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Marappan H, Am R. Parry-Romberg Syndrome: A Report of a Rare Case and a Comprehensive Review. Cureus 2024; 16:e67345. [PMID: 39310582 PMCID: PMC11413376 DOI: 10.7759/cureus.67345] [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] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Parry-Romberg syndrome (PRS), also recognized as progressive hemifacial atrophy (PHA), is a rare medical condition affecting the dermis, subcutaneous tissue, and occasionally underlying anatomical structures such as muscles and bones. While the etiology of this condition remains incompletely elucidated, it has been hypothesized that trauma, autoimmunity, infection, and autonomic dysregulation may constitute potential contributory factors. Typically, the onset of symptoms occurs within the initial two decades of life, though instances of late-onset PRS manifesting in the sixth and seventh decades of life have also been documented. The disorder is distinguished by a gradual progression over two to 20 years, ultimately culminating in stabilization. The local manifestations of PRS are accompanied by systemic symptoms. Common neurological complications include seizures and headaches. Due to the rarity of PRS, there are no established guidelines for imaging, treatment, and follow-up. Therefore, management is tailored to each case, with treatment options primarily addressing symptoms.
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Affiliation(s)
| | - Raja Am
- Ophthalmology, All India Institute of Medical Sciences, Madurai, IND
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2
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Hariri EM, Sellouti M, Ramdi H. Oral Manifestations of Parry-Romberg Syndrome: A Case Report. Cureus 2024; 16:e63984. [PMID: 39105006 PMCID: PMC11299985 DOI: 10.7759/cureus.63984] [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] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
Parry-Romberg syndrome is a rare acquired disorder characterized by unilateral idiopathic progressive atrophy of the skin and soft tissues of the face, resulting in a sunken appearance. The muscles, cartilage, and underlying bony structures may also be affected. The etiology remains unclear and is based on several hypotheses. The incoherence of atrophy and the development of associated symptoms make the diagnosis, prognosis, and management of patients difficult. Here, we report the case of a 10-year-old boy who presented to the Department of Pediatric Dentistry at the Mohamed V Military Training Hospital in Rabat with progressive left hemifacial atrophy and was diagnosed by a pediatric rheumatologist as having Parry-Romberg syndrome. On extraoral examination, the patient presented a slight facial asymmetry and a small, dark, linear scar in the left zygomatic region. Intraoral examination revealed a left lateral open bite and atrophy of the left side of the tongue. Panoramic radiography showed incomplete eruption of the left mandibular first and second premolars (34/35), with significant root atrophy giving a narrowed appearance to the corresponding pulp chambers confirmed on retro alveolar radiographs. The mandible had a slightly reduced ramus height on the affected side confirming the patient's facial asymmetry. A better understanding of this syndrome will help to improve oral care in young patients.
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Affiliation(s)
- El Mehdi Hariri
- Pediatric Dentistry, Faculty of Dental Medicine of Rabat, Mohammed V University in Rabat, Rabat, MAR
- Pediatric Dentistry, Mohammed V Military Hospital of Rabat, Rabat, MAR
| | - Mohamed Sellouti
- Neonatology, Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, MAR
| | - Hind Ramdi
- Pediatric Dentistry, Faculty of Dental Medicine of Rabat, Mohammed V University in Rabat, Rabat, MAR
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3
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Babaei K, Rahnama A, Shurvarzi N, Movahedi A. A case report of Parry-Romberg syndrome. Clin Case Rep 2024; 12:e8878. [PMID: 38689686 PMCID: PMC11060884 DOI: 10.1002/ccr3.8878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message Parry-Romberg syndrome is characterized by progressive dystrophy in one half of the face, which usually begins in childhood. Correct and timely diagnosis of this disease, as well as a multidisciplinary approach and timely surgical treatment to minimize the psychological effects and improve the patient's appearance are of particular importance. Abstract Parry-Romberg syndrome is characterized by progressive dystrophy or loss of subcutaneous tissue in one half of the face, which usually begins in childhood and continues with skin changes, and can also be associated with linear scleroderma. Although this disease has been known for more than 150 years, its exact cause and pathogenesis are not well understood. The clinical feature of Parry-Romberg syndrome that makes it possible to diagnose is unilateral idiopathic facial atrophy. The reported case is a 14-year-old boy who suffered from hemifacial atrophy of the frontal area since he was 7 years old was referred to a plastic and cosmetic surgery specialist and underwent surgery without systemic symptoms and in the inactive phase of the disease. Correct and timely diagnosis of this disease, as well as a multidisciplinary approach and timely and appropriate surgical treatment to minimize the psychological effects and improve the patient's appearance are of particular importance.
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Affiliation(s)
- Kiana Babaei
- Department of AnesthesiaNeyshabur University of Medical SciencesNeyshaburIran
| | - Ali Rahnama
- Department of Plastic SurgeryHakim Hospital, Neyshabur University of Medical SciencesNeyshaburIran
| | - Nora Shurvarzi
- Department of Operating RoomHakim Hospital, Neyshabur University of Medical SciencesNeyshaburIran
| | - Ali Movahedi
- Department of AnesthesiaNeyshabur University of Medical SciencesNeyshaburIran
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4
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Yoshida K. Hemimasticatory spasm: a series of 17 cases and a comprehensive review of the literature. Front Neurol 2024; 15:1377289. [PMID: 38566853 PMCID: PMC10986637 DOI: 10.3389/fneur.2024.1377289] [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: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Hemimasticatory spasm (HMS) is a rare movement disorder characterized by paroxysmal spasms or twitches of the unilateral jaw-closing muscles. This study aimed to comprehensively evaluate the clinical features of patients with HMS. Data from 17 patients newly diagnosed with HMS (12 females and 5 males; mean age at onset: 46.7 years) who visited our department were retrospectively analyzed, and a literature search based on electronic medical databases from their inception until November 30, 2023, was conducted. A manual search was conducted for articles cited in the related literature. A total of 117 cases (72 females and 45 males; mean age at onset: 37.1 years) from 57 studies were analyzed. The muscles involved were the masseter (97.4%), temporalis (47.9%), and medial pterygoid (6%). Morphea or scleroderma was observed in 23.9% of the patients, and facial hemiatrophy in 27.4%. In 17.9% of the cases, Parry-Romberg syndrome was either complicated or suspected. Typical electromyographic findings included the absence of a silent period during spasms (23.9%) and irregular brief bursts of multiple motor unit potentials. Oral medicines, such as clonazepam or carbamazepine, alleviated the symptoms for some patients but were often unsatisfactory. Botulinum toxin therapy was effective in most cases. Recently, microvascular decompression surgery is increasingly being used, resulting in complete relief in some cases. In conclusion, highly effective modalities are currently available, and it is necessary to raise awareness of HMS to ensure that it can be diagnosed and treated accurately by both medical and dental professionals.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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5
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He L, Liu X, Khatter NJ, Yu X, Washington KM, Shu M. Treatment of Progressive Hemifacial Atrophy by Cartilage Graft and Free Adipofascial Flap Combined with Three-Dimensional Planning. Plast Reconstr Surg 2024; 153:679-688. [PMID: 37092964 DOI: 10.1097/prs.0000000000010585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Progressive hemifacial atrophy (PHA) is a rare disease characterized by progressive atrophy of skin, soft tissue, muscles, and underlying bone structures. For severe PHA patients with obvious bone deformities, skeletal framework reconstruction is needed in addition to soft-tissue augmentation. The authors propose a new combinatorial surgical method using rib cartilage graft and free adipofascial flap for restoring facial symmetry. To improve the surgical accuracy, preoperative three-dimensional planning and printing was used. METHODS Twelve patients with severe facial atrophy were included in the authors' study. Three-dimensional facial image analyses were performed preoperatively to quantify the facial asymmetry. Rib cartilages were harvested and sculptured to the appropriate shape created by three-dimensional planning and fixed to the atrophic bone. The circumflex scapular artery-based adipofascial flap was transplanted to repair soft-tissue deficiency. A residual small monitor flap was left with the adipofascial flap. A revision surgery was performed to perfect the repair if the contour was suboptimal 6 months postoperatively. RESULTS The adipofascial flaps survived in all 12 patients. All patients achieved good healing without complications. At 1 more year after surgery, the rib cartilage was still in position and rarely absorbed. The morphologic and volumetric difference between the affected side and the unaffected side was improved significantly postoperatively. All patients were satisfied with the results, and no more additional operations were required. CONCLUSION The combinatorial surgery of rib cartilage graft and free adipofascial flap in the setting of three-dimensional planning and printing can be a good choice in restoring facial symmetry in severe cases of PHA. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Lin He
- From the Department of Plastic, Aesthetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Xiangyu Liu
- From the Department of Plastic, Aesthetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Neil J Khatter
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus
- Oakland University William Beaumont School of Medicine
| | - Xueyuan Yu
- From the Department of Plastic, Aesthetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Kia M Washington
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus
| | - Maoguo Shu
- From the Department of Plastic, Aesthetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University
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6
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Saulle I, Gidaro A, Donadoni M, Vanetti C, Mutti A, Romano ME, Clerici M, Cogliati C, Biasin M. Immunological Profiles in Parry-Romberg Syndrome: A Case-Control Study. J Clin Med 2024; 13:1219. [PMID: 38592689 PMCID: PMC10932088 DOI: 10.3390/jcm13051219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Parry-Romberg syndrome (PRS) is a rare craniofacial disorder. The aim of this study is to provide information on the immunological profile of this pathology. Since PRS can be included in a wider spectrum of sclerodermic diseases, we propose a case-control study comparing a patient affected by PRS with one with a diagnosis of scleroderma, herein used as control (CTR). Methods: B lymphocyte, T lymphocyte, and monocyte phenotypes and functions were assessed by flow cytometry in influenza (Flu)- or anti cluster differentiation (CD)3/CD28-stimulated peripheral blood mononuclear cells (PBMCs). Cytokine concentration was evaluated as well in PBMC supernatants, plasma, and saliva by Luminex assay. Results: T and B lymphocytes were similarly activated in unstimulated PRS and CTR cells but differed following antigen stimulation. T helper (Th)17 lymphocytes were expanded in PRS compared to CTR; this increase correlated with higher interleukin (IL)-17 concentration. Conclusions: Our case-control study is the first to compare the immunological profiles of PRS and scleroderma patients. The higher percentage of Th17 cells in PRS suggests the use of anti-IL17 receptor monoclonal antibody in this rare disease; however, further studies with larger numbers of patients are needed to confirm our findings.
