1
|
Iqneibi M, Al-Khawaga S, Wafi O, Steinhoff M. Successful treatment of pachyonychia congenita with simvastatin. J Eur Acad Dermatol Venereol 2024; 38:e356-e358. [PMID: 37994233 DOI: 10.1111/jdv.19630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Mariam Iqneibi
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Sara Al-Khawaga
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- School of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Omar Wafi
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- School of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
2
|
Lipner SR, Falotico JM, Matushansky JT, Evans H, Schwartz J, Hansen CD. Walking a day in a pachyonychia congenita patient's shoes: Impact on plantar pain and activity levels measured with wristband activity trackers. Indian J Dermatol Venereol Leprol 2023; 89:850-853. [PMID: 37317732 DOI: 10.25259/ijdvl_939_2022] [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: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 06/16/2023]
Abstract
Background Plantar keratoderma is a common finding in pachyonychia congenita, significantly impairing ambulation and quality of life. Due to the variation of pain reporting in pachyonychia congenita clinical studies, it is difficult to evaluate the efficacy of treatment outcomes for painful plantar keratodermas. Objectives To objectively analyse associations between plantar pain and activity levels in pachyonychia congenita patients using a wristband tracker. Methods Pachyonychia congenita patients and matched normal controls wore wristband activity trackers and completed a daily digital survey to record their highest and total pain scores (0-10 scale) each day for 28 consecutive days during four different seasons. Results Twenty four participants (12 pachyonychia congenita patients and 12 matched normal controls) completed the study. Pachyonychia congenita patients walked 1801.30 fewer steps/day (95% CI, -3666.4, 64.1) than normal controls (P = 0.072) and had greater average total [5.26; SD, 2.10] and highest (6.92; SD, 2.35) daily pain than normal controls [0.11 (SD, 0.47), 0.30 (SD, 0.22), respectively] (P < 0.001, both). On average, for each one unit increase in daily highest pain level, pachyonychia congenita activity decreased 71.54 steps/day (SE, 38.90, P = 0.066). Limitation The study had a small number of participants, limiting statistical power. Only pachyonychia congenita patients, ages 18 years or older, with keratin 6a, keratin 16, and keratin 17 mutations were included, limiting generalizability. Conclusion Pachyonychia congenita patients were less active with significantly higher pain than normal controls. There was an inverse correlation between pain and activity. Our findings suggest that wristband tracker technology may be used to evaluate treatment efficacy in future trials on severe plantar pain; therapeutic interventions that decrease plantar pain should correlate with significant increases in activity using wristband trackers.
Collapse
Affiliation(s)
- Shari R Lipner
- Department of Dermatology, Weill Cornell Medical College, New York, United States of America
| | - Julianne M Falotico
- Department of Dermatology, Renaissance School of Medicine, Stony Brook University, Stony Brook, United States of America
| | | | - Holly Evans
- Department of Dermatology, Pachyonychia Congenita Project, Salt Lake City, Utah, United States of America
| | - Janice Schwartz
- Department of Dermatology, Pachyonychia Congenita Project, Murray, Utah, United States of America
| | - C David Hansen
- Department of Dermatology, University of Utah School of Medicine, Murray, Utah, United States of America
| |
Collapse
|
3
|
Sprecher E. What do rare and common have in common? Br J Dermatol 2022; 187:279-280. [PMID: 36055765 DOI: 10.1111/bjd.21632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| |
Collapse
|
4
|
Wu TT, Eldirany SA, Bunick CG, Teng JMC. Genotype-structurotype-phenotype correlations in pachyonychia congenita patients. J Invest Dermatol 2021; 141:2876-2884.e4. [PMID: 34116063 DOI: 10.1016/j.jid.2021.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/09/2021] [Accepted: 03/21/2021] [Indexed: 01/16/2023]
Abstract
Pachyonychia congenita (PC) is a genetic disorder of keratin that presents with nail dystrophy, painful palmoplantar keratoderma, and other clinical manifestations. We investigated genotype-structurotype-phenotype correlations seen with mutations in keratin genes (KRT6A, KRT6B, KRT6C, KRT16, KRT17) and utilized protein structure modeling of high frequency mutations to examine the functional importance of keratin structural domains in PC pathogenesis. Participants of the International PC Research Registry underwent genetic testing and completed a standardized survey on their symptoms. Our results support prior reports associating oral leukokeratosis with KRT6A mutations, and cutaneous cysts, follicular hyperkeratosis, and natal teeth with KRT17 mutations. Painful keratoderma was prominent with KRT6A and KRT16 mutations. Nail involvement was most common in KRT6A and least common in KRT6C patients. Across keratin subtypes, patients with coil 2B mutations had greatest impairment in ambulation, and patients with coil 1A mutations reported more emotional issues. Molecular modeling demonstrated that hotspot missense mutations in PC largely disrupted hydrophobic interactions or surface charge. The former may destabilize keratin dimers/tetramers, while the latter likely interferes with higher-order keratin filament formation. Understanding pathologic alterations in keratin structure improves our knowledge of how PC genotype correlates with clinical phenotype, advancing insight into disease pathogenesis and therapeutic development.
