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Mahmood Alsabbagh M. Congenital Ichthyosis: Current Approaches to Prenatal Diagnoses. Fetal Pediatr Pathol 2024; 43:157-175. [PMID: 38204144 DOI: 10.1080/15513815.2023.2301468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Congenital ichthyosis represents a wide spectrum of diseases. This article reviews prenatal testing for ichthyosis. METHODS We used pubmed.ncbi.nlm.nih.gov to search for 38 types of congenital ichthyosis combined with 17 words related to prenatal testing. RESULTS Search resulted in 408 publications covering 13 types of ichthyoses and four types of tests. DISCUSSION Biochemical testing is diagnostic in trichothiodystrophy, but nonspecific in X-linked ichthyosis and Refsum syndrome. Except in X-linked ichthyosis, biochemical testing requires invasive procedures to obtain fetal skin biopsy, amniocytes, or chorionic villus samples. It is superior to histological and cytological examination of fetal skin biopsy or amniocytes because keratinization occurs later in pregnancy and microscopy cannot differentiate between ichthyosis types. Imaging is more acceptable due to noninvasiveness and routine use, although ultrasonography is operator-dependent, nonspecific, and captures abnormalities at late stage. Molecular tests are described in at-risk pregnancies but testing of free fetal DNA was not described.
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Affiliation(s)
- Manahel Mahmood Alsabbagh
- Princess Al-Jawhara Center for Molecular Medicine and Inherited Disorders & Department of Molecular Medicine, Arabian Gulf University, Manama, Kingdom of Bahrain
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González RA, Ojeda AV, Nova NA, Prasca RJ. Harlequin ichthyosis, prenatal diagnosis: the ultrasound recognition. BMJ Case Rep 2024; 17:e256859. [PMID: 38233004 PMCID: PMC10806978 DOI: 10.1136/bcr-2023-256859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Harlequin ichthyosis (HI) is an extremely rare disease with a prevalence of less than 1/300 000 live newborns and no more than 100 cases reported worldwide. It corresponds to a genodermatoses autosomal recessive inheritance, typically, with postnatal recognition due to the complexity of prenatal diagnosis. Advances in prenatal genetic testing allow sequencing of the affected gene and confirmation of the diagnosis after recognition of ultrasound markers. The prenatal acknowledgement of the disease significantly marks the course of the pregnancy; considering the perinatal high risk and neonatal mortality, this entity can be classified as lethal. Taking into account the legislation of each country, the possibility of pregnancy termination should be considered as an acceptable option. We present a case of prenatally diagnosed HI in the first ultrasound evaluation by the Maternal Fetal Medicine unit at 29 weeks of gestation, in which after counselling to the parents, the interruption of the gestation was decided.
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Affiliation(s)
- Ricardo Alfonso González
- Maternal Fetal Medicine Unit, El Bosque University Faculty of Medicine, Bogota, Colombia
- Maternal Fetal Medicine Unit, Fundacion Universitaria de Ciencias de la Salud, Bogota, Colombia
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Gutiérrez-Cerrajero C, Sprecher E, Paller AS, Akiyama M, Mazereeuw-Hautier J, Hernández-Martín A, González-Sarmiento R. Ichthyosis. Nat Rev Dis Primers 2023; 9:2. [PMID: 36658199 DOI: 10.1038/s41572-022-00412-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/20/2023]
Abstract
The ichthyoses are a large, heterogeneous group of skin cornification disorders. They can be inherited or acquired, and result in defective keratinocyte differentiation and abnormal epidermal barrier formation. The resultant skin barrier dysfunction leads to increased transepidermal water loss and inflammation. Disordered cornification is clinically characterized by skin scaling with various degrees of thickening, desquamation (peeling) and erythema (redness). Regardless of the type of ichthyosis, many patients suffer from itching, recurrent infections, sweating impairment (hypohidrosis) with heat intolerance, and diverse ocular, hearing and nutritional complications that should be monitored periodically. The characteristic clinical features are considered to be a homeostatic attempt to repair the skin barrier, but heterogeneous clinical presentation and imperfect phenotype-genotype correlation hinder diagnosis. An accurate molecular diagnosis is, however, crucial for predicting prognosis and providing appropriate genetic counselling. Most ichthyoses severely affect patient quality of life and, in severe forms, may cause considerable disability and even death. So far, treatment provides only symptomatic relief. It is lifelong, expensive, time-consuming, and often provides disappointing results. A better understanding of the molecular mechanisms that underlie these conditions is essential for designing pathogenesis-driven and patient-tailored innovative therapeutic solutions.
