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Bui TNPT, Corap A, Bygum A. Cutis marmorata telangiectatica congenita: a literature review. Orphanet J Rare Dis 2019; 14:283. [PMID: 31801575 PMCID: PMC6894123 DOI: 10.1186/s13023-019-1229-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
Background Cutis marmorata telangiectatica congenita (CMTC) is a rare capillary malformation characterised by persistent reticulated marbled erythema. It tends to be associated with cutaneous atrophy, ulcerations and body asymmetry. CMTC is usually reported to be a benign condition; however, associated anomalies are not rare. Here, we have compiled information on published CMTC patients with the aim to evaluate the proposed diagnostic criteria by Kienast et al. and address the clinical manifestations, associated anomalies, differential diagnoses, management and prognosis. Our review is based on a search of the PubMed database which retrieved studies between 1922 and April 2019. The search yielded 148 original articles with a total of 485 patients. Results Of the identified patients, 24.5% had generalised CMTC, 66.8% had localised and 8.7% had a non-specified distribution of CMTC. Associated anomalies were observed in 42.5% of patients, predominantly body asymmetry and neurological defects like seizure and developmental delay. Fewer patients (10.1%) had ophthalmological defects, usually glaucoma. The major criterium “absence of venectasia” was not met in 20.4% of patients. Conclusion We suggest that children with CMTC should be referred to an ophthalmologist for regular follow-up, and children with CMTC affecting the legs should be monitored for leg length discrepancy throughout the growth period. Furthermore, we suggest reconsideration of the major criterium “absence of venectasia” from the proposed diagnostic criteria, and instead include body asymmetry.
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Affiliation(s)
- Teresa Nu Phuong Trinh Bui
- Department of Dermatology and Allergy Centre, J.B. Winsløws Vej 4, Entrance 142, 5000, Odense C, Denmark. .,Department of Clinical Genetics, J.B.Winsløws Vej 4, Entrance 24, 5000, Odense C, Denmark.
| | - Ayse Corap
- Department of Dermatology and Allergy Centre, J.B. Winsløws Vej 4, Entrance 142, 5000, Odense C, Denmark.,Department of Clinical Genetics, J.B.Winsløws Vej 4, Entrance 24, 5000, Odense C, Denmark
| | - Anette Bygum
- Department of Dermatology and Allergy Centre, J.B. Winsløws Vej 4, Entrance 142, 5000, Odense C, Denmark.,Department of Clinical Genetics, J.B.Winsløws Vej 4, Entrance 24, 5000, Odense C, Denmark
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2
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Happle R. Syndrome mit vaskulären Anomalien der Haut. Hautarzt 2019; 70:474-480. [DOI: 10.1007/s00105-019-4418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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3
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Dutta A, Ghosh SK, Bandyopadhyay D, Bhanja DB, Biswas SK. Phakomatosis Pigmentovascularis: A Clinical Profile of 11 Indian Patients. Indian J Dermatol 2019; 64:217-223. [PMID: 31148861 PMCID: PMC6537679 DOI: 10.4103/ijd.ijd_385_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Phakomatosis pigmentovascularis (PPV) is a rare congenital syndrome characterized by the simultaneous presence of capillary malformation and pigmentary nevi. The objective of our study was to describe the clinical characteristics of a series of Indian patients presenting with this rare entity. Materials and Methods: It was a record-based descriptive case series. Results: A total of 11 patients with PPV (9 females, 2 males, age range: 7 days to 45 years; mean 11.6 years) were studied. Port wine stain was present in 10 (91%) patients and one patient (9%) had cutis marmorata telangiectatica congenita. Isolated nevi of Ota and Mongolian spots were seen in 4 (36%) patients each. Simultaneous presence of both Mongolian spots and nevus of Ota was present in 1 (9%) patient. The combination of Mongolian spots and bilateral palatal hyper-melanosis was noticed in 2 (18%) patients. Café au lait macule was present in one patient. Bilateral ocular melanosis was found in 3 (27%) patients. Unilateral ocular melanosis was noticed in 4 (36%) patients. Two patients (18%) had history of seizure disorder and intracranial vascular anomalies on MRI imaging. Two patients (18%) had features of Klippel-Trenaunay syndrome. According to the traditional classification, three patients had PPV type 2b, one patient had PPV type 5b, and seven patients had PPV type 2a. According to the Happle's classification, 10 patients had PPV of cesio flammea type, and one patient had PPV of cesio marmorata type. Limitations: We could not perform genetic study of the patients. Conclusion: Our findings emphasize the importance of detailed systemic evaluation including ocular examination and brain imaging in every patient of PPV.
