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Conto Quispe PN, Tapia Martinez AC, Vilcapoma Guerra HJ, Lavado García L, Torres Ramos G. Aesthetic oral rehabilitation of the upper-anterior sector with supra-nano filling resin in a patient with woolly hair syndrome: case report. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38375899 DOI: 10.1111/scd.12979] [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: 10/24/2023] [Revised: 12/08/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Woolly Hair Syndrome (WHS) is a rare birth condition that affects the structure of hair in non-black people. The pathogenesis is not yet defined. It is postulated that the hair follicle's desmosomes (specifically desmoplaquine, placoglobin and placofilin-1, which are cell structural proteins that keep the adhesion among close cells) would be altered in this pathology, leading to fragility in the cellular union. It is subdivided into two large groups: the localized or circumscribed variant and the generalized variant. From birth or first months of life, patients with WHS are clinically characterized by the presence of a portion or entire scalp area of very short frizzy hair, usually of a smaller diameter, brittle and lighter color. The most frequent skin manifestations are pilar keratosis and palmo-plantar keratodermia. The diagnosis is based on the clinical findings, and it is facilitated by trichotoscopic examination. However, a definitive diagnosis of WHS requires genetic testing. Oral agenesis, enamel defects (such as hypomineralization), atypical caries, dental inclusion, and malformed pin-shaped teeth may occur. OBJECTIVE To describe an aesthetic alternative of oral rehabilitation using the mock-up technique in a patient with WHS. CLINICAL CASE A 5-year-old female patient diagnosed with WHS from the National Institute of Child Health NIHCH: Breña, Lima, who was referred from the Genetic service to the Pediatric Dentistry service in order to screen outbreaks of infection associated with odontogenic origin and dental anomalies. At the ectoscopy, a patient with short capillary length, brittle and curly hair, dry skin, and nail dystrophy was observed. At the intraoral clinical examination, anterior pieces of 52, 51, 61, 62, and enamel hypomineralization were observed in all teeth. The radiographic examination showed agenesis of parts 41, 34, and 45. Integral dental treatment was performed in the operating room under general anesthesia due to the complexity of the case. Pulpectomy in pieces 52, 51, 61, 62, post of composite resin, and rehabilitation with supra-nanow filling resin using the mock-up technique were proposed as alternative treatments. CONCLUSION The making of supra-nano filling resin-based crowns using the mock-up technique is an alternative treatment for aesthetic oral rehabilitation in deciduous dentition of patients with WHS. The aesthetic treatment was achieved using supra nano-filling resins. After 12 months of dental treatment, a favorable response was observed, improving the chewing, phonation and aesthetics of the patient.
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Affiliation(s)
| | - Akemy Celeste Tapia Martinez
- Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru and Dentistry Department, National Police Hospital of Peru Luis N. Saenz, Lima, Peru
| | - Henry Jesús Vilcapoma Guerra
- Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru and Dentistry Department, Central Hospital of the Peruvian Air Force, Lima, Peru
| | - Lenny Lavado García
- Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru and Dentistry Department, Instituto Nacional de Salud del Niño, Lima, Peru
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Zhao XJ, Bai CY, Li XY, Wang L, Wang RP, Xia Y, Liu G, Zhao HL, Xu HZ. A Novel Variant in the Desmoplakin Gene in One Case of the Rare Carvajal Syndrome with Dilated Cardiomyopathy: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:2737-2748. [PMID: 37799505 PMCID: PMC10547600 DOI: 10.2147/ccid.s429030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
Carvajal syndrome is a rare hereditary cardiocutaneous syndrome caused by the variants of the desmoplakin (DSP) gene. In this study, we report a patient of Carvajal syndrome with a novel homozygous missense variant of DSP gene. We diagnosed a 7-year-old female patient with Carvajal syndrome characterized by dilated cardiomyopathy, palmoplantar keratoderma, woolly hair, and dental dysplasia, who disclosed a novel homozygous missense variant c.4597C > T (p.Q1533X) in exon 6 of the DSP gene found for the first time. Both her parents were heterozygous for the identified nonsense variant c.4597C > T (p.Q1533X) in DSP gene but neither showed evidence of Carvajal syndrome, indicating that this novel variant causes the disease in an autosomal recessive manner. Genotypes of Carvajal syndrome are even broader than so far anticipated. When patients with dilated cardiomyopathy, palmoplantar keratoderma, woolly hair, and dental dysplasia are found in clinical practice, Carvajal syndrome should be highly suspected, and family gene sequencing should be actively carried out.
