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Kadivar M, Sangsari R, Rostamli S, Sotoudeh S, Mirnia K. Amniotic membrane dressings for treatment of aplasia cutis in newborns. Pediatr Dermatol 2024; 41:445-450. [PMID: 38409959 DOI: 10.1111/pde.15540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/13/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare congenital skin defect characterized by a focal or extensive absence of the epidermis, dermis, and occasionally, subcutaneous tissue. When the wound caused by this defect is wide or deep, various treatments are used, including skin grafting. The amniotic membrane (AM) is a biological dressing that facilitates re-epithelialization as it contains mesenchymal cells and numerous growth factors. OBJECTIVE To report the efficacy of AM dressings in treating the skin defects of ACC. METHOD This study was conducted on five neonates diagnosed with ACC born between 2018 and 2022, referred to the Children's Medical Center in Tehran, Iran. AM dressings were applied on wounds larger than 1 cm2. The wounds were assessed weekly and, if required, an additional AM dressing was applied. RESULTS The skin defects gradually re-epithelialized after application of the AM. The complete healing process took around 3.5 weeks on average. No hypertrophic scarring was observed. CONCLUSION The application of AM dressing resulted in satisfactory cosmetic outcomes, with no hypertrophic scar formation. Complete healing occurred in all cases except one. The length of the hospital stay ranged from 2 to 6 weeks, depending on the size of the wound.
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Affiliation(s)
- Maliheh Kadivar
- Department of Pediatrics, Division of Neonatology, School of Medicine, Tehran University of Medical Sciences, Children's Medical Center, Tehran, Iran
| | - Razieh Sangsari
- Department of Pediatrics, Division of Neonatology, School of Medicine, Tehran University of Medical Sciences, Children's Medical Center, Tehran, Iran
| | - Somayeh Rostamli
- Neonatal Intensive Care Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Sotoudeh
- Department of Dermatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kayvan Mirnia
- Department of Pediatrics, Division of Neonatology, School of Medicine, Tehran University of Medical Sciences, Children's Medical Center, Tehran, Iran
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2
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Chi K, Li B, Huang H, Sun J, Zheng Y, Zhao L. Exploring the Research Landscape of High Myopia: Trends, Contributors, and Key Areas of Focus. Med Sci Monit 2023; 29:e941670. [PMID: 38111192 PMCID: PMC10748438 DOI: 10.12659/msm.941670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/29/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Myopia results when light rays focus before reaching the retina, causing blurred vision. High myopia (HM), defined by a refractive error of ≤-6 diopters (D) or an axial length of ≥26 mm, is an extreme form of this condition. The progression from HM to pathological myopia (PM) is marked by extensive ocular axis elongation. The rise in myopia has escalated concerns for HM due to its potential progression to pathological myopia. The covert progression of HM calls for thorough analysis of its current research landscape. MATERIAL AND METHODS HM-related publications from 2003-2022 were retrieved from the Web of Science database. Using VOSviewer and Citespace software, we conducted a bibliometric and visualized analysis to create document co-citation network maps. These maps detailed authors, institutions, countries, key terms, and significant literature. RESULTS From 9,079 articles, 8,241 were reviewed. An increasing trend in publications was observed, with Kyoko Ohno-Matsui identified as a top contributor. The Journal of Cataract and Refractive Surgery was the primary publication outlet. Chinese researchers and institutions were notably active. The document citation network identified five focal areas: refractive surgery, clinical manifestations/treatment, prevention/control, genetics, and open angle glaucoma. CONCLUSIONS Research emphasis in HM has shifted from refractive surgery for visual acuity enhancement to the diagnosis, classification, prevention, and control of HM complications. Proposals for early myopia intervention to prevent HM are gaining attention. Genetics and HM's link with open angle glaucoma, though smaller in focus, significantly enhance our understanding of HM.
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Affiliation(s)
- Kaiyao Chi
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Biao Li
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Hui Huang
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Jianhao Sun
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Yanlin Zheng
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Lei Zhao
- Department of Ophthalmology, The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, PR China
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3
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Ren F, Bressler L, Pruitt L, Wang H, Liu L, Elston DM. Midline cutaneous anomalies of the craniospinal axis. J Am Acad Dermatol 2023; 89:1238-1244. [PMID: 37598328 DOI: 10.1016/j.jaad.2023.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 08/21/2023]
Abstract
Patients with midline cutaneous anomalies of the craniospinal axis can be indicative of underlying embryonic defects, such as neural tube defects. Lack of familiarity with these midline aberrant skin findings may lead to misdiagnosis and delayed treatment. In this review, midline cutaneous anomalies of the craniospinal axis including aplasia cutis congenita, cranial and spinal dysraphism, and other developmental anomalies are explored in detail with emphasis on cutaneous clues to the diagnosis and appropriate workup.
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Affiliation(s)
- Faliang Ren
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Lindsey Bressler
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Laura Pruitt
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Liu
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Dirk M Elston
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
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4
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Meyer SN, Simmons EM, McPherson JD, Awasthi S, Kiuru M. SCALP syndrome with a germline heterozygous DOCK6 mutation and somatic mosaic NRAS Q61R mutation. Pediatr Dermatol 2023; 40:523-527. [PMID: 36456540 PMCID: PMC10250009 DOI: 10.1111/pde.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/18/2022] [Indexed: 12/04/2022]
Abstract
We present a case of SCALP syndrome, which was diagnosed in a male infant with the characteristic findings of sebaceous nevi, central nervous system malformations, aplasia cutis congenita, limbal dermoid, and giant congenital melanocytic nevi, or pigmented nevi. We identified a germline compound heterozygous DOCK6 mutation and a somatic mosaic NRAS Q61R mutation in the giant congenital melanocytic nevus. This report will increase clinician awareness of SCALP syndrome and augment the literature in characterizing this rare syndrome, including its genetic background.
