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Extramedullary hematopoiesis of the cranial dura and anhidrotic ectodermal dysplasia.

A 2-year-old amerasian male with anhidrotic ectodermal dysplasia (Christ-Siemens-Touraine Syndrome) was admitted for status epilepticus and Mycobacteria avium-intracellulare infection. A computed tomography scan of the head revealed a mass thought to be a subdural hematoma. The patient died following overwhelming Mycobacteria avium-intracellular and Pseudomonas aeruginosa sepsis. Autopsy revealed extensive extramedullary hematopoiesis of the dura forming a tumor-like thickening with focal subdural hemorrhage. To our knowledge, this is the first report of extramedullary hematopoiesis of the cranial dura associated with anhidrotic ectodermal dysplasia.

Agammaglobulinemia↗

ADULT ectodermal dysplasia syndrome resulting from the missense mutation R298Q in the p63 gene.

Several ectodermal dysplasia syndromes have been shown to result from mutations in the gene that encodes the transcription factor p63. We describe an 11-year-old boy, with clinically normal parents, who had a developmental disorder that resembled EEC (ectrodactyly ectodermal dysplasia-clefting) syndrome (OMIM 604292). He had ectrodactyly and missing middle fingers bilaterally, onychodysplasia, hypodontia with missing teeth, hypohidrosis and lacrimal duct obstruction. DNA sequencing disclosed a heterozygous G-->A substitution at nucleotide 893, that converts an arginine residue (CGA) to glutamine (CAA), the mutation being designated R298Q. This mutation occurs within the DNA-binding domain of p63, and is close to many of the published EEC syndrome mutations. However, R298Q has been described once previously in a large German pedigree, not with EEC syndrome, but another ectodermal dysplasia disorder, ADULT (acro-dermato-ungual-lacrimal-tooth) syndrome (OMIM 103285). Further clinical assessment in our patient revealed that, apart from not having cleft lip and/or palate, he had an exfoliative dermatitis of his hands and feet, and some freckling on his face and shoulders. Collectively, these features support a diagnosis of ADULT syndrome. This study has identified a specific genotype-phenotype correlation in a rare ectodermal dysplasia syndrome and the findings are useful in improving genetic counselling in this family.

Base Sequence↗

Hair and sweat glands in families with hypohidrotic ectodermal dysplasia: further characterization.

OBJECTIVES: To gather and compare clinical and histologic information from individuals affected by hypohidrotic ectodermal dysplasia (HED) and unaffected control subjects and to assess the value of these data in the diagnosis of HED. DESIGN: Volunteer subjects attending the 20th Annual Family Conference of the National Foundation for Ectodermal Dysplasia answered a questionnaire and performed a starch-iodide sweat-function test. A subset of the subjects also donated samples of hair and 4-mm punch biopsy specimens of palmar and scalp skin. Specimens from each of these tests were assessed in a blinded fashion. Analysis was performed comparing affected and control subjects for each of the following parameters: quantification of eccrine structures in the skin biopsy specimens, analysis of hair sample trichograms for hair shaft defects, and qualitative classification of starch-iodide palm-print sweat-function test results. SETTING: An international conference for families and individuals with ectodermal dysplasias. SUBJECTS: A total of 40 subjects were included in the final analysis: 15 unaffected control subjects and 25 subjects with HED. Nine affected subjects and 9 unaffected subjects donated skin biopsy specimens. MAIN OUTCOME MEASURE: This study was designed to assess the value of 4 simple tests in supporting the diagnosis of HED. RESULTS: Investigators were blinded to group during analysis of the test samples. Trichogram examination identified 3 hair shaft abnormalities, with a slightly higher prevalence in the affected group: variable shaft thickness, trichorrhexis nodosa, and pili torti. The sensitivity and specificity for each of these findings was less than 40%. Starch-iodide paper palm imprints identified a higher likelihood of diminished or absent sweat in the affected group, but this test had a low sensitivity (44%) and an imperfect specificity (93%). Examination of horizontally sectioned skin biopsy specimens from the palm were devoid of eccrine structures in a minority of affected subjects (sensitivity, 30%; specificity, 100%). In contrast, scalp biopsy specimens lacked eccrine structures in the majority of affected subjects (sensitivity, 67%; specificity, 100%). Separate analysis excluding the subjects without apparent eccrine apparatus yielded comparable numbers of eccrine ducts from control and affected groups. CONCLUSIONS: We have defined the value of simple, easily performed tests in the morphological diagnosis of HED. Noninvasive trichogram and sweat testing results can support the diagnosis of HED, but they are not sensitive or highly specific; horizontally sectioned 4-mm punch biopsy specimens of the scalp or palms that lack eccrine structures are diagnostic of HED; scalp biopsy is much more sensitive than palmar biopsy; and a scalp biopsy specimen with detectable eccrine structures suggests that a patient does not have HED.

