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Affiliation(s)
| | - Sarah A Wolfe
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Carly E Kelley
- Division of Endocrinology and Metabolism, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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2
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Shamloul G, Khachemoune A. An updated review of the sebaceous gland and its role in health and diseases Part 2: Pathophysiological clinical disorders of sebaceous glands. Dermatol Ther 2021; 34:e14862. [PMID: 33571388 DOI: 10.1111/dth.14862] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/03/2021] [Accepted: 02/06/2021] [Indexed: 12/27/2022]
Abstract
Sebaceous glands are sebum-secreting components of pilosebaceous units. In the second of this two-part series, we review the pathologies in which sebaceous glands are primarily and secondarily implicated. They are primarily involved in steatocystoma simplex and multiplex, sebaceous gland hyperplasia, sebaceoma, sebaceous adenoma, sebaceous carcinoma, nevus sebaceus, and folliculosebaceous cystic hamartoma. Sebaceous glands are secondarily involved in acne vulgaris, seborrheic dermatitis, and androgenic alopecia. Steatocystoma multiplex is a benign congenital anomaly presenting as yellow cysts primarily on the upper body. Sebaceous gland hyperplasia is characterized by yellow, telangiectatic papules with a central dell, and it can be treated with topical retinoids or surgical excision. Sebaceoma clinically presents on the head and neck region as a skin-colored nodule and can be distinguished by immunohistochemistry. Stains used in the diagnosis of sebaceous adenoma and carcinoma include epithelial membrane antigen and adipophilin immunoperoxidase. Surgical excision is the preferred treatment for sebaceoma, sebaceous adenoma, and sebaceous carcinoma. Excision is not always indicated for nevus sebaceus. Folliculosebaceous cystic hamartoma is a relatively rare condition exhibiting both epithelial and mesenchymal components. Patients with acne vulgaris commonly present with papules of closed and open comedones displaying hypercornification. Seborrheic dermatitis presents as sharply demarcated yellow or red patches or plaques; antifungal agents, corticosteroids, and combination antifungal/anti-inflammatory therapies are common treatment modalities. As a result of hair follicle miniaturization, females with androgenic alopecia present with diffuse hair thinning, while men tend to present with balding and hairline recession.
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Affiliation(s)
- Gelan Shamloul
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Amor Khachemoune
- Veterans Affairs Hospital and SUNY Downstate Dermatology Service, Brooklyn, New York, USA
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3
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Jiang L, Yan J, Chen X, Chen Y, Tang Y. A simple modified surgical technique combined with tissue adhesive for steatocystoma multiplex. J Cosmet Dermatol 2020; 20:218-221. [PMID: 32390282 DOI: 10.1111/jocd.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Steatocystoma multiplex (SM) is a disorder of the pilosebaceous unit characterized by multiple sebum-containing dermal cysts. Psychological distress of patients is always derived from these undesirable lesions. Although various treatments have been attempted to improve cosmetic outcomes, no optimal treatment strategy has been established to date.. AIMS To provide a facile and practical surgical technique combined with tissue adhesive for the treatment of steatocystoma multiplex. METHOD Forty patients diagnosed as SM were treated with simple modified surgical technique. After local anesthesia, the surface skin was incised about 1-2 mm using a No. 11 blade. When the wall was punctured, the cyst should be squeezed to cause the contents to come out first. Then, we used single toothed forceps which were inserted through the narrow incision. When the cyst was exposed, the mosquito forceps grasp the portion of the cyst and pull it out gently. Then, the incisions were pressed locally, and tissue adhesive was employed to align them when there was no bleeding. We just took approximately 1-2 minutes to excise one cyst completely. RESULT We successfully treated forty SM patients with our simple modified surgical technique. After treatment, excellent clinical outcomes and minimal adverse effects were observed in this study. And more importantly, no recurrence was found 12 months after the surgery. CONCLUSION Our simple modified surgical technique was proved to be practical and have excellent results in the long run. We highly recommend this treatment technique as the first-line therapy for SM.