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Affiliation(s)
- Abhijit Dutta
- Department of Pediatric Medicine, North Bengal Medical College, Kolkata, West Bengal, India
| | - Sudip Kumar Ghosh
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Debabrata Bandyopadhyay
- Department of Dermatology, Venereology, and Leprosy, Medical College, Kolkata, West Bengal, India
| | - Dibyendu Bikash Bhanja
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Surajit Kumar Biswas
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
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4
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Kumar A, Zastrow DB, Kravets EJ, Beleford D, Ruzhnikov MRZ, Grove ME, Dries AM, Kohler JN, Waggott DM, Yang Y, Huang Y, Mackenzie KM, Eng CM, Fisher PG, Ashley EA, Teng JM, Stevenson DA, Shieh JT, Wheeler MT, Bernstein JA. Extracutaneous manifestations in phacomatosis cesioflammea and cesiomarmorata: Case series and literature review. Am J Med Genet A 2019; 179:966-977. [PMID: 30920161 DOI: 10.1002/ajmg.a.61134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
Phacomatosis pigmentovascularis (PPV) comprises a family of rare conditions that feature vascular abnormalities and melanocytic lesions that can be solely cutaneous or multisystem in nature. Recently published work has demonstrated that both vascular and melanocytic abnormalities in PPV of the cesioflammea and cesiomarmorata subtypes can result from identical somatic mosaic activating mutations in the genes GNAQ and GNA11. Here, we present three new cases of PPV with features of the cesioflammea and/or cesiomarmorata subtypes and mosaic mutations in GNAQ or GNA11. To better understand the risk of potentially occult complications faced by such patients we additionally reviewed 176 cases published in the literature. We report the frequency of clinical findings, their patterns of co-occurrence as well as published recommendations for surveillance after diagnosis. Features assessed include: capillary malformation; dermal and ocular melanocytosis; glaucoma; limb asymmetry; venous malformations; and central nervous system (CNS) anomalies, such as ventriculomegaly and calcifications. We found that ocular findings are common in patients with phacomatosis cesioflammea and cesiomarmorata. Facial vascular involvement correlates with a higher risk of seizures (p = .0066). Our genetic results confirm the role of mosaic somatic mutations in GNAQ and GNA11 in phacomatosis cesioflammea and cesiomarmorata. Their clinical and molecular findings place these conditions on a clinical spectrum encompassing other GNAQ and GNA11 related disorders and inform recommendations for their management.
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Affiliation(s)
- Akash Kumar
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Diane B Zastrow
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
| | - Elijah J Kravets
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Daniah Beleford
- Institute for Human Genetics and Division of Medical Genetics, Pediatrics, San Francisco, California
| | - Maura R Z Ruzhnikov
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California.,Department of Neurology, Stanford School of Medicine, Stanford, California
| | - Megan E Grove
- Clinical Genomics Program, Stanford Health Care, Stanford, California
| | - Annika M Dries
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
| | - Jennefer N Kohler
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
| | - Daryl M Waggott
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
| | - Yaping Yang
- Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Yong Huang
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
| | | | | | - Christine M Eng
- Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Paul G Fisher
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California.,Department of Neurology, Stanford School of Medicine, Stanford, California
| | - Euan A Ashley
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Genetics, Stanford School of Medicine, Stanford, California
| | - Joyce M Teng
- Department of Dermatology, Stanford School of Medicine, Stanford, California
| | - David A Stevenson
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Joseph T Shieh
- Institute for Human Genetics and Division of Medical Genetics, Pediatrics, San Francisco, California
| | - Matthew T Wheeler
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jonathan A Bernstein
- Department of Pediatrics, Stanford School of Medicine, Stanford, California.,Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
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5
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Verma SB, Desai HK, Shah VN, Happle R. Phacomatosis Cesioflammea with Cutis Marmorata-like Lesions and Unusual Extracutaneous Abnormalities: Is It a Distinct disorder? Indian J Dermatol 2017; 62:207-209. [PMID: 28400644 PMCID: PMC5363148 DOI: 10.4103/0019-5154.201760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 2-month-old boy was presented with widespread lateralized blue macules (nevus cesius), an extensive nevus flammeus, and large patches of cutis marmorata telangiectatica congenita. Moreover, he had macrocephaly, a coarse facial appearance with depressed nasal bridge, retinal abnormalities, septal defects of the heart, and obliteration of the left brachiocephalic vein and major veins of the left arm with pronounced collateralization. The multisystem disorder of this boy cannot be categorized within the present classification of distinct types of phacomatosis pigmentovascularis. Although some similar complex cases have previously been reported, it seems too early to give them a specific name. Rather, the present case should be included, so far, into the group of unclassifiable types of phacomatosis pigmentovascularis.
