Eclabium

Last updated

Eclabium means the turning outwards of the lip. Eclabium comes from the Greek word "ek" meaning "out," and the Latin word "labium"[ citation needed ] meaning "lip." This deformation occurs in most babies born with harlequin type ichthyosis,[ citation needed ] caused by genetic defects.[ citation needed ] Eclabium can severely impact the quality of life. There are ways to predict if a child will have this condition before they are born through genetic testing. [1] For patients who suffer from eclabium due to improper wound healing, there are different treatment options available to restore the lips back to normal or at least to the point where they are not a hazard to the patients quality of life. Periodontitis can also cause eclabium. As eclabium is a symptom, it is treated by addressing its cause. When the underlying disease is treated, the eclabium tends to go away as well.

Contents

Classification

It is commonly classified as a congenital malformation (birth defect)[ citation needed ] however it can also result from improper healing of a wound.[ citation needed ]

Causes

Harlequin ichthyosis Harlequin ichthyosis.png
Harlequin ichthyosis

Causes of eclabium include but are not limited to

Mechanisms

Disease causing variants in adenosine triphosphate binding cassette transporter protein (A12 gene) [3] on chromosome 2 carries information for lipid transportation to keratinocytes [ citation needed ] in the cutaneous layer.[ citation needed ] The malfunction of this gene causes scaly tight skin. The tightening of the skin pulls the eyes and lips back causing eclabium and ectropion. This disease has a Rare autosomal recessive mode of inheritance.[ citation needed ]

At times the skin does not heal properly after surgery or a wound. Improper healing of a wound on or near the lips can cause eclabium. All wounds heal [ citation needed ] in 3 parts: contraction, connective tissue matrix deposition and epithelialization. If any one of those parts is disrupted, it can become a cause of eclabium

True homozygous versus compound heterozygous for the ABCA 12 gene. True homozygous versus compound heterozygous.png
True homozygous versus compound heterozygous for the ABCA 12 gene.

Signs and symptoms

Diseases that cause eclabium have the following signs and symptoms

Diagnosis

Eclabium is very clearly visible and a medical professional can identify it easily. In some cases it can be diagnosed beforehand. For example, when there has been a surgery[ citation needed ] by the lip or gums, abnormal healing can be very likely. When the tissue does not heal properly it can result in the outward turning of the lip.

Also, If a mother tests positive for a mutation in the ABCA12 gene, [6] eclabium as a result of Ichthyosis can be present in the child. Ichthyosis is characterized by tight scaly skin along with ectropion[ citation needed ] which is outward turning of eyelids. If the skin is tight enough to be pulling on the eyes then it is safe to diagnose that the tight skin is also pulling on the lips making them turn outward

If a patient is diagnosed with periodontitis[ citation needed ] it can cause swelling of the gums which in turn causes the outward turning of the lip.

Prevention

To prevent eclabium, testing for the mutation for ABCA12 gene can be done on the mother to see if the unborn child has the gene. This allows the parents to make a decision accordingly because most children with ABCA12 gene mutation [6] will have eclabium.

Healing of wounds near lips or gums should be carefully monitored to prevent severe eclabium. If the improper healing [ citation needed ] is caught at the right time it can become imperative to prevent the eclabium as soon as possible.

Basic dental hygiene[ citation needed ] can help prevent periodontitis. Basic dental hygiene includes brushing and flossing as well as regular dentist visits. If periodontitis is prevented, it reduces the chances of eclabium caused by poor dental hygiene.

Treatment

Chlorhexidine for treating Periodontitis Perichlor, 0.12%25 chlorhexidine glucomate solution medication.jpg
Chlorhexidine for treating Periodontitis

To reduce the tightness and dehydration of the skin, Lubricant ointment[ citation needed ] has been used. When the skin becomes less tense, it doesn't pull at the lips as much causing a reduction in the eclabium. Once the skin is loose enough the eclabium subsides. Eclabium can be a lifelong disorder, but drug treatment for the causing disease would heal the lips as well. For example for harlequin ichthyosis drugs such as Tazarotene [ citation needed ] and isotretinoin [ citation needed ] have been used to help the skin heal and loosen up which helps the eclabium heal. But sometimes surgery might become necessary to correct the disorder. Lateral columella base-labrum transposition flap [ citation needed ] results in soft linear scars without hyperplasia.[ citation needed ] It is an easy, minimally invasive and nearly no secondary malformation method. a type of flap used is the Limberg/Rhomboid flap.[ citation needed ] The flap is made up of Cutaneous tissue[ citation needed ] to close defects anywhere on the body.