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Affiliation(s)
- Irma Saulle
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Antonio Gidaro
- Department of Rheumatology, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Mattia Donadoni
- Department of Rheumatology, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Claudia Vanetti
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Alessandra Mutti
- Department of Rheumatology, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Maria Eva Romano
- Department of Rheumatology, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Don C. Gnocchi Foundation, IRCCS, 20122 Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Mara Biasin
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
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7
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Wróblewska A, Polańska A, Mojs E, Żaba R, Adamski Z, Dańczak-Pazdrowska A. Disturbances of the stomatognathic system and possibilities of its correction in patients with craniofacial morphea. Postepy Dermatol Alergol 2023; 40:592-598. [PMID: 38028421 PMCID: PMC10646717 DOI: 10.5114/ada.2023.131865] [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: 06/28/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
Morphea en coup de sabre and progressive hemifacial atrophy are extremely rare connective tissue disorders causing facial deformity. In extreme cases, morphological disorders are accompanied by symptoms of a clear impairment of the stomatognathic system. The aetiology of the above-mentioned diseases is still unknown. Properly planned therapy in the field of maxillofacial orthopaedics makes it possible to correct the asymmetric pattern of hard tissue growth and thus enable rehabilitation. The task of augmentation techniques is the volumetric supplementation of tissue defects resulting from atrophic processes. The degree of destruction and the extent of changes determine the method of correction. Mild and moderate defects are treated mainly with biomaterials and autologous adipose tissue. The severe course of hemifacial atrophy and morphea en coup de sabre and the associated significant tissue atrophy necessitate the search for more complex methods of treatment. In this paper, we summarize the disturbances of the stomatognathic system in patients with craniofacial morphea, together with an analysis of current treatment options.
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Affiliation(s)
- Agnieszka Wróblewska
- Student of Postgraduate Studies Facial Aesthetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Mojs
- Department of Clinical Psychology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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8
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Li D, Chen J, Chen M, Tang Y, Su J. A case of progressive crossed hemiatrophy mistaken as panniculitis. J Dermatol 2023; 50:1203-1207. [PMID: 37248853 DOI: 10.1111/1346-8138.16814] [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: 12/26/2022] [Revised: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
Progressive crossed hemiatrophy is an extremely rare clinical type of facial hemiatrophy that presents primarily as unilateral facial atrophy and contralateral trunk or limb involvement. The undistinguishable clinical manifestation and pathological changes complicate diagnosis, especially at the onset of the disease when presenting with less clinical evidence. Here, we report a case of a 9-year-old boy started with left scalp induration, following with subcutaneous tissues atrophy on the right trunk. He was mistaken as panniculitis based on the pathologic findings and treated with topical tacrolimus without any improvement. Immune-related tests were implemented to exclude connective tissues. Imaging examinations such as magnetic resonance was conducted to evaluate the range and degree of the involvement of the skin, soft tissue, and cranial changes. Although no effective treatment to hold back the progress has been reported so far, surgeries might work to restore the appearance to some extent or improve central nerves symptoms if they exist.
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Affiliation(s)
- Daishi Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Junchen Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
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9
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Kumar M, Singla R, Singh G, Kasrija R, Sharma M. Parry Romberg Syndrome: A Case Report and an Insight Into Etiology. Cureus 2023; 15:e41465. [PMID: 37546075 PMCID: PMC10404130 DOI: 10.7759/cureus.41465] [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] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Parry-Romberg syndrome (PRS) is a rare degenerative disorder of unknown cause that causes slow, progressive atrophy on one side of the face. The cause may be a malfunction of the sympathetic nervous system, with or without neurological symptoms. Atrophy usually begins in childhood and progresses gradually over several years. Stabilization can take up to 20 years. There is no definitive cure for this condition, but once the condition is stabilized, reconstructive surgery of the damaged skin and soft tissue can correct the deformity. The objective of this article is to present an insight into the etiology of PRS with a case report of a 15-year-old male patient, who was diagnosed with PRS due to trauma and developed progressive hemifacial atrophy without neurological manifestations. PRS is a progressive disease that severely affects one side of the face. Because of its devastating effects on the entire body, treatment requires a multidisciplinary approach. Further research is needed to clearly understand the etiology and provide patients with accurate treatment plans.
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Affiliation(s)
- Munish Kumar
- Department of Oral Surgery, Guru Nanak Dev Dental College, Sunam, IND
| | - Robin Singla
- Department of Oral Surgery, Guru Nanak Dev Dental College, Sunam, IND
| | - Gagandeep Singh
- Department of Oral Surgery, Guru Nanak Dev Dental College, Sunam, IND
| | | | - Manish Sharma
- Department of Oral Pathology and Microbiology, JMF's (Jawahar Medical Foundation's) ACPM (Annasaheb Chudaman Patil Memorial Medical) Dental College, Dhule, IND
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10
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Papara C, De Luca DA, Bieber K, Vorobyev A, Ludwig RJ. Morphea: The 2023 update. Front Med (Lausanne) 2023; 10:1108623. [PMID: 36860340 PMCID: PMC9969991 DOI: 10.3389/fmed.2023.1108623] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Morphea, also known as localized scleroderma, is a chronic inflammatory connective tissue disorder with variable clinical presentations, that affects both adults and children. It is characterized by inflammation and fibrosis of the skin and underlying soft tissue, in certain cases even of the surrounding structures such as fascia, muscle, bone and central nervous system. While the etiology is still unknown, many factors may contribute to disease development, including genetic predisposition, vascular dysregulation, TH1/TH2 imbalance with chemokines and cytokines associated with interferon-γ and profibrotic pathways as well as certain environmental factors. Since the disease may progress to permanent cosmetic and functional sequelae, it is crucial to properly assess the disease activity and to initiate promptly the adequate treatment, thus preventing subsequent damage. The mainstay of treatment is based on corticosteroids and methotrexate. These, however, are limited by their toxicity, especially if applied long-term. Furthermore, corticosteroids and methotrexate often do not sufficiently control the disease and/or the frequent relapses of morphea. This review presents the current understanding of morphea by discussing its epidemiology, diagnosis, management and prognosis. In addition, it will describe recent pathogenetic findings, thus proposing potential novel targets for therapeutic development in morphea.
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Affiliation(s)
- Cristian Papara
- Department of Dermatology, University of Lübeck, Lübeck, Germany,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany,*Correspondence: Cristian Papara, ✉
| | - David A. De Luca
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Artem Vorobyev
- Department of Dermatology, University of Lübeck, Lübeck, Germany,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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11
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Fan W, Obiakor B, Jacobson R, Haemel A, Gandelman J. Clinical and therapeutic course in head variants of linear morphea in adults: a retrospective review. Arch Dermatol Res 2022; 315:1161-1170. [DOI: 10.1007/s00403-022-02478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Abstract
AbstractParry Romberg Syndrome (PRS) and en coup de sabre (ECDS) are head variants of linear morphea with functional and structural implications. This study describes the clinical course, autoimmune co-morbidities, complications, and treatment of adults with PRS/ECDS at a tertiary referral center. We retrospectively reviewed the records of all 34 adult patients with PRS/ECDS identified through billing code search and seen by dermatologists at our institution between 2015 and 2021. Eight patients (23.5%) had ECDS, 8 (23.5%) had PRS, and 18 (52.9%) had overlap. Twenty-six patients (76.5%) reported ocular, oral, and/or neurologic symptoms, and 8 (23.5%) had concomitant autoimmune/inflammatory conditions. Sixteen patients (47.1%) had a skin biopsy, and 25 (73.5%) had imaging. Forty-six MRIs were obtained, of which 6 (13.0%) reported intracranial findings and 25 (54.3%) reported disease-related connective tissue damage. Twenty-four patients (70.6%) underwent systemic treatment during their disease course per available clinical records. Seventeen patients (70.8%) had improved or stable disease upon treatment completion, with an average duration of 22.2 months. Ten patients (41.7%) reported recurrence of disease following the treatment course. To address changes to facial contour, 6 patients (17.6%) opted for procedural treatments. One patient (16.7%) experienced morphea reactivation following a filler injection performed off-immunosuppression. Compared to findings in children, our study suggests adults with PRS/ECDS are more likely to have oral and ocular complications but experience less severe neurologic symptoms. While systemic treatments appear beneficial in most adult patients with PRS/ECDS, disease may recur following discontinuation.
