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Lilly E, Bunick CG. Congenital Ichthyosis: A Practical Clinical Guide on Current Treatments and Future Perspectives. Clin Cosmet Investig Dermatol 2023; 16:2473-2479. [PMID: 37719935 PMCID: PMC10503504 DOI: 10.2147/ccid.s388608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Congenital ichthyoses are a group of hereditary disorders of keratinization that are challenging to treat. Affected individuals suffer not only from thickening of the skin but also associated complications such as growth restriction, hearing and eye complications, infections, and thermodysregulation. This clinical review provides a practical roadmap to the longitudinal care of patients with ichthyosis with both general and age- and disease-specific recommendations. The allure of pathogenesis-based and targeted treatments for these monogenetic severe but orphan conditions shines bright as dermatological therapies enter a new era.
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Affiliation(s)
- Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Christopher G Bunick
- Department of Dermatology and Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT, 06520, USA
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2
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Neema S, Vasudevan B, Rathod A, Mukherjee S, Vendhan S, Gera V. Intravenous immunoglobulin for the management of Netherton syndrome. Indian J Dermatol Venereol Leprol 2023; 89:754-756. [PMID: 37317770 DOI: 10.25259/ijdvl_558_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/03/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Shekhar Neema
- Department of Dermatology, AFMC, Pune, Maharashtra, India
| | - Biju Vasudevan
- Department of Dermatology, AFMC, Pune, Maharashtra, India
| | - Amol Rathod
- Department of Dermatology, AFMC, Pune, Maharashtra, India
| | | | | | - Vinay Gera
- Department of Dermatology, AFMC, Pune, Maharashtra, India
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3
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Wang Y, Song H, Yu L, Wu N, Zheng X, Liang B, Wang P. A novel mutation in SPINK5 gene underlies a case of atypical Netherton syndrome. Front Genet 2022; 13:943264. [PMID: 36159989 PMCID: PMC9500337 DOI: 10.3389/fgene.2022.943264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Netherton syndrome (NS, OMIM #256500) is a rare autosomal recessive disease characterized by a triad of congenital ichthyosiform erythroderma (CIE) or ichthyosis linearis circumflexa (ILC), trichorrhexis invaginata (TI), and atopic predisposition. The disease is caused by a mutation in the SPINK5 gene (serine protease inhibitor of Kazal type 5) encoding LEKTI (lymphoepithelial Kazal type-related inhibitor). We performed whole-exome sequencing on one Chinese NS family and made genotype–phenotype correlation analysis on the patients clinically diagnosed with NS or congenital ichthyosis erythroderma. We identified a novel frameshift mutation c.2474_2475del (p.Glu825Glyfs*2) in the SPINK5 gene. The N-terminal mutations of LEKTI cause a severer phenotype, while the C-terminal mutations of LEKT1 are related to a milder phenotype. Our findings suggest that Netherton syndrome may be underestimated clinically, and our findings further expand the reservoir of SPINK5 mutations in Netherton syndrome.
