Concomitant Xeroderma pigmentosum and disseminated small plaque psoriasis: first case of an antinomic association
© Ezzedine et al; licensee BioMed Central Ltd. 2008
Received: 06 June 2008
Accepted: 07 August 2008
Published: 07 August 2008
We present the case of an eighteen-year-old Caucasian white boy who was diagnosed with xeroderma pigmentosum type A at age 5 and who experienced over the past year disseminated small plaque psoriasis confirmed with skin punch biopsy. The psoriatic lesions were successfully treated with multipotent topical corticosteroids and systemic retinoids. To our knowledge, the association between psoriasis and xeroderma pigmentosum has not been previously reported and may be regarded as unlikely when considering the pathogenesis of both diseases.
Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder characterized by a defect of DNA-repair occurring during UV-induced damage. The disease is quite complex and different subsets of abnormalities in the DNA-repair system may be present during the course of the disease. Thus, patients with XP have a decreased cutaneous immune surveillance which results in an increased risk of UV-induced skin tumours at an early age. Basal cell carcinoma (BCC), squamous cell carcinoma (SCC), actinic keratoses, atypical moles and malignant melanoma, all associated with severe photoaging are commonly seen in such patients. The prognosis of XP is based on early diagnosis as to permit strict UV avoidance and early detection and treatment of skin tumours, especially in photo-exposed areas.
To our knowledge, the association between psoriasis and XP has not been previously reported and may be regarded as unlikely when considering the pathogenesis of both diseases.
XP patients exhibit Langerhans cell depletion, intensified impairment of natural killer (NK) cell function and enhanced UV-immunosuppression, possibly mediated through increased prostaglandin E2 production [1–4]. By opposition, psoriatic plaques are characterized by immune activation, with NK cell activation and decreased cyclo-oxygenase activity [5, 6].
In addition, in XP, unrestricted cellular proliferation is associated with inactivation of members of the iNK4a/Arf locus, such as p14 and p16 . By opposition, in psoriasis, members of the iNK4a/Arf locus are overexpressed, which may contribute to the senescent switch and resistance of psoriatic plaques to cellular transformation despite altered differentiation, angiogenesis, increased telomerase activity, proliferative changes and apoptosis resistance characterising psoriatic skin [8, 9].
Further data are required to determine why and how those apparently antinomic diseases can coexist.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Basal cell carcinoma
desoxy ribonucleic acid
invariant natural killer
squamous cell carcinoma
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