Screening for glucose-6-phosphate dehydrogenase deficiency prior to dapsone therapy

Dapsone is widely used in dermatological practice. The case of a Greek female patient is reported who had a severe, acute, haemolytic episode shortly after commencing dapsone therapy, despite a normal glucose-6-phosphate dehydrogenase (G6PD) screening test. A subsequent quantitative assay revealed reduced levels of G6PD consistent with the heterozygous state. This illustrates that routine screening tests may fail to detect the decreased levels of (G6PD) which occur in female heterozygotes. Since these patients are at risk of severe dapsone-induced haemolysis, the need for quantitative G6PD assays in females from susceptible racial groups is emphasized.     

多部位鲍温样丘疹病1例

目的报告1例少见的多部位鲍温样丘疹病。方法对其临床、血液免疫学检查、皮肤组织病理进行分析研究。结果RPR及TPPA皆(-);HPV-DNA原位杂交:16/18、31/33型皆(-)。组织病理示表皮角化不全,假上皮瘤样增生,棘层肥厚;棘层细胞大小不等、排列紊乱,细胞核异形、深染;可见核分裂象及角化不良细胞;真皮浅层少量淋巴细胞浸润;阴茎部皮损中棘细胞大小不等、排列紊乱明显,凹空细胞数量少,而肛周皮损中可见大量凹空细胞及较多的角化不良细胞。结论该病可能是HPV16、18、31、33以外型别致病,同时具有的尖锐湿疣病理改变,颇为特殊。     

Dyskeratosis congenita. Report of a large kindred

This kindred includes six males with dyskeratosis congenita. It is the largest British pedigree so far reported and brings the total number of reported cases to fifty-nine. Our pedigree supports X-linked recessive inheritance and close linkage with the Xg² locus was excluded. Three previously unreported complications are noted; Hodgkin's disease, adenocarcinoma of the pancreas and deafness. Normal chromosomal stability was found in three patients and immunological studies precluded an early universal defect in cell-mediated immunity.     

先天性角化不良的一个新的基因突变

目的 检测一例先天性角化不良(DKC)患者DKC1基因的突变情况。方法 采用PCR技术扩增DKC1基因的15个外显子,然后采用变性高效液相色谱(DHPLC)技术进行基因突变筛查,对筛查结果异常的外显子进行DNA测序:基因突变的验证在100例无相关遗传性疾病的无关男性中进行。结果 患者DKC1基因的第12号外显子呈异常的DHPLC洗脱峰,家庭其他成员及正常群体对照未见此异常洗脱峰。测序结果显示患者DKC1基因第12外显子的1236位碱基由G→T,导致W412C突变,家庭其他成员及正常群体对照均未见此突变。结论 我们检测到的患者DKC1基因W412C是一个新的散发性突变,它可能导致患者先天性角化不良。     

Papular acantholytic dyskeratosis of the anogenital area with positive direct immunofluorescence results

Acantholytic dyskeratosis is a distinct histological pattern characterized by hyperkeratotic and parakeratotic epidermis with intraepidermal clefts harbouring acantholytic and dyskeratotic keratinocytes. This histopathological pattern is uncommon in dermatoses of the anogenital region. We report a 30-year-old woman who had numerous smooth whitish papules on the labia majora, perineum and perianal region, which coalesced into plaques in some areas. Microscopically, the lesions showed prominent suprabasal and intraspinous acantholysis with dyskeratotic keratinocytes. Direct immunofluorescence examination revealed intercellular Ig G and C(3) within the epidermis. We were unable to find a similar case of papular acantholytic dyskeratosis of the anogenital area with positive direct immunofluorescence findings reported in the literature, thus in this report, the clinicopathological features of a unique case are presented.     

Differences in recurrent COL7A1 mutations in dystrophic epidermolysis bullosa: ethnic-specific and worldwide recurrent mutations

Dystrophic epidermolysis bullosa (DEB) is caused by mutations in the gene encoding type VII collagen (COL7A1). Although most COL7A1 mutations are unique to individual families, small numbers of mutations are recurrent. The recurrent mutations R578X, 7786delG, and R2814X seem to be exclusive to a specific ethnic group, the British population. The mutations 5818delC, 6573+1GC, and E2857X are present only in individuals of Japanese ethnic origin. On the other hand, the mutations 425AG and G2043R have been found in several different ethnic groups. The purpose of this study was to clarify whether these recurrent mutations are also found in patients of other ethnic groups with DEB, mainly Asian patients. We demonstrated the absence of the recurrent mutations R578X, 7786delG, and R2814X in 42 non-British patients with DEB and detected the mutations 425AG in a French patient and G2043R in Japanese and Chinese patients with DEB. The mutations 5818delC, 6573+1GC, and E2857X were detected in 11 Japanese patients (13 alleles) with DEB. Our results confirm that R578X, 7786delG, and R2814X mutations are specifically limited to British patients, and the mutations 5818delC, 6573+1GC, and E2857X are frequent in Japanese patients. On the other hand, the mutations 425AG and G2043R can be found in different ethnic groups. In conclusion, our results further support the notion that recurrent mutations can be classified into two types, ethnic-specific mutation and worldwide mutation.     

