Neuropediatrics 2010; 41(2): 60-65
DOI: 10.1055/s-0030-1261919
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Neurological Manifestations in Individuals with Pure Cutaneous or Syndromic (Ruggieri-Happle Syndrome) Phenotypes with “Cutis Tricolor”: A Study of 14 Cases

E. Lionetti1 , P. Pavone2 , I. Kennerknecht3 , G. Failla4 , C. Schepis5 , R. De Pasquale6 , L. Pavone1 , M. Ruggieri7
  • 1Department of Paediatrics, University of Catania, Catania, Italy
  • 2Unit of Paediatrics “Costanza Gravina”, University Hospital “Vittorio Emanuele”, Catania, Italy
  • 3Institut für Humangenetik, Westfälische Wilhelms Universität, Münster, Germany
  • 4Unit of Paediatrics, IRCCS Oasi Maria SS, Troina, Italy
  • 5Unit of Dermatology, IRCCS Oasi Maria SS, Troina, Italy
  • 6Chair of Dermatology, Unit of Clinical Dermatology, University of Catania, Catania, Italy
  • 7Chair of Paediatrics, Department of Formative Processes, University of Catania, Catania, Italy
Further Information

Publication History

received 12.03.2010

accepted 15.06.2010

Publication Date:
26 August 2010 (online)

Abstract

Background: The term cutis tricolor describes the combination of congenital hyper- and hypo-pigmented skin lesions in close proximity to each other in a background of normal complexion. This phenomenon has been reported so far: (i) as pure cutaneous trait, (ii) as a part of a complex malformation syndrome (Ruggieri-Happle syndrome – RHS), (iii) as a distinct type (cutis tricolor parvimaculata); (iv) in association with other (e. g., vascular) skin disturbances.

Aim: The aim of this study was to define the spectrum of neurological abnormalities in cutis tricolor.

Methods: A retrospective and prospective 14-year study of clinical, electroencephalographic (EEG), neuroradiological (MRI), cytogenetic and ZFHX1B gene studies of 14 individuals (8 M, 6 F; aged 2–28 years) with cutis tricolor (4 pure cutaneous; 10 syndromic) was undertaken.

Results: Neurological involvement was recorded in 71.4% (10/14) of the patients [100% (10/10) in RHS and null (0/4) in cases with isolated skin manifestations] and included psychomotor delay (n=8), seizures (n=9), EEG abnormalities (n=6), a behavioural phenotype (n=4), non-specific brain abnormalities (n=6). Genetic analyses excluded ZFHX1B mutations and revealed a 19qter deletion (n=1).

Conclusions: Even though we could not exclude the ascertainment and referral biases, we concluded that cutis tricolor may be a marker of underlying neurological involvement particularly in subjects with a syndromic (RHS) phenotype.

