Search

Normolipemic plane xanthoma normally occurs in adults. We report the atypical instance of a 9-year-old boy who developed disseminated, flat, yellow-brown plaques up to 2 to 3 cm without any complaints. The histology showed the hallmarks of xanthoma, including the presence of CD68+ foam cells and Touton giant cells. No systemic involvement or lipid disorders were evident. It is important to perform regular follow-up of these patients because normolipemic plane xanthoma often precedes myeloproliferative disorders such as leukemia, paraproteinemia, or lymphoma.

Background: The diagnostic criteria of Proteus syndrome include various lesions of localized overgrowth such as digital gigantism, hemihyperplasia with unilateral macrocephaly, epidermal nevus, and mesodermal hamartomas such as lipoma, lymphangioma, hemangioma, or fibroma. Hyperplasia of the plantar dermal tissue may result in a characteristic cerebriform appearance. However, hypoplastic lesions involving various tissues such as subcutaneous fat or muscles also may be observed in this syndrome. This paradoxical phenomenon has so far been underestimated, and the presence of circumscribed lesions of dermal hypoplasia has been entirely ignored., Observations: We report 4 cases of Proteus syndrome associated with large patches of dermal hypoplasia, resulting in a more prominent appearance of venous vasculature., Conclusions: Patchy dermal hypoplasia appears to be a characteristic feature within the spectrum of Proteus syndrome. The anomaly should not be confused with partial lipohypoplasia that may likewise be associated with this multisystem birth defect. From a review of the literature, we conclude that patchy dermal hypoplasia may have occurred in several previous cases. In the future, recognition of this cutaneous anomaly may help to establish the diagnosis in otherwise doubtful cases. To explain the coexistence of lesions of dermal hyperplasia and hypoplasia, we propose the genetic concept of "twin spotting." At the gene locus of Proteus syndrome the embryo would carry 1 allele giving rise to dermal overgrowth, whereas the corresponding allele would be responsible for a diminished proliferation of cutaneous fibroblasts. Somatic recombination may result in 2 different populations of cells homozygous for either allele.

We report a 21-month-old girl with symptoms consistent with the Zunich neuroectodermal syndrome, an apparently rare condition first described in 1983. Common features of all previously reported patients as well as in this child are characteristic craniofacial dysmorphism, bilateral colobomas of the retina, sparse and fine hair, hearing loss, ichthyosiform erythroderma, mental retardation, ear anomalies, brachydactyly, and broad second toes. Light microscopic and ultrastructural investigations of the affected skin showed characteristic but nonspecific changes. The structural hair shaft abnormalities as well as the dysplastic nails in our patient have not been described before and are consistent with the previous assumption of an ectodermal dysplasia syndrome.

The technique of 20-MHz B-scan sonography is non-invasive and allows quantification of the different compartments of the skin. Seven patients with atrophic linear circumscribed scleroderma and one patient with guttate circumscribed scleroderma were examined by ultrasound. All patients were found to have a total or subtotal loss of subcutaneous fatty tissue, whereas the thickness of the dermis remained almost unchanged. These findings should lead to further investigation of the pathophysiological mechanism involved in subcutaneous atrophy in circumscribed scleroderma.

The main symptoms of chronic skin diseases, genodermatoses, malformations of the skin and phacomatoses affecting the physical and psychological development of the child are described. The advantages of early diagnosis are emphasised and recommendations made for strategies of medical care.

Sera taken from 35 children and teen-agers with different clinic variants of the circumscribed scleroderma were investigated for the presence of FANA, anti-DNA-, anti-DNP-, anti-ENA-(extractable nuclear antigens)-, and anti-Ro/SSA-antibodies. In 85.7% of the patients, humoral immune phenomena were ascertainable. Whereas FANA above all in patients with clinically rapidly progredient running linear form (71%) were present, anti-dsDNA- and anti-DNP-antibodies may be worth as hint upon a visceral manifestation. Therefore, they may be valid as leading antibodies for a subset of the circumscribed scleroderma, which is being designated by extracutaneous participation and the skin mostly exhibit a linear variant. The frequency of the evidence of the characteristic immune phenomena in patients with circumscribed scleroderma, which are typically in systemic lupus erythematosus, is considered as hint to the immune pathogenesis of the disease. The functional defects of the kidneys, catched with the isotope-clearance refer to a possible systemic character of the disease-process. Humoral immune phenomena are suitable for differentiation of the cutaneous and extracutaneous progress forms, in which high titer of FANA with homogeneous pattern of fluorescence, anti-dsDNA- and anti-DNP-antibodies have a special importance. Compared to it anti-ssDNA-antibodies and anti-Ro/SSA-antibodies characterize the high degree of activity of cutaneous and extracutaneous progress forms.