1
|
Mathis S, Solé G, Damon-Perrière N, Rouanet-Larrivière M, Duval F, Prigent J, Nadal L, Péréon Y, Le Masson G. Clinical Neurology in Practice: The Tongue (part 2). Neurologist 2024; 29:59-69. [PMID: 37639532 DOI: 10.1097/nrl.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND The tongue is an essential organ for the development of certain crucial functions such as swallowing and speech. The examination of the tongue can be very useful in neurology, as the various types of lingual alterations can lead to certain specific diagnoses, the tongue being a kind of 'mirror' of some neurological function. REVIEW SUMMARY To discuss the elements of clinical examination of the tongue in relation to neurological disorders. After reviewing the different superficial lesions of the tongue, we deal with various movement disorders of the tongue (fasciculations/myokimia, orolingual tremor, choreic movements of the tongue, dystonia of the tongue, lingual myoclonus, and psychogenic movements), disorders of taste and lingual sensitivity and lingual pain. CONCLUSIONS Examination of the tongue should not be limited to studying its motility and trophicity. It is equally important to check the sensory function and understand how to interpret abnormal movements involving the tongue. This study also aimed to demonstrate the importance of nonmotor tongue function in neurological practice.
Collapse
Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- ALS Center, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Guilhem Solé
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Nathalie Damon-Perrière
- Department of Clinical Neurophysiology, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Department of Movement disorders, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Marie Rouanet-Larrivière
- Department of Clinical Neurophysiology, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Fanny Duval
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Julia Prigent
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Louis Nadal
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Yann Péréon
- CHU Nantes, Reference Centre for Neuromuscular Diseases AOC, Filnemus, Nantes, France
| | - Gwendal Le Masson
- Department of Neurology, Muscle-Nerve Unit, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- Referral Center for Neuromuscular Diseases 'AOC', University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
- ALS Center, University Hospitals of Bordeaux (CHU Bordeaux - Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| |
Collapse
|
2
|
Guo Z, Zhu Y, Xiao H, Dai R, Yang W, Xue W, Zhang X, Hao B, Liao S. Integration of ATAC-seq and RNA-seq identifies MX1-mediated AP-1 transcriptional regulation as a therapeutic target for Down syndrome. Biol Res 2023; 56:67. [PMID: 38066591 PMCID: PMC10709892 DOI: 10.1186/s40659-023-00474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Growing evidence has suggested that Type I Interferon (I-IFN) plays a potential role in the pathogenesis of Down Syndrome (DS). This work investigates the underlying function of MX1, an effector gene of I-IFN, in DS-associated transcriptional regulation and phenotypic modulation. METHODS We performed assay for transposase-accessible chromatin with high-throughout sequencing (ATAC-seq) to explore the difference of chromatin accessibility between DS derived amniocytes (DSACs) and controls. We then combined the annotated differentially expressed genes (DEGs) and enriched transcriptional factors (TFs) targeting the promoter region from ATAC-seq results with the DEGs in RNA-seq, to identify key genes and pathways involved in alterations of biological processes and pathways in DS. RESULTS Binding motif analysis showed a significant increase in chromatin accessibility of genes related to neural cell function, among others, in DSACs, which is primarily regulated by members of the activator protein-1 (AP-1) transcriptional factor family. Further studies indicated that MX Dynamin Like GTPase 1 (MX1), defined as one of the key effector genes of I-IFN, is a critical upstream regulator. Its overexpression induced expression of AP-1 TFs and mediated inflammatory response, thus leading to decreased cellular viability of DS cells. Moreover, treatment with specific AP-1 inhibitor T-5224 improved DS-associated phenotypes in DSACs. CONCLUSIONS This study demonstrates that MX1-mediated AP-1 activation is partially responsible for cellular dysfunction of DS. T-5224 effectively ameliorated DS-associated phenotypes in DSACs, suggesting it as a potential treatment option for DS patients.
Collapse
Affiliation(s)
- Zhenglong Guo
- Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics, Medical Genetic Institute of Henan Province, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, China
- School of Medicine, People's Hospital of Henan University, Henan University, Zhengzhou, China
| | - Yongchang Zhu
- Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics, Medical Genetic Institute of Henan Province, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai Xiao
- Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics, Medical Genetic Institute of Henan Province, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, China
- School of Medicine, People's Hospital of Henan University, Henan University, Zhengzhou, China
| | - Ranran Dai
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Wenke Yang
- Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics, Medical Genetic Institute of Henan Province, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, China
- School of Medicine, People's Hospital of Henan University, Henan University, Zhengzhou, China
| | - Wei Xue
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xueying Zhang
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, China
| | - Bingtao Hao
- Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics, Medical Genetic Institute of Henan Province, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
- School of Medicine, People's Hospital of Henan University, Henan University, Zhengzhou, China.
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
| | - Shixiu Liao
- Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics, Medical Genetic Institute of Henan Province, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, China.
- School of Medicine, People's Hospital of Henan University, Henan University, Zhengzhou, China.
| |
Collapse
|
3
|
Lingua Plicata Associated with Increased Level of Proinflammatory Cytokines in Gingival Cervical Fluid: Possible New Sign in Ulcerative Colitis. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Ulcerative colitis (UC) is a complex disease in which the interaction of genetic, environmental, and microbial factors drives chronic intestinal inflammation. Gastrointestinal symptoms are predominant including pathological manifestations in the oral cavity, as well as extra-intestinal complications.
Lingua plicata (LP) is a condition characterized by an increased number of fissures and grooves at the central and lateral aspects of the dorsal surface of the tongue. LP is usually asymptomatic and discovered incidentally, but the accumulation of food in the fissures and grooves can lead to focal glossitis and halitosis.
In this study, we analyzed the level of proinflammatory cytokines in gingival crevicular fluid (GCF) and demonstrated that proinflammatory cytokines IFN-γ, IL-12, and IL-1β were significantly increased in the group of UC patients when compared with healthy controls. Obtained results have shown that 35% of UC patients have lingua plicata. The GCF levels of IFN-γ and IL-12 were higher in UC patients with LP compared with UC patients without lingua plicata.
In conclusion, increased GCF values of IFN-γ and IL-12, in UC patients with LP may be considered as a sign of the disease progression and, consequently, of a poor prognosis for patients.
