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array:24 [ "pii" => "S1578219019301015" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.03.009" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "2093" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2019;110:273-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8 "HTML" => 8 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018304903" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.10.004" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "2093" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2019;110:273-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 396 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 244 "PDF" => 151 ] ] "es" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">DERMATOLOGÍA PRÁCTICA</span>" "titulo" => "Incontinencia <span class="elsevierStyleItalic">pigmenti</span>" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:3 [ 0 => "es" 1 => "es" 2 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "273" "paginaFinal" => "278" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Incontinentia Pigmenti" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 775 "Tamanyo" => 40292 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Cammarata-Scalisi, F. Fusco, M.V. Ursini" "autores" => array:3 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Cammarata-Scalisi" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Fusco" ] 2 => array:2 [ "nombre" => "M.V." "apellidos" => "Ursini" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0015"></elsevierMultimedia></p></span>" ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019301015" "doi" => "10.1016/j.adengl.2019.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301015?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018304903?idApp=UINPBA000044" "url" => "/00017310/0000011000000004/v2_201905040606/S0001731018304903/v2_201905040606/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219019301118" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.03.017" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "2136" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2019;110:279-88" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Association Between Hidradenitis Suppurativa and Metabolic Syndrome: A Systematic Review and Meta-analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "279" "paginaFinal" => "288" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación entre la hidradenitis supurativa y el síndrome metabólico: revisión sistemática y metaanálisis" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0025" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 880 "Ancho" => 1333 "Tamanyo" => 66377 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J.M. Rodríguez-Zuñiga, H.A. García-Perdomo, A.G. Ortega-Loayza" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.J.M." "apellidos" => "Rodríguez-Zuñiga" ] 1 => array:2 [ "nombre" => "H.A." "apellidos" => "García-Perdomo" ] 2 => array:2 [ "nombre" => "A.G." "apellidos" => "Ortega-Loayza" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0025"></elsevierMultimedia></p></span>" ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101930002X" "doi" => "10.1016/j.ad.2018.10.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101930002X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301118?idApp=UINPBA000044" "url" => "/15782190/0000011000000004/v1_201905070820/S1578219019301118/v1_201905070820/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S157821901930112X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.04.001" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "2113" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Actas Dermosifiliogr. 2019;110:262-72" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8 "formatos" => array:2 [ "HTML" => 6 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Vitamin D and the Skin: A Review for Dermatologists" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "262" "paginaFinal" => "272" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vitamina D y la piel. Una revisión para dermatólogos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1462 "Ancho" => 2500 "Tamanyo" => 252455 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Vitamin D Metabolism. The body acquires vitamin D from certain foods and through a reaction that occurs when the skin is exposed to sunlight in which UV-B radiation converts 7-dehydrocholersterol (synthesized in the skin) to pre-vitamin D<span class="elsevierStyleInf">3</span>, which then becomes inactive vitamin D. This is then converted in the liver to 25(OH)D by way of hepatic hydroxylation. In a second step, 25(OH)D is metabolized in the kidney to the active metabolite 1,25(OH)D, or calcitriol, through the action of renal alpha-1-hydroxylase. This mechanism is regulated by serum levels of calcium and inorganic phosphorus, among others, which are detected by the glands that secrete parathyroid hormone (PTH) and stimulate the activity of alpha-1-hydroxylase, when necessary. Calcitriol concentrations regulate the secretion of PTH. The 1,25(OH)D acts through the vitamin D receptors (VDR) within cells, which activate the transcription and translation of messenger RNA, leading to the synthesis of vitamin D-dependent proteins and their corresponding activity, which depend on the function of the target cell. The excretion of vitamin D through bile is mediated by the activity of 24 renal hydroxylase, which converts 1,25(OH)D to calcitroic acid.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Navarro-Triviño, S. Arias-Santiago, Y. Gilaberte-Calzada" "autores" => array:3 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Arias-Santiago" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Gilaberte-Calzada" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018305313" "doi" => "10.1016/j.ad.2018.08.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018305313?