastorrhexis, and pseudoxanthoma-like papillary dermal elastolysis, which must be differentiated from more well-known disorders such as anetoderma, acquired cutis laxa, and acrokeratoelastoidosis. Learning objective At the conclusion of this learning activity, participants should have an understanding of the similarities and differences between acquired disorders of elastic tissue that are characterized by a loss of elastic tissue.
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Affiliation(s)
- Kevan G Lewis
- Department of Dermatology, Brown Medical School-Rhode Island Hospital, Providence, RI 02903, USA
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Dicker TJ, Morton J, Williamson RM, Chick J. Myeloma-associated systemic amyloidosis presenting with acquired digital cutis laxa-like changes. Australas J Dermatol 2002; 43:144-6. [PMID: 11982574 DOI: 10.1046/j.1440-0960.2002.00579.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 59-year-old woman presented with a 6-year history of lax skin on the distal fingers of both hands, as well as a recent increase in the size of her tongue. Histopathology of skin from her distal finger showed amyloid deposition and bone marrow biopsy revealed an underlying plasma cell dyscrasia. Initial treatment with cyclophosphamide, vincristine, adriamycin and methylprednisolone has produced a significant reduction in the swelling of both her hands and tongue. Acquired digital cutis laxa-like changes are a rare cutaneous manifestation of systemic amyloidosis.
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Affiliation(s)
- Tony J Dicker
- Department of Dermatology, Royal Brisbane Hospital, Post Office, Herston, Queensland 4029, Australia.
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Abstract
PURPOSE To report ocular findings in a patient with cutis laxa acquisita. METHODS Case report RESULTS A 44-year-old man complained of excessively loose skin for 4 years and had no family history of skin disease. Dermatological examination showed lax and wrinkled skin all over his body. He had bilateral subconjunctival fat prolapse and dermatochalasis. CONCLUSIONS This case of acquired form of cutis laxa is noteworthy because subconjunctival fat prolapse and dermatochalasis are uncommon at this relatively young age.
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Affiliation(s)
- Meltem F Söylev
- Department of Ophthalmology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Rongioletti F, Cutolo M, Bondavalli P, Rebora A. Acral localized acquired cutis laxa associated with rheumatoid arthritis. J Am Acad Dermatol 2002; 46:128-30. [PMID: 11756959 DOI: 10.1067/mjd.2002.117394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report the first case of the acral localization of the acquired form of cutis laxa associated with severe rheumatoid arthritis. The skin laxity was preceded by episodes of itching and swelling of the hands and feet. Histopathology showed that the elastic fibers were lost in the areas of cutis laxa and decreased in adjacent skin. The pathogenetic relationship with rheumatoid arthritis or the intake of related drugs is discussed.
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Affiliation(s)
- Franco Rongioletti
- Department of Endocrinological and Metabolic Disease, Section of Dermatology, and University of Genoa, Italy
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Kasper RC, Wood GS, Nihal M, LeBoit PE. Anetoderma arising in cutaneous B-cell lymphoproliferative disease. Am J Dermatopathol 2001; 23:124-32. [PMID: 11285407 DOI: 10.1097/00000372-200104000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anetoderma is circumscribed atrophy of the skin due to a localized deficiency in elastic tissue. It can follow inflammatory skin diseases of several types, and occasionally is present in the skin around neoplasms. There are a few reports of anetoderma in the lesional skin of cutaneous lymphoma. We report on two patients who presented with multiple lesions of anetoderma and who later proved to have low-grade cutaneous B-cell lymphomas. One patient (Patient 1) is a 39-year-old man and the other patient is a 26-year-old woman who is a renal transplant recipient (Patient 2). Some biopsy specimens from the anetodermic skin of Patient 1 appeared to show an urticarial reaction, although plasma cells were present. A large nodule showed lymphoid follicles surrounded by plasmacytoid lymphocytes, with loss of elastic tissue in the adjacent dermis. The plasmacytoid cells stained overwhelmingly for lambda light chain, and staining of the urticarial lesions from this patient also showed a marked majority of lambda positive cells. Immunoglobulin heavy chain gene (IgH) rearrangements showed a dominant clonal pattern in the nodular lesion. We classified the disease in Patient 1 as marginal zone lymphoma and the disease in Patient 2 as a post-transplant lymphoproliferative disorder. Because of the intimate association of anetoderma and cutaneous B-cell lymphoproliferative disorders in these two patients, it seems possible that anetoderma could result from either a local effect of the neoplastic cells or associated inflammatory cells, especially neutrophils as in Case 1. The infiltrates of Case 1 had many interstitial neutrophils and only a few clonal plasmacytoid lymphocytes, indicating that this presentation of B-cell lymphoma can be a diagnostic pitfall. Given these two cases and similar ones in the literature, biopsy of lesional skin in anetoderma should be performed to ensure that lymphomatous infiltrates are not present. Even if plasma cells are sparse, studies to detect clonality are appropriate. Cutaneous B-cell lymphoma can be added to the list of associations of elastolysis and cutaneous lymphoma, which includes granulomatous slack skin (T-cell lymphoma) and cutis laxa (myeloma).
