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Amyloidosis Cutis Dyschromica in a 16-Year-Old Filipino Girl: A Case Report. Dermatopathology (Basel) 2022; 10:20-24. [PMID: 36648780 PMCID: PMC9844270 DOI: 10.3390/dermatopathology10010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022] Open
Abstract
Amyloidosis cutis dyschromica is a rare variant of primary cutaneous amyloidosis characterized by hyper- and hypopigmented macules. In this paper, we reported a case of a 16-year-old Filipino girl with hyper- and hypopigmented to depigmented macules on the upper and lower extremities, which started when she was 9 years of age.
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2
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Wang H, Zhong Z, Wang X, Zheng L, Wang Y, Wang S, Liu S, Li H, Guo Z, Gao M. Case Report: Amyloidosis Cutis Dyschromica: Dermoscopy and Reflectance Confocal Microscopy and Gene Mutation Analysis of a Chinese Pedigree. Front Med (Lausanne) 2021; 8:774266. [PMID: 34926516 PMCID: PMC8671158 DOI: 10.3389/fmed.2021.774266] [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: 09/11/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Amyloidosis cutis dyschromica (ACD) is a rare type of primary localized cutaneous amyloidosis. Non-invasive techniques can provide important clues for early diagnosis. Objectives: To highlight the characteristic imaging changes of ACD under dermoscopy and reflectance confocal microscopy (RCM), investigate gene mutations in a Chinese Han pedigree of ACD, and analyze the genotype-phenotype correlation. Methods: Dermoscopy and RCM examinations were completed together for the pedigree, and the imaging characteristics were described. The diagnosis of ACD was confirmed by pathological examination. Sequencing was performed followed by bioinformatics and genotype-phenotype correlation. ACD-related articles published on PubMed between January 1970 and March 2021 were reviewed and summarized. Results: In ACD, dermoscopy showed patchy white hypopigmentation and brownish spots, stripes, or hyperpigmented blotches and patches. RCM showed a highly refractive substance with clumpy, dotted, and linear structures inside the papillary dermis. Sequencing identified glycoprotein non-metastatic melanoma protein B (GPNMB) missense mutations [c.393T>G (p.Y131X; NM_001005340.2)] and a frameshift deletion mutation [c.719_720delTG (p.V240fs; NM_001005340.2)]. The ANNOtate VARiation (ANNOVAR) software predicted that c.393T>G is a pathogenic mutation. The literature review found 14 mutations, namely, 5 (35.7%) frameshift mutations, 4 (28.6%) non-sense mutations, 4 (28.6%) missense mutations, and 1 (7.1%) splice site mutation. Blisters and epidermolysis were observed in several cases, but there was no significant association between clinical manifestations and mutations in ACD. Conclusions: This study was the first to combine dermoscopy and RCM to describe ACD. Two GPNMB gene mutations were reported in a Chinese ACD pedigree. The genotype-phenotype correlation was analyzed for the first time; however, there was no significant correlation.