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Affiliation(s)
- Xiu-Jie Zhao
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, People’s Republic of China
| | - Chun-Yu Bai
- Department of Cardiology, Shijiazhuang Great Wall Cardiovascular Hospital, Shijiazhuang, 050035, People’s Republic of China
| | - Xiao-Yan Li
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, People’s Republic of China
| | - Lei Wang
- Department of Cardiology, Shijiazhuang Great Wall Cardiovascular Hospital, Shijiazhuang, 050035, People’s Republic of China
| | - Ren-Ping Wang
- Department of Cardiology, Shijiazhuang Great Wall Cardiovascular Hospital, Shijiazhuang, 050035, People’s Republic of China
| | - Yue Xia
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, People’s Republic of China
- Department of Cardiology, Shijiazhuang Great Wall Cardiovascular Hospital, Shijiazhuang, 050035, People’s Republic of China
| | - Gang Liu
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, People’s Republic of China
| | - Hong-Liang Zhao
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, People’s Republic of China
| | - Hong-Zun Xu
- Department of Cardiology, Shijiazhuang Great Wall Cardiovascular Hospital, Shijiazhuang, 050035, People’s Republic of China
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Salik D, Richert B, Smits G. Clinical and molecular diagnosis of genodermatoses: Review and perspectives. J Eur Acad Dermatol Venereol 2023; 37:488-500. [PMID: 36502512 DOI: 10.1111/jdv.18769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
Genodermatoses are a complex and heterogeneous group of genetic skin disorders characterized by variable expression and clinical and genetic heterogeneity, rendering their diagnosis challenging. DNA-based techniques, like whole-exome sequencing, can establish a diagnosis in 50% of cases. RNA-sequencing is emerging as an attractive tool that can obtain information regarding gene expression while integrating functional genomic data with regard to the interpretation of variants. This increases the diagnostic rate by an additional 10-15%. In the present review, we detail the clinical steps involved in the diagnosis of genodermatoses, as well as the current DNA-based technologies available to clinicians. Herein, the intention is to facilitate a better understanding of the possibilities and limitations of these diagnostic technologies. In addition, this review could guide dermatologists through new emerging techniques, such as RNA-sequencing and its applications to familiarizing them with future techniques. Currently, this multi-omics approach is likely the best strategy designed to promote the diagnosis of patients with genodermatoses and discover new skin disease genes that could result in novel targeted therapies.
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Affiliation(s)
- Deborah Salik
- Department of Dermatology, CHU Saint-Pierre, CHU Brugmann and Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertrand Richert
- Department of Dermatology, CHU Saint-Pierre, CHU Brugmann and Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Guillaume Smits
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Genetics, Hôpital Universitaire des Enfants Reine Fabiola, ULB Center of Human Genetics Université Libre de Bruxelles (ULB), Brussels, Belgium.,Interuniversity Institute of Bioinformatics in Brussels, Université Libre de Bruxelles, Brussels, Belgium
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Bhat Y, Trumboo T, Krishan K. Hair shaft disorders in children – An update. Indian Dermatol Online J 2023; 14:163-171. [PMID: 37089857 PMCID: PMC10115339 DOI: 10.4103/idoj.idoj_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/18/2022] [Accepted: 06/30/2022] [Indexed: 03/12/2023] Open
Abstract
Disorders of hair shaft are a diverse group of congenital and acquired abnormalities of the hair that can pose a diagnostic and therapeutic challenge to the dermatologists. Hair shaft abnormalities can occur as an isolated phenomenon or can be associated with an underlying genetic syndrome. Any change in the texture, appearance, and growth of the hair should prompt evaluation of the patient for the presence of any hair shaft anomaly. The diagnosis can be suggested by a complete history and physical examination of the hair-bearing areas as well as other ectodermal structures (nails and teeth). A key feature in the evaluation of hair shaft defects is to determine the fragility of the hair shaft that can be elucidated by performing the "tug test." Trichoscopy and light microscopy serve as valuable tools in establishing the specific type of hair shaft disorder. An update of the approach for the diagnosis and management is included in this review.
