1
|
Cuperus E, Bygum A, Boeckmann L, Bodemer C, Bolling MC, Caproni M, Diociaiuti A, Emmert S, Fischer J, Gostynski A, Guez S, van Gijn ME, Hannulla-Jouppi K, Has C, Hernández-Martín A, Martinez AE, Mazereeuw-Hautier J, Medvecz M, Neri I, Sigurdsson V, Suessmuth K, Traupe H, Oji V, Pasmans SGMA. Proposal for a 6-step-approach for differential diagnosis of neonatal erythroderma. J Eur Acad Dermatol Venereol 2022; 36:973-986. [PMID: 35238435 PMCID: PMC9310754 DOI: 10.1111/jdv.18043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
The broad differential diagnosis of neonatal erythroderma often poses a diagnostic challenge. Mortality of neonatal erythroderma is high due to complications of the erythroderma itself and the occasionally severe and life-threatening underlying disease. Early correct recognition of the underlying cause leads to better treatment and prognosis. Currently, neonatal erythroderma is approached by a case by case basis. The purpose of this scoping review was to develop a diagnostic approach in neonatal erythroderma. After a systematic literature search in Embase (January 1990 - May 2020, 74 cases of neonatal erythroderma were identified, and 50+ diagnoses could be extracted. Main causes were the ichthyoses (40%) and primary immunodeficiencies (35%). Congenital erythroderma was present in 64% (47/74) of the cases, predominantly with congenital ichthyosis (11/11; 100%), Netherton syndrome (12/14, 86%), and Omenn syndrome (11/23, 48%). Time until diagnosis ranged from 102 days to 116 days for cases of non-congenital erythroderma and congenital erythroderma respectively. Among the 74 identified cases a total of 17 patients (23%) died within a mean of 158 days and were related to Omenn syndrome (35%), graft versus host disease (67%), and Netherton syndrome (18%). Disease history and physical examination are summarized in this paper. Age of onset and a collodion membrane can help to narrow the differential diagnoses. Investigations of blood, histology, hair analysis, genetic analysis and clinical imaging are summarized and discussed. A standard blood investigation is proposed and the need for skin biopsies with Lympho-Epithelial Kazal-Type related Inhibitor-staining is highlighted. Overall, this review shows that diagnostic procedures narrow the differential diagnosis in neonatal erythroderma. A 6-step flowchart for the diagnostic approach for neonatal erythroderma during the first month of life is proposed. The approach was made with the support of expert leaders from international multidisciplinary collaborations in the European Reference Network Skin-subthematic group Ichthyosis.
Collapse
Affiliation(s)
- E Cuperus
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
| | - A Bygum
- University of Southern Denmark, Clinical Institute, Denmark & Odense University Hospital, Department of Clinical Genetics, Denmark
| | - L Boeckmann
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker-Enfants Malades Hospital (AP-HP5), Paris-Centre University, Imagine Institute, INSERM, Paris, France
| | - M C Bolling
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Groningen, the Netherlands
| | - M Caproni
- Department of Health Sciences, Section of Dermatology, USL Toscana Centro, Rare Diseases Unit, University of Florence, Florence, Italy
| | - A Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Emmert
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Gostynski
- Department of Dermatology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Guez
- Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M E van Gijn
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - K Hannulla-Jouppi
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, HUS, Helsinki, Finland
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - A E Martinez
- Pediatric Dermatology, NHS Foundation Trust, Great Ormond Street, London, UK
| | - J Mazereeuw-Hautier
- Dermatology Department, Reference Center for Rare Skin Diseases, Toulouse, France
| | - M Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - I Neri
- Dermatology - IRCCS Policlinico di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater, Studiorum University of Bologna, Bologna, Italy
| | - V Sigurdsson
- University Medical Center Utrecht and Utrecht University, Department of Dermatology, Utrecht, The Netherlands
| | - K Suessmuth
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - S G M A Pasmans
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
| |
Collapse
|
2
|
Frommherz L, Krause A, Kopp J, Hotz A, Hübner S, Reimer-Taschenbrecker A, Casetti F, Zirn B, Fischer J, Has C. High rate of self-improving phenotypes in children with non-syndromic congenital ichthyosis: case series from south-western Germany. J Eur Acad Dermatol Venereol 2021; 35:2293-2299. [PMID: 34273205 DOI: 10.1111/jdv.17524] [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: 02/26/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Non-syndromic congenital ichthyosis describes a heterogeneous group of hereditary skin disorders associated with erythroderma and scaling at birth. Although both severe and mild courses are known, the prediction of the natural history in clinical practice may be challenging. OBJECTIVES To determine clinical course and genotype-phenotype correlations in children affected by non-syndromic congenital ichthyosis in a case series from south-western Germany. METHODS We performed a retrospective observational study of 32 children affected by non-syndromic congenital ichthyoses seen in our genodermatosis clinic between 2011 and 2020. Follow-ups included assessment of weight and severity of skin involvement utilizing a modified Ichthyosis Area Severity Index (mIASI). mIASI was calculated as a sum comprising the previously published IASI score and an additional novel score to evaluate palmoplantar involvement. Linear regression was assessed using Pearson correlation, and statistical analysis was performed using the Wilcoxon-Mann-Whitney test. RESULTS This study included 23 patients with autosomal recessive congenital ichthyosis, seven with keratinopathic ichthyosis and two with harlequin ichthyosis. Cutaneous manifestations improved in more than 70% of the children during the follow-up. Especially in patients with mutations in ALOXE3 and ALOX12B, mIASI scores dropped significantly. The most common phenotype observed in this study was designated 'mild fine scaling ichthyosis'. Severe palmoplantar involvement occurred in patients with KRT1 and ABCA12 mutations; most patients demonstrated hyperlinearity as a sign of dryness and scaling. Weight was mainly in the normal range and negatively correlated with the severity of skin involvement. CONCLUSIONS Congenital ichthyosis that self-improves and evolves with mild fine scaling ichthyosis was the most common phenotype observed in our patients. This type might be underdiagnosed if the genetic diagnosis is not performed in the first year of life. mIASI is an easy and fast instrument for scoring disease severity and adding additional points for palmoplantar involvement might be valuable.
Collapse
Affiliation(s)
- L Frommherz
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - A Krause
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - J Kopp
- Institute of Human Genetics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A Hotz
- Institute of Human Genetics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - S Hübner
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A Reimer-Taschenbrecker
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - F Casetti
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - B Zirn
- Genetikum® Stuttgart, Genetic Counselling and Diagnostics, Stuttgart, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - C Has
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
4
|
Vornweg J, Gläser S, Ahmad-Anwar M, Zimmer AD, Kuhn M, Hörer S, Korenke GC, Grothaus J, Ott H, Fischer J. Identification of compound heterozygous mutations in AP1B1 leading to the newly described recessive keratitis-ichthyosis-deafness (KIDAR) syndrome. Br J Dermatol 2021; 184:1190-1192. [PMID: 33452671 DOI: 10.1111/bjd.19815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Affiliation(s)
- J Vornweg
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Gläser
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Ahmad-Anwar
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A D Zimmer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kuhn
- Genetikum, Neu-Ulm, Germany
| | - S Hörer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - G C Korenke
- Department of Pediatric Neurology, Klinikum Oldenburg, Oldenburg, Germany
| | - J Grothaus
- Department of Pediatric Dermatology and Allergology, Center for Epidermolysis Bullosa, Children's Hospital Auf der Bult, Hanover, Germany
| | - H Ott
- Department of Pediatric Dermatology and Allergology, Center for Epidermolysis Bullosa, Children's Hospital Auf der Bult, Hanover, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|