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Affiliation(s)
- Summer N. Meyer
- Department of Dermatology, University of California Davis, Sacramento California, USA
| | - Elanee M. Simmons
- Department of Dermatology, University of California Davis, Sacramento California, USA
| | - John D. McPherson
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento California, USA
| | - Smita Awasthi
- Department of Dermatology, University of California Davis, Sacramento California, USA
- Department of Pediatrics, University of California Davis, Sacramento California, USA
| | - Maija Kiuru
- Department of Dermatology, University of California Davis, Sacramento California, USA
- Department of Pathology & Laboratory Medicine, University of California Davis, Sacramento California, USA
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5
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Yang XF, Shi SW, Chen K. Case report: Recombinant human epidermal growth factor gel plus kangfuxin solution in the treatment of aplasia cutis congenita in a case with Adams-Oliver syndrome. Front Surg 2023; 9:1072021. [PMID: 36713669 PMCID: PMC9874222 DOI: 10.3389/fsurg.2022.1072021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
Background Aplasia cutis congenita is a congenital disorder with the absence of skin, muscle and(or) bone. It usually affects the scalp. The presence of a large scalp defect can be potentially serious when complicated with hemorrhage and infection. Early healing of this condition is beneficial to improve the prognosis of infants. Study case A full-term newborn male was born with a round-shaped defect at the vertex of the scalp and skull (dimensions, 8 cm × 9 cm). The infant had a large deletion encompassing the 15.1 region of chromosome 15, including the DLL4 gene. Genetic testing was positive for Adams-Oliver syndrome (AOS). After two months of recombinant human epidermal growth factor gel combined with kangfuxin solution therapy, the skin defects of the scalp healed remarkably. The infant had regular follow-up appointments. At the age of 5 months, the defect became smaller, hairless, and showed good granulation tissue. At 2 years of age, the child's Gesell Developmental Schedules was 70. Conclusion Recombinant human epidermal growth factor gel combined with kangfuxin solution was a successful conservative treatment for an infant with a large scalp defect accompanied by AOS.
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Affiliation(s)
- Xiu-Fang Yang
- Department of Neonatology, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China,Correspondence: Xiu-Fang Yang
| | - Shang-Wen Shi
- Department of Neonatology, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
| | - Kang Chen
- Molecular Inspection Center, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
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6
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Li G, Zhang A, Yang S, Lin N, Fang X. Type VII Aplasia Cutis Congenita in Neonates Related to Maternal HBV Infection? Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:499-504. [PMID: 36855651 PMCID: PMC9968420 DOI: 10.2147/ccid.s396071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
Aplasia cutis congenita (ACC) is a rare disease with an unclear pathogenic mechanism. ACC has been suggested to result from the disrupted development or degeneration of skin in the uterus. This study describes two cases that may have underlying pathogenic cause that have not been previously reported. Two neonates who were admitted to the neonatal intensive care unit due to "skin lesions on the limbs" without other deformities or complications were diagnosed with type VII ACC by dermatologist. The mothers showed positivity for hepatitis B virus (HBV) surface antigen and elevated level of HBV DNA copies, which may be related to ACC. But this association could be a coincidence. Both neonates were treated with antibacterial dressings and achieved satisfactory healing.
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Affiliation(s)
- Guanming Li
- Department of Neonatology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
| | - Airun Zhang
- Department of Neonatology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
| | - Silan Yang
- Department of Neonatology, First Affiliated Hospital, Shantou University Medical College, Shantou, People’s Republic of China
| | - Niyang Lin
- Department of Neonatology, First Affiliated Hospital, Shantou University Medical College, Shantou, People’s Republic of China
| | - Xiaoyi Fang
- Department of Neonatology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
- Correspondence: Xiaoyi Fang, Department of Neonatology, Seventh Affiliated Hospital, Sun Yat-sen University, No. 628, Zhenyuan Road, Guangming District, Shenzhen, Guangdong, 518107, People’s Republic of China, Tel +86-18923451061, Email
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7
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Muacevic A, Adler JR, Alallah B, Alallah J. Aplasia Cutis Congenita of the Lower Limb: A Case Report. Cureus 2023; 15:e33376. [PMID: 36751246 PMCID: PMC9898798 DOI: 10.7759/cureus.33376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Aplasia cutis congenita type VI is a genetic disorder that presents with congenital skin absence, blistering, and nail abnormalities. We present the case of a male newborn who presented with an absence of skin in the entire left leg and the lower part of the left thigh. On the second day of life, he had new skin lesions that started to appear over the fingernail beds, nasal bridge, thighs, and buttocks. There were no other associated anomalies such as pyloric atresia, renal abnormalities, or ureteral stenosis. A diagnosis of Bart's syndrome was made based on clinical diagnosis and previous presentation in the family. The patient developed sepsis and osteomyelitis of the lower limb and eventually died.
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8
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Tripodi GD, Dickerman DI, LeMosy EK, Davis LS. Trichorhinophalangeal syndrome type II associated with aplasia cutis congenita in a neonate. Pediatr Dermatol 2022; 39:481-482. [PMID: 35181938 DOI: 10.1111/pde.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
Aplasia cutis congenita (ACC) was diagnosed in a newborn with dysmorphic facial features, oligodactyly of the bilateral feet, and hip instability. The neonate's clinical abnormalities in addition to genetic testing confirmed a diagnosis of trichorhinophalangeal syndrome (TRPS) type II. The possibility of concurrent Adams-Oliver syndrome (AOS) is raised.