If the eclabium is caused by periodontitis,[ citation needed ] treatment includes removal of plaque and calculus from the teeth, antimicrobial mouth rinse such as chlorhexidine, [7] antiseptic chips/gels. When the swelling in the gums reduces it will no longer push on lips making them turn outwards.

Prognosis and Epidemiology

Unfortunately, most conditions that cause eclabium, such as ichthyosis, have a very high mortality rate with worldwide figure approaching 50 percent. However, eclabium caused by improper wound healing is usually reversible through another corrective surgery and has little to no mortality.

Scarring can occur from surgery to correct eclabium. Some patients might get further cosmetic surgery[ citation needed ] to fix the scarring.

Eclabium caused by Periodontitis is almost always treatable and if it has advanced severely, surgery can help to treat it. It does not cause death but it can become very painful and decrease the quality of life if left untreated. It can affect anyone who does not follow good oral hygiene. It currently affects 20-50% of the global population [8] but only a small portion of cases become severe enough to cause eclabium.

Eclabium caused by harlequin ichthyosis is more severe. Its prognosis is very poor. [9] Most affected babies do not survive the first week of life. Survival rates based on the severity of the case have varied from 10 months to 25 years with supportive treatment. The oldest person in the united states with Harlequin Ichthyosis is 23 year old Stephanie Turner. [10] She was also the first person to have a child with this condition. She has two children and neither have the condition. There is a 25% chance of this condition reoccurring in the mothers next pregnancy. Genetic counseling[ citation needed ] is highly recommended for couples who have the mutated ABCA12 gene.[ citation needed ]

Research

A research study conducted in 2019 on a pregnant couple with a child that has Harlequin Ichthyosis[ citation needed ] talked about characteristic sonographic features. Eclabium and ectropion[ citation needed ] can be seen in the ultrasound. The mouth is persistently open and restriction of limb movement is also seen. [11]

Another Research was inducted on the use of retinoids[ citation needed ] and whether or not they are the only way to treat Harlequin Ichthyosis.[ citation needed ] The research titled survival without systemic retinoids mentions how the chances of survival are very low regardless of retinoid treatment. According to this study two neonates were able to survive with intensive care but no retinoids. [12]

Further research on the types of Ichthyosis and receiving genetic counseling[ citation needed ] for the condition is still being reviewed. The importance of neonatologist,[ citation needed ] a pediatric dermatologist,[ citation needed ] a geneticist [ citation needed ] and other specialists is discussed in this study. Their involvement can help better the treatment plan for Harlequin Ichthyosis patients and help ease symptoms such as eclabium. [13]

Related Research Articles

<span class="mw-page-title-main">Harlequin-type ichthyosis</span> Genetic skin disease

Harlequin-type ichthyosis is a genetic disorder that results in thickened skin over nearly the entire body at birth. The skin forms large, diamond/trapezoid/rectangle-shaped plates that are separated by deep cracks. These affect the shape of the eyelids, nose, mouth, and ears and limit movement of the arms and legs. Restricted movement of the chest can lead to breathing difficulties. These plates fall off over several weeks. Other complications can include premature birth, infection, problems with body temperature, and dehydration. The condition is the most severe form of ichthyosis, a group of genetic disorders characterised by scaly skin.

<span class="mw-page-title-main">Ichthyosis</span> A serious genetic disorder, usually involving the skin; often looking fish-scale like.

Ichthyosis is a family of genetic skin disorders characterized by dry, thickened, scaly skin. The more than 20 types of ichthyosis range in severity of symptoms, outward appearance, underlying genetic cause and mode of inheritance. Ichthyosis comes from the Greek ἰχθύςichthys, literally 'fish', since dry, scaly skin is the defining feature of all forms of ichthyosis.