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Affiliation(s)
| | | | - Vishal N Shah
- Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | - Rudolf Happle
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
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6
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Du G, Zhang X, Zhang T. Cutis marmorata telangiectatica congenita and aberrant Mongolian spots: Type V phacomatosis pigmentovascularis or phacomatosis cesiomarmorata. JAAD Case Rep 2016; 2:28-30. [PMID: 27051820 PMCID: PMC4809441 DOI: 10.1016/j.jdcr.2015.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Guilian Du
- Neonatology Department, the Fifth People's Hospital of Baoan, Shenzhen, China
| | - Xiaomin Zhang
- Department of Dermatology and STD, Changping Hospital of Dongguan and Zhujiang Hospital, Guangzhou, China
| | - Tangde Zhang
- Department of Dermatology and STD, Changping Hospital of Dongguan and Zhujiang Hospital, Guangzhou, China
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7
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ARL6IP6, a susceptibility locus for ischemic stroke, is mutated in a patient with syndromic Cutis Marmorata Telangiectatica Congenita. Hum Genet 2015; 134:815-22. [DOI: 10.1007/s00439-015-1561-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
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8
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Lunge SB, Mahajan P. Cutis marmorata telangiectatica congenita restricted to both breasts in a young female. Dermatol Pract Concept 2014; 4:89-92. [PMID: 25126469 PMCID: PMC4132010 DOI: 10.5826/dpc.0403a20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/17/2014] [Indexed: 11/23/2022] Open
Abstract
Cutis marmorata telangiectatica congenita (CMTC) is a very rarely occurring congenital disorder with persistent cutis marmorata, telangiectasia, and phlebectasia. This disorder may be associated with cutaneous atrophy and ulceration of the involved skin. We herewith report a 20-year-old female patient with CMTC since childhood along with ulcerations on both breasts. CMTC is a benign vascular anomaly presenting with dilatation of capillaries and veins of dermis and is apparent at birth. The patient had reticulated bluish-purple skin changes over both breasts. Although it resembled physiological cutis marmorata, it was more pronounced and definitely was unvarying and permanent in pattern. A variety of vascular malformations have been described along with this disorder. Etiology is not very clear; it may be multifactorial in origin. Prognosis in uncomplicated cases is good.
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9
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Adachi K, Togashi S, Sasaki K, Sekido M. Laser therapy treatment of phacomatosis pigmentovascularis type II: two case reports. J Med Case Rep 2013; 7:55. [PMID: 23445899 PMCID: PMC3607989 DOI: 10.1186/1752-1947-7-55] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/24/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction Phacomatosis pigmentovascularis is a rare congenital condition characterized by vascular malformation associated with extensive pigmented nevi. Even though it forms a large, prominent skin lesion, therapy for phacomatosis pigmentovascularis is rarely discussed. To the best of our knowledge, this is the first report of phacomatosis pigmentovascularis type II treated with combined laser therapy using Q-switched alexandrite and long-pulsed dye lasers. Case presentations In the first of two cases reported here, a 2-week-old Japanese baby girl was given a diagnosis of phacomatosis pigmentovascularis type II and Klippel–Trénaunay syndrome because of port-wine stains, cutis marmorata telangiectatica congenita, and aberrant Mongolian spots over her trunk and limbs. After five laser therapy sessions under general anesthesia, her aberrant Mongolian spots and port-wine stains have improved. But interestingly, the cutis marmorata telangiectatica congenita on the patient's back has improved without laser therapy. In the second case, a 4-month-old Japanese baby boy was referred to us because of port-wine stains, cutis marmorata telangiectatica congenita, and aberrant Mongolian spots over his face, trunk and limbs. Phacomatosis pigmentovascularis type II was diagnosed and laser therapy was started. After three laser therapy sessions under general anesthesia, the aberrant Mongolian spots and port-wine stains have improved. The cutis marmorata telangiectatica congenita on the baby's back, buttocks, and arms has faded somewhat without laser therapy. Conclusions Combined laser therapy improved the phacomatosis pigmentovascularis skin lesions, but was not effective for the cutis marmorata telangiectatica congenita with hemiatrophy. Cutis marmorata telangiectatica congenita without atrophy can be expected to improve on its own. Our results will assist physicians considering how best to treat patients with phacomatosis pigmentovascularis.