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Affiliation(s)
| | | | - Ellen K LeMosy
- Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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9
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Yang XF, Shi SW, Ye Y, Chen K. A successful case of preimplantation genetic testing for monogenic disorder for aplasia cutis congenita. Front Pediatr 2022; 10:1005272. [PMID: 36458141 PMCID: PMC9705585 DOI: 10.3389/fped.2022.1005272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Aplasia cutis congenita (ACC), also called congenital cutaneous hypoplasia, is a serious disease in newborns. Children with ACC often die due to wound infections and bleeding. How the incidence of ACC can be reduced is a question that needs to be solved urgently. CASE REPORT We reported a mother who had delivered two children with ACC, both of whom were diagnosed with ACC type VI, skin defects, limb deformities, and congenital heart malformations. One infant died a few days after birth, and another died in utero in the second trimester. Genetic testing in both children showed a heterozygous mutation in the ITGB4 gene [17q25 exon 8, c. 794 dupC, (p. Ala266fs) and exon 15, c. 1860G > A]. The mother later successfully gave birth to a healthy baby using Preimplantation Genetic Testing for Monogenic disorders(PGD-M). CONCLUSION The PGD-M technique is highly valuable in reducing the incidence of ACC and improving the prognoses of newborns.
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Affiliation(s)
- Xiu-Fang Yang
- Department of Neonatology, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
| | - Shang-Wen Shi
- Department of Neonatology, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
| | - Yun Ye
- Reproductive Medicine Center, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
| | - Kang Chen
- Molecular Inspection Center, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
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10
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Rojnueangnit K, Phawan T, Khetkham T, Techasatid W, Sirichongkolthong B. A novel DLL4 mutation in Adams-Oliver syndrome with absence of the right pulmonary artery in newborn. Am J Med Genet A 2021; 188:658-664. [PMID: 34755929 DOI: 10.1002/ajmg.a.62562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/13/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
Adams-Oliver syndrome (AOS), a rare inherited disorder, is characterized by scalp and terminal limb defects. Several genes associated with Notch pathway mutations have led to AOS. Here, we report a Thai male newborn presenting with aplasia cutis congenita and absence of a right pulmonary artery, which is suggestive of AOS. This was confirmed by the identification of a novel missense mutation in DLL4, a heterozygous one base pair change at nucleotide 82 (c.82G>C, p.Gly28Arg), which is in N-terminal domain. This is the first DLL4-related AOS case with arterial defect.
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Affiliation(s)
- Kitiwan Rojnueangnit
- Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Thanyalak Phawan
- Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Thanitchet Khetkham
- Division of Forensic Medicine, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Wilaiporn Techasatid
- Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Boonchu Sirichongkolthong
- Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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11
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Effendi RMRA, Nuraeni L, Diana IA, Gondokaryono SP, Gunawan H, Dwiyana RF. Extensive Type V Aplasia Cutis Congenita Without Fetus Papyraceus or Placental Infarction: A Rare Case. Clin Cosmet Investig Dermatol 2021; 14:1413-1418. [PMID: 34675576 PMCID: PMC8502006 DOI: 10.2147/ccid.s330160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
Aplasia cutis congenita (ACC) is a congenital disorder characterized by the absence of epidermis, dermis, and sometimes subcutaneous tissue and bone. There are nine types of ACC based on the number and location of the lesions as well as the presence or absence of associated deformities, with type I ACC being the most common. Type V affects the trunk with a characteristic pattern resembling the "H" letter of the alphabet, generally accompanied by fetus papyraceus (death of one of the twin fetuses) or placental infarction. Type V ACC without fetus papyraceus and placental infarction is a rare case. We reported a case of type V ACC in a 3-day-old baby girl, with clinical manifestation of extensive ulcers on the scalp, back, buttocks, and both lower extremities, in an "H"-shaped pattern, with history of placenta accreta, but no fetus papyraceus or placental infarction was found. The patient received dialkyl carbamoyl chloride hydrophobic swab with hydrogel (Sorbact® gel dressing-BSN Medical) and hydrocolloid wound dressing with good response, as indicated by the wounds becoming dried up, leaving an atrophic scar. Complete epithelialization was achieved in 72 days. The cause of type V ACC remains not completely understood. The diagnosis of ACC can be established based on clinical manifestations. Further examination is required if extracutaneous involvement is suspected. Early identification of the etiology of the lesions and appropriate investigation and treatment, including conservative wound management, are needed so that aplastic lesions can heal successfully, although cosmetic repair may be required at a later stage.
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Affiliation(s)
| | - Lita Nuraeni
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Inne Arline Diana
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Srie Prihianti Gondokaryono
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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12
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Davis MJ, Voller LM, Gonzalez SR, Abu-Ghname A, Davies LW, Bedwell JR, Lee GL, Hunt RD, Phung TL, Buchanan EP. Multidisciplinary management of a previously unreported presentation of severe aplasia cutis congenita. Pediatr Dermatol 2021; 38:472-476. [PMID: 33481290 DOI: 10.1111/pde.14528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aplasia cutis congenita (ACC) is characterized by the complete or partial absence of skin at birth, with 85% of cases of ACC involving the scalp vertex. The etiology of ACC is unclear and appears to be multifactorial. We present the case of a 3-month-old boy who presented with a diagnosis of non-scalp ACC affecting approximately 80% of his total body surface area at birth. This case adds to the literature due to the patient's survival beyond the first day of life and his unique and severe distribution of defects, which led to respiratory compromise and required multidisciplinary management.
