Lamellar ichthyosis of the newborn. A distinct clinical entity: its comparison to the other ichthyosiform erythrodermas

Dental Treatment of a Child Suffering from Non-bullous Congenital Ichthyosiform Erythroderma under General Anesthesia

Non-bullous congenital ichthyosiform erythroderma (NBCIE) is an autosomal recessive form of inherited icthyosis appears as fine white scales that gradually replace collodion membrane. This case report describes management of 5 years and 11-month-old child with NBCIE suffering from early childhood caries (ECC) under general anesthesia. How to cite this article: Choudhary R, Satish V. Dental Treatment of a Child Suffering from Non-bullous Congenital Ichthyosiform Erythroderma under General Anesthesia. Int J Clin Pediatr Dent 2015;8(2):157-162.

Clinico-epidemiological features of primary hereditary ichthyoses in the Eastern province of Saudi Arabia

BACKGROUND

A total of 10 455 new dermatology patients were seen in the dermatology clinics of King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia, between January 1990 and December 1995. We identified 71 patients with a histopathologically confirmed diagnosis of specific forms of primary hereditary ichthyoses (PHI). We have reviewed the epidemiological and clinical features of these patients.

OBJECTIVE

To document the epidemiological and clinical features of patients with PHI in the Eastern Province of Saudi Arabia.

METHODS

We used the dermatology out-patient department (OPD) logbooks to identify cases of PHI from new patients presenting with different dermatological problems over a 6-year period. We used specifically designed protocol forms to extract epidemiological and clinical data from the study patients' medical records. These were entered into a computer database and analyzed using standard statistical software.

RESULTS

A total of 71 patients, 44 males and 27 females (male : female sex ratio of 1.63 : 1), were identified from a total of 10 455 new patients seen in our dermatology clinics between January 1990 and December 1995. The occurrence rate of PHI, in our clinics, was 0.67% or 7 per 1000 new dermatology cases. The clinical pattern of PHI showed that Icthyosis Vulgaris was the most common form seen, followed by Nonbullous Ichthyosiform Erythroderma. Thirty-one patients (44.7%) with Ichthyosis Vulgaris (IV) were seen: 12 patients (16.9%) with X-linked Recessive Ichthyosis (XLRI), four patients (5.6%) with Lamellar Ichthyosis (LI), three patients (4.2%) with Bullous Ichthyosiform Erythroderma (BIE) and 21 patients (29.6%) with Nonbullous Ichthyosiform Erythroderma (NBIE). There was a significantly high consanguinity rate in our patients (85%), and the family history was positive in 53 cases out of the 71 (75%).

CONCLUSIONS

This preliminary study is the first report of its kind from Saudi Arabia and documents the clinico-epidemiological features of PHI patients in the Eastern Province. The high rate of parental consanguinity among our Saudi patients may account for the high proportion of patients with a positive family history. Consanguinity also probably explains why the most severe forms of PHI were seen in a significant number of new patients' siblings. These severe forms of PHI (Nonbullous Ichthyosiform Erythroderma, Bullous Ichthyosiform Erythroderma and Lamellar Ichthyosis) together constituted nearly 40% of all cases.

Primary hereditary ichthyoses in the Eastern Province of Saudi Arabia

BACKGROUND

Of 10,455 new dermatology patients seen at the Dermatology Clinic of King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between January 1990 and December 1995, the epidemiologic and demographic features of 71 patients, each with a histopathologically confirmed diagnosis of one specific type of primary hereditary ichthyosis (PHI), have been reviewed.

OBJECTIVE

To study and document the epidemiologic and demographic profiles of patients with PHI in the Eastern Province of Saudi Arabia.

METHODS

From the outpatient department dermatology logbooks, 71 patients with PHI, from 10,455 new cases with different dermatologic problems seen during the 5-year period, were included in this study. Using specially designed protocol forms, epidemiologic and demographic data were extracted from the medical records of the patients, entered into a computer, and analyzed using the SPSS program.

RESULTS

Seventy-one patients with PHI, 44 males and 27 females (ratio, 1.63 : 1), were seen at our Dermatology Clinic between January 1990 and December 1995. The occurrence rate of PHI in our clinic is 0.67%, i.e. approximately 7 per 1000 new cases. The clinical pattern of PHI was as follows: 31 patients (44.7%) with ichthyosis vulgaris (IV), 12 (16.9%) with X-linked recessive ichthyosis (XLRI), four (5.6%) with lamellar ichthyosis (LI), three (4.2%) with bullous ichthyosiform erythroderma (BIE), and 21 (29.6%) with nonbullous ichthyosiform erythroderma (NBIE). IV was most common, followed by NBIE. Parental consanguinity was high (approximately 85%), and the family history was positive in 53 of the 71 cases (75%).

