Abstract
Incontinentia pigmenti (IP) is a rare syndrome with skin lesions, ocular abnormalities in the retina and elsewhere, central nervous system abnormalities, and teeth defects. The authors present an updated review of the literature, highlighting diagnosis, epidemiology, pathophysiology, clinical features, and management of IP. IP is an X-linked dominant syndrome with an incidence of 0.0025%; most patients are female. IP is caused by a mutation in the IKBKG gene, causing a loss of function of NF-κß, leaving cells susceptible to apoptosis from intrinsic factors. The cardinal feature of IP is four stages of skin distinctive lesions. Of those with IP, 36.5% have detectable eye pathology and 60% to 90% of those have retinal issues. Peripheral avascularity and macular occlusive disease commonly occur. The authors performed a comprehensive review of Medline from 1947 to 2014. All papers mentioning IP in ophthalmologic journals were reviewed as well as applicable publications from other medical specialties.
[Ophthalmic Surg Lasers Imaging Retina. 2015;46:650–657.]
- 1.Garrod AE. Peculiar pigmentation of the skin of an infant. Transactions of the Clinical Society of London. 1906; 39:216. > Google Scholar
- 2.Landy SJ, Donnai D. Incontinentia pigmenti (Bloch-Sulzberger syndrome). J Med Genet. 1993; 30:53–59.
10.1136/jmg.30.1.53 > Crossref MedlineGoogle Scholar - 3.Carney RG. Incontinentia pigmenti. A world statistical analysis. Arch Dermatol. 1976; 112:535–542.
10.1001/archderm.1976.01630280059017 > Crossref MedlineGoogle Scholar - 4.Goldberg MF, Custis PH. Retinal and other manifestations of incontinentia pigmenti (Bloch-Sulzberger syndrome). Ophthalmology. 1993; 100:1645–1654.
10.1016/S0161-6420(93)31422-3 > Crossref MedlineGoogle Scholar - 5.Minic S, Obradovic M, Kovacevic I, Trpinac D. Ocular anomalies in incontinentia pigmenti: literature review and meta-analysis. Srp Arh Celok Lek. 2010; 138:408–413.
10.2298/SARH1008408M > Crossref MedlineGoogle Scholar - 6.Fusco F, Paciolla M, Conte MI, Incontinentia pigmenti: report on data from 2000 to 2013. Orphanet JRare Dis. 2014; 9:93.
10.1186/1750-1172-9-93 > Crossref MedlineGoogle Scholar - 7.Scheuerle AE. Male cases of incontinentia pigmenti: case report and review. Am J Med Genet. 1998; 77:201–218.
10.1002/(SICI)1096-8628(19980518)77:3<201::AID-AJMG5>3.0.CO;2-S > Crossref MedlineGoogle Scholar - 8.Yang Y, Guo Y, Ping Y, Zhou XG, Li Y. Neonatal incontinentia pigmenti: Six cases and a literature review. ExpTher Med. 2014; 8(6):1797–1806. > CrossrefGoogle Scholar
- 9.Scheuerle A, Ursini MV. Incontinentia Pigmenti. 1999Jun8 [Updated 2010 Oct 28]. In: , editors. GeneReviews™ [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2013. Available from: http://www.ncbi.nlm.nih.gov/books/NBK1472/. > Google Scholar
- 10.Thakur S, Puri RD, Kohli S, Saxena R, Verma IC. Utility of molecular studies in incontinentia pigmenti patients. Indian J Med Res. 2011; 133:442–445. > MedlineGoogle Scholar
- 11.Buinauskaite E, Buinauskiene J, Kucinskiene V, Strazdiene D, Valiukeviciene S. Incontinentia pigmenti in a male infant with Klinefelter syndrome: a case report and review of the literature. Pediatr Dermatol. 2010; 27:492–495.
10.1111/j.1525-1470.2010.01261.x > Crossref MedlineGoogle Scholar - 12.Kenwrick S, Woffendin H, Jakins T, Survival of male patients with incontinentia pigmenti carrying a lethal mutation can be explained by somatic mosaicism or Klinefelter syndrome. Am J Hum Genet. 2001; 69:1210–1217.
10.1086/324591 > Crossref MedlineGoogle Scholar - 13.Smahi A, Courtois G, Vabres P, Genomic rearrangement in NEMO impairs NF-kappaB activation and is a cause of incontinentia pigmenti. The International Incontinentia Pigmenti (IP) Consortium. Nature. 2000; 405:466–472.