Collapse
Affiliation(s)
- Tiffany T Wu
- Department of Dermatology, Stanford University, Palo Alto, CA
| | | | | | - Joyce M C Teng
- Department of Dermatology, Stanford University, Palo Alto, CA.
| |
Collapse
|
5
|
Martina E, Diotallevi F, Radi G, Campanati A, Offidani A. Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review. Toxins (Basel) 2021; 13:toxins13020120. [PMID: 33562846 PMCID: PMC7915854 DOI: 10.3390/toxins13020120] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.
Collapse
|
6
|
Abstract
Botulinum toxin type A (BoNTA) is a powerful neurotoxin that inhibits acetylcholine release from presynaptic vesicles. The potency and safety profile of BoNTA grant the toxin vast therapeutic potential. It has been used off-label for a variety of dermatologic conditions. This review aims to analyze published literature regarding the benefits and risks of the off-label use of BoNTA beyond facial lines, including eccrine hidrocystomas, enlarged pores, keloids and hypertrophic scars, hidradenitis suppurativa, hyperhidrosis, masseter muscle hypertrophy, and salivary gland hypertrophy, among others. A MEDLINE search from January 2000 to December 2019 was conducted on the off-label uses of botulinum toxin in dermatology.
Collapse
Affiliation(s)
- Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, 1430 K St NW, Suite 200, Washington, DC, 20005, USA.
| | - Iris S Harrison
- Washington Institute of Dermatologic Laser Surgery, 1430 K St NW, Suite 200, Washington, DC, 20005, USA
| |
Collapse
|
7
|
Onicodistrofia y leucoqueratosis oral en un paciente varón de 15 años. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:323-324. [DOI: 10.1016/j.ad.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 11/17/2022] Open
|
8
|
Combalia A, Fustà-Novell X, Estrach T. Thick Nails and White Tongue in a Fifteen-Year Old Male. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
9
|
Affiliation(s)
- B R Thomas
- Centre for Cell Biology and Cutaneous Research, The Blizard Institute, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, U.K.,Department of Dermatology, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, U.K
| | - A Sahota
- Department of Dermatology, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, U.K
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Jed M Paul
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | | | | | | |
Collapse
|
11
|
Koren A, Sprecher E, Reider E, Artzi O. A treatment protocol for botulinum toxin injections in the treatment of pachyonychia congenita‐associated keratoderma. Br J Dermatol 2019; 182:671-677. [DOI: 10.1111/bjd.18169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/30/2022]
Affiliation(s)
- A. Koren
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - E. Sprecher
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - E. Reider
- Department of Anesthesiology and Intensive Care Medicine and Pain Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - O. Artzi
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
| |
Collapse
|
12
|
Weinberg R, Coulombe P, Polydefkis M, Caterina M. Pain mechanisms in hereditary palmoplantar keratodermas. Br J Dermatol 2019; 182:543-551. [DOI: 10.1111/bjd.17880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/12/2022]
Affiliation(s)
- R.L. Weinberg
- Department of Neurosurgery Johns Hopkins School of Medicine Baltimore MD 21205 U.S.A
- Department of Biological Chemistry Johns Hopkins School of Medicine Baltimore MD 21205 U.S.A
- Solomon H. Snyder Department of Neuroscience Neurosurgery Pain Research Institute Johns Hopkins School of Medicine Baltimore MD 21205 U.S.A
| | - P.A. Coulombe
- Department of Cell and Developmental Biology University of Michigan Medical School Ann Arbor MI 48109 U.S.A
- Department of Dermatology University of Michigan Medical School Ann Arbor MI 48109 U.S.A
| | - M. Polydefkis
- Department of Neurology Johns Hopkins School of Medicine Baltimore MD 21205 U.S.A
| | - M.J. Caterina
- Department of Neurosurgery Johns Hopkins School of Medicine Baltimore MD 21205 U.S.A
- Department of Biological Chemistry Johns Hopkins School of Medicine Baltimore MD 21205 U.S.A
- Solomon H. Snyder Department of Neuroscience Neurosurgery Pain Research Institute Johns Hopkins School of Medicine Baltimore MD 21205 U.S.A