<span class="mw-page-title-main">Ichthyosis vulgaris</span> A genetic fish scale related Dermatological [skin] disorder; may become widespread.

Ichthyosis vulgaris is a skin disorder causing dry, scaly skin. It is the most common, and one of the mildest forms of ichthyosis, affecting around 1 in 250 people. For this reason it is known as common ichthyosis. It is usually an autosomal dominant inherited disease, although a rare non-heritable version called acquired ichthyosis exists.

<span class="mw-page-title-main">Lamellar ichthyosis</span> Medical condition

Lamellar ichthyosis, also known as ichthyosis lamellaris and nonbullous congenital ichthyosis, is a rare inherited skin disorder, affecting around 1 in 600,000 people.

<span class="mw-page-title-main">Epidermolytic hyperkeratosis</span> Medical condition

Epidermolytic ichthyosis (EI), is a rare and severe form of ichthyosis that affects around 1 in 300,000 people. It is caused by a genetic mutation, and thus cannot be completely cured without some form of gene therapy.

<span class="mw-page-title-main">Darier's disease</span> Medical condition

Darier's disease (DAR) is a rare, inherited skin disorder that presents with multiple greasy, crusting, thick brown bumps that merge into patches. It is an autosomal dominant disorder discovered by French dermatologist Ferdinand-Jean Darier.

<span class="mw-page-title-main">Meleda disease</span> Medical condition

Meleda disease (MDM) or "mal de Meleda", also called Mljet disease, keratosis palmoplantaris and transgradiens of Siemens, is an extremely rare autosomal recessive congenital skin disorder in which dry, thick patches of skin develop on the soles of the hands and feet, a condition known as palmoplantar hyperkeratosis. Meleda Disease is a skin condition which usually can be identified not long after birth. This is a genetic condition but it is very rare. The hands and feet usually are the first to show signs of the disease but the disease can advance to other parts of the body. Signs of the disease include thickening of the skin, on hands and soles of feet, which can turn red in color. There currently is no cure and treatment is limited, but Acitretin can be used in severe cases.

<span class="mw-page-title-main">ABCA12</span> Protein-coding gene in the species Homo sapiens

ATP-binding cassette sub-family A member 12 also known as ATP-binding cassette transporter 12 is a protein that in humans is encoded by the ABCA12 gene.

<span class="mw-page-title-main">Sjögren–Larsson syndrome</span> Medical condition

Sjögren–Larsson syndrome is a rare autosomal recessive form of ichthyosis with neurological symptoms. It can be identified by a triad of medical disorders. The first is ichthyosis, which is a buildup of skin to form a scale-like covering that causes dry skin and other problems. The second identifier is paraplegia which is characterized by leg spasms. The final identifier is intellectual delay.

Collagen IV is a type of collagen found primarily in the basal lamina. The collagen IV C4 domain at the C-terminus is not removed in post-translational processing, and the fibers link head-to-head, rather than in parallel. Also, collagen IV lacks the regular glycine in every third residue necessary for the tight, collagen helix. This makes the overall arrangement more sloppy with kinks. These two features cause the collagen to form in a sheet, the form of the basal lamina. Collagen IV is the more common usage, as opposed to the older terminology of "type-IV collagen". Collagen IV exists in all metazoan phyla, to whom they served as an evolutionary stepping stone to multicellularity.

<span class="mw-page-title-main">Netherton syndrome</span> Medical condition

Netherton syndrome is a severe, autosomal recessive form of ichthyosis associated with mutations in the SPINK5 gene. It is named after Earl W. Netherton (1910–1985), an American dermatologist who discovered it in 1958.

<span class="mw-page-title-main">Genodermatosis</span> Medical condition

Genodermatosis is a hereditary skin disease with three inherited modes including single gene inheritance, multiple gene inheritance and chromosome inheritance. There are many different types of genodermatosis, the prevalence of genodermatosis ranges from 1 per 6000 people to 1 per 500,000 people. Genodermatosis has influence on the texture, color and structure of skin cuticle and connective tissue, specific lesion site and clinical manifestations on the body vary depending on the type. In the spite of the variety and complexity of genodermatosis, there are still some common methods that can help people diagnose. After diagnosis, different types of genodermatosis require different levels of therapy including interventions, nursing interventions and treatments. Among that, research of therapy for some new, complex and rare types are still in the developing stage. The impact of genodermatosis not only can be seen in body but also can be seen in all aspects of patients' life, including but not limited to psychological, family life, economic conditions and social activities. Accordingly, the patients need treatment, support and help in these areas.