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901930112X?idApp=UINPBA000044" "url" => "/15782190/0000011000000004/v1_201905070820/S157821901930112X/v1_201905070820/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermatology</span>" "titulo" => "Incontinentia Pigmenti" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "273" "paginaFinal" => "278" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Cammarata-Scalisi, F. Fusco, M.V. Ursini" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Cammarata-Scalisi" "email" => array:1 [ 0 => "francocammarata19@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Fusco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.V." "apellidos" => "Ursini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Genética Médica, Departamento de Puericultura y Pediatría, Universidad de Los Andes, Mérida, Venezuela" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institute of Genetics and Biophysics «Adriano Buzzati-Traverso», IGB-CNR, Nápoles, Italia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incontinencia <span class="elsevierStyleItalic">pigmenti</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 803 "Ancho" => 1667 "Tamanyo" => 90787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hyperchromic macules corresponding to stage III disease (hyperpigmented lesions).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Incontinentia pigmenti (OMIM 308300), a rare neuroectodermal dysplasia,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1,2</span></a> is an X-linked dominant disorder caused by mutations in the <span class="elsevierStyleItalic">IKBKG/NEMO</span> gene (GenBankNM_003639.3, OMIM 300248), formerly known as <span class="elsevierStyleItalic">NEMO</span>. The gene is located on Xq28 and encodes a kappa light polypeptide gene enhancer in B cells, kinase gamma, which has a key role in the modulation of nuclear transcription factor kappa B (NF-κB).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1,3–7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Incontinentia pigmenti was described by Bloch in 1926 and Sulzberger in 1928<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> and is hence also known as <span class="elsevierStyleItalic">Bloch–Sulzberger syndrome</span>.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6,8</span></a> The causative gene has high penetrance and variable expressivity.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> The 11.7-kb deletion spanning exons 4 to 10 is the main cause of incontinentia pigmenti and is found in approximately 80% of cases.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3,6,9,10</span></a> It is caused by recombination between two <span class="elsevierStyleItalic">MER67B</span> repeats in introns 3 and 10 of the gene, resulting in loss of protein function. Small insertion-deletion and nonsense mutations have also been described. Some hypomorphic <span class="elsevierStyleItalic">IKBKG</span>/<span class="elsevierStyleItalic">NEMO</span> mutations cause a distinct entity: hypohidrotic ectodermal dysplasia with immunodeficiency (OMIM 300291).<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6,11</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidemiology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Incontinentia pigmenti has an estimated incidence of 0.7 cases per 100 000 births<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> and 27.6 new cases annually. Between 65% and 75% of cases are due to sporadic mutations and the remaining cases are familial.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a> The condition is usually lethal in hemizygous male embryos.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2–4,12,13</span></a> Female patients can survive due to functional mosaicism resulting from X chromosome inactivation.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2,4,9</span></a> The clinical findings in such cases are highly variable.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> Incontinentia pigmenti is therefore predominant in females, with a female to male ratio of 37:1. Male patients with clinical features of incontinentia pigmenti may also have Klinefelter syndrome (47, XXY). Survival in such cases is possible due to the second chromosome X or somatic mosaicism for the above-mentioned common deletion.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">4,5,8</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical Features and Management</span><p id="par0020" class="elsevierStylePara elsevierViewall">Incontinentia is a multisystemic disease<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">4,5,8</span></a> that affects both ectodermal and mesodermal tissues. The skin is always involved and is the main diagnostic criterion.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> Additional alterations affect the central nervous system, eyes, teeth,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3,4,10,12</span></a> mammary glands, hair, nails, and skeleton. Cardiopulmonary alterations are also observed, albeit less frequently.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Landy and Donnai<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> established the first diagnostic criteria for incontinentia pigmenti in 1993, before discovery of the causative gene.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> In 2014, Minić et al.