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Affiliation(s)
- Long Jiang
- Department of Dermatologic Surgery, Shanghai Skin Diseases Hospital, Shanghai, China
| | - Jianna Yan
- Department of Dermatologic Surgery, Shanghai Skin Diseases Hospital, Shanghai, China
| | - Xiaogang Chen
- Department of Dermatologic Surgery, Shanghai Skin Diseases Hospital, Shanghai, China
| | - Yuchong Chen
- Department of Dermatologic Surgery, Shanghai Skin Diseases Hospital, Shanghai, China
| | - Yichen Tang
- Department of Dermatologic Surgery, Shanghai Skin Diseases Hospital, Shanghai, China
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Cheon DU, Ko JY. 1927-nm fiber-optic diode laser: A novel therapeutic option for facial steatocystoma multiplex. J Cosmet Dermatol 2019; 18:1326-1329. [PMID: 30597723 DOI: 10.1111/jocd.12849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 01/24/2023]
Abstract
Steatocystoma multiplex (SM) is a cutaneous disorder that presents with multiple yellowish intradermal cysts originating from the pilosebaceous ducts. Although various treatments have been attempted to improve cosmetic outcomes, no optimal treatment strategy has been established to date. A 41-year-old man presented with a 10-year history of multiple skin-colored papulonodules over his entire body. He was diagnosed with SM, and we treated his facial SM with a 1927-nm diode laser. Two treatment sessions at a 5-week interval led to cosmetically excellent outcomes. There was no recurrence at the 8-month follow-up. Herein, we present a case of SM that was successfully treated with a 1927-nm fiber-optic diode laser.
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Affiliation(s)
- Dong Uk Cheon
- Department of Dermatology, College of Medicine, University of Hanyang, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, College of Medicine, University of Hanyang, Seoul, Korea
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5
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Zussino M, Nazzaro G, Moltrasio C, Marzano AV. Coexistence of steatocystoma multiplex and hidradenitis suppurativa: Assessment of this unique association by means of ultrasonography and Color Doppler. Skin Res Technol 2019; 25:877-880. [PMID: 31353757 DOI: 10.1111/srt.12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Steatocystoma multiplex (SM) is an uncommon skin disease manifesting as multiple sebum-containing cysts arising in pilosebaceous unit-rich body areas. Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory disease affecting the apocrine gland-bearing skin and presenting with both pseudocystic and inflammatory nodules, abscesses and fistulas. Considering that genetics has been reported to play a role in both entities, the albeit rare association between them suggests a shared genetic background. Although histology remains the gold standard for the diagnosis of SM, ultrasonography can be an useful diagnostic tool. This method is largely used in combination with Color Doppler for assessing disease severity in HS. MATERIALS AND METHODS We report three cases of coexisting SM and HS and describe the ultrasonography and Color Doppler features of the two entities. RESULTS SM lesions appeared on ultrasonography as hypoechoic nodules with well-defined hyperechoic borders and posterior acoustic enhancement, in the absence of Color Doppler signal. HS lesions had the ultrasonographic features of the fistulas, abscesses and pseudocystic nodules, some of which including hair fragments, with an intense Color Doppler signal within or around inflamed lesions. CONCLUSION The combination of ultrasonography and Color Doppler proved to be a reliable instrument for differentiating between SM and HS lesions, particularly distinguishing HS pseudocystic nodules from true cysts of SM.
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Affiliation(s)
- Martina Zussino
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Nazzaro
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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6
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Yang L, Zhang S, Wang G. Keratin 17 in disease pathogenesis: from cancer to dermatoses. J Pathol 2018; 247:158-165. [PMID: 30306595 DOI: 10.1002/path.5178] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 12/16/2022]
Abstract
Keratin 17 (K17) is a type I intermediate filament mainly expressed in the basal cells of epithelia. As a multifaceted cytoskeletal protein, K17 regulates a myriad of biological processes, including cell proliferation and growth, skin inflammation and hair follicle cycling. Aberrant overexpression of K17 is found in various diseases ranging from psoriasis to malignancies such as breast, cervical, oral squamous and gastric carcinomas. Moreover, genetic mutation in KRT17 is related to tissue-specific diseases, represented by steatocystoma multiplex and pachyonychia congenita. In this review, we summarize our findings concerning the regulatory mechanisms of K17 overexpression in psoriasis and compare them to the literature relating to other diseases. We discuss data that proinflammatory cytokines, including interleukin-17 (IL-17), IL-22, interferon-gamma (IFN-γ), transforming growth factor-beta (TGF-β) and transcription factors glioma-associated oncogene homolog 1/2 (Gli1/2), Nrf2 and p53 can regulate K17 by transcriptional and translational control. Moreover, post-translational modification, including phosphorylation and ubiquitination, is involved in the regulation of K17 stability and biological functions. We therefore review the current understanding of the K17 regulatory mechanism and its pathogenic role in diseases from dermatoses to cancer. Prospects for anti-K17 therapy in diagnosis, prognosis and disease treatment are also discussed. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Luting Yang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR, China
| | - Shaolong Zhang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR, China
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Abstract
Eruptive vellus hair cyst (EVHC) is a rare follicular developmental abnormality of the vellus hair follicles. They are usually seen in children, adolescents, or young adults and manifest as reddish-brown smooth papules most commonly involving the chest, limbs, and abdomen. An 18-year-old male presented with asymptomatic papules on the trunk and flexor aspect of both forearms for the past 2 years. There was no family history of similar lesions. His medical history was also not contributory. A clinical diagnosis of steatocystoma multiplex and chronic folliculitis was given, and a punch biopsy from the papule was performed and sent for histopathological examination. On microscopic examination, a final diagnosis of EVHC was rendered. The patient was advised topical treatment of retinoic acid cream (0.05%) for 6 months, and he is currently under follow-up period. Due to its rarity and resemblance to many similar entities, histopathological examination plays a major role in establishing a definite diagnosis and further proper management of the patient. We report this unusual case to generate awareness about this rarely diagnosed condition.