<span class="mw-page-title-main">ALOX12B</span> Protein-coding gene in the species Homo sapiens

Arachidonate 12-lipoxygenase, 12R type, also known as ALOX12B, 12R-LOX, and arachidonate lipoxygenase 3, is a lipoxygenase-type enzyme composed of 701 amino acids and encoded by the ALOX12B gene. The gene is located on chromosome 17 at position 13.1 where it forms a cluster with two other lipoxygenases, ALOXE3 and ALOX15B. Among the human lipoxygenases, ALOX12B is most closely related in amino acid sequence to ALOXE3

<span class="mw-page-title-main">Ichthyosis bullosa of Siemens</span> Medical condition

Ichthyosis bullosa of Siemens is a type of familial, autosomal dominant ichthyosis, a rare skin disorder. It is also known as bullous congenital ichthyosiform erythroderma of Siemens or ichthyosis exfoliativa. It is a genetic disorder with no known cure which is estimated to affect about 1 in 500,000 people.

Congenital ichthyosiform erythroderma, also known as nonbullous congenital ichthyosiform erythroderma, is a rare type of the ichthyosis family of skin diseases which occurs in 1 in 200,000 to 300,000 births. The disease comes under the umbrella term autosomal recessive congenital ichthyosis, which include non-syndromic congenital ichthyoses such as harlequin ichthyosis and lamellar ichthyosis.

<span class="mw-page-title-main">Neutral lipid storage disease</span> Congenital autosomal recessive disorder

Neutral lipid storage disease is a congenital autosomal recessive disorder characterized by accumulation of triglycerides in the cytoplasm of leukocytes, muscle, liver, fibroblasts, and other tissues. It commonly occurs as one of two subtypes, cardiomyopathic neutral lipid storage disease (NLSD-M), or ichthyotic neutral lipid storage disease (NLSD-I) which is also known as Chanarin–Dorfman syndrome), which are characterized primarily by myopathy and ichthyosis, respectively. Normally, the ichthyosis that is present is typically non-bullous congenital ichthyosiform erythroderma which appears as white scaling.

Alveolar capillary dysplasia (ACD) is a rare, congenital diffuse lung disease characterized by abnormal blood vessels in the lungs that cause highly elevated pulmonary blood pressure and an inability to effectively oxygenate and remove carbon dioxide from the blood. ACD typically presents in newborn babies within hours of birth as rapid and labored breathing, blue-colored lips or skin, quickly leading to respiratory failure and death. Atypical forms of ACD have been reported with initially milder symptoms and survival of many months before the onset of respiratory failure or lung transplantation.

Ichthyosis prematurity syndrome (IPS) is a dermatological disease with known genetic causes. This syndrome is a rare subcategory of autosomal recessive congenital ichthyosis (ARCI). It is associated with complications in the mid-trimester of a pregnancy leading to premature births. Although most prevalent in individuals of Scandinavian origin, there have also been scattered cases in people of Japanese, Italian and Indian ethnicity. This disorder is also referred to as ichthyosis congenital type IV.

Cerebral dysgenesis–neuropathy–ichthyosis–keratoderma syndrome is a neurocutaneous condition caused by mutation in the SNAP29 gene.

Haim–Munk syndrome is a skin disease caused, like Papillon–Lefèvre syndrome, by a mutation in the cathepsin C gene. One of its features is thick curved finger and toenails.