10.1038/35013114 > Crossref MedlineGoogle Scholar - 14.Nelson DL. NEMO, NFkappaB signaling and incontinentia pigmenti. Curr Opin Genet Dev. 2006; 16:282–288.
10.1016/j.gde.2006.04.013 > Crossref MedlineGoogle Scholar - 15.Fusco F, Pescatore A, Bal E, Alterations of the IKBKG locus and diseases: an update and a report of 13 novel mutations. Hum Mutat. 2008; 29:595–604.
10.1002/humu.20739 > Crossref MedlineGoogle Scholar - 16.Li Y, Kang J, Friedman J, Identification of a cell protein (FIP-3) as a modulator of NF-kappaB activity and as a target of an adenovirus inhibitor of tumor necrosis factor alpha-induced apoptosis. Proc Natl Acad Sci USA. 1999; 96:1042–1047.
10.1073/pnas.96.3.1042 > Crossref MedlineGoogle Scholar - 17.Smahi A, Courtois G, Rabia SH, The NF-kappaB signaling pathway in human diseases: from incontinentia pigmenti to ectodermal dysplasias and immune-deficiency syndromes. Hum Mol Genet. 2002; 11:2371–2375.
10.1093/hmg/11.20.2371 > Crossref MedlineGoogle Scholar - 18.Conte MI, Pescatore A, Paciolla M, Insight into IKBKG/NEMO locus: report of new mutations and complex genomic rearrangements leading to incontinentia pigmenti disease. Hum Mutat. 2014; 35(2):165–177.
10.1002/humu.22483 > Crossref MedlineGoogle Scholar - 19.Roberts CML, Angus JE, Leach IH, A novel NEMO gene mutation causing osteopetrosis, lymphoedema, hypohidrotic ectodermal dysplasia and immunodeficiency (OL-HED-ID). Eur J Pediatr. 2010; 169:1403–1407.
10.1007/s00431-010-1206-7 > Crossref MedlineGoogle Scholar - 20.Berlin AL, Paller AS, Chan LS. Incontinentia pigmenti: a review and update on the molecular basis of pathophysiology. J Am Acad Dermatol. 2002; 47:169–187; quiz 188.
10.1067/mjd.2002.125949 > Crossref MedlineGoogle Scholar - 21.Nenci A, Huth M, Funteh A, Skin lesion development in a mouse model of incontinentia pigmenti is triggered by NEMO deficiency in epidermal keratinocytes and requires TNF signaling. Hum Mol Genet. 2006; 15:531–542.
10.1093/hmg/ddi470 > Crossref MedlineGoogle Scholar - 22.Oster SF, McLeod DS, Otsuji T, Goldberg MF, Lutty GA. Preliminary ocular histopathological observations on heterozygous NEMO-deficient mice. Exp Eye Res. 2009; 88:613–616.
10.1016/j.exer.2008.10.027 > Crossref MedlineGoogle Scholar - 23.Makris C, Godfrey VL, Krähn-Senftleben G, Female mice heterozygous for IKK gamma/NEMO deficiencies develop a dermatopathy similar to the human X-linked disorder incontinentia pigmenti. Mol Cell. 2000; 5:969–979.
10.1016/S1097-2765(00)80262-2 > Crossref MedlineGoogle Scholar - 24.Jean-Baptiste S, O’Toole EA, Chen M, Expression of eotaxin, an eosinophil-selective chemokine, parallels eosinophil accumulation in the vesiculobullous stage of incontinentia pigmenti. Clin Exp Immunol. 2002; 127:470–478.
10.1046/j.1365-2249.2002.01755.x > Crossref MedlineGoogle Scholar - 25.Goldberg MF. The skin is not the predominant problem in incontinentia pigmenti. Arch Dermatol. 2004; 140:748–750.
10.1001/archderm.140.6.748 > Crossref MedlineGoogle Scholar - 26.Ehrenreich M, Tarlow MM, Godlewska-Janusz E, Schwartz RA. Incontinentia pigmenti (Bloch-Sulzberger syndrome): a systemic disorder. Cutis. 2007; 79:355–362. > MedlineGoogle Scholar
- 27.Minic S, Trpinac D, Obradovic M. Incontinentia pigmenti diagnostic criteria update. Clin Genet. 2014; 85(6):536–542.
10.1111/cge.12223 > Crossref MedlineGoogle Scholar - 28.Ardelean D, Pope E. Incontinentia pigmenti in boys: a series and review of the literature. Pediatr Dermatol. 2006; 23:523–527.