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a> proposed a series of updated criteria, and in 2018, with the permission of the authors, Rosser<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> modified these criteria to improve the phenotypic characterization of the disease and further update the diagnostic criteria. The major criteria proposed were the typical dermatologic findings observed in incontinentia pigmenti that are used to establish a clinical diagnosis,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3,5</span></a> while the minor criteria corresponded to other possible alterations. Additional diagnostic criteria include a positive family history (in a first-degree relative) and a mutation in the <span class="elsevierStyleItalic">IKBKG/NEMO</span> gene. These are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>,<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2–20</span></a> together with the other criteria described by Rosser<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> and the respective frequencies as reported in the literature.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Skin lesions are the presenting manifestation. They appear at birth or in the first 2 weeks of life, progress over a period of years, and are distributed along the Blaschko lines. There are 4 classic stages: a vesicobullous stage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), a verrucous/hyperkeratotic stage, a hyperpigmented stage (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and an atrophic/hypopigmented stage.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">19,20</span></a> Not all patients experience the 4 stages,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> and the first 3 can appear simultaneously.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a> These lesions are described in more detail in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2–20</span></a> The term <span class="elsevierStyleItalic">incontinentia pigmenti</span> is linked to the histologic characteristics of the lesions in stage 3 of the disease (hyperpigmentation) and specifically to melanin incontinence from melanocytes in the basal epidermal layer and deposits in the superficial dermis.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> These manifestations generally do not require specific intervention<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> or treatment. Treatment with topical corticosteroids or tacrolimus can delay progression of the vesicobullous stage, although the lesions resolve spontaneously.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Incontinence pigmenti largely becomes serious when there are neurological alterations,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">9,10</span></a> as these can cause considerable morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> Neurologic impairments are varied in nature, but the most common are seizures,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">9,21</span></a> which are generally tonic<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> or focal clonic, last for a short time, and cause loss of consciousness. They are more common in the neonatal period,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> are resistant to treatment, and have a poor prognosis. Other disorders include microcephaly, ischemic stroke, cerebellar ataxia, and delayed psychomotor development. Acute signs of encephalitis mainly appear in the first 4 days of life and include food intolerance, lethargy, and seizure-like movements. Brain magnetic resonance imaging with angiography is therefore essential in neonates with characteristic cutaneous incontinentia pigmenti lesions. Follow-up studies are also necessary to prevent sequelae.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3,9,22</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Eye impairment is observed in between 50% and 77% of patients. The most serious alterations involve the retina,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a> and retinal problems such as detachment and avascular retina are the most feared of complications. These can be treated with laser photocoagulation targeting retinal neovascularization. Cryotherapy can also be used and promising results have been observed with vascular endothelial growth factor inhibitors.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> Optical coherence tomography images show internal and external retinal layer thinning. Eye abnormalities similar to retinoblastoma have been described in some cases of incontinentia pigmenti and include leukocoria, strabismus, intraocular calcification, and, as already mentioned, retinal detachment. The differential diagnosis is therefore important.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a> Patients should have an eye examination every month for the first 4 months, every 3 months up to 1 year of age, every 6 months up to 3 years of age, and every 12 months thereafter.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Etiology and Pathogenesis</span><p id="par0045" class="elsevierStylePara elsevierViewall">NF-κB is activated by the protein product of <span class="elsevierStyleItalic">IKBKG/</span><span class="elsevierStyleItalic">NEMO</span>, which plays a key modulatory role in multiple physiological functions, such as immune response and stress, inflammatory reactions, ectodermal development, cell adhesion, and protection of cells against tumor necrosis factor–induced apoptosis.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3,4,6,22</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">IKBKG/NEMO</span> mutation leads to decreased NF-κB activity, thereby increasing susceptibility to apoptosis.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> Extensive apoptosis in males is responsible for early fetal death<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> and liver disorders.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Inflammatory reactions and epidermal recruitment of eosinophils, which occur in the first stage of disease, tend to have an important pathogenic role.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> This is probably related to eosinophil-selective chemokine (eotaxin),<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">4,16</span></a> which is produced by specific leukocytes, such as eosinophils, macrophages, and T cells, and structural cells such as endothelial cells, fibroblasts, and epithelial cells.