Correspondence
A Case Report of Inversa Acne and Evaluation for Mutations in the NCSTN, PSENEN, and PSEN1 Genes Bi‑Rong Guo1, Cong‑Sheng Li2, Qi‑Ming Zhu1, Kang Xu1, Wei Pan1, Peng Jiang1 Department of Dermatology, The Third Affiliated Hospital of Anhui Medical University, The First People’s Hospital of Hefei, Hefei, Anhui 230061, China Department of Emergency Medicine, The Third Affiliated Hospital of Anhui Medical University, The First People’s Hospital of Hefei, Hefei, Anhui 230061, China 1
2
To the Editor: Acne inversa (AI; OMIM: 142690) is a painful chronic follicular disease, characterized by recurrent draining sinuses and abscesses with subsequent scarring and chronic seepage, predominantly in skin folds that carry terminal hairs and apocrine glands. It mainly affects the scalp, neck, the axillae, perineum, and inframammary regions. AI significantly affects patients’ quality of life because of the chronic and recurrent nature of symptoms as well as the lack of satisfying treatment options. Gao et al.[1] have already discovered that the genetic locus responsible for AI is located at chromosome 1p21.1‑1q25.3 by genome‑wide linkage scan, but could not identify any causal gene for the disease. Wang et al.[2] found independent loss‑of‑function mutations in presenilin enhancer gamma-secretase subunit (PSENEN), presenilin 1 (PSEN1), or Nicastrin (NCSTN), which encode essential components of the γ‑secretase multiprotein complex. Liu et al.[3] further confirmed the pathogenic role of NCSTN mutations in AI by combining exome sequencing with previous genome‑wide linkage analysis. Jiao et al.[4] found a novel mutation of c. 1258C >T in NCSTN, which would lead to a substitution of glutamine by a premature termination codon at amino acid 420 (p.Q420X). In November 2014, a 33‑year‑old Chinese man consulted for severe facial acne associated with suppurating lesions of major body folds, which presented with typical characteristics of AI. The patient reported that cysts appeared repeatedly on his head in August 2002, subsequently, inflammatory subcutaneous nodules developed on the face, neck, and armpit [Figure 1] (the patient with AI refused to provide the photo on his face and neck, now we offer only typical photo in his armpit). Isotretinoin soft capsules, minocycline, and cephalosporins have been administered orally, while rivanol and retinoic acid cream were used on local lesions, but the lesions were not improved obviously. No other skin, nail, or hair abnormality was found. The patient denied other family member had similar lesions and denied cousins matrimony history of his parents. After physical examination by experienced clinical dermatologists, the clinical characteristics supported the diagnosis of AI. Here, we reported this patient with AI and sequenced NCSTN, PSENEN, and PSEN1 genes. The study was approved by the Ethics Access this article online Quick Response Code:
Website: www.cmj.org
DOI: 10.4103/0366-6999.185853
Chinese Medical Journal ¦ July 20, 2016 ¦ Volume 129 ¦ Issue 14
Figure 1: Clinical features of the patient with acne inversa. Fibrosis, nodules, abscesses, and scars on the armpit. Committee of Anhui Medical University and conducted according to the principles of the Declaration of Helsinki. The result of sequencing showed no causative mutation in the coding regions or splice sites of these three genes. AI is a chronic inflammatory skin disease that presents with nodules, cysts, and abscesses in apocrine gland‑bearing sites. In this study, we examined the γ‑secretase genes NCSTN, PSENEN, and PSEN1 for mutations and found no mutation. This result suggests that AI is a genetically heterogeneous disorder. The causative genes of some monogenic disorders, such as disseminated superficial actinic porokeratosis, [5] have been found by linkage analysis combined with whole Address for correspondence: Dr. Bi‑Rong Guo, Department of Dermatology, The Third Affiliated Hospital of Anhui Medical University, The First People’s Hospital of Hefei, Hefei, Anhui 230061, China E‑Mail: [email protected]
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. © 2016 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow
Received: 01‑01‑2016 Edited by: Li‑Shao Guo How to cite this article: Guo BR, Li CS, Zhu QM, Xu K, Pan W, Jiang P. A Case Report of Inversa Acne and Evaluation for Mutations in the NCSTN, PSENEN, and PSEN1 Genes. Chin Med J 2016;129:1759-60. 1759
exome sequencing, but we did not find the mutation of these disease‑causing genes in some families or sporadic patients, indicating that there may be other causative genes. Hence, additional and as yet unknown genes predispose to the development of this distressing disorder. Further study, using extensive sequencing of noncoding or regulatory sequence of these genes, is warranted.