Biopsy↗

Otolaryngologic manifestations of the ectodermal dysplasias--clinical note.

The recent formation of a national organization for ectodermal dysplasias has focused attention on this unusual congenital problem. In any rare condition, information dissemination is essential in order to appropriately educate the patients' families and the physicians caring for them. The otolaryngologist is a vital component of the health care team managing these patients. An overview of the disease process is presented with special emphasis placed on the role of the pediatric otolaryngologist in the care of children with ectodermal dysplasias.

Child↗

Ectodermal dysplasia associated with autoimmune disease.

A case is reported of hereditary ectodermal dysplasia with corneal involvement associated with polyendocrinopathy and pernicious anaemia. The presence of autoantibodies to various endocrine organs and ocular tissues is confirmed. This suggests that ectodermal dysplasia may be an autoimmune disease.

Adult↗

Cataracts, alopecia, and sclerodactyly: a previously apparently undescribed ectodermal dysplasia syndrome on the island of Rodrigues.

An unique autosomal recessive ectodermal dysplasia is present in 5 sibs from the Indian Ocean island of Rodrigues. The main manifestations are total congenital alopecia, bilateral congenital cataracts, and skin changes of the hands and feet including sclerodactyly, hyperkeratosis, contractures, and pseudoainhum formation. The phenotype differs from that of other genetic ectodermal dysplasias and independent syndromic status is probable.

Abnormalities, Multiple↗

Hypohidrotic ectodermal dysplasia: a unique approach to esthetic and prosthetic management: a case report.

Hypohidrotic ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures. The condition is usually transmitted as an x-linked recessive trait, in which gene is carried by the females and manifested in males. Manifestations of the disease differ in severity and involve teeth, skin, hair, nails and sweat and sebaceous gland. Ectodermal dysplasia is usually a difficult condition to manage. Prosthodontically, because of the typical oral deficiencies, and afflicted individuals are quite young to receive extensive prosthodontic treatment, which restores their appearance and helps them, for the development of positive self-image. This case report describes the management of upper jaw with over denture with copings on existing teeth i.e. two permanent peg shaped centrals as well as lateral incisors. However with adequate of retainer lower denture was provided with a new treatment modality.

Age Factors↗

Anhidrotic ectodermal dysplasia with spontaneous corneal perforation and keratoconus.

A patient with anhidrotic ectodermal dysplasia and severe dry eyes was admitted with spontaneous corneal perforation in his right eye. The corneal perforation was sealed with cyanoacrylate glue and bandage contact lens placement. Three weeks later, the patient underwent penetrating keratoplasty. On follow-up examination, he had corneal graft abscess that was treated successfully with topical antibiotics and corneal erosion that was treated with a bandage contact lens. Corneal topography performed as a routine examination showed inferior corneal steepening typical of keratoconus in the left eye. This accidental discovery of keratoconus in the patient's left eye may suggest a possible association between anhidrotic ectodermal dysplasia and keratoconus.

Corneal Diseases↗

The use of tricalcium phosphate to preserve alveolar bone in a patient with ectodermal dysplasia: a case report.

The prosthodontic management of the child with ectodermal dysplasia is made difficult because of the under-development of the alveolar ridges. This paper describes a case where tricalcium phosphate was placed in sockets immediately following the extraction of the primary incisor teeth to help maintain alveolar bone width, offering a valuable alternative treatment option in the prosthodontic management of the child patient with ectodermal dysplasia.

Alveolar Bone Loss↗

The nose in anhidrotic ectodermal dysplasia.

A case is presented of anhidrotic ectodermal dysplasia, of extreme rarity. This is distinguished by disorders in the structures of ectodermal origin. The clinical characteristics--hypohidrosis, hypodontia, hypotrichosis-, and the genetic features--genealogy, karyotype--are examined first. The patient's face appears to be small, due to the combination of frontal bossing, hypodontia, and a depressed nasal dorsum, somewhat resembling the saddle nose of congenital syphilis. The case is studied from various perspectives: clinical, radiological, anatomicopathological and ultrastructural. The study concentrates principally on the anomalies of the nasal cavities, where there is a notable atrophy of the nasal mucosa. This atrophic rhinitis displays all the features of ozaena: severe crusting, fetid green secretion, nasal obstruction, etc.

Anodontia↗

Familial subungual keratoacanthoma in association with ectodermal dysplasia.