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Santos-Ferreira C, Baptista R, Teixeira T, Gonçalves L. A 45-year-old man with sudden cardiac death, cutaneous abnormalities and a rare desmoplakin mutation: a case report and literature review. BMC Cardiovasc Disord 2022; 22:41. [PMID: 35151254 PMCID: PMC8840678 DOI: 10.1186/s12872-022-02472-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/24/2022] [Indexed: 02/07/2023] Open
Abstract
Background Arrhythmogenic cardiomyopathy (AC) is a rare, heritable myocardial disorder that is a leading cause of ventricular arrhythmia and sudden cardiac death (SCD) in young people. Desmoplakin (DSP) mutations account for 3–20% of AC cases. However, the number of patients with DSP mutations is extremely small in all published reports and genotype–phenotype correlations are scant and mostly non-gene-specific. Case presentation A 45-year-old man was admitted after an out-of-hospital cardiac arrest, with documented ventricular fibrillation. He had no previous history of heart disease or family history of SCD or cardiomyopathy. The cardiac magnetic resonance showed a mildly dilated left ventricle with an ejection fraction of 30% and a non-dilated right ventricle with mildly depressed systolic function, and extensive subepicardial late gadolinium enhancement. Genetic screening identified a heterozygote nonsense mutation in DSP (NM_004415.2: c.478 C > T; p.Arg160Ter). Cascade genetic screening of the relatives revealed a high prevalence of the genotype and cutaneous phenotype, but a very low penetrance of the cardiac phenotype. Conclusions We report a case of SCD and an autosomal dominant mutation in DSP that causes arrhythmogenic dilated cardiomyopathy/AC. Like the recessive mutation in DSP known to cause Carvajal syndrome, Arg160Ter may be associated with cutaneous abnormalities.
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Lodato V, Parlapiano G, Calì F, Silvetti MS, Adorisio R, Armando M, El Hachem M, Romanzo A, Dionisi-Vici C, Digilio MC, Novelli A, Drago F, Raponi M, Baban A. Cardiomyopathies in Children and Systemic Disorders When Is It Useful to Look beyond the Heart? J Cardiovasc Dev Dis 2022; 9:47. [PMID: 35200700 PMCID: PMC8877723 DOI: 10.3390/jcdd9020047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiomyopathy (CMP) is a rare disease in the pediatric population, with a high risk of morbidity and mortality. The genetic etiology of CMPs in children is extremely heterogenous. These two factors play a major role in the difficulties of establishing standard diagnostic and therapeutic protocols. Isolated CMP in children is a frequent finding, mainly caused by sarcomeric gene variants with a detection rate that can reach up to 50% of analyzed cohorts. Complex multisystemic forms of pediatric CMP are even more heterogenous. Few studies in literature take into consideration this topic as the main core since it represents a rarity (systemic CMP) within a rarity (pediatric population CMP). Identifying etiology in this cohort is essential for understanding prognosis, risk stratification, eligibility to heart transplantation and/or mechanical-assisted procedures, preventing multiorgan complications, and relatives' recurrence risk calculation. The previous points represent a cornerstone in patients' empowerment and personalized medical care approach. The aim of this work is to propose a new approach for an algorithm in the setting of the diagnostic framework of systemic pediatric CMP. On the other hand, during the literature review, we noticed a relatively common etiologic pattern in some forms of complex/multisystem CMP. In other words, certain syndromes such as Danon, Vici, Alström, Barth, and Myhre syndrome share a common pathway of directly or indirectly defective "autophagy" process, which appears to be a possible initiating/triggering factor for CMPs. This conjoint aspect could be important for possible prognostic/therapeutic implications in this category of patients. However, multicentric studies detailed functional and experimental models are needed prior to deriving conclusions.