葡萄糖-6-磷酸脱氢酶的表达抑制对A431细胞增殖和细胞周期的影响

目的研究葡萄糖?6?磷酸脱氢酶（G6PD）表达下调对皮肤鳞状细胞癌（鳞癌）细胞增殖和细胞周期的影响。方法正常培养人永生化上皮细胞HaCaT、皮肤鳞癌SCL?1和A431细胞,采用Western印迹法检测细胞中G6PD蛋白的表达。当A431细胞生长至85%~90%融合时,将siRNA对照（siRNA对照组）和G6PD siRNA（G6PD siRNA组）分别转染A431细胞,未转染的A431细胞则为未转染组。Western印迹法检测3组不同处理的A431细胞中G6PD蛋白及细胞周期蛋白D1、CDK4的表达,CCK?8法检测3组A431细胞的增殖情况,流式细胞仪分析3组A431细胞周期的变化。结果正常培养的2株皮肤鳞癌SCL?1和A431细胞中G6PD蛋白的表达水平（分别为0.308±0.023和0.643±0.046）均显著高于HaCaT细胞（0.100±0.019）,且A431细胞显著高于SCL?1细胞（均P<0.05）。A431细胞G6PD siRNA组G6PD、细胞周期蛋白D1和CDK4蛋白的表达（0.134±0.027、0.154±0.017、0.166±0.017）显著低于未转染组（0.425±0.029、0.344±0.024、0.330±0.020）和siRNA对照组（0.444±0.033、0.350±0.027、0.348±0.018）,差异均有统计学意义（P<0.05）。G6PD siRNA组在24~96 h各时间点的细胞增殖活性均明显低于siRNA对照组和未转染组（P<0.001）,而siRNA对照组与未转染组间细胞增殖差异无统计学意义（均P>0.05）。G6PD siRNA组G0/G1期A431细胞比例显著高于siRNA对照组及未转染组（P<0.001）,而G6PD siRNA组S期A431细胞比例又显著低于siRNA对照组及未转染组（P<0.001）。结论G6PD可能在调控皮肤鳞癌细胞增殖和细胞周期中发挥重要作用。     

Familial dyskeratotic comedone

INTRODUCTION: Familial dyskeratotic comedones is a rare affection of autosomal transmission and characterized by pseudo-comedone papules predominantly on the limbs. We report a new familial case characterized by its clinical and histological profile.CASE REPORT: A 6 year-old boy presented with a papular, pseudo-comedone eruption that had appeared shortly after birth and had progressively extended symmetrically to both legs. The child's father complained of a similar eruption since childhood. Histological examination of the papules revealed a pseudo-follicular invagination, obstructed by keratin and associated with areas of focal dyskeratosis. Treatment with local retinoids was ineffective.DISCUSSION: Since it is often asymptomatic, the prevalence of dyskeratosis comedones is probably underestimated. A review of the literature on the preceding observations is presented. The dermatites that would represent differential diagnoses because of the presence of comedone-like lesions and/or histological dyskeratosis are discussed.     

Pagetoid dyskeratosis of the lips

Pagetoid dyskeratosis is an incidental finding in a variety of lesions of the skin and squamous mucosa. The lesion is considered a selective keratinocytic response in which a small part of the normal population of keratinocytes is induced to proliferate in response to friction. As far as we know, pagetoid dyskeratosis has not been reported in the lips. In this article, we describe the location of the lesion in the lips and its incidence in a group of 90 unselected patients who underwent biopsy or were surgically treated for diverse labial lesions. Histochemical staining and immunohistochemical studies were performed in selected cases. Pagetoid dyskeratosis was found in 38 cases (42.2%) but only in 6 cases (6.7%) the lesion was conspicuous. There was no significant difference between the upper and the lower lip in terms of incidence of the lesion. Labial pagetoid dyskeratosis was more frequent in younger patients (46.7 +/- 25.0 versus 58.5 +/- 20.5; p < 0.05) and in women (chi(2) = 3.89; p < 0.05). Pagetoid cells were more common in suprabasal location and in the labial mucosa. These cells showed positivity for high-molecular weight cytokeratin and negative reaction for low-molecular weight cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and human papilloma virus. The immunohistochemical profile is different from the surrounding keratinocytes, indicating premature keratinization. The main differential diagnoses include white sponge nevus, leukoedema, oral koilocytoses, hairy leukoplakia, pagetoid squamous cell carcinoma in situ, and extramammary Paget's disease of the oral mucosa. The morphologic features of dyskeratotic pagetoid cells are distinctive and easily recognized as an incidental finding, thus preventing confusion with other important entities including an intraepidermal tumor.     

