Autosomal dominant ichthyosis and X-linked ichthyosis. Comparison of their clinical and histological phenotypes.

The clinical and histologic distinction between X-linked recessive and autosomal dominant ichthyosis was studied by evaluating 12 classical differential parameters in 85 patients. Thirty-three of them had X-linked and 52 autosomal dominant ichthyosis. Eight of these parameters were generally helpful in the differential diagnosis: age of onset, severity of involvement, scale size, chapping of hands and feet, atopic background, influence of warm weather, corneal opacities and state of the granular layer. Involvement of skin folds, keratosis pilaris, increased palmo-plantar markings and improvement with age were unreliable. In the literature, age of onset and corneal opacities were additionally found unreliable; the histology was of limited value in two reports. Therefore, we concluded that the herein evaluated differential criteria seem to be valid mainly when considering groups of patients. For the individual case, an error in diagnosis, particularly in X-linked ichthyosis, is not rare when relying solely on these criteria. When in doubt, determination of steroid sulphatase activity is mandatory.     

Proliferation and differentiation of cultured epidermal cells from patients with X-linked ichthyosis and ichthyosis vulgaris

The growth, differentiation, and regeneration of epidermal cultures from patients with X-linked and autosomal dominant ichthyosis and normal individuals were compared. Cell proliferation was studied by combining the technique of fluorescence-activated cell sorting with [3H]thymidine labelling and autoradiography. As in normal epidermal cultures, a marked heterogeneity in the labelling intensity of S-phase cells was observed in the ichthyotic cultures with totally unlabelled as well as very strongly labelled cells. However, in contrast to normal cultures, by far the largest proportion of S-phase cells in the ichthyotic cultures were very strongly labelled with a corresponding, severe reduction in the proportion of un- and weakly labelled cells. The increased labelling intensity of S-phase cells was observed in primary as well as in regenerating cultures, although it was most pronounced in the latter case. There was no difference between cultures from the two types of ichthyotic skin. The morphologic differentiation in the cultures was assessed by measurement of mean diameter of sorted S-phase cells and by quantitation of cornified envelop formation. Both parameters were reduced in the ichthyotic cultures, compared with normal ones. Taken together, these findings are indicative of a hyperproliferative state in the ichthyotic cultures.     

X连锁鱼鳞病并发Meleda角化病一例临床特征及SLURP-1和STS基因突变分析

目的 报道1例X连锁鱼鳞病并发Meleda角化病,并检测其基因突变.方法 收集临床资料,提取患儿及其父母外周血基因组DNA,PCR扩增SLURP-1和STS基因全部外显子及其侧翼序列,以100例健康人作为对照,对扩增产物行琼脂糖凝胶电泳检测,并对SLURP-1基因扩增产物进行DNA测序.结果 患儿躯干、四肢泛发规则排列的棕褐色或黑色多角形鳞屑,掌跖、肘膝、腹股沟、肛周红斑,过度角化,向背侧延伸,诊断为X连锁鱼鳞病并发Meleda角化病.基因检测提示,STS全基因缺失;SLURP-1基因第3外显子第286位核苷酸发生C→T纯合突变(c.286C＞T),导致其编码蛋白质在第96位氨基酸出现终止改变(p.R96*),其父母均为c.286C＞T杂合突变携带者.健康对照未发现此突变.结论 该患者携带STS全基因缺失和SLURP-1基因纯合无义突变,可能是导致X连锁鱼鳞病并发Meleda角化病的原因.     

性联隐性鱼鳞病和常染色体显性遗传鱼鳞病的Southern杂交分析

用类固醇硫酸醋酶(Steroid sulfatase, STS)基因的cDNA为探针对19例性联隐性鱼鳞病和11例常染色体显性遗传(常显)鱼鳞病分别进行Southern杂交,发现84%性联隐性鱼鳞病患者有ST5基因缺失,且为全长STS基因缺失,常显鱼鳞病组均正常.此实验室检查对鱼鳞病的基因诊断、携带者检测及产前诊断有较大的意义.     

Segregation analysis in X-linked ichthyosis: paternal transmission of the affected X-chromosome

Background Steroid sulphatase (STS) deficiency has been described in a diversity of ethnic populations. The phenotype of STS deficiency, X‐linked ichthyosis (XLI), is a genodermatosis characterized by dark scaly skin. About 90% of patients with XLI have complete deletion of the entire STS gene and flanking sequences. The variable number tandem repeats, on either side of the STS gene, appear to play an important role in these interstitial deletions due to nonallelic homologous recombination (NAHR). It is difficult to establish if this NAHR occurs between two chromosomes, between sister chromatids or between the same chromatid. Objectives To identify the parental origin of the affected X‐chromosome in seven unrelated sporadic cases of XLI. Methods Amplification of the regions from DXS89 to DXS1134 (telomeric–centromeric) including the 5′ and 3′ ends of the STS gene was performed through polymerase chain reaction. GeneScan analysis was performed using the DXS987, DXS8051 and DXS1060 markers located on the short arm of the X‐chromosome. Fluorescence in situ hybridization analysis was performed with a digoxigenin‐labelled cDNA STS probe. Results STS gene deletion in patients with XLI involved the sequences DXS1139 and DXF22S1. In five families segregation analysis showed paternal transmission of the affected X‐chromosome in the XLI carrier. It was not possible to determine the parental origin of the affected X‐chromosome in two families. Conclusions These data strongly suggest that STS gene deletion occurred in the male meiosis probably due to an intrachromosomal event, recombination between S232 sequences on the same DNA molecule, or during the process of DNA replication.     