Collapse
|
4
|
Hamaguchi Y, Kondoh T, Fukuda M, Yamasaki K, Yoshiura KI, Moriuchi H, Morii M, Muramatsu M, Minami T, Osato M. Leukopenia, macrocytosis, and thrombocytopenia occur in young adults with Down syndrome. Gene 2022; 835:146663. [PMID: 35690282 DOI: 10.1016/j.gene.2022.146663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/03/2022] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
Abstract
Down syndrome (DS) is a common congenital disorder caused by trisomy 21. Due to the increase in maternal age with population aging and advances in medical treatment for fatal complications in their early childhood, the prevalence and life expectancy of DS individuals have greatly increased. Despite this rise in the number of DS adults, their hematological status remains poorly examined. Here, we report that three hematological abnormalities, leukopenia, macrocytosis, and thrombocytopenia, develop as adult DS-associated features. Multi- and uni-variate analyses on hematological data collected from 51 DS and 60 control adults demonstrated that young adults with DS are at significantly higher risk of (i) myeloid-dominant leukopenia, (ii) macrocytosis characterized by high mean cell volume (MCV) of erythrocytes, and (iii) lower platelet counts than the control. Notably, these features were more pronounced with age. Further analyses on DS adults would provide a deeper understanding and novel research perspectives for multiple aging-related disorders in the general population.
Collapse
Affiliation(s)
- Yo Hamaguchi
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Omura, Japan; Department of Human Genetics, Atomic Bomb Disease Institute, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tatsuro Kondoh
- The Misakaenosono Mutsumi Developmental, Medical and Welfare Center, Nagasaki, Japan
| | - Masafumi Fukuda
- The Misakaenosono Mutsumi Developmental, Medical and Welfare Center, Nagasaki, Japan
| | - Kazumi Yamasaki
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Koh-Ichiro Yoshiura
- Department of Human Genetics, Atomic Bomb Disease Institute, Division of Advanced Preventive Medical Sciences and Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mariko Morii
- International Research Center for Medical Sciences, Kumamoto University, Japan
| | - Masashi Muramatsu
- Center for Animal Resources and Development, Kumamoto University, Japan
| | - Takashi Minami
- Center for Animal Resources and Development, Kumamoto University, Japan
| | - Motomi Osato
- International Research Center for Medical Sciences, Kumamoto University, Japan; Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Pediatrics, National University of Singapore, Singapore.
| |
Collapse
|
5
|
Lam M, Lu JD, Elhadad L, Sibbald C, Alhusayen R. Common Dermatologic Disorders in Down Syndrome: Systematic Review. JMIR DERMATOLOGY 2022. [DOI: 10.2196/33391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Down syndrome (DS) has been associated with cardiovascular, gastrointestinal, and immune-related abnormalities. Several dermatologic conditions, including hidradenitis suppurativa, have also been found to be associated with DS.
Objective
The objective of this study was to characterize the prevalence, presentation, and unique features of dermatologic disorders associated with DS.
Methods
Electronic searches of EMBASE (via Ovid), MEDLINE (via Ovid), and Web of Science databases were conducted on December 14, 2020. Observational studies including case reports of patients with DS presenting with concomitant primary dermatologic disorder were included.
Results
This systematic review captured 40 observational studies and 99 case reports, including 10 observational studies that examined the prevalence of common skin disorders in patients with DS. The most common dermatologic conditions reported includes atopic dermatitis (8 studies, n=180; 19.7% mean prevalence), hidradenitis suppurativa (15, n=478; 3.2%), ichthyosis (4, n=16; 4.7%), lichen nitidus (6, n=6; 1.1%), psoriasis (21, n=65; 4.8%), alopecia areata (27, n=253; 7.4%), vitiligo (8, n=40; 4.4%), onychomycosis (3, n=198; 24.7%), calcinosis cutis (14, n=15), connective tissue nevi (6, n=6), dermatofibroma (3, n=3), melanoma (3, n=3), syringomas (14, n=182; 21.2%), and elastosis perforans serpiginosa (19, n=24; 0.5%).
Conclusions
Our results indicate an increased prevalence of common cutaneous disorders in patients with DS, particularly infectious, inflammatory, autoimmune, and connective tissue conditions. Current guidelines for the screening, general management, and use of systemic immunomodulatory agents in this patient population are lacking. Patients with DS would benefit from screening for dermatologic disorders not otherwise regularly performed for earlier diagnosis and treatment.
Trial Registration
PROSPERO International Prospective Register of Systematic Reviews CRD42021226295; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226295
Collapse
|
6
|
Abstract
Down syndrome (DS) is the most common chromosomal condition and affects many organs including the skin. Dermatologists are an integral part of the DS care team. This is a review of both common and rare dermatologic conditions in DS. We provide practical strategies for a successful dermatology interview and examination. We explore the downstream effects of trisomy of chromosome 21, in particular on the immune system, and how these insights may enhance our pathophysiologic understanding of their cutaneous conditions.
Collapse
Affiliation(s)
- Chenin Ryan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Kishore Vellody
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leah Belazarian
- Departments of Pediatrics and Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jillian F Rork
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,Department of Dermatology, Dartmouth-Hitchcock Medical Center, Manchester, New Hampshire, USA
| |
Collapse
|
7
|
Wentworth AB, Hand JL, Davis DM, Tollefson MM. Skin concerns in patients with trisomy 21 (Down syndrome): A Mayo Clinic 22-year retrospective review. Pediatr Dermatol 2021; 38 Suppl 2:73-78. [PMID: 34409638 DOI: 10.1111/pde.14764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES Trisomy 21 has known associated clinical phenotypes, including skin and soft tissue concerns. However, the overall prevalence and types of findings are largely unclear. METHODS A retrospective review of children with trisomy 21 and one or more dermatologic diagnoses, seen from 1/1/1994 to 7/1/2016, was performed to record dermatologic diagnoses. If one or more diagnoses were confirmed, further data were collected, including demographics, medical specialty, referrals to dermatology, treatment, complications, and follow-up. RESULTS One hundred and seventy-four patients with a diagnosis of trisomy 21 aged 18 years or younger were confirmed to have one or more dermatologic diagnoses. In a total of 479 dermatologic diagnoses, superficial mycoses (12%), skin and soft tissue infections (10%), dermatitis (8%), and folliculitis (8%) were most common. Diagnoses were most commonly made as an outpatient (91%) and by general pediatrics (45%) or dermatology (25%). A significant difference (P < .05) in the frequency of various diagnoses made by different specialties was observed. A significant difference (P < .05) in the treatments recommended by different specialties was also observed. Referrals to dermatology were infrequent (6%). However, a frequent change in diagnosis (61%) or treatment (68%) for patients referred to dermatology was observed. CONCLUSIONS Children with trisomy 21 are most commonly diagnosed with superficial mycoses, skin and soft tissue infections, dermatitis, and folliculitis. The majority of diagnoses were made by general pediatricians and although dermatology referral was rarely necessary, consultations often resulted in change of diagnosis and/or treatment, supporting consideration of early and frequent dermatology referral.