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Affiliation(s)
- Koji Adachi
- Department of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
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10
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Smith JR, Moore MM, Stetson CL. JAAD grand rounds quiz. Red, purple, and brown skin lesions in a 2-month-old boy. Phakomatosis pigmentovascularis type V. J Am Acad Dermatol 2012; 66:341-2. [PMID: 22243735 DOI: 10.1016/j.jaad.2010.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/01/2010] [Accepted: 09/12/2010] [Indexed: 10/14/2022]
Affiliation(s)
- Jeffrey R Smith
- The Self-Assessment Task Force of American Academy of Dermatology
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11
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Affiliation(s)
- Liliana Cifuentes
- Department of Dermatology and Allergy Biederstein, Clinical Research Division of Molecular and Clinical Allergotoxicology, Helmholtz Zentrum München/Technische Universität München, Biedersteiner Strasse 29, Munich, Germany
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12
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Chatterjee R, Dey S. Cutis marmorata telangiectatica congenita with skin ulcerations in a new born. Indian J Dermatol 2009; 54:375-7. [PMID: 20101343 PMCID: PMC2807718 DOI: 10.4103/0019-5154.57618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital disorder with persistent cutis marmorata, telengiectasia, and phlebectesia, which may be associated with cutaneaus atrophy and ulceration of the involved skin. We herewith report a full-term newborn female baby with CMTC at birth with ulceration over the extensor aspects of both the knee joints and right elbow joint. CMTC is a benign vascular anomaly representing dilatation of capillaries and veins of dermis and is apparent at birth. The baby had a reticulated bluish purple skin changes all over the body including the face and limb. Although it resembled physiological cutis marmorata, it was strikingly pronounced and definitely was unvarying and permanent. A variety of vascular malformation has been described along with this disorder. Etiology is not very clear and may be multifactorial, teratogens and genes are also been suggested. Prognoses in uncomplicated cases are good.
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Affiliation(s)
- Rita Chatterjee
- Department of Pediatrics, Bankura Sammilini Medical College, Bankura (WB), India.
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13
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Hall BD, Cadle RG, Morrill-Cornelius SM, Bay CA. Phakomatosis pigmentovascularis: Implications for severity with special reference to Mongolian spots associated with Sturge-Weber and Klippel-Trenaunay syndromes. Am J Med Genet A 2008; 143A:3047-53. [PMID: 17937434 DOI: 10.1002/ajmg.a.31970] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In 1947 the term phakomatosis pigmentovascularis (PPV) was coined to represent the association of widespread, aberrant, and persistent nevus flammeus and pigmentary abnormalities. Four types of PPV have been recognized with type II (nevus flammeus and Mongolian spots) being the most common. Most early cases were of Asian or African descent. Many cases were subsequently associated with Sturge-Weber (S-W) and Klippel-Trenaunay (K-T) syndromes. Almost no literature reports have appeared in the genetic or dysmorphology literature! We present six cases of PPV in which five were either African, Asian or Hispanic, and five of six had an admixture of K-T and S-W. Four had macrocephaly, and one had microcephaly. Four had CNS abnormalities (three with hydrocephalus, one with Arnold-Chiari and one with polymicrogyria), three had mental retardation, and one had seizures. One each had thumb hypoplasia, hydronephrosis, glaucoma, coronal synostosis, and 3-4 finger syndactyly. It is our suspicion and hypothesis that in the presence of persistent, extensive and aberrant Mongolian spots, vascular abnormalities as are seen in K-T and S-W carry a worse prognosis. This may be particularly true either of children of Asian, Hispanic or African heritage or any individuals from darker pigmented skin groups.
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Affiliation(s)
- Bryan D Hall
- Division of Clinical/Biochemical Genetics and Dysmorphology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA.
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Hall BD, Cadle RG, Morrill-Cornelius SM, Bay CA. Phakomatosis pigmentovascularis: Implications for severity with special reference to Mongolian spots associated with Sturge–Weber and Klippel–Trenaunay syndromes. Am J Med Genet A 2008. [DOI: 10.1002/ajmg.a.32327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The Mediterranean area represents the area of land that borders the Mediterranean basin. It is composed of several countries that share many geographic and racial characteristics. Although Mediterraneans seem to share common skin type and are subjected to similar enviromental factors, they still represent a genetic and socioeconomic diversity. True prevalence of pigmentary disorders in this area depends on large epidemiologic studies, including countries that are not available. This article, however, highlights and classifies the most important developmental (heritable-genetic) and acquired pigmentary disorders seen and reported in this important area of the world.
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Affiliation(s)
- Medhat A El-Mofty
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Chang BPH, Hsu CH, Chen HC, Hsieh JW. An infant with extensive Mongolian spot, naevus flammeus and cutis marmorata telangiectatica congenita: a unique case of phakomatosis pigmentovascularis. Br J Dermatol 2007; 156:1068-71. [PMID: 17355231 DOI: 10.1111/j.1365-2133.2007.07798.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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