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Differential Diagnosis</span><p id="par0060" class="elsevierStylePara elsevierViewall">The entities that should be contemplated in the differential diagnosis vary with disease stage. During the first stage, incontinentia pigmenti may be confused with multiple infections of the newborn, such as congenital herpes simplex, varicella, epidermolysis bullosa, and bullous pemphigoid.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">18,23</span></a> As neonatal herpes and incontinentia pigmenti can coexist, treatment with acyclovir must be started as soon as a viral infection is confirmed. The differential diagnosis in the second stage is limited and should include linear epidermal nevus.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> The third stage is the hallmark stage of incontinentia pigmenti and must be distinguished from linear and whorled nevoid hypermelanosis. The fourth stage, if present, can be mistaken for hypomelanosis of Ito or vitiligo. These conditions, however, lack an initial inflammatory phase and do not generally affect the appendages.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions and Genetic Counseling</span><p id="par0065" class="elsevierStylePara elsevierViewall">The diagnosis of incontinentia pigmenti is based on clinical findings.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> Nonetheless, in view of the enormous variability of clinical features and the broad spectrum of molecular alterations, it is difficult to establish a homogeneous group of patients and standardize treatment. Although progress has been made in our understanding of the causes of incontinentia pigmenti and in clinical care research, the scarcity of patients seen in diagnostic centers makes it difficult to obtain a global epidemiological picture. Integration of these data could make an important contribution to future scientific endeavours.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">When dealing with a multisystemic disorder, long-term, individualized, multidisciplinary follow-up is necessary, with evaluation by dermatologists, neurologists, ophthalmologists, and dentists, among others.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3,24</span></a> Congenital hypothyroidism, myasthenia gravis, and Wilms tumor have been described in certain cases of incontinentia pigmenti,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> and one group of authors who recently observed liver disease in a patient with incontinentia pigmenti suggested including hepatic evaluation in this setting, even though they were unable to establish a link between the 2 conditions.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> This could mean that even broader care may be warranted in patients with incontinentia pigmenti.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Moreover, the updated diagnostic criteria proposed by Rosser<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> do not include skeletal alterations, (e.g., low stature, hemivertebra, kyphosis, scoliosis, supernumerary ribs, hip dysplasia, hemiatrophy, club foot, <a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> or toe syndactyly<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">4,10</span></a>) or cardiopulmonary disorders (e.g., interatrial communication,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> left ventricular endomyocardial fibrosis, tricuspid insufficiency, tetralogy of Fallot,<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">4,17</span></a> or pulmonary hypertension, even in the absence of cardiovascular alterations).<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2,4</span></a> Risk of recurrent infection is also not currently contemplated.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> Future updates will probably incorporate many of these conditions to cover the main clinical manifestations of this disease.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Genetic studies are essential for advancing our understanding of incontinentia pigmenti and confirming diagnoses through molecular diagnostic techniques, particularly in doubtful cases.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> Prognosis is generally good, but, as already mentioned, regular follow-up by a multidisciplinary team is important. Genetic family counseling is also important in patients with an X-linked dominant disorder,<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">18,23</span></a> which is usually lethal in male patients. Female patients in this case have a 50% chance of having a daughter with incontinentia pigmenti. Miscarriage occurs in approximately 50% of male fetuses. Males that do survive should be referred for a cytogenetic study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1187719" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1107568" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1187720" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1107569" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical Features and Management" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Etiology and Pathogenesis" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Differential Diagnosis" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions and Genetic Counseling" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 11 => array:2 [ "identificador" => "xack405583" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-04" "fechaAceptado" => "2018-10-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1107568" "palabras" => array:5 [ 0 => "Incontinentia pigmenti" 1 => "<span class="elsevierStyleItalic">IKBKG/NEMO</span>" 2 => "Clinical features" 3 => "Diagnosis" 4 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1107569" "palabras" => array:5 [ 0 => "Incontinencia <span