10.1111/j.1525-1470.2006.00302.x > Crossref MedlineGoogle Scholar - 29.Belligni EF, Dokal I, Hennekam RCM. Prenatal and postnatal growth retardation, microcephaly, developmental delay, and pigmentation abnormalities: Naegeli syndrome, dyskeratosis congenita, poikiloderma Clericuzio type, or separate entity?Eur J Med Genet. 2011; 54:231–235.
10.1016/j.ejmg.2011.01.001 > Crossref MedlineGoogle Scholar - 30.Nix RR, Apple DJ. Proliferative retinopathy associated with incontinentia pigmenti. Retina. 1981; 1:156–161.
10.1097/00006982-198101030-00003 > Crossref MedlineGoogle Scholar - 31.Holmström G, Thorén K. Ocular manifestations of incontinentia pigmenti. Acta Ophthalmol Scand. 2000; 78:348–353.
10.1034/j.1600-0420.2000.078003348.x > Crossref MedlineGoogle Scholar - 32.Goldberg MF. The blinding mechanisms of incontinentia pigmenti. Ophthalmic Genet. 1994; 15:69–76.
10.3109/13816819409098866 > Crossref MedlineGoogle Scholar - 33.Catalano RA. Incontinentia pigmenti. Am J Ophthalmol. 1990; 110:696–700.
10.1016/S0002-9394(14)77070-9 > Crossref MedlineGoogle Scholar - 34.Wald KJ, Mehta MC, Katsumi O, Sabates NR, Hirose T. Retinal detachments in incontinentia pigmenti. Arch Ophthalmol. 1993; 111:614–617.
10.1001/archopht.1993.01090050048026 > Crossref MedlineGoogle Scholar - 35.Watzke RC, Stevens TS, Carney RG. Retinal vascular changes of incontinentia pigmenti. Arch Ophthalmol. 1976; 94:743–746.
10.1001/archopht.1976.03910030353001 > Crossref MedlineGoogle Scholar - 36.Goldberg MF. Macular vasculopathy and its evolution in incontinentia pigmenti. Trans Am Ophthalmol Soc. 1998; 96:55–65; discussion 65. > MedlineGoogle Scholar
- 37.François J. Incontinentia pigmenti (Bloch-Sulzberger syndrome) and retinal changes. Br J Ophthalmol. 1984; 68:19–25.
10.1136/bjo.68.1.19 > Crossref MedlineGoogle Scholar - 38.Cates CA, Dandekar SS, Flanagan DW, Moore AT. Retinopathy of incontinentia pigmenti: a case report with thirteen years follow-up. Ophthalmic Genet. 2003; 24:247–252.
10.1076/opge.24.4.247.17237 > Crossref MedlineGoogle Scholar - 39.Jain RB, Willetts GS. Fundus changes in incontinentia pigmenti (Bloch-Sulzberger syndrome): a case report. Br J Ophthalmol. 1978; 62:622–626.
10.1136/bjo.62.9.622 > Crossref MedlineGoogle Scholar - 40.Shaikh S, Trese MT, Archer SM. Fluorescein angiographic findings in incontinentia pigmenti. Retina. 2004; 24:628–629.
10.1097/00006982-200408000-00025 > Crossref MedlineGoogle Scholar - 41.Patel CK, Fung TH, Muqit MM, Mordant DJ, Geh V. Non-contact ultra-widefield retinal imaging and fundus fluorescein angiography of an infant with incontinentia pigmenti without sedation in an ophthalmic office setting. J AAPOS. 2013; 17(3):309–311.
10.1016/j.jaapos.2012.12.152 > Crossref MedlineGoogle Scholar - 42.Balaratnasingam C, Lam GC. Retinal sequelae of incontinentia pigmenti. Pediatr Int. 2009; 51:141–143.
10.1111/j.1442-200X.2008.02780.x > Crossref MedlineGoogle Scholar - 43.Equi RA, Bains HS, Jampol L, Goldberg MF. Retinal tears occurring at the border of vascular and avascular retina in adult patients with incontinentia pigmenti. Retina. 2003; 23:574–576.
10.1097/00006982-200308000-00030 > Crossref MedlineGoogle Scholar - 44.Azizzadeh M, Rezaei M, Hashemi N. Incontinentia pigmenti: a newborn with characteristic skin lesions and bilateral optic atrophy: case report and review of literature. Acta Med Iran. 2013; 51(11):805–810. > MedlineGoogle Scholar
- 45.Ferreira RC, Ferreira LC, Forstot L, King R. Corneal abnormalities associated with incontinentia pigmenti. Am J Ophthalmol. 1997; 123:549–551.