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Affiliation(s)
- Yu Wang
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China
- Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Hanqing Song
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China
- Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Lingling Yu
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China
- Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Nan Wu
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China
- Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Xiaodong Zheng
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China
- Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Bo Liang
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China
- Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Peiguang Wang
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China
- Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
- *Correspondence: Peiguang Wang,
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Nouwen AEM, Schappin R, Nguyen NT, Ragamin A, Bygum A, Bodemer C, Dalm VASH, Pasmans SGMA. Outcomes of Systemic Treatment in Children and Adults With Netherton Syndrome: A Systematic Review. Front Immunol 2022; 13:864449. [PMID: 35464459 PMCID: PMC9022473 DOI: 10.3389/fimmu.2022.864449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 01/24/2023] Open
Abstract
Background Comèl-Netherton syndrome (NS) is a rare disease caused by pathogenic variants in the SPINK5 gene, leading to severe skin barrier impairment and proinflammatory upregulation. Given the severity of the disease, treatment of NS is challenging. Current treatment regimens are mainly topical and supportive. Although novel systemic treatment options for NS have been suggested in recent literature, little is known about their outcomes. Objective to provide an overview of systemic treatment options and their outcomes in adults and children with NS. Methods Embase, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to July 22, 2021. Empirical studies published in English language mentioning systemic treatment in NS were enrolled. Studies that did not define a treatment period or report at least one outcome were excluded. Methodological quality was evaluated by the Joanna Briggs Institute critical appraisal checklist for case reports or case series. Overall quality of evidence of the primary outcome, skin, was assessed by the GRADE approach. Results 36 case series and case reports were included. The effects of 15 systemic therapies were described in 48 patients, of which 27 were children. Therapies included retinoids, prednisolone, cyclosporine, immunoglobulins, and biologicals. In retinoids both worsening (4/15 cases) and improvement (6/15 cases) of the skin was observed. Use of prednisolone and cyclosporine was only reported in one patient. Immunoglobulins (13/15 cases) and biologicals (18/21 cases) showed improvement of the skin. Certainty of evidence was rated as very low. Conclusion NS is a rare disease, which is reflected in the scarce literature on systemic treatment outcomes in children and adults with NS. Studies showed large heterogeneity in outcome measures. Adverse events were scarcely reported. Long-term outcomes were reported in a minority of cases. Nonetheless, a general beneficial effect of systemic treatment was found. Immunoglobulins and biologicals showed the most promising results and should be further explored. Future research should focus on determining a core outcome set and measurement instruments for NS to improve quality of research. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=217933, PROSPERO (ID: 217933).
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Affiliation(s)
- Anouk E M Nouwen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Renske Schappin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - N Tan Nguyen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Aviël Ragamin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Christine Bodemer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC), Necker-Enfants Malades Hospital (AP-HP), Paris Centre University, Paris, France
| | - Virgil A S H Dalm
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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Pontone M, Giovannini M, Filippeschi C, Oranges T, Pedaci FA, Mori F, Barni S, Barbati F, Consonni F, Indolfi G, Lodi L, Azzari C, Ricci S, Hovnanian A. Biological treatments for pediatric Netherton syndrome. Front Pediatr 2022; 10:1074243. [PMID: 36619513 PMCID: PMC9822572 DOI: 10.3389/fped.2022.1074243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Netherton syndrome (NS) is a rare and potentially life-threatening genetic skin disease responsible for skin inflammation and scaling, hair abnormalities and severe allergic manifestations. NS is caused by loss-of-function variants in Serine Peptidase Inhibitor Kazal-Type 5 (SPINK5), encoding the serine protease inhibitor LEKTI. NS patients have a profound skin barrier defect caused by unopposed kallikrein-related proteases activity (KLKs). They develop severe skin inflammation with eczematous-like lesions and high serum IgE levels. Multiomics studies have revealed that the IL-17/IL-36 pathway is the most predominant upregulated pathway in NS. It is associated with a Th2 signature with complement activation in the ichthyosis linearis circumflexa subtype, and with interferon and Th9 activation in the scaly erythrodermic form. Several case reports proved the efficacy of different biotherapies targeting IL-17A, IL-12/IL-23, IL-4R and IL-13R, TNF-a and IL-1β in pediatric NS patients. Intravenous immunoglobulins (IVIG) have also shown efficacy. These studies showed no severe side effects. At present, IL-17 blockade seems to be the most efficient treatment, but case reports remain limited with small numbers of patients and no placebo-control. Additional pathways must also be explored, and more efficient strategies could be used to block IL-17 and IL-23 pathways. In the future, the combination of specific strategies aiming at repairing the initial skin barrier defect could potentiate the efficacy of biologics. The current reports suggest that biological therapy is safe and often effective at pediatric age. However, controlled clinical trials that include a larger number of patients need to be conducted to reach more reliable conclusions.