| |
Collapse
|
13
|
Affiliation(s)
- M A Krupiczojc
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, U.K
| | - 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, E1 2AT, U.K
| |
Collapse
|
14
|
Abdollahimajd F, Rajabi F, Shahidi-Dadras M, Saket S, Youssefian L, Vahidnezhad H, Uitto J. Pachyonychia congenita: a case report of a successful treatment with rosuvastatin in a patient with a KRT6A mutation. Br J Dermatol 2018; 181:584-586. [PMID: 30307612 DOI: 10.1111/bjd.17276] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 11/30/2022]
Abstract
Pachyonychia congenita (PC) is a rare autosomal dominant disorder characterized by nail dystrophy and palmoplantar keratoderma with severe plantar pain affecting quality of life. There is no effective treatment. Heterozygous mutations in the keratin genes KRT6A, KRT6B, KRT6C, KRT16 and KRT17 have been reported as a cause of PC. Herein we present a female patient with an amino acid substitution mutation in KRT6A (c.1381G>A, p.Glu461Lys in exon 7) and classic features of PC associated with oral leucokeratosis and follicular hyperkeratosis. We also demonstrate successful treatment of the patient with rosuvastatin. A 3.6-mm reduction in plantar callosity thickness was demonstrated by sonography. Our patient also experienced significant pain relief that allowed her to increase physical activity (Children's Dermatology Life Quality Index score dropped nine points following treatment). Collectively, these improvements suggest that rosuvastatin may offer a promising treatment for PC. What's already known about this topic? Pachyonychia congenita (PC) is an autosomal dominant disease characterized by nail dystrophy and painful plantar keratoderma. Keratolytics, emollients, retinoids and steroids have been used for treatment but with limited benefits. What does this study add? A patient with PC who had a KRT6A mutation was treated with rosuvastatin with significant improvement in plantar hyperkeratosis and pain. Statins could be a promising treatment for PC with long-term safety, but further studies are needed.
Collapse
Affiliation(s)
| | | | | | - S Saket
- Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - L Youssefian
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A.,Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Genetics, Genomics and Cancer Biology PhD Program, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - H Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A.,Biotechnology Research Center, Department of Molecular Medicine, Pasteur Institute of Iran, Tehran, Iran
| | - J Uitto
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A
| |
Collapse
|
15
|
Porter RM, Bravo AA, Smith FJ. Management of Plantar Keratodermas Lessons from Pachyonychia Congenita. J Am Podiatr Med Assoc 2017; 107:428-435. [PMID: 29077501 DOI: 10.7547/16-043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Plantar keratodermas can arise due to a variety of genetically inherited mutations. The need to distinguish between different plantar keratoderma disorders is becoming increasingly apparent because there is evidence that they do not respond identically to treatment. Diagnosis can be aided by observation of other clinical manifestations, such as palmar keratoderma, more widespread hyperkeratosis of the epidermis, hair and nail dystrophies, or erythroderma. However, there are frequent cases of plantar keratoderma that occur in isolation. This review focuses on the rare autosomal dominant keratin disorder pachyonychia congenita, which presents with particularly painful plantar keratoderma for which there is no specific treatment. Typically, patients regularly trim/pare/file/grind their calluses and file/grind/clip their nails. Topical agents, including keratolytics (eg, salicylic acid, urea) and moisturizers, can provide limited benefit by softening the skin. For some patients, retinoids help to thin calluses but may lead to increased pain. This finding has stimulated a drive for alternative treatment options, from gene therapy to alternative nongenetic methods that focus on novel findings regarding the pathogenesis of pachyonychia congenita and the function of the underlying genes.