References

  1. Rathore, Swati; David, Liji Sarah; Beck, Manisha Madhai; Bindra, Mandeep Singh; Arunachal, Gautham (November 2015). "Harlequin Ichthyosis: Prenatal Diagnosis of a Rare Yet Severe Genetic Dermatosis". Journal of Clinical and Diagnostic Research. 9 (11): QD04–QD06. doi:10.7860/JCDR/2015/15250.6705. PMC   4668483 . PMID   26675324.
  2. Salehin, Shahrbanoo; Azizimoghadam, Ahmad; Abdollahimohammad, Abdolghani; Babaeipour-Divshali, Mohammad (November 2013). "Harlequin ichthyosis: Case report". Journal of Research in Medical Sciences. 18 (11): 1004–1005. PMC   3906774 . PMID   24520234.
  3. kelsell, David (May 2005). "Mutations in ABCA12 Underlie the Severe Congenital Skin Disease Harlequin Ichthyosis". Am J Hum Genet. 76 (5): 794–803. doi:10.1086/429844. PMC   1199369 . PMID   15756637.
  4. Craiglow, Brittany G. (1 February 2013). "Ichthyosis in the newborn". Seminars in Perinatology. 37 (1): 26–31. doi:10.1053/j.semperi.2012.11.001. PMC   3758581 . PMID   23419760.
  5. Pippi, Roberto (2017). "Post-Surgical Clinical Monitoring of Soft Tissue Wound Healing in Periodontal and Implant Surgery". International Journal of Medical Sciences. 14 (8): 721–728. doi: 10.7150/ijms.19727 . PMC   5562125 . PMID   28824306.
  6. 1 2 Thomas, Anna C.; Cullup, Tom; Norgett, Elizabeth E.; Hill, Tara; Barton, Stephanie; Dale, Beverly A.; Sprecher, Eli; Sheridan, Eamonn; Taylor, Aileen E.; Wilroy, Robert S.; DeLozier, Celia (2006). "ABCA12 is the major harlequin ichthyosis gene". The Journal of Investigative Dermatology. 126 (11): 2408–2413. doi: 10.1038/sj.jid.5700455 . ISSN   1523-1747. PMID   16902423.
  7. Brookes, Zoë L.S.; Bescos, Raul; Belfield, Louise A.; Ali, Kamran; Roberts, Anthony (2020). "Current uses of chlorhexidine for management of oral disease: a narrative review". Journal of Dentistry. 103: 103497. doi:10.1016/j.jdent.2020.103497. ISSN   0300-5712. PMC   7567658 . PMID   33075450.
  8. Nazir, Muhammad Ashraf (2017). "Prevalence of periodontal disease, its association with systemic diseases and prevention". International Journal of Health Sciences. 11 (2): 72–80. ISSN   1658-3639. PMC   5426403 . PMID   28539867.
  9. Shruthi, Belide; Nilgar, B.R.; Dalal, Anita; Limbani, Nehaben (2017-06-01). "Harlequin ichthyosis: A rare case" (PDF). Journal of Turkish Society of Obstetric and Gynecology. 14 (2): 138–140. doi:10.4274/tjod.63004. PMC   5558415 . PMID   28913151.
  10. "Harlequin Ichthyosis – A Case Report – Irish Medical Journal" . Retrieved 2020-12-16.
  11. Brandão, Pedro; Seco, Sandra; Loureiro, Teresa; Ramalho, Carla (2019). "Prenatal sonographic diagnosis of Harlequin ichthyosis". Journal of Clinical Ultrasound. 47 (4): 228–231. doi:10.1002/jcu.22675. ISSN   1097-0096. PMID   30508257. S2CID   54521900.
  12. Sharma, Amit; Rozzelle, Arlene; Jahnke, Marla N.; Desai, Jagdish; Shwayder, Tor A.; Kisseih, Esther; Bryant, Justin R.; Agarwal, Prashant (2019). "ABCA12 homozygous mutation in harlequin ichthyosis: Survival without systemic retinoids". Pediatric Dermatology. 36 (3): 339–341. doi:10.1111/pde.13770. ISSN   1525-1470. PMID   30809833. S2CID   73468533.
  13. Pinkova, Blanka; Buckova, Hana; Borska, Romana; Fajkusova, Lenka (2020-12-14). "Types of congenital nonsyndromic ichthyoses". Biomedical Papers. 164 (4): 357–365. doi: 10.5507/bp.2020.050 . PMID   33087941.

Category:Lip disorders