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Affiliation(s)
- Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | | | - Santiago R Gonzalez
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Lesley W Davies
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Joshua R Bedwell
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Grace L Lee
- Division of Pediatric Dermatology, Texas Children's Hospital, Houston, TX, USA
| | - Raegan D Hunt
- Division of Pediatric Dermatology, Texas Children's Hospital, Houston, TX, USA
| | - Thuy L Phung
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
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13
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Neelam R, Nakamura M, Tejasvi T. Dermoscopy of Aplasia Cutis Congenita: A Case Report and Review of the Literature. Dermatol Pract Concept 2021; 11:e2021154. [PMID: 33614222 DOI: 10.5826/dpc.1101a154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
- Rasna Neelam
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
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14
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Schnabel F, Kamphausen SB, Funke R, Kaulfuß S, Wollnik B, Zenker M. Aplasia cutis congenita in a CDC42-related developmental phenotype. Am J Med Genet A 2020; 185:850-855. [PMID: 33283961 DOI: 10.1002/ajmg.a.62009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 11/09/2022]
Abstract
Cell division cycle 42 (CDC42) is a small Rho GTPase, which serves as a fundamental intracellular signal node regulating actin cytoskeletal dynamics and several other integral cellular processes. CDC42-associated disorders encompass a broad clinical spectrum including Takenouchi-Kosaki syndrome, autoinflammatory syndromes and neurodevelopmental phenotypes mimicking RASopathies. Dysregulation of CDC42 signaling by genetic defects in either DOCK6 or ARHGAP31 is also considered to play a role in the pathogenesis of Adams-Oliver syndrome (AOS). Here, we report a mother and her child carrying the previously reported pathogenic CDC42 variant c.511G>A (p.Glu171Lys). Both affected individuals presented with short stature, distinctive craniofacial features, pectus deformity as well as heart and eye anomalies, similar to the recently described Noonan syndrome-like phenotype associated with this variant. Remarkably, one of the patients additionally exhibited aplasia cutis congenita of the scalp. Multi-gene panel sequencing of the known AOS-causative genes and whole exome sequencing revealed no second pathogenic variant in any disease-associated gene explaining the aplasia cutis phenotype in our patient. This observation further expands the phenotypic spectrum of CDC42-associated disorders and underscores the role of CDC42 dysregulation in the pathogenesis of aplasia cutis congenita.
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Affiliation(s)
- Franziska Schnabel
- Institute of Human Genetics, University Medical Center, Göttingen, Germany
| | | | - Rudolf Funke
- Department of Neuropediatrics, Sozialpädiatrisches Zentrum, Kassel, Germany
| | - Silke Kaulfuß
- Institute of Human Genetics, University Medical Center, Göttingen, Germany
| | - Bernd Wollnik
- Institute of Human Genetics, University Medical Center, Göttingen, Germany.,Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines To Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
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15
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Silva Díaz E, Molini Menchón MO, Estébanez Corrales A, Garcia-Vázquez A, Estañ Capell J, Sáez-Martín L, Martín Hernández J. Type V aplasia cutis congenita in a preterm newborn successfully resolved. Dermatol Ther 2020; 33:e13888. [PMID: 32567088 DOI: 10.1111/dth.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
Aplasia cutis congenita (ACC) associated with fetus papyraceus is a rare subtype of aplasia cutis categorized as type V in Frieden's classification. It is characterized by stellate lesions in a symmetrical distribution over the trunk and proximal extremities. Conservative treatment is recommended, but there is not a well-defined therapeutic protocol. We report the case of a type V ACC in a preterm male newborn with lesions on the trunk and scalp successfully treated with topical 1% silver sulfadiazine and petrolatum gauze with an excellent evolution. This case associates a severe affectation of the scalp which represents a rare variant of type V ACC.
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Affiliation(s)
- Esmeralda Silva Díaz
- Department of Dermatology, Clinical University Hospital of Valencia, Valencia, Spain
| | | | | | | | - Javier Estañ Capell
- Department of Pediatrics, Clinical University Hospital of Valencia, Valencia, Spain
| | - Luis Sáez-Martín
- Department of Dermatology, Clinical University Hospital of Valencia, Valencia, Spain
| | - Jose Martín Hernández
- Department of Dermatology, Clinical University Hospital of Valencia, Valencia, Spain
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16
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Abstract
BACKGROUND/OBJECTIVES Bart syndrome was initially described as association of congenital absence of skin (CAS), nail abnormalities, and epidermolysis bullosa (EB). Further reports of patients with CAS and EB have been made with wide clinical heterogeneity among them. Current guidelines recommend the elimination of eponyms and use of the descriptive term EB with CAS. METHODS We performed a PubMed and Medline database search of patients with Bart syndrome or EB with CAS. We included case reports or case series that contained clinical and demographic information. RESULTS After review, 55 articles were included, reporting 96 patients. CAS involved the lower extremities in all patients, with additional upper limb, trunk, or head involvement in 17%. In all patients, the time to healing ranged from 2 weeks to 6 months; most received only conservative treatment. The subtype and frequency of associated EB most frequently reported were recessive dystrophic EB (41.4%) and dominant dystrophic EB (22.8%). Extracutaneous features were present in 29 patients; with pyloric atresia and ear malformations being the most common. The prognosis varied based on the subtype of EB and the presence of additional comorbidities; 50% of the patients with junctional EB with pyloric atresia and CAS died during the first months of life, while mortality among those with recessive dystrophic EB was 6.8%. CONCLUSION Epidermolysis bullosa with CAS is a clinically heterogeneous disorder, most often associated with recessive dystrophic EB, but other EB subtypes may occur. Further investigations are necessary to better establish a pathological mechanism for CAS, and its association with EB.