10.1016/S0002-9394(14)70183-7 > Crossref MedlineGoogle Scholar - 46.Selvadurai D, Salomão DR, Baratz KH. Corneal abnormalities in incontinentia pigmenti: histopathological and confocal correlations. Cornea. 2008; 27:833–836.
10.1097/ICO.0b013e31816b6a26 > Crossref MedlineGoogle Scholar - 47.Ciarallo L, Paller AS. Two cases of incontinentia pigmenti simulating child abuse. Pediatrics. 1997; 100:E6.
10.1542/peds.100.4.e6 > Crossref MedlineGoogle Scholar - 48.Minic S, Trpinac D, Obradovic M. Systematic review of central nervous system anomalies in incontinentia pigmenti. Orphanet J Rare Dis. 2013; 8:25.
10.1186/1750-1172-8-25 > Crossref MedlineGoogle Scholar - 49.Pizzamiglio MR, Piccardi L, Bianchini F, Incontinentia pigmenti: learning disabilities are a fundamental hallmark of the disease. PLoS One. 2014; 9(1):e87771.
10.1371/journal.pone.0087771 > Crossref MedlineGoogle Scholar - 50.Pinheiro A, Mathew MC, Thomas M, The clinical profile of children in India with pigmentary anomalies along the lines of Blaschko and central nervous system manifestations. Pediatr Dermatol. 2007; 24:11–17.
10.1111/j.1525-1470.2007.00325.x > Crossref MedlineGoogle Scholar - 51.Wolf NI, Krämer N, Harting I, Diffuse cortical necrosis in a neonate with incontinentia pigmenti and an encephalitis-like presentation. AJNR Am J Neuroradiol. 2005; 26:1580–1582. > MedlineGoogle Scholar
- 52.Mini S, Trpinac D, Gabriel H, Gencik M, Obradovi M. Dental and oral anomalies in incontinentia pigmenti: a systematic review. Clin Oral Investig. 2013; 17:1–8.
10.1007/s00784-012-0721-5 > Crossref MedlineGoogle Scholar - 53.Hadj-Rabia S, Rimella A, Smahi A, Fraitag S, Hamel-Teillac D, Bonnefont JP, Clinical and histologic features of incontinentia pigmenti in adults with nuclear factor-?B essential modulator gene mutations. J Am Acad Dermatol. 2011; 64:508–515.
10.1016/j.jaad.2010.01.045 > Crossref MedlineGoogle Scholar - 54.Wong GAE, Willoughby CE, Parslew R, Kaye SB. The importance of screening for sight-threatening retinopathy in incontinentia pigmenti. Pediatr Dermatol. 2004; 21:242–245.
10.1111/j.0736-8046.2004.21311.x > Crossref MedlineGoogle Scholar - 55.Jandeck C, Kellner U, Foerster MH. Successful treatment of severe retinal vascular abnormalities in incontinentia pigmenti. Retina. 2004; 24:631–633.
10.1097/00006982-200408000-00027 > Crossref MedlineGoogle Scholar - 56.Ranchod TM, Trese MT. Regression of retinal neovascularization after laser photocoagulation in incontinentia pigmenti. Retina. 2010; 30:708–709.
10.1097/IAE.0b013e3181cd4942 > Crossref MedlineGoogle Scholar - 57.Rahi J, Hungerford J. Early diagnosis of the retinopathy of incontinentia pigmenti: successful treatment by cryotherapy. Br J Ophthalmol. 1990; 74:377–379.
10.1136/bjo.74.6.377 > Crossref MedlineGoogle Scholar - 58.Yu YS, Cho BJ. Cryotherapy for retinopathy of incontinentia pigmenti. Korean J Ophthalmol. 1991; 5:47–50.
10.3341/kjo.1991.5.1.47 > Crossref MedlineGoogle Scholar - 59.Chao AN, Lai CC, Kao LY, Incontinentia pigmenti: a florid case with a fulminant clinical course in a newborn. Retina. 2000; 20:558–560.
10.1097/00006982-200005000-00026 > Crossref MedlineGoogle Scholar - 60.Lin KL, Hirose T, Kroll AJ, Lou PL, Ryan EA. Prospects for treatment of pediatric vitreoretinal diseases with vascular endothelial growth factor inhibition. Semin Ophthalmol. 2009; 24:70–76.
10.1080/08820530902800108 > Crossref MedlineGoogle Scholar - 61.Shah PK, Bachu S, Narendran V, Kalpana N, David J, Srinivas CR. Intravitreal bevacizumab for incontinentia pigmenti. J Pediatr Ophthalmol Strabismus. 2013; 50:e52–54. > LinkGoogle Scholar