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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
"ichthyosis"
symptom
child syndrome
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
harlequin ichthyosis
hirschsprung disease
junctional epidermolysis bullosa
kallmann syndrome
lamellar ichthyosis
This symptom has already been validated