Collapse
Affiliation(s)
| | - Jennifer L Hand
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Chung H, Green PHR, Wang TC, Kong XF. Interferon-Driven Immune Dysregulation in Down Syndrome: A Review of the Evidence. J Inflamm Res 2021; 14:5187-5200. [PMID: 34675597 PMCID: PMC8504936 DOI: 10.2147/jir.s280953] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023] Open
Abstract
Down syndrome (DS) is a unique genetic disease caused by the presence of an extra copy of chromosome 21, which carries four of the six interferon receptor (IFN-R) genes on its long arm. Recent studies reporting higher levels of interferon-stimulated gene (ISG) expression in primary immune cells studied ex vivo have suggested that the additional copies of the IFN-R genes in DS result in mild interferonopathy. In this review, we analyze the potential clinical and immunological impacts of this interferonopathy in DS. We performed a literature review to explore the epidemiology and risks of celiac disease, type 1 diabetes, thyroid dysfunction, mucocutaneous manifestations, infectious diseases (including COVID-19), and Alzheimer’s disease in individuals with DS relative to the general population with or without iatrogenic exposure to interferons. We analyzed immunophenotyping data and the current experimental evidence concerning IFN-R expression, constitutive JAK-STAT activation, and ISG overexpression in DS. Despite the lack of direct evidence that implicating this mild interferonopathy directly in illnesses in individuals with DS, we highlight the challenges ahead and directions that could be taken to determine more clearly the biological impact of interferonopathy on various immune-related conditions in DS.
Collapse
Affiliation(s)
- Howard Chung
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens (Queens Hospital Center), Jamaica, NY, 11432, USA
| | - Peter H R Green
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - Timothy C Wang
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Xiao-Fei Kong
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| |
Collapse
|
9
|
Oral Microbiota Features in Subjects with Down Syndrome and Periodontal Diseases: A Systematic Review. Int J Mol Sci 2021; 22:ijms22179251. [PMID: 34502159 PMCID: PMC8431440 DOI: 10.3390/ijms22179251] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022] Open
Abstract
Down syndrome (DS) is a genetic disorder associated with early-onset periodontitis and other periodontal diseases (PDs). The present work aimed to systematically review the scientific literature reporting studies in vivo on oral microbiota features in subjects with DS and related periodontal health and to highlight any correlation and difference with subjects not affected by DS, with and without PDs. PubMed, Web of Science, Scopus and Cochrane were searched for relevant studies in May 2021. The participants were subjects affected by Down syndrome (DS) with and without periodontal diseases; the study compared subjects with periodontal diseases but not affected by DS, and DS without periodontal diseases; the outcomes were the differences in oral microbiota/periodontopathogen bacterial composition among subjects considered; the study design was a systematic review. Study quality was assessed with risk of bias in non-randomized studies of interventions (ROBINS-I). Of the 954 references retrieved, 26 studies were considered. The conclusions from the qualitative assessment of the papers revealed an increasing knowledge over the last years of the microbiota associated with DS and their periodontal diseases, in comparison with healthy subjects and subjects with other kinds of mental disabilities. Few data have emerged on the mycobiome and virobiome of DS, hence, further investigations are still necessary.
Collapse
|
10
|
Rork JF, McCormack L, Lal K, Wiss K, Belazarian L. Dermatologic conditions in Down syndrome: A single-center retrospective chart review. Pediatr Dermatol 2020; 37:811-816. [PMID: 32519435 DOI: 10.1111/pde.14214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current literature addressing dermatologic conditions associated with Down syndrome is limited, with emphasis on rare skin conditions and lack of consensus on the incidence of more common disorders. OBJECTIVE We sought to evaluate dermatologic conditions in patients with Down syndrome diagnosed and managed by dermatologists. METHODS This was a retrospective analysis of 101 pediatric and adult patients with Down syndrome seen by the University of Massachusetts Dermatology Department between 2008 and 2018. RESULTS Folliculitis was the most common diagnosis overall (30.7%), followed by seborrheic dermatitis (26.7%) and hidradenitis suppurativa (22.8%). Eczematous dermatitis, alopecia areata, and xerosis were the most common diagnoses observed in children aged 0-12 years; hidradenitis suppurativa, folliculitis, and seborrheic dermatitis in adolescents aged 13-17 years; and folliculitis, seborrheic dermatitis, and xerosis in adults 18 years and older. Other notable diagnoses present overall included onychomycosis (9.9%) and psoriasis (8.9%). Malignant cutaneous tumors were present in two patients, specifically basal cell carcinoma and malignant melanoma in situ. LIMITATIONS This was a retrospective, single-institution study. CONCLUSION Dermatologic conditions in patients with Down syndrome vary by age but are most often adnexal and eczematous disorders. Trisomy of chromosome 21 and the resulting downstream effects, specifically on the immune system, may account for these findings.
Collapse
Affiliation(s)
- Jillian F Rork
- Department of Dermatology, Dartmouth Medical School, Lebanon, NH, USA
| | | | - Karan Lal
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
11
|
Abstract
People with Down syndrome show signs of chronic immune dysregulation, including a higher prevalence of autoimmune disorders, increased rates of hospitalization during respiratory viral infections, and higher mortality rates from pneumonia and sepsis. At the molecular and cellular levels, they show markers of chronic autoinflammation, including interferon hyperactivity, elevated levels of many inflammatory cytokines and chemokines, and changes in diverse immune cell types reminiscent of inflammatory conditions observed in the general population. However, the impact of this immune dysregulation in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and CoV disease of 2019 (COVID-19) remains unknown. This Perspective outlines why individuals with Down syndrome should be considered an at-risk population for severe COVID-19. Specifically, the immune dysregulation caused by trisomy 21 may result in an exacerbated cytokine release syndrome relative to that observed in the euploid population, thus justifying additional monitoring and specialized care for this vulnerable population.
Collapse
Affiliation(s)
- Joaquin M Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.,Department of Pharmacology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| |
Collapse
|
12
|
Firsowicz M, Boyd M, Jacks SK. Follicular occlusion disorders in Down syndrome patients. Pediatr Dermatol 2020; 37:219-221. [PMID: 31626333 DOI: 10.1111/pde.14012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/24/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
Disorders involving follicular occlusion, such as hidradenitis suppurativa, folliculitis, acneiform eruptions, and pilonidal cysts, have shown an increased prevalence in the Down syndrome (DS) population, but there are limited published data examining this association. We conducted a retrospective chart review of 243 DS patients presenting to a pediatric dermatology clinic to further examine the prevalence of disorders of follicular occlusion in DS patients. Our study showed high rates of disorders of follicular occlusion in DS patients, with prevalent disorders including folliculitis (21.0%), keratosis pilaris (17.3%), acne vulgaris (11.1%), hidradenitis suppurativa (7.0%), and furunculosis (4.5%), and overall prevalence of 44.9%. These findings add to a limited but growing body of evidence that documents an increased rate of disorders of follicular occlusion in pediatric DS patients.