A clinical and genetic study of X-linked recessive ichthyosis and contiguous gene defects

X-linked recessive ichthyosis (XLI) is caused by a deletion, or mutation, of the steroid sulphatase gene on the distal short arm of the X chromosome (Xp22.3). This region of the X chromosome is particularly susceptible to deletions. Such deletions can occasionally extended to involve neighbouring genes, causing a contiguous gene defect. Therefore, XLI may be associated with Kallmann's syndrome (KS), mental retardation, X-linked recessive chondrodysplasia punctata and short stature. We have reviewed 33 patients with XLI. Nine showed evidence of contiguous gene defects. A further four had neurological deficit sustained at the time of birth. This study highlights the importance of screening patients with X-linked recessive ichthyosis for neighbouring genetic disorders and, in particular, the early identification of KS, as delay in diagnosis may lead to infertility and osteoporosis. Parents should be warned about possible obstetric complications due to prolonged labour in future pregnancies.     

Diagnosis and clinical features of pemphigus vulgaris

Autoimmune bullous diseases are associated with autoimmunity against structural components that maintain cell-cell and cell-matrix adhesion in the skin and mucous membranes. They include those where the skin blisters at the basement membrane zone and those where the skin blisters within the epidermis (pemphigus vulgaris, pemphigus foliaceus, and other subtypes of pemphigus). The variants of pemphigus are determined according to the level of intraepidermal split formation. There are 5 main variants of pemphigus: pemphigus vulgaris, pemphigus foliaceus, pemphigus erythematosus, drug-induced pemphigus, and paraneoplastic pemphigus. This review focuses only on pemphigus vulgaris.     

Prenatal diagnosis and variable presentation of recessive X-linked ichthyosis

Three infants with X-linked ichthyosis have been observed following pregnancies in which placental sulphatase deficiency (PSD) was suggested prenatally by low oestrogen excretion and an abnormal urinary steroid excretion pattern. This was confirmed in two cases by the absence of placental enzyme activity. In one case labour was spontaneous but all deliveries required Caesarean section. At 8 months the first infant showed an eczema in an atopic distribution but when seen at 5 years had typical X-linked ichthyosis. The skin of the second child peeled extensively at the age of 2 days but was not troublesome for 2 years, when ichthyosis vulgaris was diagnosed on clinical grounds. This pattern has persisted for 3 years. The third infant showed a mildly scaly skin in the neonatal period but at 3 months the features and distribution of X-linked ichthyosis were apparent. X-linked ichthyosis may have a variable presentation which is not always apparent at birth.     

人乳头瘤病毒型别及载量与寻常疣临床特征相关性研究

目的 探讨人乳头瘤病毒型别、载量与寻常疣临床特征的相关性。 方法 提取48例寻常疣组织DNA;正反向测序通用引物PCR扩增片段,通过blast比对分型,并通过型别特异性引物PCR来验证和补充测序结果;实时荧光定量PCR相对定量ΔCt法检测HPV病毒载量;HE染色法观察病理变化。 结果 35例HPV PCR检测阳性的标本中HPV 7型32例;HPV 57型1例,为四肢末端多发;HPV 2和HPV 7混合感染2例,为头面部、躯干多发病例。单发组与多发组、病程 ＜ 6个月组与病程6个月至1年组病毒载量、空泡化细胞数目无明显差异,1年后病毒载量有下降趋势,病程 ＞ 2年的皮损,角化过度更明显,空泡化细胞减少。 结论 寻常疣的HPV感染型别主要是HPV 7;HPV 7型感染好发于头面部;对于病程1年内的寻常疣,HPV病毒载量及空泡化细胞数目与其数目、病程长短无明显相关性。     

X-linked ichthyosis: relation between cholesterol sulphate, dehydroepiandrosterone sulphate and patient's age

Steroid sulphatase deficiency is a feature of recessive X-linked ichthyosis (RXLI) that causes the accumulation of sulphated steroids (SS) in various organs and cells. In a previous study, we detected elevated cholesterol sulphate (CS) and dehydroepiandrosterone sulphate (DHEAS) serum levels in a group of 15 RXLI patients selected in a narrow age range. In the present study both CS and DHEAS serum levels were qualitatively and quantitatively determined using gas-chromatographic analysis in a group of 33 RXLI patients ranging in age from 3 to 70 years. The levels of CS and DHEAS were significantly increased in all patients. Variations in SS were related both to patients' ages and clinical course of the disease. Serum SS levels start to increase in early infancy, peak at puberty, remain elevated in adults and decrease slightly in the elderly.     

应用多重连接探针扩增技术检测X-性连锁鱼鳞病一家系STS基因

目的: 检测X-性连锁鱼鳞病一家系STS基因突变情况.方法: 提取先证者(男,31岁)及其父母外周血DNA,父母均无鱼鳞病临床表现,运用多重连接探针扩增技术检测所有成员的STS基因是否存在外显子缺失,若无外显子缺失,运用聚合酶链式反应特异性扩增STS基因,检测是否存在基因突变.结果: 家系中先证者为STS基因半合子缺失...