Acknowledgment
We are most grateful to the patient with AI.
Financial support and sponsorship
This work was supported by a grant from the National Natural Science Foundation of China (No. 81301352).
Conflicts of interest
There are no conflicts of interest.
1760
References 1. Gao M, Wang PG, Cui Y, Yang S, Zhang YH, Lin D, et al. Inversa acne (hidradenitis suppurativa): A case report and identification of the locus at chromosome 1p21.1‑1q25.3. J Invest Dermatol 2006;126:1302‑6. doi: 10.1038/sj.jid.5700272. 2. Wang B, Yang W, Wen W, Sun J, Su B, Liu B, et al. Gamma‑secretase gene mutations in familial acne inversa. Science 2010;330:1065. doi: 10.1126/science.1196284. 3. Liu Y, Gao M, Lv YM, Yang X, Ren YQ, Jiang T, et al. Confirmation by exome sequencing of the pathogenic role of NCSTN mutations in acne inversa (hidradenitis suppurativa). J Invest Dermatol 2011;131:1570‑2. doi: 10.1038/jid.2011.62. 4. Jiao T, Dong H, Jin L, Wang S, Wang J. A novel nicastrin mutation in a large Chinese family with hidradenitis suppurativa. Br J Dermatol 2013;168:1141‑3. doi: 10.1111/bjd.12135. 5. Zhang SQ, Jiang T, Li M, Zhang X, Ren YQ, Wei SC, et al. Exome sequencing identifies MVK mutations in disseminated superficial actinic porokeratosis. Nat Genet 2012;44:1156‑60. doi: 10.1038/ng.2409.
Chinese Medical Journal ¦ July 20, 2016 ¦ Volume 129 ¦ Issue 14
A Case Report of Inversa Acne and Evaluation for Mutations in the NCSTN, PSENEN, and PSEN1 Genes Bi‑Rong Guo1, Cong‑Sheng Li2, Qi‑Ming Zhu1, Kang Xu1, Wei Pan1, Peng Jiang1 Department of Dermatology, The Third Affiliated Hospital of Anhui Medical University, The First People’s Hospital of Hefei, Hefei, Anhui 230061, China Department of Emergency Medicine, The Third Affiliated Hospital of Anhui Medical University, The First People’s Hospital of Hefei, Hefei, Anhui 230061, China 1
2
To the Editor: Acne inversa (AI; OMIM: 142690) is a painful chronic follicular disease, characterized by recurrent draining sinuses and abscesses with subsequent scarring and chronic seepage, predominantly in skin folds that carry terminal hairs and apocrine glands. It mainly affects the scalp, neck, the axillae, perineum, and inframammary regions. AI significantly affects patients’ quality of life because of the chronic and recurrent nature of symptoms as well as the lack of satisfying treatment options. Gao et al.[1] have already discovered that the genetic locus responsible for AI is located at chromosome 1p21.1‑1q25.3 by genome‑wide linkage scan, but could not identify any causal gene for the disease. Wang et al.[2] found independent loss‑of‑function mutations in presenilin enhancer gamma-secretase subunit (PSENEN), presenilin 1 (PSEN1), or Nicastrin (NCSTN), which encode essential components of the γ‑secretase multiprotein complex. Liu et al.[3] further confirmed the pathogenic role of NCSTN mutations in AI by combining exome sequencing with previous genome‑wide linkage analysis. Jiao et al.[4] found a novel mutation of c. 1258C >T in NCSTN, which would lead to a substitution of glutamine by a premature termination codon at amino acid 420 (p.Q420X). In November 2014, a 33‑year‑old Chinese man consulted for severe facial acne associated with suppurating lesions of major body folds, which presented with typical characteristics of AI. The patient reported that cysts appeared repeatedly on his head in August 2002, subsequently, inflammatory subcutaneous nodules developed on the face, neck, and armpit [Figure 1] (the patient with AI refused to provide the photo on his face and neck, now we offer only typical photo in his armpit). Isotretinoin soft capsules, minocycline, and cephalosporins have been administered orally, while rivanol and retinoic acid cream were used on local lesions, but the lesions were not improved obviously. No other skin, nail, or hair abnormality was found. The patient denied other family member had similar lesions and denied cousins matrimony history of his parents. After physical examination by experienced clinical dermatologists, the clinical characteristics supported the diagnosis of AI. Here, we reported this patient with AI and sequenced NCSTN, PSENEN, and PSEN1 genes. The study was approved by the Ethics Access this article online Quick Response Code:
Website: www.cmj.org
DOI: 10.4103/0366-6999.185853
Chinese Medical Journal ¦ July 20, 2016 ¦ Volume 129 ¦ Issue 14
Figure 1: Clinical features of the patient with acne inversa. Fibrosis, nodules, abscesses, and scars on the armpit. Committee of Anhui Medical University and conducted according to the principles of the Declaration of Helsinki. The result of sequencing showed no causative mutation in the coding regions or splice sites of these three genes. AI is a chronic inflammatory skin disease that presents with nodules, cysts, and abscesses in apocrine gland‑bearing sites. In this study, we examined the γ‑secretase genes NCSTN, PSENEN, and PSEN1 for mutations and found no mutation. This result suggests that AI is a genetically heterogeneous disorder. The causative genes of some monogenic disorders, such as disseminated superficial actinic porokeratosis, [5] have been found by linkage analysis combined with whole Address for correspondence: Dr. Bi‑Rong Guo, Department of Dermatology, The Third Affiliated Hospital of Anhui Medical University, The First People’s Hospital of Hefei, Hefei, Anhui 230061, China E‑Mail: [email protected]
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. © 2016 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow
Received: 01‑01‑2016 Edited by: Li‑Shao Guo How to cite this article: Guo BR, Li CS, Zhu QM, Xu K, Pan W, Jiang P. A Case Report of Inversa Acne and Evaluation for Mutations in the NCSTN, PSENEN, and PSEN1 Genes. Chin Med J 2016;129:1759-60. 1759
exome sequencing, but we did not find the mutation of these disease‑causing genes in some families or sporadic patients, indicating that there may be other causative genes. Hence, additional and as yet unknown genes predispose to the development of this distressing disorder. Further study, using extensive sequencing of noncoding or regulatory sequence of these genes, is warranted.
Acknowledgment
We are most grateful to the patient with AI.
Financial support and sponsorship
This work was supported by a grant from the National Natural Science Foundation of China (No. 81301352).
Conflicts of interest
There are no conflicts of interest.
1760
References 1. Gao M, Wang PG, Cui Y, Yang S, Zhang YH, Lin D, et al. Inversa acne (hidradenitis suppurativa): A case report and identification of the locus at chromosome 1p21.1‑1q25.3. J Invest Dermatol 2006;126:1302‑6. doi: 10.1038/sj.jid.5700272. 2. Wang B, Yang W, Wen W, Sun J, Su B, Liu B, et al. Gamma‑secretase gene mutations in familial acne inversa. Science 2010;330:1065. doi: 10.1126/science.1196284. 3. Liu Y, Gao M, Lv YM, Yang X, Ren YQ, Jiang T, et al. Confirmation by exome sequencing of the pathogenic role of NCSTN mutations in acne inversa (hidradenitis suppurativa). J Invest Dermatol 2011;131:1570‑2. doi: 10.1038/jid.2011.62. 4. Jiao T, Dong H, Jin L, Wang S, Wang J. A novel nicastrin mutation in a large Chinese family with hidradenitis suppurativa. Br J Dermatol 2013;168:1141‑3. doi: 10.1111/bjd.12135. 5. Zhang SQ, Jiang T, Li M, Zhang X, Ren YQ, Wei SC, et al. Exome sequencing identifies MVK mutations in disseminated superficial actinic porokeratosis. Nat Genet 2012;44:1156‑60. doi: 10.1038/ng.2409.
Chinese Medical Journal ¦ July 20, 2016 ¦ Volume 129 ¦ Issue 14