Collapse
Affiliation(s)
- Maya Firsowicz
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - McKenna Boyd
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie K Jacks
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
13
|
Feeding problems and gastrointestinal diseases in Down syndrome. Arch Pediatr 2019; 27:53-60. [PMID: 31784293 DOI: 10.1016/j.arcped.2019.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/26/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND METHOD Feeding problems and gastrointestinal disorders are the most common anomalies in people with Down syndrome (DS) and have a significant impact on their daily life. This study lists the various anomalies on the basis of 504 references selected from a PubMed search in October 2018. RESULTS The anomalies are grouped into three categories: anatomical anomalies: duodenal atresia and stenosis (3.9%), duodenal web and annular pancreas; aberrant right subclavian artery (12% of children with DS with cardiac anomaly); Hirschsprung's disease (2.76%); anorectal malformation (1.16%); congenital vascular malformations of the liver; orofacial cleft, bifid uvula (4.63%), and submucous orofacial cleft; esophageal atresia (0.5-0.9%); pyloric stenosis (0.3%); diaphragmatic hernia; malrotation of small intestine or duodenum inversum; omphalocele, gastroschisis or anomalies of the median line, anomalies of the umbilical vein; biological, immunological, and infectious anomalies: neonatal cholestasis (3.9%); neonatal hepatic fibrosis; Helicobacter pylori infection (75.8% in institutionalized children with DS, between 29.2 and 19.5% in non-institutionalized); non-alcoholic fatty liver disease (NAFLD; 82% in obese and 45% in non-obese); biliary lithiasis (6.9% under 3 years); celiac disease (6.,6%); geographical tongue (4%); hepatitis B virus sensitivity; autoimmune hepatitis and cholangitis; Crohn's disease, inflammatory bowel disease (IBD); pancreatitis; vitamin D deficiency (45.2% in Italy); functional disorders: suction, swallowing and chewing disorders (13 of 19 children with DS under 4 years); gastroesophageal reflux (47% in children with sleep apnea); achalasia (0,5% in adults); obesity (51.6% of males and 40.0% of females in Ireland) and overweight (32.0% and 14.8%); constipation (19.0%). Based on their practice, the authors insist on the following points: malformations are sometimes detected late (chronic vomiting after the introduction of food pieces, resistant constipation despite appropriate measures); prescription of preventive doses of vitamin D is advised; jaundice in a baby with DS may be retentional; in the event of transient leukemoid reaction it is vital to monitor liver function; the patient with geographic tongue must be reassured; for celiac serology there is no consensus on the staring age and the frequency, we propose every year from the age of 2; we advise to test people with DS for H. pylori infection if they are attending specialized institutions; abdominal ultrasounds must be systematic during the first months of life; detection of NAFLD is recommended; people with DS must be vaccinated against hepatitis B; breastfeeding is possible with maternal support; it is important to start speech therapy very early; feeding difficulties are often overlooked by the family and educators; gastroesophageal reflux is often pathological; preventing obesity must start from birth using body mass index for the general population; it is necessary to do everything for their meals to be joyful.
Collapse
|
14
|
Fölster-Holst R, Rohrer T, Jung AM. Dermatological aspects of the S2k guidelines on Down syndrome in childhood and adolescence. J Dtsch Dermatol Ges 2019; 16:1289-1295. [PMID: 30300491 DOI: 10.1111/ddg.13665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With an incidence of 1 in 700 births, Down syndrome (DS) is not an uncommon condition. It is associated with various disorders of different organ systems. Serious disorders include cardiac defects and leukemia. With an onset during the newborn period, the latter does not always progress to classic myeloid leukemia (transient myeloproliferative disorder). Skin manifestations in newborns include pustules/vesiculopustules. In individuals with DS, such lesions should not only prompt suspicion for typical neonatal rashes and infections but also for transient myeloproliferative disorder. However, most dermatoses are benign. They essentially comprise disorders of keratinization that present as xerosis, keratosis pilaris, lichenification, and ichthyosis vulgaris. Also typical but not specific is the four-finger palmar crease (simian crease). Patients frequently develop folliculitides, which - due to elastolysis - subsequently progress to anetoderma. The known immune disturbance in DS patients explains the occurrence of autoimmune diseases such as alopecia areata and vitiligo. Typical skin conditions associated with DS include elastosis perforans serpiginosa, syringomas, milia-like calcinosis cutis, and multiple eruptive dermatofibromas.
Collapse
Affiliation(s)
- Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Tilman Rohrer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetology, Saarland University Medical Center, Homburg, Germany
| | - Anna-Maria Jung
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetology, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
15
|
Miles JH, Takahashi N, Muckerman J, Nowell KP, Ithman M. Catatonia in Down syndrome: systematic approach to diagnosis, treatment and outcome assessment based on a case series of seven patients. Neuropsychiatr Dis Treat 2019; 15:2723-2741. [PMID: 31571888 PMCID: PMC6759875 DOI: 10.2147/ndt.s210613] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The goal is to expand our knowledge of catatonia occurring in adolescents and young adults with Down syndrome (DS) by describing the first prospective, consecutive, well-characterized cohort of seven young people with DS diagnosed with catatonia and treated between 2013 and 2018, and to assess each patient's treatment responses. Longitudinal assessment of each patient's response to treatment is intended to provide clinicians and psychiatrists a firm foundation from which assess treatment efficacy. STUDY DESIGN Young adults with Down syndrome were consecutively enrolled in the study as they were diagnosed with catatonia. A comprehensive data set included medical, laboratory, developmental, demographic, family, social and genetic data, including query into disorders for which individuals with DS are at risk. Catatonia was diagnosed based on an unequivocal history of regression, positive Bush-Francis Catatonia Rating Scale and positive response to intravenous lorazepam. Patients' longitudinal progress was monitored using the Catatonia Impact Scale (CIS) developed for this purpose. RESULTS Seven consecutive DS patients, who presented with unequivocal regression were diagnosed with catatonia and treated for 2.7-6 years using standard-of-care therapies; primarily GABA agonist, lorazepam, electroconvulsive therapy (ECT) and glutamate antagonists (dextromethorphan/quinidine, memantine, minocycline). Responses to each treatment modality were assessed at clinic visits and through weekly electronic CIS reports. CONCLUSION Seven young adults with DS were diagnosed with catatonia; all responded to Lorazepam and/or ECT therapy with good to very good results. Though ECT most dramatically returned patients to baseline, symptoms often returned requiring additional ECT. Dextromethorphan/quinidine, not used until mid-2017, appeared to reduce the reoccurrence of symptoms following ECT. Though all seven patients improved significantly, each continues to require some form of treatment to maintain a good level of functioning. Findings of a significant number of autoimmune disorders and laboratory markers of immune activation in this population may guide new diagnostic and treatment opportunities.