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Affiliation(s)
- Hui Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Zhenyu Zhong
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Xiuli Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Liyun Zheng
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Yifan Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Shan Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Siqi Liu
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Hui Li
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Ze Guo
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Min Gao
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
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3
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Familial Mottled Pigmentation: Answer. Am J Dermatopathol 2021; 43:844. [PMID: 34651596 DOI: 10.1097/dad.0000000000001899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Amyloidosis cutis dyschromica cases caused by GPNMB mutations with different inheritance patterns. J Dermatol Sci 2021; 104:48-54. [PMID: 34551863 DOI: 10.1016/j.jdermsci.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/04/2021] [Accepted: 08/08/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Amyloidosis cutis dyschromica (ACD) is a rare form of primary cutaneous amyloidosis featured by reticulate dotted hypo- and hyperpigmentation. Recently, loss-of-function mutations in GPNMB, encoding glycoprotein (transmembrane) nonmetastatic melanoma protein B, were found in autosomal-recessive or semi-dominant ACD. OBJECTIVE This study aims to detect the genetic defect underlying ACD in nine separate cases and to investigate the functional consequences of the mutants. METHODS Nine ACD cases were collected including eight with autosomal-recessive pattern and one with autosomal-dominant pattern. Whole-exome sequencing or Sanger sequencing of the GPNMB gene was performed to detect the pathogenic mutations. Haplotype analysis was employed to determine the origin of mutation c.565C > T using adjacent highly polymorphic SNPs. Immunoblotting and subcellular localization assessments were performed to evaluate the expression of the mutants using HEK293 cells transfected with the GPNMB constructs. RESULTS We detected four recurrent mutations (c.393 T > G, p.Y131*; c.565C > T, p.R189*; c.1056delT, p.P353Lfs*20; c.1238 G > C, p.C413S) and two novel mutations (c.935delA, p.N312Tfs*4; c.969 T > A, p.C323*) in GPNMB. Mutation c.565C > T found in six separate ACD cases shared a common haplotype. The two novel mutations caused a decreased abundance of truncated proteins. The c.1238 G > C mutation, which was detected in the autosomal-dominant case, caused abnormal reticular subcellular localization of the protein. A major percentage of wildtype changed its expression pattern when co-expressed with this mutant. CONCLUSIONS Our findings proved that the recurrent mutation c.565C > T originated from a founder effect. The autosomal-dominant ACD associated mutation p.C413S played its pathogenic role through a dominant-negative effect on wild-type GPNMB. This study expands the genotype and inherited modes of ACD and improves our understanding of the pathogenesis of this disorder.
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Rahman OU, Kim J, Mahon C, Jelani M, Kang C. Two missense mutations in GPNMB cause autosomal recessive amyloidosis cutis dyschromica in the consanguineous pakistani families. Genes Genomics 2021; 43:471-478. [PMID: 33687658 DOI: 10.1007/s13258-021-01071-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Amyloidosis cutis dyschromica (ACD) is a rare variant of cutaneous amyloidosis. This disorder often clusters in families, and it has been suggested that genetic factors might be involved in its development. OBJECTIVE To identify the genetic causes of ACD, we recruited a consanguineous Pakistani family with multiple cases of ACD that display a recessive mode of inheritance. METHODS We performed whole-exome sequencing of samples from 7 members of this family, followed by bioinformatic and in silico analyses to identify the causative variant. For the replication study, we recruited a British family with Pakistani ancestry, and sequenced all exons of glycoprotein non-metastatic melanoma protein b (GPNMB) to identify mutations. We also investigated effects of the mutations on the stability of the GPNMB protein using the I-TASSER three-dimensional modeling tool. RESULTS We found a novel homozygous mutation, p.Gly363Val (c.1088 G>T), in GPNMB in all affected cases. In a replication study, another homozygous missense mutation in GPNMB, pIle174Met (c.522 C>G), was carried by the affected son. The two mutations were not observed in our in-house data set comprising 217 healthy Pakistani individuals or in The Genome Aggregation Database. Our structural modeling of GPNMB suggested that p.Gly363Val enhanced its stability, whereas p.Ile174Met caused instability. CONCLUSIONS This study reports two novel missense mutations in two Pakistani families that cause ACD. The mutations appear to influence GPNMB stability, as revealed by protein modeling.
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Affiliation(s)
- Obaid Ur Rahman
- Biochemistry Department, Swat Medical College, Swat, Pakistan
| | - Jeena Kim
- Department of Biotechnology, Sungshin Women's University, Seoul, Republic of Korea
| | - Caroline Mahon
- Department of Dermatology, Christchurch School of Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - Musharraf Jelani
- Centre for Omic Sciences, Islamia College Peshawar, Khyber Pakhtunkhwa, Pakistan.
| | - Changsoo Kang
- Department of Biotechnology, Sungshin Women's University, Seoul, Republic of Korea.