CONCLUSIONS

This preliminary study has attempted to document the epidemiologic patterns of PHI patients in Saudi Arabia and, to our knowledge, this is the first report of its kind in this country. We found a high rate of parental consanguinity, a high percentage of patients with a positive family history, and many siblings affected by the severest forms of PHI, namely NBIE, BIE, and LI, which accounted for 39.4% of all cases of PHI.

Expression of transglutaminase 1 in human hair follicles, sebaceous glands and sweat glands

To explore the function of the enzyme transglutaminase 1 (TGase 1), its distribution was analysed by immunofluorescence microscopy, postembedding immunoelectron microscopy and in situ hybridization. TGase 1 was expressed in the outer root sheath (ORS) cells in the distal portion of the isthmus and infundibulum of human hair follicles. In the level of the proximal and middle portion of the isthmus, TGase 1 was observed in the keratinized area of the inner root sheath (IRS) and ORS cells. In the bulbar and suprabulbar portions, TGase 1 was present in the ORS and IRS cells. The cortex and medulla cells in these regions also contained TGase 1. A high level of fluorescence was observed at the cuticle of the cortex. Sebaceous and sweat gland cells contained abundant TGase 1. Possible functions of TGase 1 in these epidermal appendages are discussed.

Cutaneous histopathology of Conradi-Hunermann syndrome

The histopathology of the skin in the ichthyosiform erythroderma associated with classical Conradi-Hunermann syndrome has been rarely described. Skin biopsies from 2 infants with the classical features of Conradi-Hunermann syndrome including ichthyosiform erythroderma contained hyperkeratosis, dilated ostia of pilosebaceous structures, and calcium salts in the stratum corneum detectable with special stains. An unusual feature of one case was dilatation of acrosyringeal structures. We hypothesize that dilatation of acrosyringeal structures is analogous to the plugging noted in pilosebaceous units. Taken together, the ichthyosiform erythroderma of Conradi-Hunermann has a distinctive histologic appearance.

Lethal chondrodysplasia punctata, Conradi Hünermann subtype A, one case

Lethal Conradi Hünermann disease is described in a patient with severe skin and skeletal involvement. Skin lesions, now considered as a peculiar form of ichthyosis, consisted of adnexal and pilar follicle hyperkeratosis, polymorphonuclear exocytosis, irregular keratohyaline distribution and frequent paranuclear vacuoles in stratum Malpighi. Numerous chondrocyte clusters and calcified masses were found in the epiphyseal cartilage. The growth plate was disorganised. There was a bilateral cataract. This severe lethal form of Conradi Hünermann disease corresponds to the subgroup A denomination of Spranger and may be a severe manifestation of X-linked Chondrodysplasia punctata.

X-linked dominant chondrodysplasia punctata. Review of literature and report of a case

X-linked dominant chondrodysplasia punctata is a syndrome consisting of skeletal, ocular, and cutaneous anomalies with asymmetric involvement of the body. The skin lesions, the hallmark of this condition, are distributed in a linear or blotchy pattern and include congenital ichthyosiform erythroderma, systematized atrophoderma mainly involving the hair follicles, and circumscribed alopecia. The remaining scalp hair is in part normal and in part irregularly twisted and coarse. The eyebrows and lashes are sparse. The nails may be flattened and split into layers. Thirty-five cases of this new syndrome are reviewed, and an additional observation is reported. The ratio of females to males is 36:0. The concept of X-linked dominant chondrodysplasia punctata has been suggested, and it has been postulated that there is a connection between the mosaic phenotype and the limitation to the female sex. Both facts would be explained by an X-linked gene giving rise to a pattern of lyonization in females, and lethal in hemizygous males. The classification of chondrodysplasia punctata thus includes three forms: the rhizomelic type, the Conradi-Hünermann type, and the X-linked dominant type. Two of these, the rhizomelic type and the X-linked dominant type, are well-defined entities. Whether the Conradi-Hünermann type, after separation of the X-linked form, is still heterogeneous, remains to be determined.