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12
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Muacevic A, Adler JR, Seadey MY, Brakohiapa EK, Asiamah S, Mensah SK, Kekeshie KK, Ntiamoah-Koufie CE, Agala DK, Acheampong F. Parry Romberg Syndrome in a Young Ghanaian: A Case Report and a Literature Review. Cureus 2022; 14:e32287. [PMID: 36627986 PMCID: PMC9817484 DOI: 10.7759/cureus.32287] [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] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Parry Romberg syndrome (PRS), also known as progressive hemifacial atrophy, is a very rare self-limiting disease, which affects the skin and subcutaneous tissues, underlying musculature, cartilage, and bony structures of one half of the face with a resultant hemiatrophy and alopecia areata. It presents in children and young adults, with a slow progression of the atrophy for several years, and then becomes stable. Magnetic resonance imaging (MRI) or computed tomography (CT) scan of the cranium demonstrates the radiological feature of hemiatrophy very clearly. We report a case of PRS in a nine-year-old girl with characteristic features which was diagnosed based on medical history, clinical signs, and radiological findings on cranial CT scan and MRI.
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13
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Gunasekera CL, Middlebrooks EH, Burkholder DB, Chen B, Sirven JI, Wong-Kisiel LC, Freund BE, Tatum WO, De la Garza-Ramos CC, Okromelidze L, Feyissa AM. Association of intracranial abnormalities with the development of epilepsy and drug-resistant epilepsy in patients with Parry-Romberg syndrome. J Neurol Sci 2022; 442:120455. [PMID: 36242808 DOI: 10.1016/j.jns.2022.120455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epilepsy represents an essential component of Parry Romberg syndrome (PRS). This study aimed to identify clinical factors that influence the development of epilepsy and drug-resistant epilepsy (DRE) in PRS. METHODS We retrospectively reviewed the medical records of eighty patients with PRS. Data including the age of onset for PRS, history of seizures, use and timing of immunotherapy, antiseizure medication use, and EEG and brain imaging findings were reviewed. For comparison with the patients with epilepsy (PRSe+) group, we selected 18 age and sex-matched controls from the patient without epilepsy (PRSe-) cohort using propensity score matching. RESULTS Eighteen (22.5%) had epilepsy: 12 were female, and the median age was 14.5 years (range = 6-48 years). Eleven patients developed DRE. The median latency between the onset of cutaneous manifestations and diagnosis and timing and use of immunotherapy was similar between the PRSe + and PRSe- groups. Intracranial abnormalities were commonly seen in the PRSe + group (16 vs. 2, p < 0.01). White matter disease and ipsilateral atrophy were common among the PRSe + group. Timing and use of immunotherapy, epileptiform discharges, and brain imaging abnormalities did not differ between those with DRE and without. CONCLUSIONS The presence and degree of severity of ipsilateral brain abnormalities are risk factors for the development of epilepsy in PRS but not factors in predicting drug resistance. The timing of immunotherapy did not influence the development of PRSe + or DRE. Prospective studies are needed to identify biomarkers for epilepsy and assess the role of immunotherapy on seizure outcomes in PRSe + .
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Affiliation(s)
| | | | | | - Baibing Chen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Brin E Freund
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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14
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Murashkin NN, Savelova AA, Misbakhova AR. Face Lesions in En Coup De Sabre Scleroderma in Children: Modern Treatment and Outcomes Improvement. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i5.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Localized scleroderma (LS) is an inflammatory sclerosing disease of the skin and subcutaneous tissues associated with its atrophy. Commonly, LS is a benign self-limited disease, although, the chronic form of this disease is recurrent. Particular attention is paid to the research of treatments methods that could eliminate not only immune-mediated mechanisms, but also its outcomes (such as gross cosmetic defects on the face), which negatively affect child’s physical and psycho-emotional development. Recently, fat transplantation efficacy has been studied as it can restore the volume and improve skin quality. This article presents the results of such surgery in a patient (15 years old) with linear form of LS.
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Affiliation(s)
- Nikolay N. Murashkin
- National Medical Research Center of Children’s Health; Sechenov First Moscow State Medical University; Central State Medical Academy of Department of Presidential Affairs
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Mbodji AB, Seck M, Diagne NS, Faye I, Mbacke SS, Ndiaye M. Facial spasms revealing a Parry-Romberg syndrome: A case report. Ann Med Surg (Lond) 2022; 82:104716. [PMID: 36268386 PMCID: PMC9577821 DOI: 10.1016/j.amsu.2022.104716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Parry-Romberg syndrome (PRS) is a rare clinical entity characterized by progressive atrophy of the hemifacial region, occasionally associated with systemic manifestations. The presence of facial muscles spasms is exceptional. Case presentation We report the case of a young woman who presented with progressive atrophy of the right hemiface associated with vitiligo and facial muscles spasms. The diagnosis of Parry Romberg syndrome was retained. Electromyogram showed an intermittent motor unit potential. Cerebral MRI showed atrophy of the muscle and subcutaneous fat of the right hemiface. She received corticosteroid in combination with botulinum toxin injection, which stopped the spasms. Clinical discussion It is a rare condition with a poorly understood etiology, which is responsible for the delay in diagnosis often noted. The association of this syndrome with neurological signs is exceptional and rarely described in the literature. Injection of botulinum toxin associated with corticosteroids can stop the spasms but only surgery can reduce the facial deformities. Conclusion Parry-Romberg syndrome is a rare disease, more frequent in women. It poses a real diagnostic problem and its treatment is poorly codified. Parry-Romberg syndrome is a rare disease whose prevalence isn't well known. This is an unknown disease and is the reason for the delay in diagnosis. Facial muscles spams is rarely associated with Parry-Romberg syndrome. Botulinum toxin can stop facial muscle spasms.
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Discussion: Soft-Tissue Reconstruction in Progressive Hemifacial Atrophy: Current Evidence and Future Directions. Plast Reconstr Surg 2022; 150:618-619. [PMID: 36040997 DOI: 10.1097/prs.0000000000009424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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ter Horst R, Maal TJJ, de Koning MJJ, Mertens JS, Schatorjé EJH, Hoppenreijs EP, Seyger MMB. 3D stereophotogrammetry in children and adolescents with Scleroderma En Coup De Sabre/Parry-Romberg Syndrome: Description of a novel method for monitoring disease progression. SKIN HEALTH AND DISEASE 2022; 2:e132. [PMID: 36092259 PMCID: PMC9435452 DOI: 10.1002/ski2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022]
Abstract
Background The diagnosis of Scleroderma En Coup de Sabre (ECDS)/Parry Romberg Syndrome (PRS) is mainly based on characteristic clinical findings. Methods to objectively monitor the course of the disease in a standardized way are lacking. Objectives This descriptive, retrospective, single centre cohort study aims to describe the contribution of 3D photographs in the assessment of the degree of facial asymmetry changes over time in growing children and adolescents with ECDS and PRS. Methods Six patients diagnosed with ECDS/PRS, with a follow-up period of at least 24 months and at least three 3D photographs were included. Mirroring these 3D photographs was automatically performed using surface-based matching to generate a colour-coded distance map, illustrating the inter-surface distance and thereby asymmetry between the original and mirrored 3D photographs. The percentage of absolute distances between the original and mirrored 3D photograph were calculated. Results In two patients, impressive decreases in the percentages of absolute distance levels over time were found, whereas the other patients did not show progression of asymmetry over time. Conclusion This study shows the potential of 3D stereophotogrammetry as an objective tool to measure disease activity over time in patients with ECDS/PRS.