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Affiliation(s)
- Adrian Martinez-Moreno
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Ocampo-Candiani
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Erika Alba-Rojas
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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17
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Yang MY, Ha DL, Kim HS, Ko HC, Kim BS, Kim MB. Aplasia cutis congenita in Korea: Single center experience and literature review. Pediatr Int 2020; 62:804-809. [PMID: 32037608 DOI: 10.1111/ped.14192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare congenital malformation characterized by a localized absence of skin. which most commonly affects the scalp. We performed the present study to elucidate the basic clinical data regarding ACC in Korea, including demographics, clinical features, radiological and therapeutic results. METHODS Fifty-nine patients (70 lesions) with ACC (35 from our department and 24 from a Koreamed database search) were enrolled. We assessed demographics, family and obstetrical histories, clinical features (multiplicity, subtype, size, shape, hair collar sign, location, and Frieden's classification), and radiologic and therapeutic results. RESULTS The mean age of patients was 2.62 years, with a male-to-female ratio of 1.03. A minority of patients had a family history (three patients), birth trauma (one patient), maternal drug use (two patients), or human immunodeficiency virus infection (one patient) during pregnancy, and fetus papyraceus of placental infarcts (two patients). Six patients (6/59, 10.17%) had multiple lesions. Scarring was the most common manifestation (39/70, 55.71%). The scalp was the most commonly affected site (50 cases, 71.43%). Thirty-nine patients (66.10%) met Frieden's type I classification (scalp ACC without multiple anomalies). Radiological investigations were performed in 30 patients (30/59, 50.85%) with abnormal findings in eight patients. Twenty-five patients (42.37%) were managed conservatively, and 17 patients (28.81%) were treated with local wound care. CONCLUSIONS This is the first and largest study assessing the basic clinical data of ACC in Korea. The results of the present study could be useful for pediatricians and dermatologists who routinely manage ACC.
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Affiliation(s)
- Min-Young Yang
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dae-Lyong Ha
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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18
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Abstract
BACKGROUND Adams-Oliver syndrome (AOS) is a rare, inherited multi-systemic malformation syndrome characterized by a combination of aplasia cutis congenita and transverse terminal limb defects along with variable involvement of the central nervous system, eyes, and cardiovascular system. AOS can be inherited as both autosomal-dominant and recessive traits. Pathogenic variants in the DOCK6, ARHGAP31, EOGT, RBPJ, DLL4, and NOTCH1 genes have been associated with AOS. PURPOSE To report a novel homozygous variant in the DOCK6 gene associated with Adams-Oliver syndrome type 2. MATERIALS AND METHODS Case report. RESULTS We report a case of a 4-month-old male who presented with microcephaly, global developmental delay, truncal hypotonia, and limb reduction defects. Ophthalmic examination revealed bilateral nystagmus and retinal detachment with mild cataractous changes in addition to retrolental plaque in the left eye. Next generation sequencing analysis identified a novel homozygous frameshift likely pathogenic variant (c.1269_1285dup (p.Arg429Glnfs*32)) in the DOCK6 gene. The constellation of the clinical findings and the genetic mutation were consistent with a diagnosis of AOS type 2. CONCLUSION The discovery of this new likely pathogenic variant enriches the genotypic spectrum of DOCK6 gene and contributes to genetic diagnosis and counseling of families with AOS. Neurologic and ocular findings appear to be consistent with AOS type 2 for which multidisciplinary clinical evaluation is crucial.
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Affiliation(s)
- Tariq Alzahem
- Vitreoretinal Division, King Khaled Eye Specialist Hospital , Riyadh, Saudi Arabia.,Ophthalmology Department, King Saud University , Riyadh, Saudi Arabia
| | - Abrar K Alsalamah
- Vitreoretinal Division, King Khaled Eye Specialist Hospital , Riyadh, Saudi Arabia
| | - Marco Mura
- Vitreoretinal Division, King Khaled Eye Specialist Hospital , Riyadh, Saudi Arabia
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19
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Wehrens KM, De Jongh F, Ter Laak MP, Cornips EM, Van der Hulst R. Treatment of a Large Skull Defect and Brain Herniation in a Newborn With Adams-Oliver Syndrome. Cureus 2020; 12:e7047. [PMID: 32211278 PMCID: PMC7083258 DOI: 10.7759/cureus.7047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Adams-Oliver syndrome (AOS) is a rare congenital disorder characterised by a wide variety of clinical expression ranging from the occurrence of aplasia cutis congenita (ACC), transverse limb defects, and cutis marmorata telangiectica to extensive lethal anomalies. In this article, we present the conservative and surgical management of a male newborn infant diagnosed with AOS. Surgical treatment included wound management, the removal of protruding brain, and treatment of cerebrospinal fluid (CSF) leakage. After spontaneous reepithelization of the wounds, conservative treatment was chosen instead of reconstruction with an occipital flap; this was continued until the total healing of the dermal defect after eight months, during which the patient was continuously treated with antibiotics. At 17 months, the child was in good physical condition with a three-month development delay in comparison with infants of his age and no evidence of neurological deficit.
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Affiliation(s)
- Kim M Wehrens
- Plastic Surgery, Haaglanden Medisch Centrum, The Hague, NLD
| | - Frank De Jongh
- Plastic Surgery, Haaglanden Medisch Centrum, The Hague, NLD
| | - M P Ter Laak
- Neurosurgery, Maastricht University Medical Center, Maastricht, NLD
| | - E M Cornips
- Neurosurgery, Maastricht University Medical Center, Maastricht, NLD
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20
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Gassenmaier M, Bösmüller H, Metzler G. Aplasia cutis congenita of the scalp: Histopathologic features and clinicopathologic correlation in a case series. J Cutan Pathol 2020; 47:439-445. [PMID: 31904134 DOI: 10.1111/cup.13644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/01/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare and heterogeneous disorder characterized by congenital absence of skin. The scalp is the most commonly affected site and lesions may overlie deeper ectodermal abnormalities. The exact etiology is still unknown, and histopathologic features are poorly defined. METHODS A series of 10 cases from nine patients was analyzed to characterize the clinicopathologic spectrum and age-related changes of ACC of the scalp. Hematoxylin and eosin, S100, Elastica van Gieson, and Weigert elastic stains were performed, and clinical information was retrieved from archived medical files. RESULTS Patient ages ranged from 1 day to 39 years (median 57 months). All cases resembled deep-reaching scars with almost complete loss of all adnexal structures. Isolated residual hair follicles were present in 8/10 and sweat glands and ducts in 2/10 cases. The subcutis was thinned or absent. Elastic fibers were always more fragmented than in normal tissue, and the thickness and density increased over time. There was no gain of adnexal structures with increasing age. CONCLUSIONS ACC represents a congenital scarring alopecia with permanent loss of skin appendages. Histopathologic changes resemble a deep-reaching scar with fragmented elastic fibers and differentiate ACC from all other forms of non-traumatic congenital alopecias.
