Congenital ectodermal defect with amastia.
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Idiopathic hypoparathyroidism is a rare disorder produced by parathyroid hormone deficiency of unknown cause. It is often associated with other endocrine abnormalities. Patients with idiopathic hypoparathyroidism frequently develop ectodermal disease, including dry, rough skin: coarse, brittle hair; and lusterless, distally split nails. All of these complaints are relatively common in a dermatologic practice. Chronic mucocutaneous candidiasis is also a manifestation of idiopathic hypoparathyroidism. A patient is presented with a prominent ectodermal dysplasia and a chronic mucocutaneous candidiasis that were due to the underlying idiopathic hypoparathyroidism. A brief review of idiopathic hypoparathyroidism is included, as well as the implications of this diagnosis in terms of differential diagnosis, associated endocrine disorders, and therapy.
It is postulated that, in the nevoid basal cell carcinoma syndrome, independent mosaic pleiotropic action of the mutant gene on morphogenesis and histogenesis produces primary malformations of midline and nonmidline structures and dysplasias more or less highly predisposed to cancer development. However, in focal dermal hypoplasia and the Bartsocas-Papas syndrome, it is highly tempting to postulate that embryonic dysplasias, ie, breakdown or necrosis of ectoderm, especially in the region of the Ekdodermring, are responsible for the production of many of the congenital anomalies seen in these patients, and that these anomalies more likely represent sequences rather than primary malformations. The sequences in the type 1 fetal epidermal dysplasias probably represent mucosal breakdown, producing various upper gut atresias and an epidermal "disease" with loss of epidermis and many severe secondary consequences. Polyhydramnios, micrognathia, "arthrogryposis," reduced fetal growth, and short umbilical cord are other consequences of fetal hypokinesia due to stiff skin in the type 2 fetal epidermal dysplasias, with severe muscle involvement in the Hutterite-Mennonite type possibly responsible for additional fetal hypokinesia. Thus it seems likely that embryonic and fetal dysplasias can now be held responsible, directly and indirectly, for a fascinating variety of human congenital anomalies.
A 12 month-old female is described, with clinical features of AEC syndrome. This case is a novo mutation. Clinical diagnosis at an early age is emphasised to get a better management and genetic counseling. Also we review the literature.
Light- and electron-microscopical examination of 4 skin biopsies from 2 members of the initially described family with Nägeli-Franceschetti-Jadassohn syndrome revealed that the already reported pigment incontinence is accompanied by varying amounts of colloid-amyloid bodies located in the superficial dermis. Occasionally, such bodies could also be seen around sweat glands in the reticular dermis. These findings indicate that cutaneous colloid-amyloid formation could be a pathogenic factor in the phenotypic expression of this autosomal dominant syndrome.
A daughter of second cousins is described as having lipoatrophic diabetes, unusual facial appearance, generalized hypotrichosis, two natal teeth with enamel dysplasia, eruption of four dysplastic deciduous teeth, absence of permanent dentition, low birth weight, short stature, lumbar scoliosis, renal alterations, aplasia of a breast and hypoplasia of the other, hypoplastic and hypopigmented areolae with diffuse limits, hyperostosis of the cranial vault, metacarpal hypoplasias, difficulty of grasping with the left hand, exertional dyspnea, absence of DIP extension and flexion creases, dermatoglyphic alterations, and other anomalies. Her sister, dead at 1 1/2 years, had had some manifestations of the condition; seven sibs are normal. It is more likely that the whole clinical picture represents a single syndrome rather than homozygosity of different autosomal-recessive genes.
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The ankyloblepharon-ectodermal defects-cleft lip and palate (Hay-Wells) syndrome is a rare autosomal dominant form of congenital ectodermal dysplasia. It is characterized by coarse, wiry, sparse hair; dystrophic nails; slight hypohidrosis; scalp infections; ankyloblepharon filiforme adnatum; hypodontia; maxillary hypoplasia; and cleft lip and palate. To date, 12 patients have been reported; however, the diagnosis has been questioned in 3 of these patients. We report 2 additional patients, one of whom has nasal speech but not cleft palate, in contrast to all other reported patients. This entity must be distinguished from numerous other forms of ectodermal dysplasia, especially those forms that can be associated with oral clefts and/or ankyloblepharon.
Taurodontism and a reduced tooth length are reported to occur in patients with oligondontia. The aim of this study was to evaluate the occurrence of these factors in Dutch patients with oligodontia. Panoramic radiographs of 117 patients with oligodontia and 91 controls were collected. Taurodontism of the mandibular first molars was recorded and the length of cuspids, bicuspids and first molars of the mandible were measured. In patients with oligodontia 28.9% showed taurodontism of one or two mandibular first molars. The prevalence of taurodontism in normal Dutch subjects was 9.9%. No significant differences were found between the two sexes in both groups. Neither was there a significant difference in the unilateral and bilateral occurrence of taurodontism. The present findings supported the hypothesis that taurodontism may be the result of an ectodermal defect and a manifestation of developmental instability in patients with oligodontia. The length of mandibular cuspids and first molars in females were significantly reduced. In males only the lower right first molar was significantly reduced. The reduced length of the teeth may also be the result of a defect in ectodermal cells. Both taurodontism and a reduced length are of importance considering dental therapy.
In the present study, the morphological aspect of the skin and the hairs of athymic, macroscopically nude mice (NMRI, nu/nu) was investigated by descriptive light- and electron-microscopical methods and compared with the appearance of the skin and the hairs in normally haired mice (NMRI). These morphological studies revealed that athymic, macroscopically nude mice are not at all hairless, but have about the same number of hair bulbs, embedded in the hypodermis, as normally haired animals. However, within the hair follicles of athymic mice, the keratinization processes are obviously deeply impaired, resulting in the formation of short, crippled and bent hair shafts which only seldom emerge from the hair follicles. The cuticles of the inner root sheath and the hair are not built up, the cortex of the hair being composed by abnormal globular aggregates. The epidermis shows similar disturbances of keratinization, which are reflected by the presence of only few and thin bundles of tonofilaments in the basal, spinous and granular layers of the epidermis and, in the stratum corneum, by bizarrely formed and irregularly arranged lamellae of corneocytes, separated from one another. These results demonstrate that athymic, nude mice are not hairless but that the development and differentiation of hairs are severely injured in this mouse mutant. Analogously, the keratinization of the epidermis is also impaired. In view of the previously shown ectodermal defect as primary cause for the dysgenesis of the thymus, it seems to be probable that defects of the ectoderm are actually the common reason for both the thymus dysgenesis and the severe disturbances of hair development in 'athymic, nude' mice.