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Affiliation(s)
- Rutger ter Horst
- Department of Oral and Maxillofacial SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Thomas J. J. Maal
- Department of Oral and Maxillofacial SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Martien J. J. de Koning
- Department of Oral and Maxillofacial SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Jorre S. Mertens
- Department of DermatologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Ellen J. H. Schatorjé
- Department of PediatricsPediatric Rheumatology, Radboud University Medical CenterNijmegenThe Netherlands
| | - Esther P. Hoppenreijs
- Department of PediatricsPediatric Rheumatology, Radboud University Medical CenterNijmegenThe Netherlands
| | - Marieke M. B. Seyger
- Department of DermatologyRadboud University Medical CenterNijmegenThe Netherlands
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18
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"Soft Tissue Reconstruction in Progressive Hemifacial Atrophy: Current Evidence and Future Directions". Plast Reconstr Surg 2022; 150:607-617. [PMID: 35791266 DOI: 10.1097/prs.0000000000009423] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Progressive Hemifacial Atrophy (PHA) is a rare disorder characterized by gradual unilateral soft tissue atrophy in the face, which may also include clinically significant degeneration of underlying muscle and bone. In recent years, there has been a growing body of evidence regarding different soft-tissue reconstructive strategies in PHA, and the impact of intervention timing on disease progression. This article provides a comprehensive synthesis of the latest evidence in order to guide optimal management. METHODS A comprehensive multi-database search was performed through April 2020 using relevant search terms to identify clinical studies. Outcomes, complications, disease- and patient-related indications pertaining to different soft-tissue reconstructive strategies in PHA were collected and critically appraised. RESULTS 35 articles reporting on a total of 824 PHA patients were evaluated; 503 (61%) were managed by microvascular free flaps, 302 patients (37%) were managed by autologous fat grafts, and 19 (2%) by pedicled flaps. A detailed synthesis of outcomes is presented herein, as well as a comparative evaluation of different microvascular free-flap options. CONCLUSION Soft-tissue reconstruction in PHA remains an evolving field. Operative decision-making is often multifaceted, and guided by specific volumetric, aesthetic and functional deficiencies. Serial fat grafting is the primary modality utilized for patients with mild soft-tissue atrophy, while microvascular free flaps widely remain the treatment of choice for reconstruction of large volume defects. There exists a growing role of graft supplementation to improve fat graft survival, while recent evidence demonstrates that early intervention may help curb disease progression.
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19
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Fang CL, Tsai CB, Chen MS. Multi-Staged Surgeries for Coexisting Facial Asymmetry and Strabismus in Parry-Romberg Syndrome. J Craniofac Surg 2022; 33:e495-e497. [PMID: 35758422 DOI: 10.1097/scs.0000000000008400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Parry-Romberg syndrome (PRS) is a rare disorder resulting in disfiguring facial asymmetry. Ocular manifestations can result in complex strabismus. There were limited reports on the treatment of PRS with coexisting strabismus. We present a multistaged surgical approach to manage the facial asymmetry and strabismus.
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Affiliation(s)
- Chien-Liang Fang
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City.,Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung City
| | - Chong-Bin Tsai
- Department of Ophthalmology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City.,Department of Optometry, College of Medical and Health Science, Asia University, Taichung City
| | - Ming-Shan Chen
- Department of Anesthesiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City; and.,Department of Biotechnology, Asia University, Taichung City, Taiwan
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20
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De la Garza-Ramos C, Jain A, Montazeri SA, Okromelidze L, McGeary R, Bhatt AA, Sandhu SJS, Grewal SS, Feyissa A, Sirven JI, Ritaccio AL, Tatum WO, Gupta V, Middlebrooks EH. Brain Abnormalities and Epilepsy in Patients with Parry-Romberg Syndrome. AJNR Am J Neuroradiol 2022; 43:850-856. [PMID: 35672084 DOI: 10.3174/ajnr.a7517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parry-Romberg syndrome is a rare disorder characterized by progressive hemifacial atrophy. Concomitant brain abnormalities have been reported, frequently resulting in epilepsy, but the frequency and spectrum of brain involvement are not well-established. This study aimed to characterize brain abnormalities in Parry-Romberg syndrome and their association with epilepsy. MATERIALS AND METHODS This is a single-center, retrospective review of patients with a clinical diagnosis of Parry-Romberg syndrome and brain MR imaging. The degree of unilateral hemispheric atrophy, white matter disease, microhemorrhage, and leptomeningeal enhancement was graded as none, mild, moderate, or severe. Other abnormalities were qualitatively reported. Findings were considered potentially Parry-Romberg syndrome-related when occurring asymmetrically on the side affected by Parry-Romberg syndrome. RESULTS Of 80 patients, 48 (60%) had brain abnormalities identified on MR imaging, with 26 (32%) having abnormalities localized to the side of the hemifacial atrophy. Sixteen (20%) had epilepsy. MR imaging brain abnormalities were more common in the epilepsy group (100% versus 48%, P < .001) and were more frequently present ipsilateral to the hemifacial atrophy in patients with epilepsy (81% versus 20%, P < .001). Asymmetric white matter disease was the predominant finding in patients with (88%) and without (23%) epilepsy. White matter disease and hemispheric atrophy had a higher frequency and severity in patients with epilepsy (P < .001). Microhemorrhage was also more frequent in the epilepsy group (P = .015). CONCLUSIONS Ipsilateral MR imaging brain abnormalities are common in patients with Parry-Romberg syndrome, with a higher frequency and greater severity in those with epilepsy. The most common findings in both groups are white matter disease and hemispheric atrophy, both presenting with greater severity in patients with epilepsy.
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Affiliation(s)
- C De la Garza-Ramos
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - A Jain
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S A Montazeri
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - L Okromelidze
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - R McGeary
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - A A Bhatt
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S J S Sandhu
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S S Grewal
- Department of Neurologic Surgery (S.S.G.), Mayo Clinic, Jacksonville, Florida
| | - A Feyissa
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - J I Sirven
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - A L Ritaccio
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - W O Tatum
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - V Gupta
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - E H Middlebrooks
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
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In Vitro Study on the Biological Characteristics of Adipose-Derived Stem Cells from Liposuction Area in Patients with Progressive Hemifacial Atrophy. Aesthetic Plast Surg 2022; 46:2526-2538. [PMID: 35552479 DOI: 10.1007/s00266-022-02902-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/02/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE In this study, we investigate the biological characteristics of ADSCs from the liposuction area in patients with hemifacial atrophy in vitro. METHODS ADSCs were respectively extracted from the donor site of patients with hemifacial atrophy and healthy ones. ADSCs of two groups were respectively tested for proliferation ability, phenotype, multipotency, migration ability, self-repair ability, apoptosis, and autophagy. Exosomes extracted from the supernatant of two groups were detected by NTA particle size, electron microscopy (TEM), and WB for CD63 and TSG10, respectively. RESULTS CCK-8 showed a statistically less increase in cell proliferation in PHA-ADSCs after the sixth day. ADSCs in both groups had typical phenotypes and multidirectional abilities. PHA-ADSCs exhibited weaker droplet formation. The cell migration ability in PHA-ADSCs was weaker tested by Transwell assay. The live/dead proportion calculated by ImageJ following calcein-AM/PI double staining revealed live cells in PHA-ADSCs was 46.11% compared with 54.21% in NORM-ADSCs after OGD treatment. A significant down-regulation of ATG7 and ATG12 and a higher percentage of apoptosis were found in PHA-ADSCs. A significant up-regulation of BAX occurred in PHA-ADSCs.ARPC5 expression in the PHA group was extremely distinct down-regulated.CDKN1A and CDKN2A expression in the PHA group was significantly up-regulated.WB analyses confirmed that both groups' ADSCs-Exosomes surface markers CD63 and TSG101 were positively expressed but varied significantly. CONCLUSIONS PHA-ADSCs exhibited a poorer proliferation ability, higher apoptosis percentage, weaker lipid droplets formation, weaker cell migration, poorer intolerance to OGD, aging earlier, and weaker self-renewal and repairability.PHA-ADSCs-Exosomes showed low expressions of CD63 and TSG101.This study provides strong evidence that the addition of exosomes with specific cytokines can improve the fat survival rate after fat filling in patients with hemifacial atrophy. NO LEVEL ASSIGNED This journal requires that authors 42 assign a level of evidence to each submission to which 43 Evidence-Based Medicine rankings are applicable. This 44 excludes Review Articles, Book Reviews, and manuscripts 45 that concern Basic Science, Animal Studies, Cadaver 46 Studies, and Experimental Studies. For a full description of 47 these Evidence-Based Medicine ratings, please refer to the 48 Table of Contents or the online Instructions to Authors 49 https://www.springer.com/00266 .
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22
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Chakraborty U, Bhat S, Bhattacharyya A, Sadhukhan S, Chandra A, Ray BK. Parry-Romberg Syndrome with Intracranial Calcification. Am J Med 2022; 135:e90-e91. [PMID: 35081381 DOI: 10.1016/j.amjmed.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Uddalak Chakraborty
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, India
| | - Saumen Bhat
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, India
| | - Aishee Bhattacharyya
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, India
| | - Soumita Sadhukhan
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, Kolkata, India.