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Affiliation(s)
| | - Hans Bösmüller
- Institute of Pathology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Gisela Metzler
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
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21
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Koumaki D, Koumaki V, Boumpoucheropoulos S, Baltaga L, Bitados P, Katoulis A, Krasagakis K. Newborn with a solitary hairless skin defect on the scalp vertex. Clin Case Rep 2019; 7:2281-2282. [PMID: 31788305 PMCID: PMC6878089 DOI: 10.1002/ccr3.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022] Open
Abstract
Aplasia cutis congenita is a rare congenital disorder usually presenting as an isolated lesion on the scalp that may be associated with genetic syndromes and congenital anomalies. Therefore, it is important to be aware of this syndrome.
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Affiliation(s)
- Dimitra Koumaki
- Paediatric Dermatology DepartmentChelsea and Westminster Foundation TRUSTLondonUK
| | - Vasiliki Koumaki
- Department of MicrobiologyMedical School University of AthensAthensGreece
| | | | | | | | - Alexander Katoulis
- 2nd Department of Dermatology and VenereologyNational and Kapodistrian University of Athens, Medical School, “Attikon” General University HospitalAthensGreece
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22
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Yaşar Ş, Yaşar B, Cebeci F, Bayoğlu D, Nuhoğlu Ç. Topical sucralfate cream treatment for aplasia cutis congenita with dystrophic epidermolysis bullosa: a case study. J Wound Care 2019; 27:768-771. [PMID: 30398936 DOI: 10.12968/jowc.2018.27.11.768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bart syndrome consists of aplasia cutis congenita (ACC) and dominant or recessive dystrophic epidermolysis bullosa (DEB), associated with skin fragility and nail dysplasia. ACC in DEB is thought to be caused by trauma, the most cited cause being in utero formation of bullae consequent to friction of the limbs. Epidermolysis bullosa (EB) refers to a hereditary mechanobullous disease following trauma, characterised by formation of blisters on the skin and mucous membranes. There are four categories of the disease, including epidermolysis bullosa simplex, junctional epidermolysis bullosa, dystrophic epidermolysis bullosa and Kindler syndrome. Infection, sepsis and death may occur as a consequence of generalised blistering with complication. We present the case of a newborn diagnosed with DEB and whose lesions became almost fully epithelialised after treatment with 10% topical sucralfate.
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Affiliation(s)
- Şirin Yaşar
- Associate Professor; Haydarpasa Numune Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Bulent Yaşar
- Associate Professor; Başkent University, Department of Gastroenterology, Istanbul, Turkey
| | - Filiz Cebeci
- Associate Professor; Goztepe Training and Research Hospital, Department of Dermatology, Istanbul
| | - Duygu Bayoğlu
- Haydarpasa Numune Training and Research Hospital, Department of Pediatric Clinic, Istanbul, Turkey
| | - Çağatay Nuhoğlu
- Associate Professor, Haydarpasa Numune Training and Research Hospital, Department of Pediatric Clinic, Istanbul, Turkey
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23
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Abstract
INTRODUCTION Bart's syndrome, a hereditary mechanobullous disorder characterized by aplasia cutis congenita (ACC) with epidermolysis bullosa (EB), has not been genotyped frequently. CASE REPORT A full-term female neonate had well-demarcated absence of skin on both legs at birth, with blisters and erosive patches developing immediately after birth. Electron microscopy showed blister formation under the lamina densa layer. Genetic studies revealed two heterogenous frameshift mutations in exons 31 and 109 of COL7A1. A diagnosis of Bart's syndrome, recessive dystrophic EB with ACC, was made. There was no pyloric atresia or ureteral stenosis, but congenital hypothyroidism was diagnosed 42 days after birth. CONCLUSION The novel frameshift mutations in COL7A1 may result in Bart's syndrome and suggest the importance of genetic testing in diagnosis of this disease.
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Affiliation(s)
- Young Mi Han
- a Department of Pediatrics , Pusan National University Children's Hospital , Yangsan , Republic of Korea.,b Department of Pediatrics , Pusan National University School of Medicine , Yangsan , Republic of Korea
| | - Narae Lee
- a Department of Pediatrics , Pusan National University Children's Hospital , Yangsan , Republic of Korea.,b Department of Pediatrics , Pusan National University School of Medicine , Yangsan , Republic of Korea
| | - Shin Yun Byun
- a Department of Pediatrics , Pusan National University Children's Hospital , Yangsan , Republic of Korea.,b Department of Pediatrics , Pusan National University School of Medicine , Yangsan , Republic of Korea
| | - Sang-Jin Cheon
- c Department of Dermatology , Pusan National University Yangsan Hospital , Yangsan , Republic of Korea
| | - Hyun-Chang Ko
- c Department of Dermatology , Pusan National University Yangsan Hospital , Yangsan , Republic of Korea.,d Department of Dermatology , Pusan National University School of Medicine , Yangsan , Republic of Korea
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24
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Xu L, Liu KX, Senna MM. A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents. Front Med (Lausanne) 2017; 4:112. [PMID: 28791288 PMCID: PMC5522886 DOI: 10.3389/fmed.2017.00112] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/04/2017] [Indexed: 12/13/2022] Open
Abstract
Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions. Diagnostic tools for hair loss in children include a detailed history, physical examination with a focused evaluation of the child’s hair and scalp, fungal screens, hair pull and tug test, and if possible, light microscopy and/or trichoscopy. Management of alopecia requires a holistic approach including psychosocial support because treatments are only available for some hair loss conditions, and even the available treatments are not always effective. This review outlines the clinical presentations, presents a diagnostic algorithm, and discusses management of these various hair loss disorders.