Collapse
Affiliation(s)
| | | | - Frances J.D. Smith
- Pachyonychia Congenita Project, School of Life Sciences, University of Dundee, Dundee Scotland
| |
Collapse
|
16
|
Abstract
BotulinumtoxinA (BoNT-A) is now widely established for the main approved indication of reducing glabellar lines, and is also widely used off-label to improve the appearance of wrinkles and lines in other parts of the face. The number of aesthetic procedures continues to increase as the patient population becomes more diverse, in particular with increasing numbers of people of color and men. Further developments in treatment may continue to expand the audience for BoNT-A by making procedures more comfortable and by delivering a more natural, less static appearance. These may be achieved through use of combinations of BoNT-A with other aesthetic procedures, tailoring the dose of toxin to the patient's muscle mass or by using novel injection and application techniques. Beyond amelioration of facial lines, encouraging results have been seen with the use of BoNT-A to improve the appearance of hypertrophic and keloid scars and even to prevent them. Studies have been conducted with scars in various parts of the body and further research is ongoing. Dermatological and other medical uses for BoNT-A are also active areas of research. Injections of BoNT-A have been shown to reduce signs and symptoms of acne, rosacea, and psoriasis, to reduce neuromuscular pain, and to bring about significant improvements in a number of rare diseases that are caused or exacerbated by hyperhidrosis. This paper reviews these new uses for BoNT-A, looking at the rationale for their use and discussing the results of published case studies and clinical trials. These areas have shown great promise to date, but more and larger clinical studies will be required before these treatments become a clinical reality. To this end details are also provided of clinical trials currently listed in the main clinical trials database to highlight research areas of particular interest.
Collapse
Affiliation(s)
- Joel Schlessinger
- Dermatologist and cosmetic surgeon in private practice in Omaha, NE, USA
| | - Erin Gilbert
- Dermatologist in private practice in Brooklyn, NY, USA
| | - Joel L Cohen
- Dermatologist in private practice in Greenwood Village, CO, USA
| | | |
Collapse
|
17
|
Rittié L, Kaspar RL, Sprecher E, Smith FJD. Report of the 13th Annual International Pachyonychia Congenita Consortium Symposium. Br J Dermatol 2017; 176:1144-1147. [PMID: 28345191 DOI: 10.1111/bjd.15417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
The International Pachyonychia Congenita Consortium (IPCC) is a group of physicians and scientists from around the world dedicated to developing therapies for pachyonychia congenita, a rare autosomal dominant skin disorder. The research presented at the 13th Annual Research Symposium of the IPCC, held on 10-11 May 2016, in Scottsdale, AZ, U.S.A., is reported here.
Collapse
Affiliation(s)
- L Rittié
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, U.S.A
| | - R L Kaspar
- TransDerm Inc., 2161 Delaware Ave, Santa Cruz, CA, 95060, U.S.A
| | - E Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F J D Smith
- Pachyonychia Congenita Project, Salt Lake City, UT, U.S.A
| |
Collapse
|
18
|
Campanati A, Martina E, Giuliodori K, Consales V, Bobyr I, Offidani A. Botulinum Toxin Off-Label Use in Dermatology: A Review. Skin Appendage Disord 2017; 3:39-56. [PMID: 28612001 DOI: 10.1159/000452341] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/05/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum which causes a flaccid muscle paralysis. It is currently used for aesthetic treatments and in the focal hyperhidrosis. Recently, botulinum toxin has also been used experimentally in many other dermatological conditions with good results. OBJECTIVE To review and analyze the possible botulinum toxin off-label applications published. METHODS A retrospective review of the published data was conducted. CONCLUSIONS this potent drug can lead to several off-label indications of interest for dermatologists. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and dose protocols.