Coats plus syndrome (cerebroretinal microangiopathy with calcifications and cysts‐1): A case report

We present a 6‐year‐old girl with skin hyperpigmentation, leukoplakia, and onychodystrophy, the classic mucocutaneous triad usually associated with dyskeratosis congenita. The patient also had premature graying of the hair, bone marrow failure, hepatitis, exudative retinopathy, osteopenia with multiple long bone fractures, and intracranial calcifications and brain cysts. Coats plus syndrome is a rare disease with a clinical and genetic overlap with dyskeratosis congenita. This disease is reviewed, with a focus on the pathogenesis of the genetic anomalies and its background as a telomere biology disorder.     

Intertriginöse akantholytische Dyskeratose Abortive Form eines Morbus Darier oder eigene klinische Entität?

A 69-year-old woman presented with widespread symmetrical papular lesions in submammary and inguinal areas. History revealed that the disease had only been present for a few years. A skin biopsy showed focal suprabasal acantholysis, dyskeratosis up to the horny layer and in part parakeratotic hyperkeratosis. The patient had no further evidence for Darier disease, Hailey-Hailey disease or pemphigus vegetans. In particular, characteristic lesions of Darier disease of hands and nails were absent. We found several reports in the literature describing similar skin lesions in intertriginous and genital areas with histological evidence of acantholytic dyskeratosis under various terms. This report discusses the difference between these cases and the differential diagnoses, in particular Darier disease. We propose to designate cases of intertriginous papulosis with histological proof of acantholytic dyskeratosis but without further evidence of Darier disease as intertriginous acantholytic dyskeratosis.     

先天性角化不良6例

报道6例先天性角化不良，均有典型的临床表现，即皮肤异色症样皮损、指趾甲萎缩脱落和粘膜白斑等。其中1例伴有再生障碍性贫血。5例患者的皮损曾行组织病理学检查，其改变均与本病相符。     

Acantholytic dyskeratotic acanthoma: a variant of a benign keratosis

Acantholytic acanthoma was originally described as a solitary lesion displaying histologic features of acantholysis without dyskeratosis. Solitary, non-genital lesions displaying confluent acantholysis and dyskeratosis have not been well described in the literature, clinically or histologically. We screened cases at our institution over a 6-month period and found 28 such lesions. Lesions were most often found on the trunk as a solitary papule, for which the clinical diagnosis was often basal cell carcinoma. There was a slight female predominance. Confluent acantholysis and dyskeratosis is a histologic pattern that may present as a solitary keratosis.     

Dyskeratosis Congenita Associated with Elevated Fetal Hemoglobin, X-Linked Ocular Albinism, and Juvenile-Onset Diabetes Mellitus

An 11-year-old boy had dyskeratosis congenita, elevated fetal hemoglobin level, X-linked ocular albinism, and juvenile-onset diabetes mellitus. A review of the international literature revealed that elevated fetal hemoglobin has been noted in 15 reported cases of dyskeratosis congenita. It is a previously unrecognized, commonly associated finding in dyskeratosis congenita that may provide insight into the location and function of the gene for dyskeratosis congenita.     

Comparative study of pagetoid dyskeratosis between acrochordons and soft fibromas

BACKGROUND: Pagetoid dyskeratosis (PD) is considered a casual finding. We can find it in some conditions, including acrochordons and soft fibromas. OBJECTIVE: (1) to compare the presence of PD in soft fibromas and acrochordons and (2) to compare PD positive fibromas and PD negative fibromas. MATERIALS AND METHODS: We reviewed all acrochordons and soft fibromas diagnosed in the General Hospital of Lanzarote, Spain, between January 2001 and December 2002. We assessed the presence of PD, size, acanthosis, basal pigmentation, and the presence of pseudohorn cysts. RESULTS: Three hundred sixty one acrochordons and 164 soft fibromas were included in this study. There were striking differences in the presence of PD, size, acanthosis, and basal pigmentation between both entities. PD positive fibromas predominated in axillas. There were no other differences between PD positive fibromas and PD negative fibromas. CONCLUSION: Although soft fibromas and acrochordons are actually fibroepithelial polyps, including the presence of PD, there are striking differences between them. Thus, both conditions have to be considered as different entities. PD could be related to friction and moisture. PD has to be distinguished from other conditions such as Paget's disease, pagetoid melanoma, koilocytes, clear cell papulosis, among others.     