class="elsevierStyleItalic">pigmenti</span>" 1 => "<span class="elsevierStyleItalic">IKBKG/NEMO</span>" 2 => "Clínica" 3 => "Diagnóstico" 4 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Incontinentia pigmenti (Bloch-Sulzberger syndrome) is a rare neuroectodermal dysplasia. It is an X-linked dominant disorder caused by mutations in the <span class="elsevierStyleItalic">IKBKG/NEMO</span> gene on Xq28. Approximately 80% of patients have a deletion of exons 4 to 10. Incontinentia pigmenti has an estimated incidence of 0.7 cases per 100 000 births. In hemizygous males, it is usually lethal, while in females, it has a wide spectrum of clinical manifestations. Incontinentia pigmenti is a multisystemic disease that invariably features skin changes. These changes are the main diagnostic criteria and they evolve in 4 stages, in association with other abnormalities affecting the central nervous system, eyes, teeth, mammary glands, hair, nails, skin, and other parts of the body. The aim of this brief review is to highlight the clinical features of this genodermatosis and underline the importance of case-by-case interdisciplinary management, including genetic counseling.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La incontinencia <span class="elsevierStyleItalic">pigmenti</span> (síndrome de Bloch-Sulzberger) es una displasia neuroectodérmica infrecuente, con patrón de herencia ligado al X dominante, causada por mutaciones en el gen <span class="elsevierStyleItalic">IKBKG/NEMO</span> y se encuentra localizado en Xq28. La deleción del exón 4 al 10 corresponde con la principal causa en aproximadamente el 80% de los casos. La incidencia estimada es de 0,7 en 100.000 nacimientos, usualmente letal en hombres hemicigotos y en el sexo femenino puede exhibir hallazgos clínicos variables. Es una entidad multisistémica, que incluye defectos en la piel, siempre presente y principal criterio diagnóstico, la cual evoluciona en cuatro etapas, asociada a alteraciones en el sistema nervioso central, globo ocular, dientes, glándula mamaria, pelo, uñas, entre otros. El objeto de esta breve revisión es resaltar los hallazgos clínicos de esta genodermatosis, con la finalidad de brindar el seguimiento médico individualizado e interdisciplinario que incluya un adecuado asesoramiento genético familiar.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Cammarata-Scalisi F, Fusco F, Ursini MV. Incontinencia <span class="elsevierStyleItalic">pigmenti</span>. Actas Dermosifiliogr. 2019;110:273–278.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1158 "Ancho" => 1667 "Tamanyo" => 168889 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Blister-like erythematous lesions on the extremities corresponding to stage I disease (vesiculobullous lesions).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 803 "Ancho" => 1667 "Tamanyo" => 90787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hyperchromic macules corresponding to stage III disease (hyperpigmented lesions).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar9040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span>Adapted from references <a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2–20</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Criteria \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency, % \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Major</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typical skin lesions following the lines of Blaschko \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stage I — vesiculobullous stage: erythematous or inflammatory lesions characterized by vesicles, bullae, or pustules; more common on extremities and scalp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Present from birth to second week of life \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stage II — verrucous/hyperkeratotic stage: hyperpigmented pustules or crusts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Occurs from week 2 to week 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stage III — hyperpigmentation stage: whorled hyperchromic macules; predominant in intertriginous areas and on trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">These appear between week 12 and 26 and can improve in adolescence or persist into adulthood \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stage IV — atrophy/hypopigmentation stage: hypochromic macules and possibly alopecia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">This stage is not always present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The above stages may overlap and not necessarily follow the given order \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Minor</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Central nervous system/neurologic impairments</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seizures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spastic paralysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psychomotor delay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mental retardation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Microcephaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cerebral/cerebellar atrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.4<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Microgyria/polymicrogyria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypoplasia of the corpus callosum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basal ganglia alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Periventricular leukomalacia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hydrocephaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Porencephaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffuse hemorrhagic necrosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Encephalomyelitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Eye alterations</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Visual