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Affiliation(s)
- Valentina Lodato
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Giovanni Parlapiano
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Federica Calì
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimo Stefano Silvetti
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Rachele Adorisio
- Heart Failure Clinic-Heart Failure, Heart Transplant, Mechanical Circulatory Support Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Michela Armando
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - May El Hachem
- Dermatology and Genodermatosis Units, Genetics and Rare Disease Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonino Romanzo
- Ophtalmology Unit, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy;
| | - Anwar Baban
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
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Cabrera-Borrego E, Montero-Vilchez T, Bermúdez-Jiménez FJ, Tercedor-Sánchez J, Tercedor-Sánchez L, Sánchez-Díaz M, Macías-Ruiz R, Molina-Jiménez M, Cañizares-García FJ, Fernández-Segura E, Fernandez-Flores A, Arias-Santiago S, Jiménez-Jáimez J. Heterozygous Arrhythmogenic Cardiomyopathy- desmoplakin Mutation Carriers Exhibit a Subclinical Cutaneous Phenotype with Cell Membrane Disruption and Lack of Intercellular Adhesion. J Clin Med 2021; 10:jcm10194608. [PMID: 34640625 PMCID: PMC8509745 DOI: 10.3390/jcm10194608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 01/20/2023] Open
Abstract
Genetic variants that result in truncation in desmoplakin (DSP) are a known cause of arrhythmogenic cardiomyopathy (AC). In homozygous carriers, the combined involvement of skin and heart muscle is well defined, however, this is not the case in heterozygous carriers. The aim of this work is to describe cutaneous findings and analyze the molecular and ultrastructural cutaneous changes in this group of patients. Four women and eight men with a mean age of 48 ± 14 years were included. Eight met definitive criteria for AC, one was borderline and three were silent carriers. No relevant macroscopic changes in skin and hair were detected. However, significantly lower skin temperature (29.56 vs. 30.97 °C, p = 0.036) and higher transepidermal water loss (TEWL) (37.62 vs. 23.95 g m 2 h 1, p = 0.028) were observed compared to sex- and age-matched controls. Histopathology of the skin biopsy showed widening of intercellular spaces and acantholysis of keratinocytes in the spinous layer. Immunohistochemistry showed a strongly reduced expression of DSP in all samples. Trichogram showed regular nodules (thickening) compatible with pseudomonilethrix. Therefore, regardless of cardiac involvement, heterozygous patients with truncation-type variants in DSP have lower skin temperature and higher TEWL, constant microscopic skin involvement with specific patterns and pseudomonilethrix in the trichogram.
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Affiliation(s)
- Eva Cabrera-Borrego
- Cardiology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain; (E.C.-B.); (F.J.B.-J.); (L.T.-S.); (R.M.-R.); (M.M.-J.); (J.J.-J.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
| | - Trinidad Montero-Vilchez
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
- Dermatology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain
| | - Francisco José Bermúdez-Jiménez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain; (E.C.-B.); (F.J.B.-J.); (L.T.-S.); (R.M.-R.); (M.M.-J.); (J.J.-J.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, CP, Spain
| | - Jesús Tercedor-Sánchez
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
- Dermatology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain
| | - Luis Tercedor-Sánchez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain; (E.C.-B.); (F.J.B.-J.); (L.T.-S.); (R.M.-R.); (M.M.-J.); (J.J.-J.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
| | - Manuel Sánchez-Díaz
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
- Dermatology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain
| | - Rosa Macías-Ruiz
- Cardiology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain; (E.C.-B.); (F.J.B.-J.); (L.T.-S.); (R.M.-R.); (M.M.-J.); (J.J.-J.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
| | - María Molina-Jiménez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain; (E.C.-B.); (F.J.B.-J.); (L.T.-S.); (R.M.-R.); (M.M.-J.); (J.J.-J.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
| | | | - Eduardo Fernández-Segura
- Department of Histology, University of Granada, 18016 Granada, CP, Spain; (F.J.C.-G.); (E.F.-S.)
| | | | - Salvador Arias-Santiago
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
- Dermatology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain
- Correspondence:
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, CP, Spain; (E.C.-B.); (F.J.B.-J.); (L.T.-S.); (R.M.-R.); (M.M.-J.); (J.J.-J.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, Universidad de Granada, 18012 Granada, CP, Spain; (T.M.-V.); (J.T.-S.); (M.S.-D.)