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6
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Danescu S, Salavastru C, Tiplica GS, Fritz K. [Treatment of pigmentation disorders in association with systemic diseases]. Hautarzt 2020; 71:932-943. [PMID: 33201325 DOI: 10.1007/s00105-020-04715-y] [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] [Indexed: 01/19/2023]
Abstract
Pigmentation disorders are a frequent skin problem and incorporate a broad spectrum of diseases, caused by an abnormal melanin pigmentation or also non-melanin pigmentation of the skin. Both hypermelanosis and hypomelanosis can be hereditary or acquired. This article summarizes the treatment approaches that are used in the majority of acquired pigmentation disorders of the skin. The following forms of hypermelanosis are addressed: lentiginosis, hyperpigmentation due to endocrine disorders or other systemic diseases, drug-induced hyperpigmentation. Acquired hypomelanoses include postinflammatory hypomelanosis, chemical depigmentation, idiopathic guttate hypomelanosis and punctate leucoderma. With reference to non-melanin pigmentation, the exogenous pigmentation due to chemicals, metals and drug exposure are discussed. The treatment is primarily based on finding the cause of the alterations to the pigment. The affected area, age and ethnic origin are also important factors. The spectrum of therapeutic options is broad: topical agents, chemical peeling, systemic agents, laser and light-based treatment. As some of these treatment procedures can have side effects, the availability of a protocol that contains information on the drug concentration, dose, parameters for laser treatment and the number of sessions is important. For every disorder the specific dermatological treatment is presented even when some pigmentation alterations that occur in association with systemic diseases, are cured by the treatment of the primary disease. Most diseases are exacerbated by exposure to UV light. Therefore, sun protection is recommended and a cosmetic coverage is indicated.
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Affiliation(s)
- Sorina Danescu
- Abteilung für Dermatologie, Universität Iuliu Hatieganu für Medizin und Pharmazie, Cluj, Rumänien
| | - Carmen Salavastru
- Abteilung für pädiatrische Dermatologie, Krankenhaus "Colentina", 19-21 Stefan cel Mare Av., Bukarest, Rumänien.
- Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien.
| | - G S Tiplica
- Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
- 2. Klinik für Dermatologie, Krankenhaus "Colentina", Bukarest, Rumänien
| | - K Fritz
- Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
- Hautärzte und Laserzentrum, Landau, Deutschland
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7
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Hennessy K, Kim A, Rodriguez-Waitkus P, Morey G, Seminario-Vidal L. Amyloidosis cutis dyschromica treated with acitretin. A case report. Dermatol Ther 2020; 33:e13955. [PMID: 32621627 DOI: 10.1111/dth.13955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kerry Hennessy
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
| | - Anna Kim
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
| | - Paul Rodriguez-Waitkus
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
| | - Gabriel Morey
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA.,Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA.,Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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8
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Wang X, Sun J. Case of amyloidosis cutis dyschromica with palmoplantar keratoderma. Australas J Dermatol 2019; 60:319-320. [PMID: 30912135 DOI: 10.1111/ajd.13032] [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)
- Xiaopo Wang
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Jianfang Sun
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
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9
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10
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Primary Localized Cutaneous Amyloidosis Affecting Female Individuals of a Pakistani Pedigree. Am J Dermatopathol 2018; 41:382-385. [PMID: 30308545 DOI: 10.1097/dad.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Primary localized cutaneous amyloidosis is a group of rare conditions where amyloid deposition is limited to the skin without systemic manifestations. Most cases are sporadic; however, mutations in the oncostatin M receptor (OSMR) and interleukin-31 receptor A (IL31RA) genes can cause a familial form of the condition in up to 10% of cases. Here, we describe a family in which 8 female individuals are affected by either macular amyloidosis or amyloidosis cutis dyschromica. To the best of our knowledge, a sex-specific expression or the coexistence of 2 different phenotypes of primary localized cutaneous amyloidosis in 1 pedigree has not yet been reported.
