Zghal M, Fazaa B, Abdelhak S, Mokni M
Service de dermatologie, Hôpital Charles Nicolle, Tunis, Tunisie.
Laboratory of Biomedical Genomics and Oncogenetics LR11IPT05, Institut Pasteur, Tunis, Tunisie.
Ann Dermatol Venereol. 2018 Nov;145(11):706-722. doi: 10.1016/j.annder.2018.09.004. Epub 2018 Nov 6.
Xeroderma pigmentosum (XP) is a form of general dermatosis characterised by photo-induced cutaneous-ocular impairment and by skin cancers. In addition to these signs, there may also be neurological involvement. This disease is related to a defect in genes within the nucleotide excision repair system for the first seven genetic groups (A-G), and to an abnormality in transcription groups for the eighth group (xeroderma pigmentosum variant - XPV). Cutaneous carcinomas are the most common types of cancer seen. They may begin in childhood. Multiple melanoma commonly occurs during the course of XP but given the frequency of spontaneous regression, the incidence is underestimated. The clinical appearance is characterised by polymorphous lesions with characteristic dyschromia and in most cases it is sufficient to establish the diagnosis. Investigation of unscheduled DNA synthesis (UDS) and cell survival following ultraviolet (UV) radiation were formerly considered the reference examination for laboratory diagnosis. However, these tests are now being replaced by new molecular biology techniques to screen for the genetic mutations characteristic of the disease. These techniques have proved extremely useful in identifying heterozygous patients and in antenatal diagnosis. Photoprotection is the key preventive measure: patients must avoid all exposure to the sun and to artificial sources of UV radiation. The therapeutic arsenal has recently been enriched by several modern therapeutic methods used to destroy cutaneous tumours such as imiquimod and photodynamic therapy (PDT). These approaches are valuable since they eliminate incipient tumours while sparing healthy skin. Surgery and cryosurgery are the most suitable methods for treating cutaneous tumours in children. Chemotherapy may be considered an alternative for the treatment of keratoacanthomas and squamous cell carcinomas (SCC). Cryosurgery may be combined with other therapeutic approaches to eliminate SCC of the lip. Management of these patients in reference centres, coupled with assistance from associations providing support for patients' families, has resulted in improved quality of therapy while slowing down disease progression.
着色性干皮病(XP)是一种全身性皮肤病,其特征为光诱导的皮肤 - 眼部损伤和皮肤癌。除了这些症状外,还可能有神经受累。该疾病与前七个基因组(A - G)的核苷酸切除修复系统中的基因缺陷以及第八组(着色性干皮病变异型 - XPV)的转录组异常有关。皮肤癌是最常见的癌症类型。它们可能在儿童期开始。多发性黑色素瘤在XP病程中常见,但由于自发消退的频率,其发病率被低估。临床表现的特征是具有特征性色素沉着异常的多形性病变,在大多数情况下,这足以确立诊断。以前,非计划DNA合成(UDS)和紫外线(UV)辐射后细胞存活情况的检测被认为是实验室诊断的参考检查。然而,现在这些检测正被用于筛查该疾病特征性基因突变的新分子生物学技术所取代。这些技术在识别杂合子患者和产前诊断方面已被证明非常有用。光防护是关键的预防措施:患者必须避免所有阳光照射和紫外线辐射的人工来源。最近,用于破坏皮肤肿瘤的几种现代治疗方法,如咪喹莫特和光动力疗法(PDT),丰富了治疗手段。这些方法很有价值,因为它们能消除早期肿瘤,同时 sparing healthy skin(此处原文有误,推测应为“保护健康皮肤”)。手术和冷冻手术是治疗儿童皮肤肿瘤最合适的方法。化疗可被视为治疗角化棘皮瘤和鳞状细胞癌(SCC)的替代方法。冷冻手术可与其他治疗方法联合用于消除唇部的SCC。在参考中心对这些患者进行管理,再加上为患者家庭提供支持的协会的协助,提高了治疗质量,同时减缓了疾病进展。