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Affiliation(s)
- Priyanka Anand
- Department of Pathology, Hindu Rao Hospital and NDMC Medical College, NewDelhi, India
| | - Namrata Sarin
- Department of Pathology, Hindu Rao Hospital and NDMC Medical College, NewDelhi, India
| | - Rachita Misri
- Department of Dermatology, Hindu Rao Hospital and NDMC Medical College, NewDelhi, India
| | - V K Khurana
- Department of Dermatology, Hindu Rao Hospital and NDMC Medical College, NewDelhi, India
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Abstract
Pachyonychia Congenita (PC) refers to a group of autosomal dominant disorders with variable clinical presentations. While nail dystrophy and plantar keratoderma are the most consistent features in all the variants, a myriad of other manifestations has been observed. This report highlights a case of young female presenting with multiple asymptomatic cutaneous cysts associated with plantar kearatoderma and nail dystrophy. Similar nail changes were evident in her son also. Such clinical presentation, in corroboration with histopathological evaluation of the cutaneous cyst prompted us to make a diagnosis of Pachyonychia Congenita type II.
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Affiliation(s)
- Romana Ghosh
- Department of Dermatology, Venereology and Leprosy, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Kingshuk Chatterjee
- Department of Dermatology, Venereology and Leprosy, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Jayanta Kumar Barua
- Department of Dermatology, Venereology and Leprosy, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Anupam Roy
- Department of Dermatology, Venereology and Leprosy, School of Tropical Medicine, Kolkata, West Bengal, India
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Abstract
Eruptive vellus hair cysts (EVHCs) often occur on the trunk and limbs. Facial involvement is uncommon. Autosomal dominant inheritance has been described, but associated extracutaneous anomalies have not. We describe a 4-patient kindred presenting with multiple facial EVHCs and an association of preauricular pits, lipomas, joint hypermobility, and cardiac defects. Histopathologic examination confirmed the diagnosis of EVHCs in 3 affected individuals. We propose that facial EVHCs may indicate the presence of an inherited autosomal dominant disorder with extracutaneous manifestations. Extracutaneous manifestations noted in the kindred have been sporadically described in association with steatocystoma multiplex (SM), a condition occasionally noted in the presence of EVHCs, further supporting an association between these disorders.
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Affiliation(s)
- Marisa G Ponzo
- 1 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot I Van Allen
- 2 Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Linlea Armstrong
- 2 Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Magdalena Martinka
- 3 Department of Pathology and Laboratory Medicine and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jan P Dutz
- 1 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,4 Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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Santana CNLEL, Pereira DDN, Lisboa AP, Leal JM, Obadia DL, da Silva RS. Steatocystoma multiplex suppurativa: case report of a rare condition. An Bras Dermatol 2016; 91:51-53. [PMID: 28300893 PMCID: PMC5324992 DOI: 10.1590/abd1806-4841.20164539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/20/2015] [Indexed: 11/25/2022] Open
Abstract
Steatocystoma multiplex is a rare genetic disorder characterized by the presence of hamartomatous malformations at the junction of the pilosebaceous duct. It consists of encapsulated cystic lesions in the dermis, with adjacent sebaceous gland. When associated with inflammation, resembling hidradenitis, it is called steatocystoma multiplex suppurativa, a condition rarely reported. This is the first case of steatocystoma multiplex suppurativa reported in the Brazilian literature. Female patient, 23 years old, with papular and nodular cystic lesions that started in the armpits and groin, later spreading to the trunk, lower limbs, anticubital fossa, face and scalp. The presence of papular-nodular lesions associated with disseminated hidradenitis-like lesions in flexural areas and the histopathological diagnosis of steatocystoma defined the diagnosis of steatocystoma multiplex suppurativa.