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Affiliation(s)
- Liwen Xu
- Harvard Medical School, Boston, MA, United States
| | - Kevin X Liu
- Harvard Medical School, Boston, MA, United States
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
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25
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Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a rare congenital disease, characterised by absence of skin, that can affect different parts of the body. ACC is more frequent on the scalp, but can involve limbs, with partial-or total-thickness loss of skin, with a functional impairment of the joint affected. There is no clear indication for surgical or conservative treatment, therefore, it would be helpful to find scientific support for the optimal treatment strategies. CLINICAL PRESENTATION We present a case of a newborn female, with six wounds on the inferior limbs, treated with conservative therapy. To prevent infection and promote healing, the defects were kept moist and covered with non-adherent/antimicrobical dressings. Complete wound healing occurred in eight weeks. The duration of follow-up was three years. RESULTS In this kind of ACC with superficial partial-thickness wounds of the lower limbs, conservative treatment was successful. The same conservative treatment can be proposed for larger or deeper wounds of lower limbs with no involvement of underlying structures, with delayed scar excision after the complete growth of the patient. ACC scar excision could require complex tissue rearrangement, tissue expansion, or skin grafting. CONCLUSION In the evaluation for treatment of ACC of inferior limbs, even in cases of total-thickness skin loss, even on joints, the conservative approach could be considered as the first choice. DECLARATION OF INTEREST None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
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Affiliation(s)
- M Cherubino
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,University of Insubria, Varese Italy
| | - F Maggiulli
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - R Dibartolo
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - L Valdatta
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,University of Insubria, Varese Italy
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26
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Hassed S, Li S, Mulvihill J, Aston C, Palmer S. Adams-Oliver syndrome review of the literature: Refining the diagnostic phenotype. Am J Med Genet A 2017; 173:790-800. [PMID: 28160419 DOI: 10.1002/ajmg.a.37889] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/31/2016] [Indexed: 01/08/2023]
Abstract
The Adams-Oliver syndrome (AOS) is defined as aplasia cutis congenita (ACC) with transverse terminal limb defects (TTLD). Frequencies of associated anomalies are not well characterized. Six causative genes have been identified: ARHGAP31, DOCK6, EOGT, RBPJ, NOTCH1, and DLL4. We review 385 previously described individuals (139 non-familial and 246 familial probands and family members) and add clinical data on 13 previously unreported individuals with AOS. In addition to ACC and TTLD, the most commonly associated anomalies included a wide variety of central nervous system (CNS) anomalies and congenital heart defects each seen in 23%. CNS anomalies included structural anomalies, microcephaly, vascular defects, and vascular sequelae. CNS migration defects were common. Cutis marmorata telangiectasia congenita (CMTC) was found in 19% of the study population and other vascular anomalies were seen in 14%. Hemorrhage was listed as the cause of death for five of 25 deaths reported. A relatively large number of non-familial probands were reported to have hepatoportal sclerosis with portal hypertension and esophageal varices. Non-familial probands were more likely to have additional anomalies than were familial probands. The data reported herein provide a basis for refining the diagnostic features of AOS and suggest management recommendations for probands newly diagnosed with AOS. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Susan Hassed
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Shibo Li
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - John Mulvihill
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Christopher Aston
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Susan Palmer
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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27
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Marble M, Guillen Sacoto MJ, Chikarmane R, Gargiulo D, Juusola J. Missense variant in UBA2 associated with aplasia cutis congenita, duane anomaly, hip dysplasia and other anomalies: A possible new disorder involving the SUMOylation pathway. Am J Med Genet A 2017; 173:758-761. [PMID: 28110515 DOI: 10.1002/ajmg.a.38078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/15/2016] [Indexed: 11/08/2022]
Abstract
We report a patient with aplasia cutis congenita, Duane anomaly, hip dysplasia, and other anomalies who had a de novo missense variant in UBA2, which encodes for a protein involved in the SUMOylation pathway. It has previously been suggested that UBA2 haploinsufficiency underlies scalp defects in the 19q13.11 deletion syndrome. We propose that disturbance of the SUMOylation pathway, mediated by pathogenic variants in UBA2, is a novel mechanism for aplasia cutis congenita and other phenotypic abnormalities. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Michael Marble
- Division of Clinical Genetics and Metabolism, Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Children's Hospital of New Orleans, New Orleans, Louisiana
| | | | | | - Dominic Gargiulo
- Children's Hospital of New Orleans, New Orleans, Louisiana.,Division of Pediatric Orthopedics, Department of Orthopedics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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28
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Lee EH, Park TS, Choi YS, Cho EH. Familial aplasia cutis congenita associated with mega-cisterna magna. Pediatr Int 2016; 58:1054-1056. [PMID: 27594612 DOI: 10.1111/ped.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/13/2016] [Accepted: 04/20/2016] [Indexed: 11/29/2022]
Abstract
Aplasia cutis congenita (ACC; MIM 107600) is a congenital skin disorder that manifests as localized absence of skin. Here we report a case of familial ACC and mega-cisterna magna. A female neonate was born with skin defects on the scalp. Brain magnetic resonance imaging demonstrated retrocerebellar space widening suggesting mega-cisterna magna. Her father also had a skin defect on the scalp at birth, and brain computed tomography of the father showed a cystic lesion over the right occipital lobe, similar to the patient's brain imaging. Karyotype 46,XX, t(6;18)(q23.2;q11.2) was identified on G-banded karyotype analysis of the patient and her father, after which whole exome sequencing was carried out, but this was thought to be a coincidental finding. This indicates that ACC may be associated with brain anomaly, although it is very rare.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Tae Sung Park
- Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
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29
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Duan X, Yang GE, Yu D, Yu C, Wang B, Guo Y. Aplasia cutis congenita: A case report and literature review. Exp Ther Med 2015; 10:1893-5. [PMID: 26640568 DOI: 10.3892/etm.2015.2737] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/09/2015] [Indexed: 11/05/2022] Open
Abstract
Aplasia cutis congenita (ACC) is a rare condition with an unclear pathogenic mechanism, although the condition has been suggested to occur as a result of the disrupted development or degeneration of skin in utero. ACC associated with fetus papyraceus has been described in numerous studies. Although there have been several reports of ACC, surgical treatment of ACC using the head as a site of donor skin is rarely reported. The present study describes the case of a 1-week-old patient with ACC that was healed by skin grafting, using the scalp as the donor site. The outcome of the procedure showed that the use of the scalp as a donor skin site for grafting is an effective treatment for large and deep ACC lesions arising on sites other than the head.