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, India
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OPTIMIZATION OF COMPLEX THERAPY OF PATIENTS WITH LOCALIZED SCLERODERMA. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-4-82-12-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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24
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Ng CC, Suresh S, Rosenbaum JT, McDonald HR, Cunningham ET. Occlusive retinal vasculitis associated with systemic sclerosis and antiphospholipid antibodies. Am J Ophthalmol Case Rep 2021; 24:101206. [PMID: 34568641 PMCID: PMC8449073 DOI: 10.1016/j.ajoc.2021.101206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/18/2021] [Accepted: 09/10/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To report a series of patients with occlusive retinal vasculitis associated with systemic sclerosis (SSc) and elevated antiphospholipid antibody titers. METHOD Case series. Main outcome measures included clinical and fluorescein angiographic findings at presentation and over time. OBSERVATIONS Case 1 - A 61-year-old woman initially diagnosed with idiopathic, bilateral panuveitis and retinal vasculitis causing peripheral nonperfusion was subsequently diagnosed with limited cutaneous systemic sclerosis (lcSSc). Her ocular inflammation and retinal vasculitis were controlled with topical and periocular corticosteroids, but she eventually developed peripheral retinal vascular occlusion that progressed to macular ischemia 11 years after presentation. Repeat serologic evaluation detected interval development of antiphospholipid antibodies. Case 2 - A 58-year-old woman was found to have bilateral peripheral nonperfusion and retinal neovascularization in her right eye. Given her elevated hemoglobin A1c of 8.5%, she was diagnosed with presumed proliferative diabetic retinopathy. Three years after initial presentation, she was diagnosed with lcSSc. Subsequent serum workup detected elevated B2-glycoprotein antibody titers. Her peripheral nonperfusion progressed despite adequate glycemic control, resulting in further neovascularization in each eye. Case 3 - A 40-year-old woman with diffuse cutaneous systemic sclerosis (dcSSc) and elevated titers of anti-cardiolipin antibodies developed multiple branch retinal artery occlusions with subsequent neovascularization of the retina, optic disc, and angle in the right eye. CONCLUSION AND IMPORTANCE Vision-threatening occlusive retinal vasculitis may develop in select patients with SSc. The presence of elevated anti-phospholipid antibody titers may confer increased risk for this vision-threatening complication.
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Affiliation(s)
- Caleb C. Ng
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Sandip Suresh
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | - James T. Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - H. Richard McDonald
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Emmett T. Cunningham
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
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25
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Foiadelli T, Rossi A, Trabatti C, Spreafico E, Santi V, Orsini A, Verrotti A, Savasta S. Headache in progressive facial hemiatrophy (Parry-Romberg syndrome): A paradigmatic case and systematic review of the literature. Cephalalgia 2021; 42:409-425. [PMID: 34569314 DOI: 10.1177/03331024211043452] [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] [Indexed: 01/15/2023]
Abstract
BACKGROUND Parry-Romberg syndrome is a neuro-cutaneous disease characterized by progressive hemifacial atrophy. Although common, headache in this population is scarcely reported in the literature. OBJECTIVE To evaluate the clinical features of headache in pediatric and adult patients with Parry-Romberg syndrome, and to discuss diagnostic and treatment approaches of headache in Parry-Romberg syndrome. METHODS We conducted a systematic review in accordance with PRISMA guidelines. We searched the MEDLINE database to identify eligible studies and identified patients with Parry-Romberg syndrome and headache. We further reported a paradigmatic case with a complex headache disorder and described its management and outcome. RESULTS We identified 74 articles, 41 of which were included in the analysis. A total of 52 patients (55.8% female) were included for data analysis. The main age at onset of headache was 20 years (SD 15.2; range 3-56). A diagnosis of migraine was made in 53.9%. Abnormal brain imaging was found in 82.2% of patients. CONCLUSION Long-term follow-up of patients is required, because headache may develop (and evolve) at any time over the course of the disease. Primary and secondary headaches often co-occur in patients with Parry-Romberg syndrome. Further research into the underlying etiopathogenesis and therapeutic targets would be recommended.
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Affiliation(s)
- Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandra Rossi
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Chiara Trabatti
- Pediatric Clinic, Maggiore Hospital, ASST Crema, Crema, Italy
| | - Eugenia Spreafico
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Viola Santi
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Orsini
- Neuropediatric Section, Pediatric Clinic, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alberto Verrotti
- Department of Pediatrics, 9309University of Perugia, University of Perugia, Perugia, Italy
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Hixon AM, Christensen E, Hamilton R, Drees C. Epilepsy in Parry-Romberg syndrome and linear scleroderma en coup de sabre: Case series and systematic review including 140 patients. Epilepsy Behav 2021; 121:108068. [PMID: 34052630 DOI: 10.1016/j.yebeh.2021.108068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
Parry-Romberg syndrome (PRS) and linear sclerosis en coup de sabre (LScs) are rare, related, autoimmune conditions of focal atrophy and sclerosis of head and face which are associated with the development of focal epilepsy. The scarcity of PRS and LScs cases has made an evidence-based approach to optimal treatment of seizures difficult. Here we present a large systematic review of the literature evaluating 137 cases of PRS or LScs, as well as three new cases with epilepsy that span the spectrum of severity, treatments, and outcomes in these syndromes. Analysis showed that intracranial abnormalities and epileptic foci localized ipsilateral to the external (skin, eye, mouth) manifestations by imaging or EEG in 92% and 80% of cases, respectively. Epilepsy developed before external abnormalities in 19% of cases and after external disease onset in 66% of cases, with decreasing risk the further from the start of external symptoms. We found that over half of individuals affected may achieve seizure freedom with anti-seizure medications (ASMs) alone or in combination with immunomodulatory therapy (IMT), while a smaller number of individuals benefitted from epilepsy surgery. Although analysis of case reports has the risk of bias or omission, this is currently the best source of clinical information on epilepsy in PRS/LScs-spectrum disease. The paucity of higher quality information requires improved case identification and tracking. Toward this effort, all data have been deposited in a Synapse.org database for case collection with the potential for international collaboration.
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Affiliation(s)
- Alison M Hixon
- Medical Scientist Training Program, University of Colorado, CU Anschutz Fitzsimons Building 13001 East 17th Place, Aurora, CO 80045, USA
| | - Elijah Christensen
- Medical Scientist Training Program, University of Colorado, CU Anschutz Fitzsimons Building 13001 East 17th Place, Aurora, CO 80045, USA
| | - Robert Hamilton
- Blue Sky Neurology, 499 E. Hampden Ave. Ste. 360 Englewood, CO 80113, USA
| | - Cornelia Drees
- Department of Neurology, University of Colorado, CU Anschutz Research Complex II, 12700 East 19th Avenue, Aurora, CO 80045, USA; Mayo Clinic Neurology and Neurosurgery, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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27
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Clapp AN, DePold Hohler A. A case of parasympathetic hyperactivity and associated Parry-Romberg syndrome. SAGE Open Med Case Rep 2021; 9:2050313X211034351. [PMID: 34367643 PMCID: PMC8312147 DOI: 10.1177/2050313x211034351] [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: 04/14/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
This case report describes a 46-year-old female with a history of multiple endocrine neoplasia type 1 syndrome status post-parathyroidectomy, thymectomy via robotic video-assisted thoracoscopic surgery, and pituitary adenoma resection presenting with parasympathetic hyperactivity and Parry-Romberg syndrome. Parry-Romberg syndrome is a rare disorder that manifests as facial hemiatrophy. Reported symptoms include cognitive dysfunction, olfactory hallucinations, and parasympathetic hyperactivity: miosis of the right eye, anhidrosis, diarrhea, urinary incontinence, bowel incontinence, and orthostatic hypotension. Previous reports have noted associations between Parry-Romberg syndrome and sympathetic hyperactivity and dysregulation. This case report focuses on an association between Parry-Romberg syndrome and unopposed parasympathetic activity.
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Affiliation(s)
- Andrea N Clapp
- Tufts University School of Medicine, Boston, MA, USA
- Andrea N Clapp, Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA.
| | - Anna DePold Hohler
- Tufts University School of Medicine, Boston, MA, USA
- Department of Neurology, St. Elizabeth’s Medical Center, Brighton, MA, USA
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28
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Duan J, Zhang Y, Ge G, Zhang M. Fundus changes of Parry-Romberg syndrome: A report of three cases and literature review. Eur J Ophthalmol 2021; 32:NP13-NP19. [PMID: 34020574 DOI: 10.1177/11206721211015560] [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] [Indexed: 02/05/2023]
Abstract
PURPOSE To report three cases of Parry-Romberg syndrome (PRS) with progressive hemifacial atrophy and similar fundus changes. METHODS Retrospective case series of three patients who presented to the ophthalmology department with blurred vision in one eye. All of them underwent three-dimensional reconstruction of head computed tomography (CT), related physical examinations, and also monthly ocular examinations of both eyes, including the slit-lamp microscope, fundus autofluorescence, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). We also reviewed the current literature about the fundus change in PRS from inception to March 2020 via PubMed. RESULTS Coats-like fundus and exudative retinal detachment were found in all three eyes of three patients during the follow-up. No systematic changes were found except for hemifacial atrophy. The final diagnoses of these three patients were PRS. CONCLUSION Only a subset of PRS patients have concomitant ocular changes, but it still should be noticed that the diagnosis of PRS should be considered if adults presented with Coats-like retinopathy and hemifacial atrophy.
