Exome sequencing enables diagnosis of X-linked hypohidrotic ectodermal dysplasia in patient with eosinophilic esophagitis and severe atopy.

X-linked hypohidrotic ectodermal dysplasia (XLHED) is the most common form of ectodermal dysplasia. Clinical and genetic heterogeneity between different ectodermal dysplasia types and evidence of incomplete penetrance and variable expressivity increase the potential for misdiagnosis. We describe a family with X-linked hypohidrotic ectodermal dysplasia (XLHED) presenting with variable expressivity of symptoms between affected siblings. In addition to the classical signs of hypohidrosis, hypotrichosis and hypodontia, the index patient-a 5 year old boy, also presented with a severe atopy phenotype that was not observed in the other two affected brothers. Exome sequencing in the index and the mother identified a pathogenic nonsense variant in EDA (NM_001399.4: c.766 C>T; p. Gln256Ter). This study highlights how exome sequencing was crucial in establishing a precise molecular diagnosis of XLHED by enabling us to rule out other differential diagnoses including NEMO deficiency syndrome, that was initially presented as a clinical diagnosis to the family.

Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis.

BACKGROUND: Medication nonadherence is a significant problem in psoriasis. Although previous research has aimed to quantify the prevalence of nonadherence in topical medication users, patient motivations for intentional nonadherence are not fully understood. OBJECTIVE: Our purpose was to determine the relative importance of factors contributing to nonadherence in topical corticosteroid users with psoriasis. METHODS: A survey was distributed to psoriasis patients visiting an outpatient clinic. RESULTS: Among the 53 persons surveyed, medication nonadherence was 40%. Frustration with medication efficacy, inconvenience, and fear of side effects were the most important reasons patients deviated from usage instructions. Subjects who did not receive instructions on topical treatment duration used corticosteroids longer (>8 weeks) than subjects who were instructed (P < .05). LIMITATIONS: A relatively small sample size prevented trends in demographic predictors of adherence from reaching statistical significance. The patient self-report format has the potential to introduce recall bias. CONCLUSIONS: Factors contributing to intentional nonadherence, including dissatisfaction with efficacy, inconvenience, and fear of side effects, are the most important patient-identified barriers to appropriate use of topical steroids in psoriasis. Clear patient instructions on the intended steroid treatment duration may reduce adverse effects from overuse.

Facial resurfacing for nonmelanoma skin cancer prophylaxis.

OBJECTIVE: To determine the effect of facial skin resurfacing for treatment of actinic keratoses (AKs) and prophylaxis against new primary basal and squamous cell carcinomas in individuals with previous nonmelanoma skin cancer (NMSC) or severe photodamage. DESIGN: Randomized, prospective 5-year trial. SETTING: Dermatology and otolaryngology clinics of a Veterans Affairs hospital. PATIENTS: Thirty-four patients with a history of facial or scalp AKs or basal or squamous cell carcinoma were enrolled. Five of 7 eligible patients who declined study-related treatment were used as controls. Twenty-seven patients were randomized to 3 treatment arms; 3 patients were discontinued from the study. INTERVENTIONS: Carbon dioxide laser resurfacing, 30% trichloroacetic acid peel, or 5% fluorouracil cream applied twice daily for 3 weeks. MAIN OUTCOME MEASURES: Reduction in the number of AKs was measured 3 months after treatment. The incidence of new NMSC in treated areas was assessed between January 1, 2001, and June 30, 2005. Times from baseline to diagnosis of first skin cancer were compared between the treatment and control groups. RESULTS: Treatment with fluorouracil, trichloroacetic acid, or carbon dioxide laser resulted in an 83% to 92% reduction in AKs (P< or =.03), a lower incidence of NMSC compared with the control group (P<.001), and a trend toward longer time to development of new skin cancer compared with the control group (P=.07). However, no significant differences were noted among the treatment groups. CONCLUSION: All 3 modalities demonstrated benefit for AK reduction and skin cancer prophylaxis compared with controls and warrant further study in a larger trial.

Double-blinded, placebo-controlled trial of green tea extracts in the clinical and histologic appearance of photoaging skin.

BACKGROUND: Green tea extracts have gained popularity as ingredients in topical skin care preparations to treat aging skin. Green tea polyphenolic compounds have significant antioxidant and anti-inflammatory activities, and studies suggest that these extracts help mediate ultraviolet radiation damage. OBJECTIVE: To evaluate the effects of a combination regimen of topical and oral green tea supplementation on the clinical and histologic characteristics of photoaging. METHODS: Forty women with moderate photoaging were randomized to either a combination regimen of 10% green tea cream and 300 mg twice-daily green tea oral supplementation or a placebo regimen for 8 weeks. RESULTS: No significant differences in clinical grading were found between the green tea-treated and placebo groups, other than higher subjective scores of irritation in the green tea-treated group. Histologic grading of skin biopsies did show significant improvement in the elastic tissue content of treated specimens (p<.05). CONCLUSION: Participants treated with a combination regimen of topical and oral green tea showed histologic improvement in elastic tissue content. Green tea polyphenols have been postulated to protect human skin from the cutaneous signs of photoaging, but clinically significant changes could not be detected. Longer supplementation may be required for clinically observable improvements.