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David S. Nieves, MD; Richard P. Phipps, PhD; Stephen J. Pollock, BS; Hans D. Ochs, MD; Qili Zhu, PhD; Glynis A. Scott, MD; Charlotte K. Ryan, MD; Ichiro Kobayashi, MD, PhD; Thomas M. Rossi, MD; Lowell A. Goldsmith, MD

Arch Dermatol. 2004;140:466-472.

Background  The immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare genodermatosis associated with dermatitis, enteropathy, type 1 diabetes, thyroiditis, hemolytic anemia, and thrombocytopenia. IPEX results from mutations of FOXP3, a gene located on the X chromosome that encodes a DNA-binding protein required for development of regulatory T cells. If untreated, affected males die early in life from malabsorption and other complications. To our knowledge, this syndrome has never been described in the dermatology literature.

Observations  We studied an 11-year-old boy with IPEX. Mutation analysis revealed a GA transition (1150G>A) in exon 11, resulting in a putative substitution of AlaThr at residue 384, within the DNA-binding site. Histopathologic examination of an active skin lesion revealed psoriasiform dermatitis. The lesions improved with clobetasol ointment. The patient also displayed alopecia universalis, which had been present since age 18 months, accompanied by longitudinal ridging of the nails. Lymphocyte challenge tests revealed a profound inability to synthesize interferon (INF-) and dysregulated production of other cytokines.

Conclusions  IPEX is an often fatal genodermatosis associated with multiple autoimmune disorders. Cutaneous findings may include dermatitis, bullae, urticaria, alopecia universalis, and trachyonychia. Recognition of this life-threatening disorder is crucial for optimal treatment and genetic counseling.

From the Departments of Dermatology (Drs Nieves and Scott), Microbiology and Immunology (Dr Phipps and Mr Pollock); Pathology (Dr Ryan), and Pediatrics (Dr Rossi), University of Rochester, Rochester, NY; Departments of Pediatrics, University of Washington, Seattle (Drs Ochs and Zhu), and Hokkaido University School of Medicine, Sapporo, Japan (Dr Kobayashi); and Dermatology, University of North Carolina–Chapel Hill, Chapel Hill (Dr Goldsmith). The authors have no relevant financial interest in this article.

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