Donor dominance cures CHILD nevus.
BACKGROUND
Congenital hemidysplasia with ichthyosiform nevus and limb defects (MIM 308050, CHILD) syndrome is an X-linked dominant, male-lethal, multisystem birth defect. Patients suffer from an inflammatory nevus that covers large areas, predominantly of one side of the body, with a sharp midline demarcation. Treatment of CHILD nevus is notoriously difficult.


OBJECTIVE
The aim of this study was to develop a novel surgical approach for this disorder.


METHODS
In 2 patients, the CHILD nevus was dermabraded, and the area was covered with split skin grafts obtained from a contralateral unaffected donor region. In a third patient, papillomatous, strawberry-like lesions on fingers and toes were excised, and the defects were covered with full-thickness grafts obtained from the unaffected left, gluteal area.


RESULTS
Highly satisfying functional and cosmetic results were documented during a follow-up period ranging from 3 to 8 years.


CONCLUSIONS
The favorable outcome, superior to that obtained by simple dermabrasion or extensive plastic surgery, can best be explained by the donor dominance of the grafted skin samples that carried, in all or most cells, the mutant X chromosome in an inactivated form.
König
Arne
A
Department of Dermatology, Philipp University, Deutschhausstrasse 9, Marburg, Germany.
Skrzypek
Jan
J
Löffler
Harald
H
Oeffner
Frank
F
Grzeschik
Karl-Heinz
KH
Happle
Rudolf
R
D015096:3-Hydroxysteroid Dehydrogenases / Q000235:genetics; D000328:Adult; D002648:Child; D018389:Codon, Nonsense; D005260:Female; D005385:Fingers; D040181:Genetic Diseases, X-Linked / Q000601:surgery*; D006801:Humans; D016113:Ichthyosiform Erythroderma, Congenital / Q000601:surgery*; D017880:Limb Deformities, Congenital / Q000601:surgery*; D009506:Nevus / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods; D013577:Syndrome; D016896:Treatment Outcome
D018389:Codon, Nonsense; D015096:3-Hydroxysteroid Dehydrogenases; C478776:Nsdhl protein, human