Collapse
Affiliation(s)
- Anna Campanati
- Dermatology Unit, Department of Clinical and Molecular Sciences, United Hospital of Ancona, Polytechnic Marche University, Ancona, Italy
| | - Emanuela Martina
- Dermatology Unit, Department of Clinical and Molecular Sciences, United Hospital of Ancona, Polytechnic Marche University, Ancona, Italy
| | - Katia Giuliodori
- Dermatology Unit, Department of Clinical and Molecular Sciences, United Hospital of Ancona, Polytechnic Marche University, Ancona, Italy
| | - Veronica Consales
- Dermatology Unit, Department of Clinical and Molecular Sciences, United Hospital of Ancona, Polytechnic Marche University, Ancona, Italy
| | - Ivan Bobyr
- Dermatology Unit, Department of Clinical and Molecular Sciences, United Hospital of Ancona, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, United Hospital of Ancona, Polytechnic Marche University, Ancona, Italy
| |
Collapse
|
19
|
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.
Collapse
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
| | | | | |
Collapse
|
20
|
González-Ramos J, Sendagorta-Cudós E, González-López G, Mayor-Ibarguren A, Feltes-Ochoa R, Herranz-Pinto P. Efficacy of botulinum toxin in pachyonychia congenita type 1: report of two new cases. Dermatol Ther 2015; 29:32-6. [PMID: 26445325 DOI: 10.1111/dth.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pachyonychia congenita (PC) is a rare genodermatosis caused by a mutation in keratin genes, which can lead to hypertrophic nail dystrophy and focal palmoplantar keratoderma (predominantly plantar), amongst other manifestations. Painful blisters and callosities, sometimes exacerbated by hyperhidrosis, are major issues that can have a significant impact on patient quality of life. Many alternative treatments for this condition have been applied with variable and partial clinical response, but a definitive cure for this disease has yet to be discovered. After obtaining informed consent, two patients with genetically confirmed PC type 1 were treated with plantar injections of botulinum toxin type A. Both patients showed a marked improvement in pain and blistering with an average response time of one week, a six-month mean duration of effectiveness, and a lack of any side effects or tachyphylaxis.
Collapse
Affiliation(s)
| | | | | | | | - Rosa Feltes-Ochoa
- Department of Dermatology, La Paz University Hospital, Madrid, Spain
| | | |
Collapse
|
21
|
Jiráková A, Rajská L, Rob F, Džambová M, Sečníková Z, Göpfertová D, Schwartz M, Smith F, Lotti T, Hercogová J. First case of pachyonychia congenita in the Czech Republic. Dermatol Ther 2014; 28:10-2. [PMID: 25174302 DOI: 10.1111/dth.12142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pachyonychia congenita (PC) is a rare autosomal dominant skin disorder characterized predominantly by hypertrophic nail dystrophy, oral leukokeratosis, and painful palmoplantar keratoderma. It is associated with a mutation in one of five keratin genes, KRT6A, KRT6B, KRT6C, KRT16, or KRT17. The International PC Research Registry (IPCRR) confirms that as of January 2014 there have been 547 cases of PC genetically confirmed. It is estimated that there are between 2000 and 10,000 cases of PC in the world. However, the exact prevalence of PC is not yet established. We report a case of PC-K6a, p.Arg164Pro, in a 40-year-old man. Initially he was diagnosed with onychomycosis and was treated with systemic antifungals. This is the first genetically confirmed case of PC in the Czech Republic.