Collapse
Affiliation(s)
- Judith H Miles
- Department of Child Health, University of Missouri Healthcare, Columbia, MO, USA
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Nicole Takahashi
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Julie Muckerman
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Kerri P Nowell
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
- Department of Health Psychology, University of Missouri Healthcare, Columbia, MO, USA
| | - Muaid Ithman
- Department of Psychiatry, University of Missouri Health Care, Columbia, MO, USA
| |
Collapse
|
16
|
Ogueta I, Ramírez M, Jiménez C, Cifuentes M. Geographic Tongue: What a Dermatologist Should Know. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
17
|
Ogueta C I, Ramírez P M, Jiménez O C, Cifuentes M M. Geographic Tongue: What a Dermatologist Should Know. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:341-346. [PMID: 31005233 DOI: 10.1016/j.ad.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/19/2018] [Accepted: 10/28/2018] [Indexed: 11/19/2022] Open
Abstract
Geographic tongue, also known as benign migratory glossitis, is a benign chronic inflammatory condition of the tongue. It is characterized by erythematous lesions with filiform papillae atrophy, surrounded by white limited areas in the dorsal and lateral aspects of the tongue, producing a map-like aspect. This lesions change in size and shape with time, and are characterized by periods of exacerbation and remission without scaring. The cause is unknown, but multiple associations have been described, which will be discussed below.
Collapse
Affiliation(s)
- I Ogueta C
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
| | - M Ramírez P
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - C Jiménez O
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - M Cifuentes M
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| |
Collapse
|
18
|
Castellanos J, Toledo-Bahena M, Mena-Cedillos C, Ramirez-Cortes E, Valencia-Herrera A. Onychomycosis in Children with Down Syndrome. CURRENT FUNGAL INFECTION REPORTS 2018. [DOI: 10.1007/s12281-018-0331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
19
|
Fölster-Holst R, Rohrer T, Jung AM. Dermatologische Aspekte aus der S2k-Leitlinie zum Down-Syndrom im Kindes- und Jugendalter. J Dtsch Dermatol Ges 2018; 16:1289-1296. [DOI: 10.1111/ddg.13665_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Regina Fölster-Holst
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum Schleswig-Holstein; Campus Kiel Kiel
| | - Tilman Rohrer
- Universität des Saarlandes; Kliniken für Kinder- und Jugendmedizin; Sektion Pädiatrische Endokrinologie und Diabetologie Homburg
| | - Anna-Maria Jung
- Universität des Saarlandes; Kliniken für Kinder- und Jugendmedizin; Sektion Pädiatrische Endokrinologie und Diabetologie Homburg
| |
Collapse
|
20
|
Wang JF, Orlow SJ. Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options. Am J Clin Dermatol 2018; 19:733-757. [PMID: 30043128 DOI: 10.1007/s40257-018-0368-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Keratosis pilaris is a common skin disorder comprising less common variants and rare subtypes, including keratosis pilaris rubra, erythromelanosis follicularis faciei et colli, and the spectrum of keratosis pilaris atrophicans. Data, and critical analysis of existing data, are lacking, so the etiologies, pathogeneses, disease associations, and treatments of these clinical entities are poorly understood. The present article aims to fill this knowledge gap by reviewing literature in the PubMed, EMBASE, and CINAHL databases and providing a comprehensive, analytical summary of the clinical characteristics and pathophysiology of keratosis pilaris and its subtypes through the lens of disease associations, genetics, and pharmacologic etiologies. Histopathologic, genomic, and epidemiologic evidence points to keratosis pilaris as a primary disorder of the pilosebaceous unit as a result of inherited mutations or acquired disruptions in various biomolecular pathways. Recent data highlight aberrant Ras signaling as an important contributor to the pathophysiology of keratosis pilaris and its subtypes. We also evaluate data on treatments for keratosis pilaris and its subtypes, including topical, systemic, and energy-based therapies. The effectiveness of various types of lasers in treating keratosis pilaris and its subtypes deserves wider recognition.
Collapse
Affiliation(s)
- Jason F Wang
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA.
| |
Collapse
|
21
|
Garg A, Strunk A, Midura M, Papagermanos V, Pomerantz H. Prevalence of hidradenitis suppurativa among patients with Down syndrome: a population-based cross-sectional analysis. Br J Dermatol 2018; 178:697-703. [DOI: 10.1111/bjd.15770] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 02/03/2023]
Affiliation(s)
- A. Garg
- Donald and Barbara Zucker School of Medicine at Hofstra / Northwell; New Hyde Park Hempstead NY U.S.A
| | - A. Strunk
- Donald and Barbara Zucker School of Medicine at Hofstra / Northwell; New Hyde Park Hempstead NY U.S.A
| | - M. Midura
- Donald and Barbara Zucker School of Medicine at Hofstra / Northwell; New Hyde Park Hempstead NY U.S.A
| | - V. Papagermanos
- Donald and Barbara Zucker School of Medicine at Hofstra / Northwell; New Hyde Park Hempstead NY U.S.A
| | - H. Pomerantz
- Donald and Barbara Zucker School of Medicine at Hofstra / Northwell; New Hyde Park Hempstead NY U.S.A
| |
Collapse
|
22
|
Coexistence of eruptive syringoma and bilateral nipple vitiligo: Could there be a common immunopathogenesis? North Clin Istanb 2017; 4:195-198. [PMID: 28971181 PMCID: PMC5613271 DOI: 10.14744/nci.2016.51523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/13/2016] [Indexed: 11/23/2022] Open
Abstract
The rarely seen eruptive syringoma (ES) is characterized by small, skin-colored, papules. Lesions are benign; however, treatment is often unsuccessful. Recent studies have a suggested role of the autoimmune response, rather than reactive proliferation of acrosyringium in the pathogenesis of ES. There are reports in the literature of an association between syringoma and diabetes mellitus as well as alopecia areata, which support a theory of an autoimmune role; however, there has been no report of coexistence of ES and vitiligo thus far. Presently described is a case of bilateral nipple vitiligo and eruptive syringoma in a 29-year old female.