Described is the first report of familial SUKA, occurring in two of three sisters with ectodermal dysplasia, a rare, hereditary disorder involving ectodermally derived organ systems. Although rare, SUKA should be considered when assessing rapidly growing nailbed lesions. Differentiation from subungual squamous cell carcinoma is essential. Tumor excision and curettage and close postoperative follow-up are recommended, with conservative amputation reserved for tumor recurrences. If the diagnosis of SUKA is confirmed in a female, an association with ectodermal dysplasia should be sought.

Adult↗

[Mutation detection in ED1 gene in hypohidrotic ectodermal dysplasia (HED) families].

OBJECTIVE: To detect ED1 gene mutation in three hypohidrotic ectodermal dysplasia (HED) nuclear families. METHODS: Peripheral blood samples were obtained from three different families of hypohidrotic ectodermal dysplasia. Genomic DNA was extracted. Polymerase chain reaction, direct sequencing and restriction enzyme reaction were performed to identify the mutations. RESULTS: Different missense mutation in ED1 gene were found in each family: C412G, A1201G and C1375T. Two of the mutations had not been previously reported. CONCLUSION: Mutations in the ED1 gene are responsible for the phenotypes of HED of the patients in the family.

Ectodermal Dysplasia 1, Anhidrotic↗

[Prosthetic rehabilitation in ectodermal dysplasia. Case report].

The oral and dental rehabilitation of patients with ectodermal dysplasia is a demanding and complex process. Close cooperation of medical and dental specialists is is mandatory. The individual age related situation and aspects of social integration have to be considered, when doing treatment planning for these patients. A major problem is the highly reduced number of teeth, the impaired development of the jaws and the dysplastic alteration of the teeth. The prosthodontic rehabilitation of a young girl with the congenital disease of ectodermal dysplasia is presented and discussed.

Adult↗

Genetic mapping of anhidrotic ectodermal dysplasia: DXS159, a closely linked proximal marker.

Three families with anhidrotic ectodermal dysplasia (AED) have been studied by linkage analysis with seven polymorphic DNA markers from the Xp11-q21 region. Previously reported linkage to DXYS1 (Xq13-q21) has been confirmed (z (theta) = 4.08 at theta = 0.05) and we have also established linkage to another polymorphic locus, DXS159, located in Xq11-q12 (z (theta) = 4.28 at theta = 0.05). Physical mapping places DSX159 proximal to the Xq12 breakpoint of an X autosome translocation found in a female with clinical signs of ectodermal dysplasia. Of all markers that have been used in linkage analysis of AED, DXS159 would appear the closest on the proximal side of the disease locus.

Chromosome Mapping↗

Gene localisation of X-linked hypohidrotic ectodermal dysplasia (C-S-T syndrome).

Genetic linkage studies were carried out in families with X-linked hypohidrotic ectodermal dysplasia (C-S-T syndrome). A DNA probe DXYS1 (pDP34), which maps both to the proximal part of the long arm of the X chromosome, Xq13-Xq21, and proximally on Yp, was used to detect a TaqI restriction fragment length polymorphism of the X-chromosomal locus in the DNA samples from 11 families. This locus was found to be closely linked to the X-linked hypohidrotic ectodermal dysplasia locus, with a lod score of 2.66 at recombination fraction (theta) of 0.06 (90% confidence limits 0.01-0.26). Only one crossover was observed in nineteen meioses. This indicates that the probe DXYS1 is closely linked to the X-linked hypohidrotic ectodermal dysplasia locus and is likely to facilitate carrier detection and prenatal diagnosis tests.

Alleles↗

Prenatal diagnosis of X-linked hypohidrotic ectodermal dysplasia by linkage analysis.

Prenatal diagnosis of X-linked hypohidrotic ectodermal dysplasia was previously performed by the direct histological analysis of fetal skin obtained by late second trimester fetoscopy. The recent gene mapping of the locus for the disorder to the region of Xq11-21.1 now permits the indirect prenatal diagnosis of the disorder by the method of linkage analysis, based on closely linked marker loci, during the first trimester of pregnancy. We report the prenatal diagnosis of a male fetus with a high probability of the disorder by a linkage analysis utilizing restriction fragment length polymorphisms at the DXS159, PGK1, and DXS72 loci, from a DNA sample obtained by a chorionic villus biopsy at 9 weeks gestation. After further counseling, the pregnancy was terminated but the diagnosis could not be confirmed by histological analysis, even though analysis of skin samples by light and electron microscopy showed lack of hair germs, primary dermal ridges, and sweat gland primordia, due to the early developmental stage of the fetus. The use of DNA-based linkage analysis now offers the opportunity for an earlier diagnosis of X-linked hypohidrotic ectodermal dysplasia by a method other than fetal skin sampling. However, families must also fully understand the present limitations of the method prior to undertaking the procedure.

Adult↗