title: Anetoderma in a patient with terminal osseous dysplasia with pigmentary defects.
abstract: Terminal osseous dysplasia with pigmentary defects (TODPD) is a rare, X-linked syndrome classically characterized by distal limb anomalies, pigmented skin defects of the face, and recurrent digital fibromas. X-inactivation plays a major role in determining the range of phenotypic expression. Thus, patients can demonstrate a wide spectrum of disease severity, making accurate diagnosis more challenging. Recent studies have identified a FLNA c.5217G>A mutation as the cause of TODPD, allowing for diagnostic genetic testing. We present a case of molecularly confirmed TODPD in a girl with the 47,XXX chromosomal complement and deformities of the hands and feet, craniofacial abnormalities, and discolored, linear facial lesions. Skin biopsy of the patient's facial lesion revealed absent papillary dermal elastic fibers, consistent with anetoderma, which contrasts with the dermal hypoplasia described in the only other such facial biopsy reported in the literature. The finding of absent elastic fibers in the skin lesions suggests that mutated filamin A, in part, exerts its effects through dysregulated elastin biology, which may explain the nature of many connective tissue pleotropic effects in FLNA-related disorders.
authors.affiliation: Carver College of Medicine, University of Iowa Hospitals and Clinics.
authors.forename: Cody J
authors.initials: CJ
authors.lastname: Connor
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa Hospitals and Clinics.
authors.forename: Oleg A
authors.initials: OA
authors.lastname: Shchelochkov
authors.affiliation: Department of Dermatology, University of Iowa Hospitals and Clinics.
authors.forename: Heather
authors.initials: H
authors.lastname: Ciliberto
mesh_terms: D057088:Anetoderma / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D005260:Female; D018214:Fibroma, Ossifying / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D064448:Filamins / Q000235:genetics*; D005385:Fingers / Q000002:abnormalities* / Q000473:pathology; D015870:Gene Expression; D040181:Genetic Diseases, X-Linked / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D059785:Karyotype; D017880:Limb Deformities, Congenital / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D009154:Mutation; D010009:Osteochondrodysplasias / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D010859:Pigmentation Disorders / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D014034:Toes / Q000002:abnormalities* / Q000473:pathology; D049951:X Chromosome Inactivation
chemical_list: C578663:FLNA protein, human; D064448:Filamins
keywords: FLNA; TODPD; anetoderma; digital fibromas; elastin; filamin A; oral frenulum; terminal osseous dysplasia with pigmentary defects