Collapse
|
23
|
[Physical examination of oral cavity and physiological variations]. Presse Med 2017; 46:286-295. [PMID: 28233707 DOI: 10.1016/j.lpm.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/24/2016] [Accepted: 01/16/2017] [Indexed: 11/23/2022] Open
Abstract
Clinical examination from front to rear of oral cavity, mouth closed then open. Inspection and bimanuel exam. Face examination but also cervical lymph nodes, skin and mucous. Early diagnosis of oral cancer. To reduce diagnostic wavering and patient's stress, physiological varants are important to know. In most cases, clinical examination is enough for diagnosis.
Collapse
|
24
|
|
25
|
Williams K, Shinkai K. Evaluation and management of the patient with multiple syringomas: A systematic review of the literature. J Am Acad Dermatol 2016; 74:1234-1240.e9. [PMID: 26850654 DOI: 10.1016/j.jaad.2015.12.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/01/2015] [Accepted: 12/05/2015] [Indexed: 11/24/2022]
Abstract
Syringomas are benign adnexal tumors with distinct histopathologic features, including the characteristic comma ("tadpole") shaped tail comprised of dilated, cystic eccrine ducts. Clinically, syringomas typically present in adolescent females predominantly in the periorbital region. They may present as solitary or multiple lesions, and more rare sites of involvement include the genitals, palms, scalp, and the chest. Over the past 50 years, there have been >800 reported cases of syringoma either alone or in conjunction with a systemic syndrome, most commonly Down syndrome. The primary aim of this systematic review is to discuss the clinical features and associations of syringomas with a focus on the patient with multiple syringomas. Its secondary aims are to explore pathophysiology with a focus on multiple syringomas and provide comprehensive data on both traditional and novel treatments. Importantly, multiple syringomas present across a broad clinical spectrum. Though noted in many textbooks to be related to tumor syndromes, the association of syringomas with inherited tumor syndromes is only rarely reported in the literature. Despite multiple reported cases of syringoma, the pathophysiology remains poorly understood and treatment continues to pose a significant challenge.
Collapse
Affiliation(s)
- Kiyanna Williams
- University of California San Francisco School of Medicine, San Francisco, California
| | - Kanade Shinkai
- Department of Dermatology, University of California San Francisco, San Francisco, California.
| |
Collapse
|
26
|
Al-Maweri SA, Tarakji B, Al-Sufyani GA, Al-Shamiri HM, Gazal G. Lip and oral lesions in children with Down syndrome. A controlled study. J Clin Exp Dent 2015; 7:e284-8. [PMID: 26155347 PMCID: PMC4483338 DOI: 10.4317/jced.52283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/05/2015] [Indexed: 11/18/2022] Open
Abstract
Background Down syndrome (DS) is the most common chromosomal abnormality affecting numerous organs, including the orofacial region. The objective of the present study was to assess the prevalence of lip and oral soft tissue lesions, with particular emphasize on the incidence of fissured tongue, lip fissures and angular cheilitis, among individuals with DS in Yemen. Material and Methods This controlled cross-sectional study included 50 children with DS (6-18 years), and 50 age-and gender-matched healthy controls. The prevalence of orofacial soft tissue lesions was evaluated in both groups. Data were analyzed by Chi-square and Fisher tests, and p < 0.05 was considered to be statistically significant. Results Ten orolabial lesions were identified among the subjects. The most frequently seen lesions were: Fissured tongue (78.0%), lip fissures (64.0%), angular cheilitis (38.0%) and Cheilitis (14.0%). The frequencies of these lesions were significantly higher in children with DS than healthy controls (P< 0.001). Most of lip fissures were in the lower lip, and 80% of the fissures were in the midline. Conclusions The prevalence of lip and oral lesions among individuals with DS is remarkably high. Hence, oral physicians should be more aware of the orofacial findings seen more frequently in this genetic disorder. Key words:Down syndrome, lesions, lips, oral.
Collapse
Affiliation(s)
- Sadeq-Ali Al-Maweri
- Assistant Professor, Department of Oral and Maxillofacial Sciences, Al-Farabi Colleges of Dentistry and Nursing, Saudi Arabia; Department of Oral Medicine and Diagnosis, Sana'a University, Yemen
| | - Bassel Tarakji
- Professor, Head Department of Oral and Maxillofacial Sciences, Al-Farabi Colleges of Dentistry and Nursing,, Saudi Arabia
| | | | - Hashem M Al-Shamiri
- Lecturer, Department of Oral and Maxillofacial Sciences, Al-Farabi Colleges of Dentistry and Nursing
| | - Giath Gazal
- Assistant Professor, Department of Oral Maxillofacial Sciences, College of Dentistry, Taibah University
| |
Collapse
|
27
|
Abstract
Facial involvement represents a characteristic feature of a wide range of genodermatoses. Specific facial findings often help point to the correct diagnosis, which improves counseling and management. In particular, this can facilitate the identification and treatment of associated extracutaneous disease. The highly visible nature of facial lesions in genodermatoses and facial birthmarks can result in stigmatization and frequently leads to particular concern in patients and their family members. It is therefore critical for dermatologists to be aware of the broad spectrum of facial manifestations in genetic skin disease, especially when these findings have important implications with regard to monitoring and treatment. In this contribution, facial involvement in genodermatoses is divided into five morphologic categories based on the most prominent feature: Papules, scaling, photosensitivity/findings associated with aging (eg, telangiectasias, atrophy, lentigines), blisters/erosions, and birthmarks. Hopefully, this will provide a practical and clinically useful approach to a large and diverse assortment of genetic skin conditions.
Collapse
|
28
|
Estefan JL, Oliveira JC, Abad ED, Saintive SB, Porto LCMS, Ribeiro M. HLA antigens in individuals with down syndrome and alopecia areata. World J Clin Cases 2014; 2:541-545. [PMID: 25325065 PMCID: PMC4198407 DOI: 10.12998/wjcc.v2.i10.541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/03/2014] [Accepted: 08/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To describe human leukocyte antigen (HLA) alleles in individuals with Down syndrome and alopecia areata.
METHODS: A cross-sectional study was conducted, which evaluated 109 individuals. Ten with down syndrome (DS) and alopecia areata (AA), ten with DS without AA and ten with AA without DS, and their families. The individuals were matched by gender and age. The following data were computed: gender, age, ethnic group, karyotype, clinical presentation and family history of alopecia areata. Descriptive analysis: measures of central tendency and frequency distribution. Inferential analysis: Fisher’s exact test to compare categorical data between the three groups and Kruskal-Wallis ANOVA test for numerical data.