References

  • 1 Baba M, Seckin D, Akcali C. et al . Familial cutis tricolor: a possible example of paradominant inheritance.  Eur J Dermatol. 2003;  13 343-345
  • 2 Battaglia A, Gurrieri F, Bertini E. et al . The inv dup (15) syndrome: a clinically recognizable syndrome with altered behaviour, mental retardation, and epilepsy.  Neurology. 1997;  48 1081-1086
  • 3 Boente M del C, Obeid R, Asial RA. et al . Cutis tricolor coexistent with cutis marmorata telangiectatica congenita: “phacomatosis achromico-melano-marmorata”.  Eur J Dermatol. 2008;  18 394-396
  • 4 De las Heras E, Boixeda JP, Lader A. et al . Paired melanotic and achromic macules in a case of phacomatosis pigmentovascularis: A further example of twin spotting?.  Am J Med Genet. 1997;  70 336-337
  • 5 Happle R. Mosaicism in human skin. Understanding the patterns and mechanisms.  Arch Dermatol. 1993;  129 1460-1470
  • 6 Happle R. Loss of heterozygosity in human skin.  J Am Acad Dermatol. 1999;  41 143-161
  • 7 Happle R, Barbi G, Eckert D. et al . “Cutis tricolor”: congenital hyper- and hypopigmented macules associated with a sporadic multisystem birth defect: an unusual example of twin spotting?.  J Med Genet. 1997;  34 676-678
  • 8 Khumalo NP, Joss DV, Huson SM. et al . Pigmentary anomalies in ataxia-telangiectasia: a clue to diagnosis and an example of twin spotting.  Br J Dermatol. 2001;  1444 369-371
  • 9 Koopman RJJ. Concept of twin spotting.  Am J Med Genet. 1999;  85 355-358
  • 10 Larralde M, Happle R. Cutis tricolor parvimaculata: a distinct neurocutaneous phenotype?.  Dermatology. 2005;  211 149-151
  • 11 Lezak MD. Neuropsychological Assessment. 3rdedn. New York: Oxford University Press; 1995
  • 12 Mowat DR, Wilson MJ, Goosens M. Mowat-Wilson syndrome.  J Med Genet. 2003;  40 305-310
  • 13 O’Brien G, Yule W. Behavioural Phenotypes. London: Cambridge University Press; 1995
  • 14 POSSUM [Possum-web]. Pictures of Standard Syndromes and Undiagnosed Malformations . Version 7.0. Melbourne: Murdoch Institute for Research into Birth Defects & Murdoch Children Research Institute, ©.  2007–2010 available at http://www.possum.net.au
  • 15 Ruggieri M. “Cutis tricolor”: congenital hyper- and hypopigmented lesions in a background of normal skin, with and without associated systemic features: further expansion of the phenotype.  Eur J Pediatr. 2000;  159 745-749
  • 16 Ruggieri M, Iannetti P, Pavone L. Delineation of a newly recognised neurocutaneous malformation syndrome with “cutis tricolor”.  Am J Med Genet. 2003;  120 110-116
  • 17 Ruggieri M, Roggini M, Kennerknecht I. et al .Cutis tricolor (Ruggieri-Happle syndrome). In: Ruggieri M, Pascual-Castroviejo I, Di Rocco C (eds.): Neurocutaneous Disorders. Phakomatoses & Hamartoneoplastic Syndromes Wien/New York: Springer-Verlag; 2008: 461-471
  • 18 Ruggieri M, Pascual-Castroviejo I, Di Rocco C. Neurocutaneous Disorders. Phakomatoses & Hamartoneoplastic Syndromes. Wien/New York: Springer-Verlag; 2008
  • 19 Ruggieri M, Iannetti F, Polizzi A. et al . Cataracts in 3 children with a newly recognised neurocutaneous malformation phenotype with “cutis tricolour”.  Br J Ophthalmol. 2009;  93 127-128
  • 20 Seraslan G, Atik E. Cutis tricolor: 2 case reports.  Case Rep Clin Pract Rev. 2005;  6 317-319
  • 21 Vélez A, Salido R, Amorrich-Campos V. et al . Hereditary congenital hypopigmented and hyperpigmented macules (Westerhof syndrome) in 2 siblings.  Br J Dermatol. 2009;  161 1399-1400
  • 22 Westerhof W, Beemer FA, Cormane RH. et al . Hereditary congenital hypopigmented and hypopigmented macules.  Arch Dermatol. 1978;  114 931-936
  • 23 Wilson M, Mowat D, Dastot-Le Moal F. et al . Further delineation of the phenotype associated with heterozygous mutations in ZFHX1B.  Am J Med Genet A. 2003;  119 257-265
  • 24 Winter RM, Baraitser M. The London Dysmorphology Database [version 1.0.19 to 1.0.20]. Oxford: Oxford University Press, ©; 2008. available at http://www.Imdatabases.com
  • 25 Zweier C, Horn D, Kraus C. et al . Atypical ZFHX1B mutation associated with a mild Mowat-Wilson syndrome phenotype.  Am J Med Genet. 2006;  140 869-872

Correspondence

Martino RuggieriMD, PhD 

Department of Formative

Processes

University of Catania

Via Biblioteca 4 [Palazzo Ingrassia]

95124 Catania

Italy

Phone: +39/095/746 6301

Fax: +39/095/316 792

Email: m.ruggieri@unict.it