Collapse
Affiliation(s)
- Anna Jiráková
- Department of Dermatovenerology, 2nd Faculty of Medicine, Charles University, Bulovka Hospital, Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Pachyonychia congenita: Report of two cases and mutation analysis. DERMATOL SIN 2012. [DOI: 10.1016/j.dsi.2012.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
23
|
Chamcheu JC, Wood GS, Siddiqui IA, Syed DN, Adhami VM, Teng JM, Mukhtar H. Progress towards genetic and pharmacological therapies for keratin genodermatoses: current perspective and future promise. Exp Dermatol 2012; 21:481-9. [PMID: 22716242 PMCID: PMC3556927 DOI: 10.1111/j.1600-0625.2012.01534.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hereditary keratin disorders of the skin and its appendages comprise a large group of clinically heterogeneous disfiguring blistering and ichthyotic diseases, primarily characterized by the loss of tissue integrity, blistering and hyperkeratosis in severely affected tissues. Pathogenic mutations in keratins cause these afflictions. Typically, these mutations in concert with characteristic features have formed the basis for improved disease diagnosis, prognosis and most recently therapy development. Examples include epidermolysis bullosa simplex, keratinopathic ichthyosis, pachyonychia congenita and several other tissue-specific hereditary keratinopathies. Understanding the molecular and genetic events underlying skin dysfunction has initiated alternative treatment approaches that may provide novel therapeutic opportunities for affected patients. Animal and in vitro disease modelling studies have shed more light on molecular pathogenesis, further defining the role of keratins in disease processes and promoting the translational development of new gene and pharmacological therapeutic strategies. Given that the molecular basis for these monogenic disorders is well established, gene therapy and drug discovery targeting pharmacological compounds with the ability to reinforce the compromised cytoskeleton may lead to promising new therapeutic strategies for treating hereditary keratinopathies. In this review, we will summarize and discuss recent advances in the preclinical and clinical modelling and development of gene, natural product, pharmacological and protein-based therapies for these disorders, highlighting the feasibility of new approaches for translational clinical therapy.
Collapse
Affiliation(s)
- Jean Christopher Chamcheu
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Feily A, Fallahi H, Zandian D, Kalantar H. A succinct review of botulinum toxin in dermatology; update of cosmetic and noncosmetic use. J Cosmet Dermatol 2011; 10:58-67. [PMID: 21332916 DOI: 10.1111/j.1473-2165.2010.00545.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Botulinum toxin A has a wide variety of clinical applications in medical and dermatologic sciences. Nowadays, researchers introduce some other indications for botulinum toxin in cosmetic and especially noncosmetic aspects of dermatology such as medical rhinoplasty, hypertrophic scar, chemical brow lift, supraciliary wrinkles, pompholix, eccrine angiomatosis, Hailey-Hailey, dermatochalasis, lichen simplex, nosthalgia parestetica, and granulosis rubra nasi. In this general overview of the use of botulinum toxin in dermatology, an extensive literature search was carried out to updates of all dermatology-oriented experiments and clinical trials on the mentioned aspect of botulinum toxin.
Collapse
Affiliation(s)
- Amir Feily
- Department of Dermatology, Jondishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | | |
Collapse
|
25
|
Swartling C, Karlqvist M, Hymnelius K, Weis J, Vahlquist A. Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita. Br J Dermatol 2011; 163:1072-6. [PMID: 20618323 DOI: 10.1111/j.1365-2133.2010.09927.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Painful foot blistering is a common problem in patients with epidermolysis bullosa simplex (EBS) and pachyonychia congenita (PC). Hyperhidrosis, a condition which can be effectively blocked by plantar injections of botulinum toxin (Btx), often exacerbates the blistering. OBJECTIVES A retrospective evaluation of the effects of Btx injections in 14 patients with EBS and PC with foot blisters and painful callosities. METHODS After informed consent, patients with EBS (n = 6) and PC (n = 8), aged 7-66 years, who had received Btx therapy at our centre since 2003, were included. The treatment consisted of multiple plantar injections of Btx A or Btx B after prior regional or general anaesthesia. Patients were interviewed about the treatment effect and were asked to score the improvement from 0 to 5, where 5 is 'excellent'. One patient with PC with painful callosities was studied by magnetic resonance (MR) spectroscopic microimaging before and after Btx injections to disclose any underlying blisters. RESULTS In total, 76 treatments were evaluated (one to 19 sessions per patient). Thirteen patients (93%) reported reduced plantar blistering and pain; the improvement score was ≥ 4 in four of six patients with EBS and six of eight patients with PC. The mean effect duration was 3 months. No adverse events, apart from mild anticholinergic side-effects in two patients, were noted. MR spectroscopic microimaging showed disappearance of intraepidermal blistering after Btx therapy. CONCLUSIONS Plantar injection of Btx is an efficient, long-lasting and safe treatment of painful blistering and callosities in EBS and PC that can be given repeatedly without loss of efficacy.