RESULTS: Seventy per cent of evaluated individuals in the DS and AA group were male; presented mean age of 18.6 (SD ± 7.2) years and 70% were Caucasian. We observed involvement of the scalp, with a single lesion in 10% and multiple in 90% of subjects. It was observed that there is no significant difference in the frequency distributions of the alleles HLA loci A, B, C, DRB1 and DQB1 of subjects studied. However, according to Fisher’s exact test, there is a trend (P = 0.089) of DS group to present higher proportions of HLA-A 36 and HLA-B 15 than the AA group and AA and DS group.
CONCLUSION: There was a tendency for the DS group, to present proportion of HLA-A 36 and HLA-B 15 higher than the AA group and group of individuals with AA and DS. However, there was no significant difference in the frequency distribution of the alleles.
Collapse
|
29
|
Järvinen J, Mikkonen JJ, Kullaa AM. Fissured tongue: A sign of tongue edema? Med Hypotheses 2014; 82:709-12. [DOI: 10.1016/j.mehy.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/05/2014] [Indexed: 02/08/2023]
|
30
|
Zigman WB. Atypical aging in down syndrome. ACTA ACUST UNITED AC 2013; 18:51-67. [DOI: 10.1002/ddrr.1128] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 11/14/2012] [Accepted: 11/29/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Warren B. Zigman
- Department of Psychology, Laboratory of Community Psychology, NYS Institute for Basic Research in Developmental Disabilities; Staten Island; New York
| |
Collapse
|
31
|
Thomas M, Khopkar US. Keratosis pilaris revisited: is it more than just a follicular keratosis? Int J Trichology 2013; 4:255-8. [PMID: 23766609 PMCID: PMC3681106 DOI: 10.4103/0974-7753.111215] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Keratosis pilaris (KP) is characterized by keratinous plugs in the follicular orifices and varying degrees of perifollicular erythema. The most accepted theory of its pathogenesis proposes defective keratinization of the follicular epithelium resulting in a keratotic infundibular plug. We decided to test this hypothesis by doing dermoscopy of patients diagnosed clinically as keratosis pilaris. MATERIALS AND METHODS Patients with a clinical diagnosis of KP seen between September 2011 and December 2011 were included in the study. A clinical history was obtained and examination and dermoscopic evaluation were performed on the lesions of KP. RESULTS The age of the patients ranged from 6-38 years. Sixteen patients had history of atopy. Nine had concomitant ichthyosis vulgaris. All the 25 patients were found to have coiled hair shafts within the affected follicular infundibula. The hair shafts were extracted with the help of a sterile needle and were found to retain their coiled nature. Perifollicular erythema was seen in 11 patients; perifollicular scaling in 9. CONCLUSION Based on our observations and previously documented histological data of KP, we infer that KP may not be a disorder of keratinization, but caused by the circular hair shaft which ruptures the follicular epithelium leading to inflammation and abnormal follicular keratinization.
Collapse
Affiliation(s)
- Mary Thomas
- Department of Dermatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | | |
Collapse
|
32
|
Sorrell A, Espenschied C, Wang W, Weitzel J, Chu S, Parker P, Saldivar S, Bhatia R. Hereditary leukemia due to rare RUNX1c splice variant (L472X) presents with eczematous phenotype. ACTA ACUST UNITED AC 2012; 3. [PMID: 24353905 DOI: 10.4236/ijcm.2012.37110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deleterious mutations in the RUNX1 gene cause hereditary leukemia due to a rare syndrome called Familial platelet Disorder with Associated Myeloid Malignancy (FPDMM). We describe the characteristics of a family with FPDMM due to a novel RUNX1 mutation (L472X), located in the most 3-prime end of the gene reported to date. Our 36-year old proband presented with incidentally detected thrombocytopenia and a family history suggestive of FPDMM. Contrary to previously described families, affected members of our kindred express an eczematous phenotype, reportedly most severe in members who develop leukemia. Pedigree analysis shows that the L472X mutation tracks with thrombocytopenia, acute leukemia, and eczema. The L472X mutation produces a stably expressed RUNX1 protein product with a corresponding decrease in wild type RUNX1 expression. Our data supports the inclusion of eczema in the FPDMM phenotype and suggests the possibility that the RUNX1 L472X mutant causes the type of dominant negative affect that is associated with an elevated risk of leukemia in FPDMM families.
Collapse
Affiliation(s)
- A Sorrell
- Department of Pediatrics, City Hope National Medical Center, Duarte, CA ; Division of Clinical Cancer Genetics, City Hope National Medical Center, Duarte; CA
| | - C Espenschied
- Division of Clinical Cancer Genetics, City Hope National Medical Center, Duarte; CA
| | - W Wang
- Division of Population Sciences, City Hope National Medical Center, Duarte, CA
| | - J Weitzel
- Division of Clinical Cancer Genetics, City Hope National Medical Center, Duarte; CA
| | - S Chu
- Division of Hematology and Transplantation, City Hope National Medical Center, Duarte, CA
| | - P Parker
- Division of Hematology and Transplantation, City Hope National Medical Center, Duarte, CA
| | - S Saldivar
- Department of Molecular Genetics, City Hope National Medical Center, Duarte, CA
| | - R Bhatia
- Division of Hematology and Transplantation, City Hope National Medical Center, Duarte, CA
| |
Collapse
|
33
|
Sampaio ALSB, Mameri ÂCA, Vargas TJDS, Ramos-e-Silva M, Nunes AP, Carneiro SCDS. Dermatite seborreica. An Bras Dermatol 2011; 86:1061-71; quiz 1072-4. [DOI: 10.1590/s0365-05962011000600002] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/24/2011] [Indexed: 01/14/2023] Open
Abstract
A dermatite seborreica é uma doença eritêmato-escamativa de caráter crônico-recidivante que acomete entre 1 e 3% da população geral dos Estados Unidos. Possui dois picos de incidência - o primeiro, durante os três primeiros meses de vida, e o segundo, a partir da puberdade, atingindo seu ápice entre os 40 e 60 anos de idade. Os indivíduos HIV positivos têm maior prevalência da doença, que apresenta maior intensidade e tendência à refratariedade ao tratamento. Doenças neurológicas e outras doenças crônicas também estão associadas ao desenvolvimento da dermatite seborreica. Como mecanismo fisiopatogênico, reconhece-se que o fungo Malassezia sp., presente na pele de indivíduos suscetíveis, leve a uma irritação não-imunogênica a partir da produção de metabólitos à base de ácidos graxos insaturados deixados na superfície cutânea. Este artigo faz uma revisão da literatura sobre dermatite seborreica, com ênfase nos aspectos imunogenéticos, formas clínicas e tratamento.