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Affiliation(s)
| | | | - Alice Paixão Lisboa
- Universidade do Estado do Rio de Janeiro (UERJ) – Rio de Janeiro
(RJ), Brazil
| | | | - Daniel Lago Obadia
- Universidade do Estado do Rio de Janeiro (UERJ) – Rio de Janeiro
(RJ), Brazil
- Hospital Central do Exército (HCE) – Rio de Janeiro (RJ),
Brazil
- Universidade do Grande Rio (Unigranrio) – Rio de Janeiro (RJ),
Brazil
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Pietrzak A, Bartosinska J, Filip AA, Rakowska A, Adamczyk M, Szumilo J, Kanitakis J. Steatocystoma multiplex with hair shaft abnormalities. J Dermatol 2015; 42:521-3. [PMID: 25808203 DOI: 10.1111/1346-8138.12837] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
Abstract
Steatocystoma multiplex (SM) is an unusual benign disorder of the pilosebaceous duct characterized by multiple cysts with little or no nail and hair involvement. We report a 30-year-old woman with multiple cystic nodules located on the neck, axillae and forearms as well as patchy scalp alopecia. Histopathological examination of the lesions was diagnostic of SM. Trichoscopy revealed pili torti and pili canaliculi. This patient represents an unusual clinical presentation of SM because of the presence of hair abnormalities.
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Affiliation(s)
- Aldona Pietrzak
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
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Fernandez-Flores A, Cuesta CCÁ, García CS, del Río JS. Steatocystoma multiplex associated with bilateral preauricular sinuses. J Cutan Pathol 2014; 41:677-9. [PMID: 24666120 DOI: 10.1111/cup.12315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/12/2013] [Accepted: 01/21/2014] [Indexed: 11/30/2022]
Abstract
Steatocystoma multiplex is characterized by the development of numerous steatocystomas. The condition has occasionally been related to congenital bilateral preauricular sinuses. Herein, we present the third case of such an association, a 34-year-old male who was born with bilateral preauricular sinuses that were surgically repaired. When he was 14 years old, he presented with multiple steatocystomas on his forehead and temples, one of which was biopsied. There was no family history of the condition.
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Abstract
Eruptive vellus hair cysts were first described in 1977. They usually appear as yellow to reddish-brown papules on the chest. Usual onset is between ages 17 and 24 years, but they may be congenital. Some believe that they may be inherited as an autosomal dominant disorder. Histologically the cyst has a stratified squamous epithelium and it contains laminated keratin and vellus hairs. They are felt to be caused by an abnormality at the infundibular level of the vellus hair. We present this because of this patient's unusual distribution of eruptive vellus hair cysts.
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Affiliation(s)
- Swapna Khatu
- Department of Dermatology, K. J. Somaiya Medical College, Mumbai, Maharashtra, India
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Abstract
Background: Steatocystoma multiplex (SM) is a disorder of the pilosebaceous unit characterized by multiple sebum-containing dermal cysts. Different surgical modalities like cryosurgery, aspiration, surgical excision, incision with a surgical blade or sharp-tipped cautery followed by expression of cyst contents and forceps-assisted removal of the cyst wall and carbon dioxide laser have been used in the past. Aims: To study the efficacy of a modified surgical technique in the treatment of steatocystoma multiplex. Materials and Methods: We have used a simple modified surgical technique using a radiofrequency instrument as the incision tool for the treatment of SM in two patients. Results: The results were cosmetically excellent with no complications developing during or after the procedure. No recurrences were observed after five and half months of follow-up. Conclusions: This is a simple, easy, fast office-based procedure that is associated with minimal blood loss and post inflammatory hypo or hyperpigmentation and scarring are practically absent.
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Affiliation(s)
- Sanjiv Choudhary
- Department of Dermatology, JNMC Sawangi, Wardha, Maharashtra, India
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Abstract
Onset of type I keratin 17 (K17) synthesis marks the adoption of an appendageal fate within embryonic ectoderm, and its expression persists in specific cell types within mature hair, glands, and nail. We report that K17 null mice develop severe alopecia during the first week postbirth, correlating with hair fragility, alterations in follicular histology, and apoptosis in matrix cells. These alterations are incompletely penetrant and normalize starting with the first postnatal cycle. Absence of a hair phenotype correlates with a genetic strain-dependent compensation by related keratins, including K16. These findings reveal a crucial role for K17 in the structural integrity of the first hair produced and the survival of hair-producing cells. Given that identical inherited mutations in this gene can cause either pachyonychia congenita or steatocystoma multiplex, the features of this mouse model suggest that this clinical heterogeneity arises from a cell type-specific, genetically determined compensation by related keratins.
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Affiliation(s)
- Kevin M McGowan
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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