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Sun Q, Wine Lee L, Hall EK, Choate KA, Elder RW. Hair and skin predict cardiomyopathies: Carvajal and erythrokeratodermia cardiomyopathy syndromes. Pediatr Dermatol 2021; 38:31-38. [PMID: 33275305 DOI: 10.1111/pde.14478] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Carvajal and erythrokeratodermia cardiomyopathy syndromes (EKC) are rare, inherited cardiocutaneous disorders with potentially fatal consequences in young children. Some patients display features of congestive heart failure and rapidly deteriorate; others exhibit no evident warning signs until sudden death reveals underlying heart disease. We present two patients to illustrate the characteristic hair, skin, teeth, and nail abnormalities, which-especially when distinct from that of other family members-should prompt cardiac evaluation and genetic analysis. In this article, we discuss established treatments as well as a promising, novel therapeutic that has led to nearly complete resolution of the cutaneous and cardiac pathology in EKC syndrome.
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Affiliation(s)
- Qisi Sun
- Departments of Dermatology, Genetics, and Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Lara Wine Lee
- Medical University of South Carolina Health, Charleston, SC, USA
| | - E Kevin Hall
- Section of Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Keith A Choate
- Departments of Dermatology, Genetics, and Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Robert W Elder
- Section of Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Ahmed A, Almohanna H, Griggs J, Tosti A. Genetic Hair Disorders: A Review. Dermatol Ther (Heidelb) 2019; 9:421-448. [PMID: 31332722 PMCID: PMC6704196 DOI: 10.1007/s13555-019-0313-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/23/2022] Open
Abstract
Hair loss in early childhood represents a broad differential diagnosis which can be a diagnostic and therapeutic challenge for a physician. It is important to consider the diagnosis of a genetic hair disorder. Genetic hair disorders are a large group of inherited disorders, many of which are rare. Genetic hair abnormalities in children can be an isolated phenomenon or part of genetic syndromes. Hair changes may be a significant finding or even the initial presentation of a syndrome giving a clue to the diagnosis, such as Netherton syndrome and trichothiodystrophy. Detailed history including family history and physical examination of hair and other ectodermal structures such as nails, sweat glands, and sebaceous glands with the use of dermoscopic devices and biopsy all provide important clues to establish the correct diagnosis. Understanding the pathophysiology of genetic hair defects will allow for better comprehension of their treatment and prognosis. For example, in patients with an isolated hair defect, the main problem is aesthetic. In contrast, when the hair defect is associated with a syndrome, the prognosis will depend mainly on the associated condition. Treatment of many genetic hair disorders is focused on treating the primary cause and minimizing trauma to the hair.
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Affiliation(s)
- Azhar Ahmed
- Department of Dermatology, King Fahad General Hospital, Medina, Saudi Arabia.
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, FL, USA.
| | - Hind Almohanna
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Jacob Griggs
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, FL, USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, FL, USA
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Li GL, Saguner AM, Fontaine GH. Naxos disease: from the origin to today. Orphanet J Rare Dis 2018; 13:74. [PMID: 29747658 PMCID: PMC5946438 DOI: 10.1186/s13023-018-0814-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
Naxos disease, first described by Dr. Nikos Protonotarios and colleagues on the island of Naxos, Greece, is a special form of arrhythmogenic right ventricular dysplasia (ARVD). It is an inherited condition with a recessive form of transmission and a familial penetrance of 90%. It is associated with thickening of the skin of the hands and sole, and a propensity to woolly hair. The cardiac anomalies characterized by ventricular arrhythmias with ventricular extrasystoles and tachycardia and histologic features of the myocardium are consistent with ARVD, but in a more severe form of dysplasia with major dilatation of the right ventricle. The identification of the responsible first gene on chromosome 17, and its product plakoglobin as the responsible protein for Naxos disease proved to be a milestone in the study of ARVD, which opened a new field of research. Thanks to those with the determination to discover Naxos disease, there is and will be more clarity in understanding the mechanisms of juvenile sudden death in the young who have an apparently otherwise normal heart.
