Pachyonychia congenita complicated by epidermolysis bullosa simplex Ogna:a pedigree analysis / 中华皮肤科杂志

A 23-year-old male patient presented with repeated painful erosion on the soles of both feet for 10 years, and with walking difficulties for half a month. Skin examination showed thick dark-brown finger and toe nails with distal protuberance, and hard keratinous materials under the nails. Obvious hyperkeratosis and maceration occurred on the soles of both feet, which appeared milky-white in color;diffuse papulovesicles were observed on the soles and lateral margins of both feet with scattered erosions. Vesicles were observed on the wrist and forehead. Follicular papules and fine scales were scattered on the extensor aspect of the forearm and elbow, and diffuse white patches were observed on the surface of the tongue. The above clinical manifestations were consistent with pachyonychia congenita. Peripheral blood samples were obtained from the patient, his parents and grandmother, and subjected to whole-exome sequencing. Sequencing showed two mutations in both the patient and his father, including base deletions at position 516- 518 (c.516-518 del CAA) in exon 1 of the KRT6A gene, which caused pachyonychia congenita-K6a, and a base substitution at position 3970(c.3970 C>T)in exon 27 of the PLEC gene, which may cause epidermolysis bullosa simplex Ogna. The same mutation in the PLEC gene was found in the patient' s grandmother. The patient was diagnosed with pachyonychia congenita complicated by suspected epidermolysis bullosa simplex Ogna. After 9-month treatment with acitretin, the nails became lighter in color, plantar skin lesions were obviously relieved, and scattered millet-like vesicles in the wrist completely subsided. The patient was followed up at present.

Genetic study of a Chinese pedigree affected with pachyonychia congenita / 中华医学遗传学杂志

Objective@#To explore the genetic basis for a Chinese pedigree affected with pachyonychia congenita (PC).@*Methods@#With informed consent obtained, peripheral blood samples were taken from the pedigree. Genomic DNA was extracted with a phenol/chloroform method. Based on the clinical manifestation of the patients, candidate genes for PC were selected. Potential mutation was screened by PCR and Sanger sequencing. Suspected mutation was verified in other family members by PCR-high resolution melting (HRM) analysis. Haplotype analysis using microsatellite markers was also carried out to determine the founder of the mutation.@*Results@#A heterozygous c. 275A>G (Asn92Ser) mutation was discovered in exon 1 of the KRT17 gene in the proband. PCR-HRM analysis showed that all affected members were heterozygous carriers of the mutation. The same mutation was found in none of the unaffected members. Haplotype analysis and sequencing indicated the mother of the proband to be the founder.@*Conclusion@#The c. 275A>G (Asn92Ser) mutation of the KRT17 gene probably underlies the disease in this pedigree. Above finding has facilitated genetic counseling and prenatal diagnosis for this pedigree.

Pachyonychia congenita complicated by epidermolysis bullosa simplex Ogna: a pedigree analysis / 中华皮肤科杂志

A 23-year-old male patient presented with repeated painful erosion on the soles of both feet for 10 years, and with walking difficulties for half a month. Skin examination showed thick dark-brown finger and toe nails with distal protuberance, and hard keratinous materials under the nails. Obvious hyperkeratosis and maceration occurred on the soles of both feet, which appeared milky-white in color; diffuse papulovesicles were observed on the soles and lateral margins of both feet with scattered erosions. Vesicles were observed on the wrist and forehead. Follicular papules and fine scales were scattered on the extensor aspect of the forearm and elbow, and diffuse white patches were observed on the surface of the tongue. The above clinical manifestations were consistent with pachyonychia congenita. Peripheral blood samples were obtained from the patient, his parents and grandmother, and subjected to whole-exome sequencing. Sequencing showed two mutations in both the patient and his father, including base deletions at position 516-518 (c.516-518 del CAA) in exon 1 of the KRT6A gene, which caused pachyonychia congenita-K6a, and a base substitution at position 3 970 (c.3970 C>T) in exon 27 of the PLEC gene, which may cause epidermolysis bullosa simplex Ogna. The same mutation in the PLEC gene was found in the patient′s grandmother. The patient was diagnosed with pachyonychia congenita complicated by suspected epidermolysis bullosa simplex Ogna. After 9-month treatment with acitretin, the nails became lighter in color, plantar skin lesions were obviously relieved, and scattered millet-like vesicles in the wrist completely subsided. The patient was followed up at present.

A novel H1 mutation in keratin 6a in an infant with pachyonychia congenita.

Pachyonychia congenita (PC) is a rare genetic disorder which is inherited in an autosomal dominant pattern. We report a sporadic novel H1 mutation in the KRT6A gene (c. 428G>A/p. Ser143Asn) in a Chinese infant patient. The mutation is concurrent with a single-nucleotide polymorphism and resulted in a serine for asparagine substitution in H1 subdomain of KRT6A chain next to the rod domain. The infant showed the classic symptoms of pachyonychia congenita. Conclusion: The heterozygous missense mutation c. 428G > A/p.Ser143Asn in KRT6A exon 1 may cause severe disease

Nails: Diagnostic clue to genodermatoses.