Probable involvement of a germ-line mutation of an unknown mismatch repair gene in a Japanese Muir-Torre syndrome phenotype

A combination of haplotype analysis and direct sequencing were conducted on Japanese Muir-Torre syndrome kindred. In the kindred, two females revealed a hereditary non-polyposis colon cancer (HNPCC) phenotype and one male had a sebaceous tumor in addition to a HNPCC phenotype. Haplotype analysis and direct sequencing failed to show involvement of the known mismatch repair genes, with the exception of MSH5, in this kindred. Analysis of large fragments (from 3.9 to 6. 2 kb) covering the entire 25 kb MSH5 gene in the proband revealed the absence of gross changes in the promoter region and exons. The direct sequencing of the promoter region and all 25 exons failed to demonstrate any mutations in the coding regions except for a CA repeat polymorphism in intron 3 and a C/A polymorphism in intron 15. Taken together present results indicate that a novel and yet unknown mismatch repair gene is likely involved in the HNPCC in this kindred.     

Identification of a novel mutation and a de novo mutation in DKC1 in two Chinese pedigrees with Dyskeratosis congenita

Dyskeratosis congenita (DKC) is a rare and fatal congenital syndrome characterized by the triad of reticular skin pigmentation, nail dystrophy and mucosal leukoplakia, and the predisposition to bone marrow failure and malignancies. Mutations in DKC1 gene encoding dyskerin are responsible for the X-linked dyskeratosis congenita. Here we report mutation analysis of two Chinese pedigrees with dyskeratosis congenita. The 15 coding exons of DKC1 and their flanking regions were amplified from genomic DNA by PCR. DNA sequencing and restriction endonuclease digestion were used for mutation detection. Transition mutation of 1226C-->T (P409L) found in the first pedigree is a novel mutation. In the second pedigree, the proband's mother phenotypically normal carried a de novo transition mutation of 1058C-->T (A353 V) in one allele, and transmitted the mutant allele to her two sons who had typical manifestations of dyskeratosis congenita.     

Uncommon vascular naevi associated with focal acantholytic dyskeratosis

Cutis marmorata telangiectatica congenita and vascular twin naevi are rare vascular anomalies in which focal acantholytic dyskeratosis is usually not observed. We describe a 44-year-old-man who presented for evaluation of skin lesions that had been present since birth. Physical examination revealed anaemic macules adjacent to a naevus telangiectaticus on the chest. Naevus anaemicus was also seen on the shoulders, arms, and left leg. There was bluish-reddish reticulate marking of the skin and cutaneous atrophy. Shortening and hypoplasia of the left leg was observed. Histologic examination of two biopsy specimens revealed focal acantholytic dyskeratosis. In vivo confocal laser scanning microscopy showed dilated capillaries and vessels of the upper dermal plexus in the telangiectatic and decreased capillary blood flow in the anaemic skin sites. The findings were consistent with a diagnosis of cutis marmorata telangiectatica congenita, vascular twin naevi, and incidental focal acantholytic dyskeratosis. The particularities of the present case are the following: firstly, the association of two rare vascular anomalies to which the genetic concept of mosaicism can be applied; secondly, the occurrence of incidental focal acantholytic dyskeratosis in sites of vascular naevi.     

Heat-labile glucose-6-phosphate dehydrogenase in cultured fibroblasts from patients with De Sanctis-Cacchione syndrome

Summary The normal senescent fibroblasts in culture accumulate a significantly high proportion of altered enzymes, and the alterations are considered to be the manifestation of ageing in molecular terms. To detect the possible molecular alterations in patients with De Sanctis-Cacchione syndrome, the severest form of xeroderma pigmentosum, in which repair processes to UV light-damaged DNA are defective and the neurologic abnormalities are considered to reflect accelerated ageing, we studied the heat stability of glucose-6-phosphate dehydrogenase (G6PD) in crude extracts of cultured skin fibroblasts. Three patients with the syndrome were the center of our investigation. Even at early passage in culture the heat-labile portion of G6PD was increased in the cells from patients in comparison to normal controls.The life span of the cells in culture from patients was not reduced below normal age-matched controls, and no appreciable senescent appearance was observed. The increase in the heat-labile portion of G6PD from cells of De Sanctis-Cacchione syndrome patients to reflect that defective repair of DNA damage occurs, rather than being a direct result of ageing of cultured cells.