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Affiliation(s)
- Carlos Gutiérrez-Cerrajero
- Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amy S Paller
- Departments of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | | | - Rogelio González-Sarmiento
- Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
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Tran VK, Diep QM, Zilong Q, Phuong LT, Tran HA, Van Tung N, Lien NTK, Xuan NT, Ha LT, Van Ta T, Tran TH, Hoang NH. Case Report: Novel rare mutation c.6353C > G in the ABCA12 gene causing harlequin ichthyosis identified by whole exome sequencing. Front Pediatr 2023; 11:1128716. [PMID: 36873642 PMCID: PMC9977293 DOI: 10.3389/fped.2023.1128716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Harlequin ichthyosis (HI) is a severe rare genetic disease that mainly affects the skin. Neonates with this disease are born with thick skin and large diamond-shaped plates covering most of their bodies. Affected neonates lose the ability to control dehydration and regulate temperature and are more susceptible to infections. They also face respiratory failure and feeding problems. These clinical symptoms are factors associated with high mortality rates of neonates with HI. Until now, there are still no effective treatments for HI patients and most patients die in the newborn period. Mutation in the ABCA12 gene, which encodes an adenosine triphosphate-binding cassette (ABC) transporter, has been demonstrated as the major cause of HI. CASE PRESENTATION In this study, we report the case who is one infant that was born prematurely at 32 gestational weeks with the whole body covered with thick plate-like scales of skin. The infant was severely infected with mild edema, multiple cracked skins full of the body, yellow discharge, and necrosis of fingers and toes. The infant was suspected to be affected by HI. Whole exome sequencing (WES) was performed as a tool for detecting the novel mutation in one prematurely born Vietnam infant with HI phenotype. And after that, the mutation was confirmed by the Sanger sequencing method in the patient and the members of his family. In this case, one novel mutation c.6353C > G (p.S2118X, Hom) in the ABCA12 gene, was detected in the patient. The mutation has not been reported in any HI patients previously. This mutation was also found in a heterozygous state in the members of the patient's family, including his parents, an older brother, and an older sister who are no symptoms. CONCLUSIONS In this study, we identified a novel mutation in a Vietnamese patient with HI by whole exome sequencing. The results for the patient and the members of his family will be helpful in understanding the etiology of the disease, diagnosing carriers, assisting in genetic counseling, and emphasizing the need for DNA-based prenatal screening for families with a history of the disease.
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Affiliation(s)
- Van Khanh Tran
- Department of Molecular Pathology Faculty of Medical Technology and Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | - Quang Minh Diep
- Assisted Reproductive Technology Center, Quang Ninh Hospital for Obstetric and Pediatric, Quang ninh, Vietnam
| | - Qiu Zilong
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Le Thi Phuong
- Department of Molecular Pathology Faculty of Medical Technology and Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Anh Tran
- Department of Molecular Pathology Faculty of Medical Technology and Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Van Tung
- Institute of Genome Research, Vietnam Academy of Science and Technology, Hanoi, Vietnam.,Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Nguyen Thi Kim Lien
- Institute of Genome Research, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Nguyen Thi Xuan
- Institute of Genome Research, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Le Thi Ha
- Neonatal Care Center, Vietnam National Hospital of Pediatrics, Hanoi, Vietnam
| | - Thanh Van Ta
- Department of Molecular Pathology Faculty of Medical Technology and Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | - Thinh Huy Tran
- Department of Molecular Pathology Faculty of Medical Technology and Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Huy Hoang
- Institute of Genome Research, Vietnam Academy of Science and Technology, Hanoi, Vietnam.,Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi, Vietnam
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Tsivilika M, Kavvadas D, Karachrysafi S, Sioga A, Papamitsou T. Management of Harlequin Ichthyosis: A Brief Review of the Recent Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:893. [PMID: 35740830 PMCID: PMC9221756 DOI: 10.3390/children9060893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/05/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
Harlequin ichthyosis (HI) is a life-threatening genetic disorder that largely affects the skin of infants. HI is the most severe form of the autosomal recessive disorder known as ichthyosis. It is caused by mutations in the A12 cassette (lipid-transporter adenosine triphosphate-binding cassette A12). Neonates affected by this disease are born with specific morphological characteristics, the most prominent of which is the appearance of platelet keratotic scales separated by erythematous fissures. The facial features include eclabium, ectropion, a distinct flattened nose, and dysplastic ears. A common finding among those with HI is impaired skin barrier function. The purpose of the present narrative review is to assess the most recent literature regarding the management of HI. Emphasis is given to surgical management and consultation, to the indications for timing and surgical intervention, to the risks that are presented with surgery, and to the details of the surgical procedure itself. Management of HI requires a multidisciplinary team of experts, and specific guidelines are needed in order for the risks to be minimized and viability to be increased.
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