Nails are cutaneous appendages mostly involved in mechanical functions. However, nails may reflect presence of various systemic disorders evidenced by alteration of their shape, size, color or texture. Genodermatoses are multisystem disorders with cutaneous involvement. Many of the genodermatoses present with nail changes and some of these may be the clinical pointers to the diagnosis. Diagnostic clues to various genodermatoses derived from nail findings have been discussed.

Pachyonychia Congenita Affecting the Nails Only in the Mother and Son / 대한피부과학회지

Pachyonychia congenita (PC) is a rare autosomal-dominant ectodermal dysplasia, which is characterized by hypertrophic nail dystrophy, diffuse or focal symmetrical hyperkeratosis of the palms and soles, oral leukokeratosis, follicular keratosis on the extensor surfaces of the extremities, and other ectodermal defects. However, the variable degree of gene mutation may result in nail abnormalities alone. The nail changes presented in our patient are the only clinical manifestation. Hypertrophic nail dystrophy and yellowish discoloration, without involving any other organs, were shown in both mother and baby since birth. To the best of our knowledge, the case of PC affecting only the nails has never been reported in Korea before. Herein, we report monosymptomatic form of PC, which is notable for its rareness and unique pattern, distinct from previously reported cases.

Você conhece esta síndrome? / Do you know this syndrome?

A paquioníquia congênita é uma rara genodermatose da ceratinização, primeiramente descrita em 1906 por Jadassohn e Lewandowsky. Além de pouco conhecida, a variabilidade fenotípica e as formas oligossintomáticas dificultam o diagnóstico. Relatamos uma família com três gerações afetadas, até recentemente sem diagnóstico. A busca ativa por casos familiares em pacientes com quadro suspeito e a identificação de manifestações peculiares de seus subtipos, como esteatocistoma múltiplo, permitem diagnóstico clínico precoce. Além disso, oportunizam a orientação familiar e de prognóstico ao portador.

Pachyonychia Congenita is a rare genodermatosis of keratinization, first described in 1906 by Jadassohn and Lewandowsky. Besides not being well known, phenotypic variability and oligosymptomatic subtypes make the diagnosis difficult. We report a family with three generations affected, until recently not diagnosed. The active search for familial cases in patients with suspicious manifestations and identification of peculiar characteristics of its subtypes, as multiplex steatocystoma, provide early clinical diagnosis. In addition, nurture the family counseling and informations about prognosis.

A Case of Type 1 Pachyonychia Congenita (Jadassohn-Lewandowsky Syndrome) / 대한피부과학회지

Pachyonychia congenita (PC) is characterized by hypertrophic nail dystrophy, focal palmoplantar keratoderma and blistering, oral leukokeratosis, cyst formation, palmoplantar hyperhydrosis, and follicular keratoses on the trunk and extremities. PC is diagnosed by clinical findings and molecular genetic studies. A 26-year-old man presented with hypertrophic nail dystrophy and subungual debris of all 20 nails, hyperkeratotic plaques on the heels of both soles, and oral leukokeratosis. He had no family history of similar clinical findings. The patient's clinical presentation and history were consistent with PC. Herein we report on a rare case of pachyonychia congenita with a review of literature.

Gene diagnosis in a family with hidrotic ectodermal dysplasia / 中华皮肤科杂志

Objective To confirm the diagnosis and to localize the pathogenic gene of ectodermal dysplasia in a family SUffering from only hair and nail abnormalities.MethodsBlood samples were collected from 7 affected patients and 15 unafiected individuals in the family.Genomic DNA was extracted from blood samples by routine phenol-chloroform methods.The whole coding regions of candidate genes K16,K17,K6a,K6b and GJB6 were amplified by PCR followed by direct sequencing.Then,the gene mutation was further confirmed at mRNA level by RT-PCR.ResultsA heterozygous missense mutation 3 1G→A in the GJB6 gene.which leads to the substitution of glycine by arginine at codon 11(G11R)on the N-terminal of the protein,was detected in all the patients.but in none of the 15 normal individuals in this family.The mutation was also confirmed in the CDNA originating from the proband's skin biopsy.Conelusionn A missense mutation G31A.which has been shown previously to cause hidrotic ectodermal dysplasia(HED),is localized in the GJB6 gene of patients in this family.

Polymorphisms of Keratin 16 and 6A Genes in Two Chinese Families with Pachyonychia Congenita TypeⅠ / 中华皮肤科杂志

G (E165E) in exon 1 of KRT6A gene, were found in this patient. Conclusions A novel single nucleotide polymorphism of KRT16 gene which can result in the change of amino acid sequence is firstly reported and some known single nucleotide polymorphisms in KRT16 and KRT6A genes are also found in this study.

Two Cases of Pachyonychia Congenita / 대한피부과학회지

We report herein two cases of pachyonychia congenita in 19-month-old and 7-year-old girls. In addition to severely deformed nails, both had white plaques on the tongue and keratotic papules on the elbows and knees. In the 19-month-old girl, her father showed deformity of the nails and severe hyperkeratosis of the palms and soles, The family history was normal in other case.