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Affiliation(s)
- Jianan Duan
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhang
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Ge
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Knights H, Minas E, Khan F, Shaw L, Al Obaidi M, Mankad K, Eleftheriou D. Magnetic resonance imaging findings in children with Parry-Romberg syndrome and en coup de sabre. Pediatr Rheumatol Online J 2021; 19:42. [PMID: 33757522 PMCID: PMC7986399 DOI: 10.1186/s12969-021-00512-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of this study was to: (i) describe the abnormalities seen on brain imaging in a group of children with en coup de sabre (EDCS) with/without Parry-Romberg syndrome (PRS); and (ii) identify clinical predictors of brain imaging abnormalities. METHODS This was a single centre (Great Ormond Street Hospital, London) retrospective case series of patients with ECDS/PRS seen from 2000 to 2018. We identified patients with cutaneous manifestations consistent with the clinical descriptions of ECDS/PRS. Presenting clinical, laboratory, and radiological brain findings are described. Results are expressed as medians and ranges or frequencies and percentages. Fisher's exact test was used to identify clinical associations with magnetic resonance imaging (MRI) abnormalities. RESULTS Fourteen patients were studied: 6 males and 8 females; median age 14 years (range 3-20). We observed neuroimaging abnormalities in 2/6 ECDS and 5/8 ECDS/PRS patients. White matter signal abnormality, dystrophic calcification, leptomeningeal enhancement, and sulcal crowding were the typical findings on brain imaging. A total of 50% of patients had no MRI abnormality despite some of these patients having neurological symptoms. The presence of seizures was significantly associated with ipsilateral enhanced white matter signalling on MRI (p < 0.05). CONCLUSIONS In summary, we observed several distinct radiographic patterns associated with ECDS/PRS. Seizure disorder was strongly associated with the presence of ipsilateral enhanced white matter signalling. Improved neuroimaging techniques that combine morphological with functional imaging may improve the detection rate of brain involvement in children with ECDS/PRS in the future.
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Affiliation(s)
- Harry Knights
- Department of Paediatric Rheumatology, University College London Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Imperial College School of Medicine, Imperial College London, London, UK.
| | - Elizabeth Minas
- grid.413820.c0000 0001 2191 5195Department of Radiology, Charing Cross Hospital, London, UK
| | - Faraan Khan
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Lindsay Shaw
- grid.424537.30000 0004 5902 9895Department of Paediatric Dermatology, University College London Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Muthana Al Obaidi
- grid.424537.30000 0004 5902 9895Department of Paediatric Rheumatology, University College London Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- grid.424537.30000 0004 5902 9895Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- grid.424537.30000 0004 5902 9895Department of Paediatric Rheumatology, University College London Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, UK
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30
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Skolka MP, Marks LA, Jones LK, Tollefson MM, Smith JH. Trigeminal nerve electrophysiological findings in hemifacial atrophy: A systematic literature review and retrospective chart review. Clin Neurophysiol Pract 2021; 6:50-55. [PMID: 33615047 PMCID: PMC7881166 DOI: 10.1016/j.cnp.2020.12.003] [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: 10/30/2020] [Revised: 12/03/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022] Open
Abstract
Trigeminal nerve electrophysiology is commonly abnormal in cases of HFA. Trigeminal abnormalities are seen in cases with moderate-severe disease. Both central and peripheral nervous system abnormalities may result in HFA.
Objective Hemifacial atrophy (HFA) is a rare disorder characterized by progressive unilateral wasting facial soft tissue, muscle, and/or bone. Trigeminal nerve abnormalities may contribute to or result from disease pathophysiology. We aimed to gain further insights into the role of trigeminal pathophysiology along the HFA severity spectrum. Methods A systematic literature review was performed according to PRISMA standards. Retrospective cases of HFA from the literature and Mayo Clinic EMG database were pooled for descriptive and semi-quantitative analysis. Results Overall, 13 total HFA patients were identified through literature and database reviews. Trigeminal nerve testing was abnormal in 9/13 (69%), exclusively in moderate-severe cases. Abnormalities suggested a peripheral (7/9, 78%) or mixed central/peripheral (2/9, 22%) localization. Trigeminal nerve abnormalities were not identified in any of the 4 cases with mild disease severity. Conclusion Moderate to severe cases of HFA were associated with electrophysiological trigeminal abnormalities. No abnormalities were seen in mild cases of HFA. Significance Trigeminal nerve electrophysiology may serve as a biomarker of moderate-severe disease progression, likely reflecting the consequences of progressive soft tissue atrophy.
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Affiliation(s)
| | - Lisa A Marks
- Department of Library Services, Mayo Clinic, Scottsdale, AZ, USA
| | - Lyell K Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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31
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Arif T, Fatima R, Sami M. Parry–Romberg syndrome: a mini review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Efficacy of Autologous Fat Grafting in Restoring Facial Symmetry in Linear Morphea-Associated Lesions. Symmetry (Basel) 2020. [DOI: 10.3390/sym12122098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Morphea is a rare sclerotic autoimmune disorder primary affecting the skin and subcutaneous tissues. The linear head variants involve the facial area, with asymmetries and deformities. Eighteen patients with hemifacial deformity (age range 14–75 years) were assessed before surgery (T0), and after one (T1, 18 patients) or two (T2, six patients) surgical treatments of facial autologous fat grafting. A stereophotogrammetric reconstruction of the facial surface was obtained for each patient and a group of control subjects, and facial symmetry was quantified according to the root mean square distance between homologous areas of trigeminal innervation. Values obtained from the control subjects were used to calculate z-scores for patients. At T0, all facial thirds of the patients resulted significantly more asymmetrical than those of the control subjects (Mann–Whitney test, p < 0.05), while at T1, the symmetry of the middle facial third did not differ from that of control subjects (p = 0.263). At T2, the upper and the lower facial thirds also did not differ from the control values (p > 0.05). The faster result obtained in the facial middle third was in accord with clinical findings. In conclusion, autologous fat grafting significantly improved facial asymmetry after one (middle facial third) or two (lower and upper thirds) treatments; the outcomes were efficaciously quantified by stereophotogrammetry.
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33
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Secukinumab treatment of Parry-Romberg syndrome. JAAD Case Rep 2020; 6:1082-1084. [PMID: 32995450 PMCID: PMC7516175 DOI: 10.1016/j.jdcr.2020.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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34
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Liu J, Liu Y, Wang L, Zhang X, Hao P, Li X. Progressive hemifacial atrophy with characteristic ocular manifestations in a Chinese patient with a CRB1 mutation. J Int Med Res 2020; 48:300060520910635. [PMID: 32351147 PMCID: PMC7221477 DOI: 10.1177/0300060520910635] [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] [Indexed: 12/05/2022] Open
Abstract
Progressive hemifacial atrophy (PHA) is mainly characterized by asymmetrical
atrophy of craniofacial tissue; however, 10% to 30% of patients with PHA exhibit
ocular manifestations. Here, we describe abnormal ocular findings in a Chinese
patient with PHA. The patient was a 29-year-old Chinese man. Characteristic
ocular findings in his affected eye included keratic precipitate, corneal
endothelial degeneration, fundus tessellation, pupillary dilation, direct light
reflex loss, and visual evoked potential alteration. Whole exosome sequencing
revealed that the patient harbored a mutation in the CRB1 gene;
this gene has been associated with various retinal dystrophies. During 10 years
of follow-up, the patient’s ocular status remained stable. To the best of our
knowledge, this is the first report of ocular manifestations of PHA in a Chinese
patient, and the first report of a CRB1 mutation in a patient
with PHA; these findings may inform future research regarding PHA.
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Affiliation(s)
- Jinghua Liu
- Tianjin Medical University, Tianjin, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Ying Liu
- Southwest Medical University, Luzhou, China
| | - Liming Wang
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Nankai University Eye Hospital, Tianjin, China
| | - Xiaohan Zhang
- Tianjin Medical University, Tianjin, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Peng Hao
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Nankai University Eye Hospital, Tianjin, China
| | - Xuan Li
- Tianjin Medical University, Tianjin, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Nankai University Eye Hospital, Tianjin, China
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35
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Creadore A, Watchmaker J, Maymone MBC, Pappas L, Lam C, Vashi NA. Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with morphea/systemic sclerosis. J Am Acad Dermatol 2020; 83:315-341. [PMID: 32360721 DOI: 10.1016/j.jaad.2019.12.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/06/2023]
Abstract
Morphea and systemic sclerosis are inflammatory, sclerosing disorders. Morphea primarily affects the dermis and subcutaneous fat, while systemic sclerosis typically involves the skin and internal organs. Functional impairment and cosmetic disfigurement are common in both diseases. Treatment options to mitigate disease progression remain limited. Both functional impairment and cosmetic deficits negatively impact quality of life and psychological well-being in this patient population. While the number of cosmetic procedures performed in the United States continues to rise each year, limited data exist regarding best practices for correcting aesthetic deficits caused by autoimmune conditions. There is scarce information to guide safety decisions regarding laser parameters, soft tissue augmentation, treatment intervals, and the concurrent use of immune-modifying or immune-suppressing medications. Given the fears of disease reactivation and exacerbation from postprocedural inflammation along with limited data, it is difficult for clinicians to provide evidence-based cosmetic treatment with realistic expectations with regard to short- and long-term outcomes. In the first article in this continuing medical education series, we attempt to address this practice gap.
