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Prenatal diagnosis for severe inherited skin disorders: 25 years' experience.
[harlequin ichthyosis]
Over
the
last
25
years
there
have
been
major
advances
in
methods
for
prenatal
testing
of
inherited
skin
disorders
.
Since
1979
,
our
group
at
the
St
John
's
Institute
of
Dermatology
has
performed
269
prenatal
diagnoses
,
using
a
variety
of
approaches
,
including
fetal
skin
biopsy
(
FSB
)
,
chorionic
villus
sampling
(
CVS
)
and
preimplantation
genetic
diagnosis
(
PGD
)
.
This
study
was
designed
to
review
the
clinical
indications
,
testing
procedures
and
laboratory
analyses
for
all
prenatal
tests
conducted
at
St
John
's
over
this
period
.
FSBs
were
examined
for
morphological
and
,
when
relevant
or
feasible
,
immunohistochemical
abnormalities
.
The
DNA-based
tests
involved
screening
by
nucleotide
sequencing
,
restriction
enzyme
digests
or
,
in
a
few
cases
,
by
linkage
analysis
.
Results
Of
the
269
tests
,
191
were
FSB
,
76
were
CVS
and
two
were
PGD
.
The
major
indications
for
FSB
were
epidermolysis
bullosa
(
EB
)
(
138
cases
,
including
88
junctional
and
48
dystrophic
)
,
ichthyoses
(
37
cases
,
including
22
tests
for
harlequin
ichthyosis
)
and
oculocutaneous
albinism
(
12
cases
)
.
Of
the
CVS
procedures
,
75
were
for
EB
(
40
junctional
,
35
dystrophic
)
and
one
was
for
the
EEC
(
ectrodactyly
,
ectodermal
dysplasia
,
clefting
)
syndrome
.
Both
of
the
PGD
procedures
were
for
the
skin
fragility
-
ectodermal
dysplasia
syndrome
.
All
tests
provided
accurate
diagnoses
and
the
fetal
loss
rate
was
approximately
1
%
for
both
FSB
and
CVS
.
T
he
development
of
prenatal
testing
has
proved
to
be
of
great
benefit
for
individuals
or
couples
at
risk
of
having
children
with
severe
inherited
skin
disorders
and
,
in
the
absence
of
a
cure
,
prenatal
testing
along
with
appropriate
counselling
has
become
an
important
translational
benefit
of
basic
research
and
an
integral
part
of
clinical
management
.
Diseases
Validation
Diseases presenting
"skin fragility"
symptom
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erythropoietic protoporphyria
harlequin ichthyosis
junctional epidermolysis bullosa
kindler syndrome
This symptom has already been validated