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MESH Headings
- Adult
- Atrophy/pathology
- Cutis Laxa/etiology
- Cutis Laxa/genetics
- Cutis Laxa/metabolism
- Cutis Laxa/pathology
- Cyclosporine/adverse effects
- DNA/analysis
- Elastic Tissue/pathology
- Female
- Fluorescein-5-isothiocyanate
- Gene Rearrangement, B-Lymphocyte, Heavy Chain
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunocompromised Host
- Immunohistochemistry
- In Situ Hybridization
- Kidney Transplantation/adverse effects
- Leukemia, Lymphocytic, Chronic, B-Cell/chemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoproliferative Disorders/complications
- Lymphoproliferative Disorders/pathology
- Lymphoproliferative Disorders/virology
- Male
- Polymerase Chain Reaction
- RNA, Viral/analysis
- Skin Neoplasms/chemistry
- Skin Neoplasms/complications
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Tacrolimus/adverse effects
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Affiliation(s)
- R C Kasper
- Department of Pathology, University of California, San Francisco 94115, USA
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Joss N, Boulton-Jones JM, More I. Premature ageing and glomerulonephritis. Nephrol Dial Transplant 2001; 16:615-8. [PMID: 11239041 DOI: 10.1093/ndt/16.3.615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Joss
- Renal Unit, Glasgow Royal Infirmary, Pathology Department, Western Infirmary, Glasgow, UK
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Daoud MS, Lust JA, Kyle RA, Pittelkow MR. Monoclonal gammopathies and associated skin disorders. J Am Acad Dermatol 1999; 40:507-35; quiz 536-8. [PMID: 10188670 DOI: 10.1016/s0190-9622(99)70434-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The monoclonal gammopathies are characterized by clonal proliferation of plasma cells and other clonally related cells in the B-cell lineage. These disorders include monoclonal gammopathy of undetermined significance, multiple myeloma, Waldenström macroglobulinemia, heavy chain diseases, plasmacytoma, and primary amyloidosis. Many skin disorders have been described in association with monoclonal gammopathies. This article provides an introduction to the definition, detection, natural course, and spectrum of monoclonal gammopathies and a brief discussion of pathogenesis. The article also reviews the skin disorders associated with monoclonal gammopathies, categorizes the association, and evaluates the strength of the association.
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Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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Nikko A, Dunnigan M, Black A, Cockerell CJ. Acquired cutis laxa associated with a plasma cell dyscrasia. Am J Dermatopathol 1996; 18:533-7. [PMID: 8902101 DOI: 10.1097/00000372-199610000-00013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Acquired cutis laxa (generalized acquired elastolysis) is characterized by skin laxity often with systemic involvement of the lungs, aorta, gastrointestinal tract, and pelvic organs. Although there have been many speculations regarding its pathogenesis, the etiology of this condition is still unclear. We describe a patient with generalized acquired cutis laxa associated with a plasma cell dyscrasia. Immunofluorescence studies were used to evaluate the pathogenesis of the elastolysis. Lesional skin was examined by direct and indirect immunofluorescence techniques for evidence of deposition of immunoglobulins on elastic fibers in the dermis. Direct immunofluorescence revealed deposition of IgG on elastic fibers in the dermis. Some patients with acquired cutis laxa have underlying lymphoreticular disorders such as plasma cell dyscrasia and may have immunoglobulins deposited on dermal elastic fibers. Immune-mediated mechanisms may play a major role in the pathogenesis of acquired cutis laxa in at least some cases.
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Affiliation(s)
- A Nikko
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA
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GARCÍA-PATOS V, PUJOL R, BARNADAS M, PÉREZ M, MORENO A, CONDOMINES J, GELPI C, RODRÍGUEZ J, MORAGAS J. Generalized acquired cutis laxa associated with coeliac disease: evidence of immunoglobulin A deposits on the dermal elastic fibres. Br J Dermatol 1996. [DOI: 10.1111/j.1365-2133.1996.tb03625.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A 31-year-old man had cutis laxa after an urticarial eruption. He had no systemic manifestations. In urticarial lesions, elastolysis occurred only within the inflammatory infiltrate of neutrophils around the vessels and between the collagen bundles. In lax skin, elastolysis occurred throughout the entire dermis. Electron microscopic study showed a markedly decreased number of elastic fibers, with elastolysis most predominant near the inflammatory cells. These findings suggest that the neutrophil plays a significant role in the destruction of elastic fibers and subsequent development of cutis laxa.
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Affiliation(s)
- S I Chun
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
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Van Maldergem L, Vamos E, Liebaers I, Petit P, Vandevelde G, Simonis-Blumenfrucht A, Bouffioux R, Kulakowski S, Hanquinet S, Van Durme P. Severe congenital cutis laxa with pulmonary emphysema: a family with three affected sibs. AMERICAN JOURNAL OF MEDICAL GENETICS 1988; 31:455-64. [PMID: 3232707 DOI: 10.1002/ajmg.1320310226] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Clinical and morphologic findings in 3 sibs with congenital cutis laxa are presented. A severe urinary malformation in one affected infant is reported in detail. Elevated serum copper concentrations were observed in 2 of the sibs and in the healthy mother. However, the 64Cu uptake of fibroblast cells from tissue culture was not increased. Ultrastructural pathologic findings from skin biopsies have been studied and compared at birth and at age 2 years. The lack of junction between the 2 elastic fiber components was similar. Further evidence for clinical heterogeneity of this disease is stressed.
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Affiliation(s)
- L Van Maldergem
- Department of Pediatrics, Hôpital Universitaire Saint-Pierre, Brusssels, Belgium
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Abstract
A 10-year-old boy developed cutis laxa while receiving isoniazid therapy; no systemic manifestations occurred. There are several well-documented cases of acquired cutis laxa. We propose a classification of the elastolysis syndromes, including inherited, neonatal, and acquired forms of cutis laxa.
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