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Affiliation(s)
| | - Jacqueline Watchmaker
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mayra B C Maymone
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Leontios Pappas
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Christina Lam
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
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36
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Ojeda Lewis E, Díaz Arangoitia S, Duránd Anahua P. Progressive hemifacial atrophy or Parry-Romberg syndrome: A pediatric case report. Medwave 2020; 20:e7880. [DOI: 10.5867/medwave.2020.03.7880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/13/2020] [Indexed: 11/27/2022] Open
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37
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Glaser DH, Schutt C, Schollaert-Fitch K, Torok K. Linear Scleroderma of the Head - Updates in management of Parry Romberg Syndrome and En coup de sabre: A rapid scoping review across subspecialties. Eur J Rheumatol 2020; 7:S48-S57. [PMID: 35929860 PMCID: PMC7004261 DOI: 10.5152/eurjrheum.2019.19183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 07/27/2023] Open
Abstract
To provide an update on the current management, including evaluation and treatment, and the available diagnostic tools for linear scleroderma of the head, i.e., Parry-Romberg Syndrome and en coup de sabre (PRS/ECDS). A rapid scoping review of the literature was conducted to include manuscripts published in English between 2010 and 2019. Literature searches were performed in PubMed and EMBASE databases. The were analyzed for descriptive statistic reporting. This study reviewed 215 manuscripts reporting these 1430 patients. Surgical reports comprised the majority of the reviewed literature. Most PRS/ECDS did not appear to receive comprehensive multisubspecialty evaluation for extracutaneous manifestations; 21% of cases noted neurological screening, 4% noted dental screening, and 3% noted ophthalmologic screening. Methotrexate and glucocorticoids remain the most frequent choice for immunosuppressive treatment, though fewer than 7% of patients reported receiving systemic medical therapies. Surgical procedures for cosmetic or functional improvement were common (59%) among the reported patients. Autologous fat grafting was the most frequently utilized cosmetic treatment (50% of procedures) followed by free flap transfers (24% of procedures). There is ongoing need for standardized evaluation, monitoring, and treatment to prevent morbidity in PRS/ECDS, especially in children. When these patients are managed by rheumatologists, methotrexate, and steroids remain the first-line treatment, but a review of the published literature reflects that this may be a minority. Most PRS/ECDS patients are not evaluated in a multidisciplinary fashion. We propose comprehensive evaluations across subspecialties at the baseline and follow-up levels to monitor disease activity and record extracutaneous manifestations, treatment algorithms, and surgical intervention considerations.
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Affiliation(s)
| | | | | | - Kathryn Torok
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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38
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Li SC, Zheng RJ. Overview of Juvenile localized scleroderma and its management. World J Pediatr 2020; 16:5-18. [PMID: 31786801 DOI: 10.1007/s12519-019-00320-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Juvenile localized scleroderma (JLS) is a rare pediatric disease characterized by inflammation and skin thickening. JLS is associated with deep tissue and extracutaneous involvement that often results in functional impairment and growth disturbances. This article provides an overview of the disease with a focus on active features and treatment. DATA SOURCES We searched databases including PubMed, Elsevier and MedLine and Wanfang, reviewing publications from 2013 to 2019. Selected earlier publications were also reviewed. RESULTS Linear scleroderma is the most common JLS subtype. Several lines of evidence suggest that JLS is an autoimmune disease. Extracutaneous involvement is common and can present before the onset of skin disease. Multiple skin features are associated with disease activity, and activity can also manifest as arthritis, myositis, uveitis, seizures, and growth impairment. Systemic immunosuppressive treatment, commonly methotrexate with or without glucocorticoids, greatly improves outcome and is recommended for treating JLS patients with active disease and moderate or higher severity. Long term monitoring is needed because of the disease's chronicity and the high frequency of relapses off of treatment. CONCLUSIONS JLS is associated with a risk for disabling and disfiguring morbidity for the growing child. Identifying active disease is important for guiding treatment, but often difficult because of the paucity of markers and lack of a universal skin activity feature. More studies of JLS pathophysiology are needed to allow the identification of biomarkers and therapeutic targets. Comparative effectiveness treatment studies are also needed to work towards optimizing care and outcome.
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Affiliation(s)
- Suzanne C Li
- Department of Pediatrics, Division of Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Imus 337, Hackensack, 07601, NJ, USA.
- Department of Pediatrics, Hackensack Meridian School of Medicine at Seton Hall University, Clifton, 07110, NJ, USA.
| | - Rong-Jun Zheng
- Department of Rheumatology, Immunology, and Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
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39
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Rocha R, Kaliakatsos M. Epilepsy in paediatric patients with Parry-Romberg syndrome: A review of the literature. Seizure 2020; 76:89-95. [PMID: 32044693 DOI: 10.1016/j.seizure.2020.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/15/2020] [Accepted: 01/26/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Parry-Romberg syndrome (PRS) is a rare disorder characterized by unilateral slow progressive facial atrophy that can be associated with neurologic manifestations, namely seizures. There is scarce data about seizures in paediatric patients with PRS. The aim of our work was to clarify the clinical features of paediatric patients with PRS and seizures. METHODS We performed a literature review based on a literature search using PubMed and EMBASE databases. We included original articles in which the main diagnosis was PRS and the patients were 17 years old or less when the first seizure occurred. RESULTS We included 40 patients. Most of the patients had previously normal development and had their first seizure in the first decade of life. Neurologic examination was abnormal in 56 % of patients. Seizures are typically focal, frequently with impaired awareness, and became refractory in about 40 % of patients. Few patients have generalized seizures. On electroencephalogram, epileptic discharges are generally focal, on the same side as the facial atrophy, without a predominant cerebral lobe localization. Brain MRI is almost always abnormal, typically with T2 subcortical hyperintensities, and sometimes brain atrophy or calcifications. In addition to the classic antiepileptic drugs, immunosuppressive drugs should be considered as potential epilepsy treatment. CONCLUSION To the best of our knowledge, this is the first review dedicated to the characteristics of paediatric patients with PRS and epilepsy. Seizures are usually focal, became refractory in 40 %, and have a significant impact on the quality of life and neurodevelopment of patients.
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Affiliation(s)
- Ruben Rocha
- Centro Materno infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Marios Kaliakatsos
- Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
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40
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Abstract
Parry-Romberg syndrome is a rare craniofacial disorder characterized by progressive hemifacial atrophy with systematic manifestations. The combination with hemimasticatory spasm is rare, with only 9 patients reported before. In this study, a study of a young male patient with Parry-Romberg syndrome and hemimasticatory spasm on his left side was presented. Radiologic examinations showed severe atrophy limited to subcutaneous tissue and electromyography demonstrated as hemimasticatory spasm. Injection of botulinum toxin type A was applied for the treatment of hemimasticatory spasm and after 2 separated injections, the patient was significantly relieved from symptom. The theory of focal demyelination of the trigeminal nerve peripheral brunches is the possible link between hemifacial atrophy and hemimasticatory spasm, although the pathogenesis of both diseases requires further study and current therapeutic methods are still limited to symptomatic treatments. Injection of botulinum toxin type A is an effective way to treat hemimasticatory spasm and autologous fat transplant is a promising solution to correct facial asymmetry.
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41
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Srinivasan R, Joy ST. Parry-Romberg syndrome in an adolescent: a case report on progressive hemifacial atrophy. Oxf Med Case Reports 2020; 2020:omz127. [PMID: 32038874 PMCID: PMC6996043 DOI: 10.1093/omcr/omz127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/25/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022] Open
Abstract
Parry-Romberg syndrome is a rare degenerative disorder causing progressive atrophy of skin and soft tissues of the face and neck, which is usually unilateral. The mean age of onset is usually in the second decade of life and the disease causes functional, aesthetic and psychological disabilities in the affected individual. We present a 14-year-old boy with this disorder. The diagnosis was based on clinical characteristics. A multidisciplinary team approach involving rheumatologists, dermatologists, maxillofacial surgeons, dentists and psychologists is required for the management of this problem, which is mainly targeted at controlling active inflammation with the use of immunosuppressive agents in addition to possible surgical correction of repositioning of adipose tissue that is lost due to atrophy.
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Affiliation(s)
- Ranjini Srinivasan
- Department of Pediatrics, St. John’s National Academy of health sciences, Sarjapur Main Rd, John Nagar, Koramangala, Bengaluru 560034, Karnataka, India
| | - Shasta Theresa Joy
- Department of Pediatrics, St. John’s National Academy of health sciences, Sarjapur Main Rd, John Nagar, Koramangala, Bengaluru 560034, Karnataka, India
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42
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Velandia-Martínez A, Ortega-Sanchez MA, Martínez-Perez SO, Peña I, Pradilla O, Gomez R, Martínez-Perez A. Parry-Romberg Syndrome and Temporal Lobe Refractory Epilepsy: Case Report. J Epilepsy Res 2019; 9:157-160. [PMID: 32509553 PMCID: PMC7251345 DOI: 10.14581/jer.19020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 11/05/2022] Open
Abstract
The Parry-Romberg syndrome (PRS), also known as hemifacial atrophy, is a rare neurocutaneous disease with the prevalence of 1/700,000 cases. It is more common in women than men, with an early onset of disease usually within the first two decades of life. Even though the etiology of PRS is unknown, it is thought to be a multifactorial disease that involves hereditary, posttraumatic, autoimmune, infectious, and neoplastic factors. There are a variety of systemic manifestations described in PRS including neurological conditions that range from intractable headache to refractory epilepsy. The manifestations must be identified in a timely manner to ensure an early therapeutic intervention, considering that an appropriate approach during the initial phase might halt the disease progression and markedly improve the quality of life in these patients. This article is aimed to describe the case of a 23 years old female with left hemifacial atrophy and dermatologic, dental, and neurologic compromise, associated with refractory temporal lobe epilepsy evidenced in neuroimaging and electrodiagnostic testings.