Collapse
|
34
|
|
35
|
|
36
|
Ehara H, Ohno K, Ito H. Benign and malignant tumors in Down syndrome: analysis of the 1514 autopsied cases in Japan. Pediatr Int 2011; 53:72-7. [PMID: 20573041 DOI: 10.1111/j.1442-200x.2010.03189.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Down syndrome is known for its association with neoplasms. The aim of this study was to examine this association. METHODS We surveyed the association with benign and malignant neoplasms in Down syndrome patients registered in the Annual of Pathological Autopsy Cases of Japan (1974-2000), a database of autopsied cases operated by the Japanese Society of Pathology. RESULTS In a total of 1514 cases with Down syndrome, there were eight cases with 10 benign tumors (four male and four female) and 104 cases with malignant disorders (61 male, 42 female and one case with unrecorded sex), in which 87 cases with hematopoietic malignancies (83.7%) and 17 cases with solid tumors (16.3%), were identified. The association of gallbladder adenocarcinoma with a benign tumor of the colon was noted in one case, while a further two cases with double benign tumors were confirmed as well. No case with a double malignancy was found. Hematopoietic malignancies (87 cases) included 31 cases (35.6%) with acute myelocytic leukemia, 10 (11.4%) with acute lymphocytic leukemia and two (2.3%) with chronic myelocytic leukemia. The ratio of acute myelocytic leukemia to acute lymphocytic leukemia was 3.1 in the present study. A peak in the age distribution was at 0 years in our data in contrast to the previous data (at 1 year) for myelocytic leukemia. The 17 solid tumors identified included three hepatocellular carcinomas, three extrahepatic cholangiocarcinomas, two gallbladder adenocarcinomas, three brain tumors, and three seminomas. CONCLUSION We present new associations of benign and malignant tumors with Down syndrome.
Collapse
Affiliation(s)
- Hiroaki Ehara
- Department of Special Education, Faculty of Education, Shiga University, Otsu, Shiga, Japan.
| | | | | |
Collapse
|
37
|
Saint-Jean M, Tessier MH, Barbarot S, Billet J, Stalder JF. [Oral disease in children]. Ann Dermatol Venereol 2010; 137:823-37. [PMID: 21134589 DOI: 10.1016/j.annder.2010.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2010] [Indexed: 02/08/2023]
Affiliation(s)
- M Saint-Jean
- Clinique Dermatologique, CHU Hôtel-Dieu, Place A.-Ricordeau, 44093 Nantes Cedex, France
| | | | | | | | | | | |
Collapse
|
38
|
Kalifatidis A, Albanidou-Farmaki E, Daniilidis M, Markopoulos AK, Karyotis N, Antoniades DZ. HLA alleles and fissured tongue. Int J Immunogenet 2010; 37:509-11. [DOI: 10.1111/j.1744-313x.2010.00944.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Jahanbani J, Sandvik L, Lyberg T, Ahlfors E. Evaluation of oral mucosal lesions in 598 referred Iranian patients. Open Dent J 2009; 3:42-7. [PMID: 19444343 PMCID: PMC2681169 DOI: 10.2174/1874210600903010042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 10/23/2008] [Accepted: 02/26/2009] [Indexed: 12/13/2022] Open
Abstract
The mucosal membrane of the oral cavity displays at times classical developmental lesions considered to be variations of normal structures rather than having disease characteristics. Of these lesions leukoedema, Fordyce granules, geographic-, fissured- and hairy tongue, median rhomboid glossitis and lingual varices were studied in 598 patients referred to the School of Dentistry, Tehran, Iran. The prevalence was studied in relation to age, gender, occupation, education, smoking habits, general health, addictions and or drug therapies. Oral developmental lesions were seen in 295 patients (49.3%). Only Fordyce granules (27,9%), fissured tongue (12,9%), leukoedema (12,5%) and hairy tongue (8,9%) had enough cases for statistical analysis. Three of these lesions increased with age but not fissured tongue. All were more common in men. After adjusting for age, the parameters education, occupation and complaints upon referral had little influence on the prevalence of the lesions. Fewer Fordyce granules were seen in oral mucosa of smoking men. Leukoedema and hairy tongue were significantly associated with smoking, leukoedema with diabetes mellitus. We conclude that there was a highly significant association between these oral lesions and age, gender and smoking. Few significant associations were found between oral lesions and general diseases.
Collapse
Affiliation(s)
- Jahanfar Jahanbani
- Department of Oral Pathology, School of Dentistry, Islamic Azad University of Tehran, Iran
| | | | | | | |
Collapse
|
40
|
Schieve LA, Boulet SL, Boyle C, Rasmussen SA, Schendel D. Health of children 3 to 17 years of age with Down syndrome in the 1997-2005 national health interview survey. Pediatrics 2009; 123:e253-60. [PMID: 19171577 DOI: 10.1542/peds.2008-1440] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study provides population-based estimates of recent medical conditions, concurrent developmental disorders, and health impact and utilization indicators for US children with and without Down syndrome. METHODS The sample included children 3 to 17 years of age in the 1997-2005 National Health Interview Survey Child Sample Core and specifically included 146 children with Down syndrome, 604 children with mental retardation but without Down syndrome, and 95 454 children without either condition reported. Developmental and medical conditions, health status, and service use were reported by parents or other knowledgeable caregivers. RESULTS After adjustment for demographic factors, children with Down syndrome had higher odds, compared with children without mental retardation, of recent food/digestive allergy, frequent diarrhea/colitis, > or =3 ear infections in the previous year, very recent head/chest cold, and developmental disabilities other than mental retardation. They had increased odds that approached significance for recent seizures, very recent stomach/intestinal illness, and asthma. They had substantially higher rates (threefold or higher, compared with children without mental retardation) for nearly all health impact and health and special education service use measures. Of note, >25% of children with Down syndrome needed help with personal care, regularly took prescription medications, had recently seen a medical specialist, and received physical therapy or related therapy. The comparison group with mental retardation without Down syndrome represented many children with multiple serious disabilities who also had high rates of medical conditions and high levels of health impact and service use. CONCLUSION These findings provide empirical, population-based data to inform guidelines for frequent monitoring and support for children with Down syndrome.
Collapse
Affiliation(s)
- Laura A Schieve
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention,Atlanta, GA 30333, USA.
| | | | | | | | | |
Collapse
|