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11
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Yang CF, Lin SP, Chiang CP, Wu YH, H'ng WS, Chang CP, Chen YT, Wu JY. Loss of GPNMB Causes Autosomal-Recessive Amyloidosis Cutis Dyschromica in Humans. Am J Hum Genet 2018; 102:219-232. [PMID: 29336782 DOI: 10.1016/j.ajhg.2017.12.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022] Open
Abstract
Amyloidosis cutis dyschromica (ACD) is a distinct form of primary cutaneous amyloidosis characterized by generalized hyperpigmentation mottled with small hypopigmented macules on the trunks and limbs. Affected families and sporadic case subjects have been reported predominantly in East and Southeast Asian ethnicities; however, the genetic cause has not been elucidated. We report here that the compound heterozygosity or homozygosity of GPNMB truncating alleles is the cause of autosomal-recessive ACD. Six nonsense or frameshift mutations were identified in nine individuals diagnosed with ACD. Immunofluorescence analysis of skin biopsies showed that GPNMB is expressed in all epidermal cells, with the highest staining observed in melanocytes. GPNMB staining is significantly reduced in the lesional skin of affected individuals. Hyperpigmented lesions exhibited significantly increased amounts of DNA/keratin-positive amyloid deposits in the papillary dermis and infiltrating macrophages compared with hypo- or depigmented macules. Depigmentation of the lesions was attributable to loss of melanocytes. Intracytoplasmic fibrillary aggregates were observed in keratinocytes scattered in the lesional epidermis. Thus, our analysis indicates that loss of GPNMB, which has been implicated in melanosome formation, autophagy, phagocytosis, tissue repair, and negative regulation of inflammation, underlies autosomal-recessive ACD and provides insights into the etiology of amyloidosis and pigment dyschromia.
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Affiliation(s)
- Chi-Fan Yang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Shuan-Pei Lin
- Department of Medical Research, MacKay Memorial Hospital, Taipei 104, Taiwan; Department of Pediatrics, MacKay Memorial Hospital, Taipei 104, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan
| | - Chien-Ping Chiang
- Departments of Dermatology, Tri-Service General Hospital, Taipei 114, Taiwan; Department of Biochemistry, National Defense Medical Center, Taipei 114, Taiwan
| | - Yu-Hung Wu
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan; Department of Dermatology, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Weng Siong H'ng
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Chun-Ping Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Yuan-Tsong Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Jer-Yuarn Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan.
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12
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Clinical and Genetic Review of Hereditary Acral Reticulate Pigmentary Disorders. Dermatol Res Pract 2017; 2017:3518568. [PMID: 29201043 PMCID: PMC5672609 DOI: 10.1155/2017/3518568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/17/2017] [Indexed: 12/23/2022] Open
Abstract
Reticulated pigmentation is a unique pigmentary change caused by a heterogeneous group of hereditary and acquired disorders. This pigmentation is characterized by a mottled appearance, with lesions that vary in size and pigmentary content. This review discusses the hereditary group of the reticulated pigmentation disorders, such as dyschromatosis symmetrica hereditaria, dyschromatosis universalis hereditaria, and reticulate acropigmentation of Kitamura. The clinical presentation and histopathological features often overlap, making diagnosis difficult. However, each of these hereditary conditions possesses a unique genetic mutation, and genetic analysis is thus more useful in the diagnosis of these conditions. This article delivers an update regarding the clinical features, detailed histopathological description, and genetic information concerning hereditary reticulate pigmentary disorders and aims to provide useful background for use by clinical dermatologists and histopathologists when approaching this group of hereditary disorders.
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13
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Kuseyri O, Haas D, Lang N, Schäkel K, Bettendorf M. Amyloidosis Cutis Dyschromica, a Rare Cause of Hyperpigmentation: A New Case and Literature Review. Pediatrics 2017; 139:peds.2016-0170. [PMID: 28557715 DOI: 10.1542/peds.2016-0170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
Abstract
Amyloidosis cutis dyschromica is a rare form of primary cutaneous amyloidosis without systemic involvement and characterized by asymptomatic, progressive hyper- and hypopigmentation. We present the first case of a patient with amyloidosis cutis dyschromica diagnosed previously elsewhere as having Addison disease with generalized hyperpigmentation of the skin. This case suggests that in patients presenting with asymptomatic cutaneous dyschromia a skin biopsy for histopathological examination should be considered.