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Affiliation(s)
- Matteo Pontone
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy.,Allergy Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Cesare Filippeschi
- Dermatology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Teresa Oranges
- Dermatology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | | | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Federica Barbati
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Filippo Consonni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giuseppe Indolfi
- Pediatric and Liver Unit, Meyer Children's University Hospital, Florence, Italy
| | - Lorenzo Lodi
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Alain Hovnanian
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute and University of Paris, Paris, France.,Department of Genetics, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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Wang Q, Qiu F, Wu H, Fan YM. New compound heterozygous SPINK5 mutations in a Chinese infant with Netherton syndrome. J Eur Acad Dermatol Venereol 2021; 35:e782-e784. [PMID: 34138484 DOI: 10.1111/jdv.17457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Q Wang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - F Qiu
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - H Wu
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Y-M Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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7
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Mintoff D, Borg I, Vornweg J, Mercieca L, Merdzanic R, Numrich J, Aquilina S, Pace NP, Fischer J. A novel SPINK5 donor splice site variant in a child with Netherton syndrome. Mol Genet Genomic Med 2021; 9:e1611. [PMID: 33534181 PMCID: PMC8104165 DOI: 10.1002/mgg3.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Netherton syndrome (NS) is a genodermatosis caused by loss-of-function mutations in SPINK5, resulting in aberrant LEKTI expression. METHOD Next-generation sequencing of SPINK5 (NM_001127698.1) was carried out and functional studies were performed by immunofluorescence microscopy of a lesional skin biopsy using anti-LEKTI antibodies. RESULTS We describe a novel SPINK5 likely pathogenic donor splice site variant (NM_001127698.1:c.2015+5G>A) in a patient with NS and confirm its functional significance by demonstrating complete loss of LEKTI expression in lesional skin by immunofluorescence analysis. CONCLUSION The 2015+5G>A is a novel, likely pathogenic variant in NS. Herein we review and assimilate documented SPINK5 pathogenic variants and discuss possible genotype-phenotype associations in NS.
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Affiliation(s)
- Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Isabella Borg
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.,Medical Genetics Unit, Department of Pathology, Mater Dei Hospital, Msida, Malta.,Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Julia Vornweg
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Liam Mercieca
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | | | | | - Susan Aquilina
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Nikolai Paul Pace
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Judith Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Zhang Z, Pan C, Wei R, Li H, Yang Y, Chen J, Li M, Yao Z. Netherton syndrome caused by compound heterozygous mutation, c.80A>G mutation in SPINK5 and large-sized genomic deletion mutation, and successful treatment of intravenous immunoglobulin. Mol Genet Genomic Med 2021; 9:e1600. [PMID: 33452875 PMCID: PMC8104177 DOI: 10.1002/mgg3.1600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Netherton syndrome (NS) is an autosomal recessive disorder due to mutations in the SPINK5 gene. Here, we report the first case of NS caused by a large genomic deletion. Methods We present the clinical data of a 3‐year‐old Chinese boy who was initially misdiagnosed with severe atopic dermatitis. Subsequently, the patient presented with typical ichthyosis linearis circumflexa and had representative hair shaft of trichorrhexis invaginate, which alerted the physician of the high possibility of NS. A genomic DNA sample was extracted from peripheral blood and whole‐exome sequencing (WES) was performed. Sanger sequencing and quantitative real‐time polymerase chain reaction (qRT‐PCR) were performed to verify the mutation and genomic deletion, respectively, in the pedigree. Results WES revealed compound heterozygous mutations in SPINK5, including a c.80A>G mutation and a ~275 Kb‐sized genomic deletion (chr5:147443576‐147719312). The c.80A>G mutation was verified by Sanger sequencing in the pedigree. The father had the same heterozygous mutation; however, the mutation was absent in the proband's mother. The qRT‐PCR results identified a large deletion (chr5:147444834‐147445034) in SPINK5 in the proband and his mother. The eruptions improved remarkably after intravenous immunoglobulin (IVIG) therapy. Conclusions This is the first observation of NS caused by a large deletion. Our findings have important implications for mutation screening and genetic counseling in NS. Our report also verifies and supports the safety and efficacy of IVIG therapy in patients with NS.
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Affiliation(s)
- Zhen Zhang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chaolan Pan
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruoqu Wei
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huaguo Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijun Yang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiawen Chen
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
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