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Affiliation(s)
- A Velandia-Martínez
- Department of Neurology, Carlos Ardila Lulle Medical Center, Santander, Colombia
| | - M A Ortega-Sanchez
- Department of Neurology, Carlos Ardila Lulle Medical Center, Santander, Colombia
| | - S O Martínez-Perez
- Department of Dermatology, Carlos Ardila Lulle Medical Center, Santander, Colombia
| | - I Peña
- Department of Neurology, Carlos Ardila Lulle Medical Center, Santander, Colombia
| | - O Pradilla
- Department of Neurosurgery, Carlos Ardila Lulle Medical Center, Santander, Colombia
| | - R Gomez
- Department of Neurosurgery, Carlos Ardila Lulle Medical Center, Santander, Colombia
| | - A Martínez-Perez
- Department of Neurosurgery, Carlos Ardila Lulle Medical Center, Santander, Colombia.,Department of Radiology, Carlos Ardila Lulle Medical Center, Santander, Colombia
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Yamasaki R, Yonekawa T, Inamizu S, Shinoda K, Ochi H, Matsushita T, Isobe N, Tsuji G, Sadashima S, Kuma Y, Oda Y, Iwaki T, Furue M, Kira JI. A case of overlapping adult-onset linear scleroderma and Parry-Romberg syndrome presenting with widespread ipsilateral neurogenic involvement. Neuropathology 2019; 40:109-115. [PMID: 31775183 DOI: 10.1111/neup.12614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
Linear scleroderma is a variant of localized scleroderma. We report a 43-year-old woman who had developed left arm weakness and linear scleroderma on her back during pregnancy at 25 years of age, followed by left hemifacial atrophy and left leg weakness. She had multiple linear scleroderma lesions on her trunk and left limbs, left eyelid ptosis, impairment of vertical movement and abduction of the left eye, left hemifacial atrophy, and weakness and atrophy of the sternocleidomastoid, trapezius, and proximal limb muscles on the left side. On serology, antibodies to U1-ribonucleoprotein and Jo-1 were positive; anti-scleroderma-70 antibody was negative. Skin biopsy demonstrated increased hypertrophic collagen fibers without inflammatory infiltrates. Needle electromyography of left limb muscles revealed mild neurogenic patterns; left quadriceps muscle biopsy showed chronic neurogenic changes. Brain magnetic resonance imaging revealed mild left hemispheric atrophy. This is a rare case of linear scleroderma and Parry-Romberg syndrome presenting with widespread ipsilateral neurogenic manifestations.
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Affiliation(s)
- Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Tomomi Yonekawa
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Saeko Inamizu
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Koji Shinoda
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Hirofumi Ochi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Gaku Tsuji
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Shoko Sadashima
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yuki Kuma
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Toru Iwaki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
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44
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Duan J, Li M, Chai Q, Zhou N, Hao Y. Multimodal Imaging of Parry Romberg Syndrome-associated Panuveitis: A Case Report and Review of Literature. Ocul Immunol Inflamm 2019; 29:179-186. [PMID: 31577463 DOI: 10.1080/09273948.2019.1653932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: We describe a case of Parry-Romberg syndrome (PRS) presenting with panuveitis and retinal vasculitis.Methods: We conducted a retrospective review of our patient's case and related literature published through May 2019.Results: A 26-year-old woman with history of PRS was diagnosed with panuveitis and retinal vasculitis. Intraocular inflammation was controlled with local and systemic corticosteroids. The relationship between PRS and intraocular inflammation is discussed with references to the relevant on literature.Conclusions: Our findings and the accompanying literature review suggest that the patient's ocular involvement included multiple fundus lesions, retinal vascular disorder, and unilateral poliosis - all of which may be attribute to trigeminal neuro vasculitis. As the Varicella-zoster virus may contribute to the onset of the autoimmune processes associated with PRS, this requires further exploration. This report confirms the utility of multimodal imaging in the study, screening, and follow-up of intraocular inflammation in patients with PRS.
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Affiliation(s)
- Jialiang Duan
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Minhao Li
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qiannan Chai
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nalei Zhou
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuhua Hao
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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45
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Watchmaker J, Saadeh D, Lam C, Vashi NA. A case of bilateral Parry-Romberg syndrome successfully treated with hyaluronic acid filler augmentation. J Cosmet Dermatol 2019; 18:1261-1263. [PMID: 30985058 DOI: 10.1111/jocd.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/08/2019] [Indexed: 01/24/2023]
Abstract
Parry-Romberg syndrome is a rare acquired neurocutaneous disorder typically characterized by hemifacial atrophy. Few cases of bilateral facial involvement have been reported. We report a case of a 60-year-old female with a 20-year history of progressive bilateral facial atrophy. Although an initial diagnosis of acquired partial lipodystrophy was considered, a diagnosis of bilateral Parry-Romberg was favored for three main reasons: (a) lipoatrophy was confined to the face (b) imaging findings of enophthalmos and underlying white matter changes (c) laboratories showing absence of C3 nephritic factor and normal complement levels. The patient was treated with hyaluronic acid fillers with dramatic improvement in cosmetic appearance.
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Affiliation(s)
- Jacqueline Watchmaker
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Dana Saadeh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Christina Lam
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
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46
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Kumar NG, Maurya BS, Sudeep CS. Parry Romberg Syndrome: Literature Review and Report of Three Cases. J Maxillofac Oral Surg 2019; 18:210-216. [PMID: 30996540 DOI: 10.1007/s12663-018-1147-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022] Open
Abstract
Parry Romberg Syndrome or Progressive Hemifacial Atrophy is a rare disease usually affecting one side of face with loss of soft and hard tissues. The disease appears suddenly and is usually self-limiting in 2-10 years time. The loss of soft and hard tissue leads to aesthetic and functional deficits which are compounded by the presence of associated symptoms like neuralgia, migraine, epilepsy and ocular involvement. The degree of deformity depends on the age at which the disease manifests first; the younger the age, the more severe the deformity. These patients undergo severe psychological trauma and social problems. The exact etiology is not known, and treatment is largely cosmetic. A report of three cases and a literature review is presented.
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Affiliation(s)
- N Girish Kumar
- 1Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Golden Hills, Vattapara, Thiruvananthapuram, 695028 India
| | | | - Col S Sudeep
- Command Military Dental Centre, Chandimandir, India
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47
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Jiang L, Li M, Liu Q, Liu C, Zhou J. Nummular Headache: 2 Cases With Good Beta Blocker Responses and a Narrative Review. Headache 2019; 59:593-602. [PMID: 30869172 DOI: 10.1111/head.13503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Li Jiang
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Maolin Li
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Qing Liu
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Chaoyang Liu
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Jiying Zhou
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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48
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Mishra K, Sood A, Smidt A, Price HN. Botulinum toxin A for pain reduction in pediatric patients with Parry-Romberg syndrome. Pediatr Dermatol 2019; 36:223-226. [PMID: 30739340 DOI: 10.1111/pde.13746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Parry-Romberg syndrome (PRS) is characterized by hemiatrophy of facial structures, including skin, subcutaneous fat, muscle, bone, and cartilage. Complications associated with PRS include headaches, seizures, and chronic facial pain. Protocol for the treatment of chronic facial pain is not clear; reports on the use of botulinum toxin A injections for pain reduction in adults but not in the pediatric/adolescent population are available. Here, we discuss two pediatric PRS cases in which treatment with botulinum toxin A injections reduced or eliminated facial pain.
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Affiliation(s)
- Kriti Mishra
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Arun Sood
- Pediatric Dermatology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Aimee Smidt
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico.,Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | - Harper N Price
- Pediatric Dermatology, Phoenix Children's Hospital, Phoenix, Arizona.,College of Medicine, University of Arizona, Phoenix, Arizona
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49
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Affiliation(s)
| | - Michael J. Cunningham
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Patrick J. O'Donnell
- Department of Anatomic Pathology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nikki A. Levin
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
- Correspondence to: Nikki A. Levin, MD, PhD, Department of Dermatology, University of Massachusetts Medical School, 281 Lincoln St, Worcester, MA 01605.
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50
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Abstract
Parry-Romberg syndrome, or progressive hemifacial atrophy, is a rare disorder of unknown etiology. Patients present with unilateral atrophy of skin that may progress to involve underlying fat, muscle, and osseocartilaginous structures. Neurologic complications are common. After self-limited disease stabilization, various reconstructive options may be used to restore patients' facial symmetry. Serial autologous fat grafting has shown favorable results in reconstruction of mild or moderate soft tissue deficiency, but free tissue transfer remains the treatment of choice for severe disease.
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Affiliation(s)
- Kelly P Schultz
- Division of Plastic Surgery, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030
| | - Elaine Dong
- Division of Plastic Surgery, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030
| | - Tuan A Truong
- Division of Plastic Surgery, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030
| | - Renata S Maricevich
- Division of Plastic Surgery, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030.
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