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Affiliation(s)
- Oya Kuseyri
- Department of General Pediatrics and Division of Pediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Heidelberg, Germany; and
| | - Dorothea Haas
- Department of General Pediatrics and Division of Pediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Heidelberg, Germany; and
| | - Nina Lang
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Markus Bettendorf
- Department of General Pediatrics and Division of Pediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, Heidelberg, Germany; and
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14
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Abstract
We are reporting a rare case of amyloidosis cutis dyschromica in a 41-year-old man. This is a rare form of primary cutaneous amyloidosis characterized by reticulate pigmentation with hypopigmented and hyperpigmented macules, onset in childhood, familial tendency in some, occasional mild itching and deposition of amyloid in the papillary dermis. Our case also had multiple bilaterally symmetrical hyperpigmented keratotic papules abutting the axillary vault resembling those seen in Dowling–Deogs disease. The other unusual feature in this patient was the strong family history of vitiligo, which we are unable to explain. We have also tried to explain the mechanism leading to the hyperpigmentation and hypopigmentation in amyloidosis cutis dyschromica.
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Affiliation(s)
- Shyam Verma
- Department of Dermatology, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - Rajiv Joshi
- Department of Dermatology, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
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15
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Mahon C, Oliver F, Purvis D, Agnew K. Amyloidosis cutis dyschromica in two siblings and review of the epidemiology, clinical features and management in 48 cases. Australas J Dermatol 2015; 57:307-311. [PMID: 25866143 DOI: 10.1111/ajd.12342] [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] [Received: 02/09/2015] [Accepted: 03/15/2015] [Indexed: 11/27/2022]
Abstract
Amyloidosis cutis dyschromica (ACD) is a rare form of primary cutaneous amyloidosis (PCA). There is a paucity of information in the dermatology literature to guide its diagnosis, investigation and treatment. We present two siblings with ACD and summarise the epidemiology, clinical features, natural history and treatments in 48 cases of ACD from the literature. Familial cases were more common (37) than sporadic cases. ACD is predominantly reported in those of East and South-East Asian ethnicity (63%). The mean age of onset was 6 years in familial cases, and 23 years in sporadic cases. The clinical features of familial and sporadic ACD do not differ substantially. Pruritus was the only symptom, and was reported in 19% of all cases. There were no reported ACD cases with systemic amyloidosis. Acitretin was reported to result in improvement in seven of 10 patients treated. Routine investigation for systemic involvement is not necessary. Acitretin may be helpful.
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Affiliation(s)
- Caroline Mahon
- Dermatology Department, Greenlane Clinical Centre, Auckland, New Zealand
| | - Fergus Oliver
- Dermatology Department, Greenlane Clinical Centre, Auckland, New Zealand
| | - Diana Purvis
- Department of Paediatric Dermatology, Starship Children's Hospital, Auckland, New Zealand
| | - Karen Agnew
- Department of Paediatric Dermatology, Starship Children's Hospital, Auckland, New Zealand
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16
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Affiliation(s)
- Sai Yee Chuah
- Department of Dermatology, National Skin Centre, Singapore, Singapore
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17
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Hermawan M, Rihatmadja R, Sirait SP. Familial amyloidosis cutis dyschromica in three siblings: report from indonesia. Dermatol Reports 2014; 6:5375. [PMID: 25386328 PMCID: PMC4224002 DOI: 10.4081/dr.2014.5375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 08/01/2014] [Accepted: 10/26/2014] [Indexed: 11/23/2022] Open
Abstract
Amyloidosis cutis dyschromica (ACD) is an extremely rare type of primary cutaneous amyloidosis. To date there are fewer than 40 published cases worldwide; some were reported affecting several family members. Its resemblance to other common pigmentation disorders makes it rarely recognized at first sight. Our patient, the 12-year-old firstborn son of non-consanguineous parents presented with generalized mottled pigmentation starting from lower extremities. His siblings suffered from similar condition. The clue for diagnosis is the amyloid deposition in the papillary dermis. The etiology of ACD is still unknown, but genetic factors and ultraviolet radiation are implicated. It is proposed that disturbance of keratinocyte repair following ultraviolet radiation results in amyloid deposition. The treatment remains a challenge. Oral acitretin treatment, thought to repair keratinization defect, gave a slight improvement in our case. Our is the first case of ACD reported in Indonesia.
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Affiliation(s)
- Melyawati Hermawan
- Department of Dermatovenereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital , Jakarta, Indonesia
| | - Rahadi Rihatmadja
- Department of Dermatovenereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital , Jakarta, Indonesia
| | - Sondang Pandjaitan Sirait
- Department of Dermatovenereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital , Jakarta, Indonesia
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