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Hakimi I, Benabdejlil Y, Ourraï A, Kouach J, Moussaoui D, Deyahni M. [Pemphigoid gestationis and aplasia cutis congenita: report of a case]. Pan Afr Med J 2015; 19:47. [PMID: 25667709 PMCID: PMC4315481 DOI: 10.11604/pamj.2014.19.47.4914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/10/2014] [Indexed: 11/11/2022] Open
Abstract
La pemphigoïde gestationis est une dermatose gravidique apparaissant en général entre la 28ème et la 32ème semaine d'aménorrhée. L’éruption cutanée est prurigineuse, bulleuse ou vésiculopapuleuse et de topographie péri-ombilicale. Outre la clinique, son diagnostic repose sur la biopsie cutanée avec analyse en immunofluorescence directe. Elle se caractérise par sa tendance à récidiver. Le traitement habituel nécessite des dermocorticoïdes. Les conséquences peuvent être maternelles (menace d'accouchement prématuré), fœtales (retard de croissance intra-utérin), et néo-natales (éruption cutanée). Nous rapportons un cas de pemphigoïde gestationis associé à une aplasie cutanée congénitale type 2. S'agit il d'une association fortuite?
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Affiliation(s)
- Ihssane Hakimi
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Youssef Benabdejlil
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Abdelhakim Ourraï
- Service de Pédiatrie, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Jaouad Kouach
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Driss Moussaoui
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Mohammed Deyahni
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
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Fröjd V, Maltese G, Kölby L, Tarnow P. Conservative Healing of an 11 × 9-cm Aplasia Cutis Congenita of the Scalp with Bone Defect. J Neurol Surg Rep 2014; 75:e220-3. [PMID: 25485218 PMCID: PMC4242817 DOI: 10.1055/s-0034-1387195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/30/2014] [Indexed: 11/13/2022] Open
Abstract
Objectives Aplasia cutis congenita is a rare congenital condition, and it is difficult to find scientific support for optimal treatment strategies. In addition, these may vary due to defect size, tissue layers involved, contemporary malformations, and the physiologic status of the affected child. Clinical Presentation This case report describes complete skin coverage in 20 weeks and uneventful healing of a large 11 × 9-cm defect of the vertex, involving both skin and skull bone, using conservative treatment. To prevent infection and promote healing, the defect was kept moist and covered at all times, and it was treated with surgical debridement when necessary. For infection control, ionized silver-coated dressings were used in addition to prophylactic antibiotics over the first 3.5 weeks. Follow-up was 2 years. Conclusion Surgical treatment is usually preferred for larger aplasia cutis congenita defects, but it is accompanied with potential risks and will exacerbate secondary reconstruction of alopecia or skull bone defects. This case shows that even very complex defects may be treated conservatively.
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Affiliation(s)
- Victoria Fröjd
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giovanni Maltese
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Tarnow
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ustüner P, Dilek N, Saral Y, Ustüner I. Coexistence of aplasia cutis congenita, faun tail nevus and fetus papyraceus. J Dermatol Case Rep 2013; 7:93-6. [PMID: 24133564 DOI: 10.3315/jdcr.2013.1148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 02/27/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Aplasia cutis congenita is a disorder of the skin embryonic development characterized by a defect of localized or widespread areas of skin at birth. The lesions are mostly oval, 1-3 cm in diameter, with localization on the parietal part of scalp (60%) and rarely on the face and extremities. MAIN OBSERVATIONS Herein, we reported a case of aplasia cutis congenita termly born at 39 weeks of gestation to a 30-year-old mother with bronchial asthma attacks. She was referred for 3 punched-out punctate depressed defective lesions in 0.4 cm's diameter on the vertex covered with necrotic and hemorrhagic crusts. There was a hypertrichotic area consisting of tufts of terminal hair on the lumbosacral area over a sinus tract. Maternal perinatal drugs included aerosol salbutamol sulfate, ipratropium bromide and oral montelukast sodium for bronchial asthma. The pregnancy was firstly started as a di-chorionic, di-amniotic twin gestation, but deteriorated after the fetal resorption of the co-twin in the 20th gestational week resulting in fetus papyraceus. CONCLUSION In multi-gestational pregnancies, the presence of the fetus papyraceus or the death of the co-twins should make the neonatologists and dermatologists be aware of the possible cutaneous defects like aplasia cutis congenita. We emphasize that the possibility of this rare entity should be kept in mind in the presence of fetus papyraceus, perinatal drug use, maternal cigarette smoke, or maternal diseases like bronchial asthma in multiple gestations.
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Affiliation(s)
- Pelin Ustüner
- Rize State Hospital, Dermatology Clinic, Rize, Turkey
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