Pachyonychia Congenita 1; Pc1

Description

Pachyonychia congenita (PC) is an autosomal dominant genodermatosis with the main clinical features of hypertrophic nail dystrophy, painful and highly debilitating plantar keratoderma, oral leukokeratosis, and a variety of epidermal cysts. Although the condition had previously been subdivided clinically into Jadassohn-Lewandowsky PC type 1 and Jackson-Lawler PC type 2, patients with PC were later found to have a mixed constellation of both types, leading to a classification of PC based on genotype (summary by Sybert, 2010; Eliason et al., 2012; McLean et al., 2011). Historical Classification of Pachyonychia CongenitaGorlin et al. (1976) suggested that 2 distinct syndromes are subsumed under the designation pachyonychia congenita. PC type 1, the Jadassohn-Lewandowsky type, shows oral leukokeratosis. PC type 2, the Jackson-Lawler type, has natal teeth and epidermoid cysts (cylindromas), but no oral leukoplakia. Corneal dystrophy may be a feature exclusively of the Jackson-Lawler type.Smith et al. (1998) stated that PC type 2, in contrast to PC type 1, has minimal oral involvement and milder keratoderma, and multiple steatocystomas (OMIM ) is a major clinical feature. Steatocystoma, also known as eruptive vellus cyst, is a cystic hamartoma lined by sebaceous ductal epithelium.On the basis of a study of 13 patients with PC type 1 or type 2, Terrinoni et al. (2001) concluded that the presence of pilosebaceous cysts following puberty is the best indicator of PC type 2; prepubescent patients are more difficult to classify due to the lack of cysts. Natal teeth are indicative of PC type 2, although their absence does not preclude the PC type 2 diagnosis. Genetic Heterogeneity of Pachyonychia CongenitaSee pachyonychia congenita-2 (PC2 ), caused by mutation in the KRT17 gene (OMIM ) on chromosome 17; PC3 (OMIM ), caused by mutation in the KRT6A gene (OMIM ) on chromosome 2; and PC4 (OMIM ), caused by mutation or in the KRT6B gene (OMIM ) on chromosome 12.See {260130} for a possible autosomal recessive form of pachyonychia congenita.

Clinical Features

• Intellectual disability
• Respiratory distress
• Alopecia
• Hyperhidrosis
• Hyperkeratosis
• Nail dystrophy
• Inability to walk
• Hoarse voice
• Corneal dystrophy
• Palmoplantar hyperkeratosis

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