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Affiliation(s)
- Guo-Liang Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China. .,Institut de Cardiologie, Unité de Rythmologie, Hôpital Universitaire La Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, France.
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Guy H Fontaine
- Institut de Cardiologie, Unité de Rythmologie, Hôpital Universitaire La Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, France
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11
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Birnbaum J, Ulrich SM, Schramm R, Hagl C, Lehner A, Fischer M, Haas NA, Heineking B. Transient severe tricuspid regurgitation after transplantation of an extremely oversized donor heart in a child-Does size matter? A case report. Pediatr Transplant 2017; 21. [PMID: 27925367 DOI: 10.1111/petr.12863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 12/01/2022]
Abstract
In pediatric heart transplantation, the size of the donor organ is an important criterion for organ allocation. Oversized donor hearts are often accepted with good results, but some complications in relation to a high donor-recipient ratio have been described. Our patient was transplanted for progressive heart failure in dilated cardiomyopathy. The donor-to-recipient weight ratio was 3 (donor weight 65 kg, recipient weight 22 kg). The intra-operative echocardiography before chest closure showed excellent cardiac function, no tricuspid valve regurgitation, and a normal central venous pressure. After chest closure, central venous pressure increased substantially and echocardiography revealed a severe tricuspid insufficiency. As other reasons for right ventricular dysfunction, that is, myocardial ischemia, pulmonary hypertension, and rejection, were excluded, we assumed that the insufficiency was caused by an alteration of the right ventricular geometry. After 1 week, the valve insufficiency regressed to a minimal degree. In pediatric heart transplant patients with a high donor-to-recipient weight ratio, the outlined complication may occur. If other reasons for right ventricular heart failure can be ruled out, this entity is most likely caused by an acute and transient alteration of the right ventricular geometry that may disappear over time.
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Affiliation(s)
- J Birnbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - S M Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - R Schramm
- Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - C Hagl
- Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - A Lehner
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M Fischer
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - N A Haas
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - B Heineking
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Islam AM, Rahman MT, Chowdhury AH. Cardiocutaneous syndrome (Naxos disease) in a Bangladeshi boy. Cardiovasc Diagn Ther 2016; 6:462-465. [PMID: 27747171 DOI: 10.21037/cdt.2016.03.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Naxos disease is a rare autosomal recessive form of arrhythmogenic right ventricular cardiomyopathy (ARVC) with woolly hair and palmoplantar keratoderma. The cardiomyopathy presents by adolescence with syncope, ventricular tachycardia (VT) of left bundle branch block (LBBB) morphology, and/or ventricular fibrillation. The diagnosis and management of ARVC are at present in evolution; the recently published modified Task Force Criteria for diagnosis and International Task Force consensus statement for treatment of ARVC will hopefully bring about uniformity in recognition and management of Naxos disease as well. Here, typical phenotype and diagnostic work up have been presented in a Bangladeshi boy with the Cardiocutaneous syndrome.
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Affiliation(s)
- Akm Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh; ; Department of Cardiology, Jessore Medical College, Jessore, Bangladesh
| | - Md Toufiqur Rahman
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Abu Hana Chowdhury
- Department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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13
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Singh G, Miteva M. Prognosis and Management of Congenital Hair Shaft Disorders without Fragility-Part II. Pediatr Dermatol 2016; 33:481-7. [PMID: 27293153 DOI: 10.1111/pde.12902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective of this study was to review the literature regarding the prognosis and treatment options for hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in English related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, woolly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati, improve with minoxidil. Oral retinoids have been found to improve hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Furthermore, any inherited or congenital disorder requires genetic counseling as part of management.
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Affiliation(s)
- Gaurav Singh
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida.
| | - Mariya Miteva
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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