Collapse
Affiliation(s)
- C Swartling
- Department of Dermatology, County Council of Gävleborg, Uppsala University, University Hospital, SE-751 85 Uppsala, Sweden.
| | | | | | | | | |
Collapse
|
26
|
Abstract
The recessive forms of epidermolysis bullosa (EB) are common in Scandinavia, especially in the northern parts of Norway and Sweden. The daily care of EB in Scandinavia is organized around the patient via settings at the local hospital or health service. However, the diagnosis of EB and providing correct patient/family information usually require a specialized service. Specialized EB care in Scandinavia is mainly provided by dermatologists, pediatricians, and dentists working together in a team. The increasing number of EB families with foreign ethnic backgrounds and language problems is a challenge to the health service, especially in Sweden, and demands increased facilities. Also, the high expectations by parents of children with junctional EB and recessive dystrophic EB about new, revolutionizing therapies are challenges that can only be met by international collaboration and more research in specialized centers for EB. A close collaboration with patient organizations and various charity organizations will be very helpful in this respect.
Collapse
Affiliation(s)
- Anders Vahlquist
- Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden.
| | | |
Collapse
|
27
|
Zamiri M, Wylie D, Munro CS. Peripheral nerve blockade for biopsy of plantar skin. Br J Dermatol 2010; 163:219-21. [PMID: 20346024 DOI: 10.1111/j.1365-2133.2010.09780.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
La toxine botulique dans les maladies dermatologiques invalidantes. Ann Dermatol Venereol 2009; 136 Suppl 4:S129-36. [DOI: 10.1016/s0151-9638(09)74540-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
29
|
Liao H, Sayers JM, Wilson NJ, Irvine AD, Mellerio JE, Baselga E, Bayliss SJ, Uliana V, Fimiani M, Lane EB, McLean WHI, Leachman SA, Smith FJD. A spectrum of mutations in keratins K6a, K16 and K17 causing pachyonychia congenita. J Dermatol Sci 2007; 48:199-205. [PMID: 17719747 DOI: 10.1016/j.jdermsci.2007.07.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 07/04/2007] [Accepted: 07/10/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pachyonychia congenita (PC) is a rare autosomal dominant keratin disorder, subdivided into two major variants, PC-1 and PC-2. Predominant characteristics include hypertrophic nail dystrophy, focal palmoplantar keratoderma and oral leukokeratosis. Multiple steatocystomas that develop during puberty are a useful feature distinguishing PC-2 from PC-1. At the molecular level it has been shown that mutations in keratin K6a or K16 cause PC-1 whereas those in K6b or K17 lead to PC-2. OBJECTIVE To identify mutations in 22 families presenting with clinical symptoms of either PC-1/focal non-epidermolytic palmoplantar keratoderma (FNEPPK) or PC-2. METHODS Mutation analysis was performed on genomic DNA from PC patients by direct sequencing. RESULTS Here, we report four new missense and five known mutations in K6a; one new deletion and three previously identified missense mutations in K16; plus one known mutation in K17. CONCLUSION With one exception, all these heterozygous mutations are within the highly conserved helix boundary motif regions at either end of the keratin rod domain. In one sporadic case, a unique mutation in K16 resulting in deletion of 24bp was found within the central rod domain, in a child with a phenotype predominantly consisting of focal plantar keratoderma. The identification of mutations in cases of PC is prerequisite for future development of gene-specific and/or mutation-specific therapies.
Collapse
Affiliation(s)
- Haihui Liao
- Epithelial Genetics Group, Human Genetics Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|