defects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retinopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retinal detachment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retinal vascular alteration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pigmentation disorders (hyper/hypopigmentation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Optic atrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Foveal hypoplasia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retrolental fibroplasia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Microphthalmia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Strabismus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nystagmus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dental alterations</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17-34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Delayed primary tooth eruption \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anodontia/hypodontia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Microdontia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dental dystrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal (conical) shape \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Impacted teeth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diastema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malocclusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Palate disorders</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High-arched palate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mammary gland alterations</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Supernumerary nipple \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hair abnormalities (hair, eyebrows, eyelashes)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28-38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alopecia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertrichosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nail disorders</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dystrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yellowing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vertical or horizontal splitting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male miscarriage</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Typical histopathologic findings in skin</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Additional conditions for confirming diagnosis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No history of incontinentia pigmenti in a first-degree female relative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">If molecular diagnosis is not available, at least 2 major criteria or 1 major criterion plus 1 minor criterion are needed to confirm diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">An <span class="elsevierStyleItalic">IKBKG</span> mutation combined with any major or minor criterion confirms diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of incontinentia pigmenti in a first-degree female relative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">One major criterion or 2 minor criteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In all cases, diagnosis is supported by eosinophilia and skewed X-chromosome inactivation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2026139.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Brain atrophy.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Proposed Diagnostic Criteria for Incontinentia Pigmenti and Prevalence of Some of the Corresponding Conditions as Reported in the Literature.<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0125" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "1111/ajd.12805" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel IKBKG mutation in a patient with incontinentia pigmenti and features of hepatic ciliopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. 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año/Mes | Html | Total | |
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2024 Noviembre | 17 | 10 | 27 |
2024 Octubre | 219 | 58 | 277 |
2024 Septiembre | 202 | 46 | 248 |
2024 Agosto | 354 | 66 | 420 |
2024 Julio | 223 | 46 | 269 |
2024 Junio | 207 | 66 | 273 |
2024 Mayo | 183 | 64 | 247 |
2024 Abril | 185 | 34 | 219 |
2024 Marzo | 195 | 50 | 245 |
2024 Febrero | 186 | 41 | 227 |
2024 Enero | 155 | 55 | 210 |
2023 Diciembre | 103 | 28 | 131 |
2023 Noviembre | 164 | 49 | 213 |
2023 Octubre | 174 | 56 | 230 |
2023 Septiembre | 149 | 51 | 200 |
2023 Agosto | 97 | 37 | 134 |
2023 Julio | 128 | 47 | 175 |
2023 Junio | 113 | 31 | 144 |
2023 Mayo | 107 | 41 | 148 |
2023 Abril | 94 | 26 | 120 |
2023 Marzo | 114 | 30 | 144 |
2023 Febrero | 106 | 25 | 131 |
2023 Enero | 114 | 60 | 174 |
2022 Diciembre | 97 | 46 | 143 |
2022 Noviembre | 57 | 39 | 96 |
2022 Octubre | 60 | 31 | 91 |
2022 Septiembre | 71 | 37 | 108 |
2022 Agosto | 54 | 50 | 104 |
2022 Julio | 39 | 41 | 80 |
2022 Junio | 49 | 42 | 91 |
2022 Mayo | 98 | 46 | 144 |
2022 Abril | 139 | 49 | 188 |
2022 Marzo | 163 | 84 | 247 |
2022 Febrero | 175 | 78 | 253 |
2022 Enero | 125 | 59 | 184 |
2021 Diciembre | 84 | 37 | 121 |
2021 Noviembre | 129 | 62 | 191 |
2021 Octubre | 92 | 68 | 160 |
2021 Septiembre | 108 | 73 | 181 |
2021 Agosto | 85 | 54 | 139 |
2021 Julio | 99 | 35 | 134 |
2021 Junio | 114 | 36 | 150 |
2021 Mayo | 130 | 97 | 227 |
2021 Abril | 278 | 147 | 425 |
2021 Marzo | 233 | 76 | 309 |
2021 Febrero | 168 | 51 | 219 |
2021 Enero | 136 | 47 | 183 |
2020 Diciembre | 113 | 52 | 165 |
2020 Noviembre | 76 | 40 | 116 |
2020 Octubre | 77 | 48 | 125 |
2020 Septiembre | 90 | 41 | 131 |
2020 Agosto | 63 | 63 | 126 |
2020 Julio | 83 | 39 | 122 |
2020 Junio | 63 | 47 | 110 |
2020 Mayo | 75 | 41 | 116 |
2020 Abril | 118 | 45 | 163 |
2020 Marzo | 281 | 40 | 321 |
2020 Febrero | 2 | 0 | 2 |
2019 Mayo | 8 | 0 | 8 |