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Pachyonychia congenita 4(PC4)

MedGen UID:
811524
Concept ID:
C3714949
Disease or Syndrome
Synonym: PC4
 
Gene (location): KRT6B (12q13.13)
 
Monarch Initiative: MONDO:0014325
OMIM®: 615728

Disease characteristics

Excerpted from the GeneReview: Pachyonychia Congenita
Pachyonychia congenita (PC) is characterized by hypertrophic nail dystrophy, painful palmoplantar keratoderma and blistering, oral leukokeratosis, pilosebaceous cysts (including steatocystoma and vellus hair cysts), palmoplantar hyperhydrosis, and follicular keratoses on the trunk and extremities. [from GeneReviews]
Authors:
Frances JD Smith  |  C David Hansen  |  Peter R Hull, et. al.   view full author information

Additional descriptions

From OMIM
Pachyonychia congenita (PC) is an autosomal dominant genodermatosis with the main clinical features of hypertrophic nail dystrophy, painful and highly debilitating plantar keratoderma, oral leukokeratosis, and a variety of epidermal cysts. Although the condition had previously been subdivided clinically into Jadassohn-Lewandowsky PC type 1 and Jackson-Lawler PC type 2, patients with PC were later found to have a mixed constellation of both types, leading to a classification of PC based on genotype (summary by Sybert, 2010; Eliason et al., 2012; McLean et al., 2011). For a discussion of genetic heterogeneity of pachyonychia congenita, see 167200. Historical Classification of Pachyonychia Congenita Gorlin et al. (1976) suggested that 2 distinct syndromes are subsumed under the designation pachyonychia congenita. PC type 1, the Jadassohn-Lewandowsky type, shows oral leukokeratosis. PC type 2, the Jackson-Lawler type, has natal teeth and epidermoid cysts (cylindromas), but no oral leukoplakia. Corneal dystrophy may be a feature exclusively of the Jackson-Lawler type. Smith et al. (1998) stated that PC type 2, in contrast to PC type 1, has minimal oral involvement and milder keratoderma, and multiple steatocystomas (184500) is a major clinical feature. Steatocystoma, also known as eruptive vellus cyst, is a cystic hamartoma lined by sebaceous ductal epithelium. On the basis of a study of 13 patients with PC type 1 or type 2, Terrinoni et al. (2001) concluded that the presence of pilosebaceous cysts following puberty is the best indicator of PC type 2; prepubescent patients are more difficult to classify due to the lack of cysts. Natal teeth are indicative of PC type 2, although their absence does not preclude the PC type 2 diagnosis.  http://www.omim.org/entry/615728
From MedlinePlus Genetics
Some affected individuals also develop widespread cysts called steatocystomas, which are filled with an oily substance called sebum that normally lubricates the skin and hair. Some babies with pachyonychia congenita have prenatal or natal teeth, which are teeth that are present at birth or in early infancy. Some babies and children with pachyonychia congenita have pain in one or both ears when beginning to eat or drink. Pachyonychia congenita can also affect the voice box (larynx), causing hoarseness or breathing problems.

Researchers used to classigy pachyonychia congenita as either PC-1 or PC-2 based on the genetic cause and pattern of signs and symptoms. However, as more affected individuals were identified, it became clear that the signs and symptoms of the types overlapped considerably. Pachyonychia congenita is now classified into five types based on the gene that is altered.

Pachyonychia congenita can have several additional features. These features include thickened skin on the palms of the hands (palmar keratoderma), which can be painful; thick, white patches on the tongue and inside of the cheeks (oral leukokeratosis); bumps that develop around hair follicles (follicular keratoses) on the elbows, knees, and waistline; cysts in the armpits, groin, back, or scalp; and excessive sweating on the palms and soles (palmoplantar hyperhidrosis).

Most people with pachyonychia congenita also show some signs of hypertrophic nail dystrophy, which causes the fingernails and toenails to become thick and abnormally shaped. The number of affected nails varies.

Almost everyone with pachyonychia congenita develops very painful calluses on the soles of the feet. This condition is known as plantar keratoderma. Calluses usually begin to form on the feet in childhood when kids first start to walk. The calluses can make walking painful or impossible. In some affected individuals, blisters, bundles of blood vessels and nerves (neurovascular structures), or a deep itch may develop under or near the calluses, increasing pain and discomfort.

Pachyonychia congenita is a condition that primarily affects the skin and nails. The signs and symptoms of this condition usually become apparent within the first few years of life.  https://medlineplus.gov/genetics/condition/pachyonychia-congenita

Clinical features

From HPO
Steatocystoma multiplex
MedGen UID:
75476
Concept ID:
C0259771
Neoplastic Process
Steatocystoma multiplex is a skin disorder characterized by the development of multiple noncancerous (benign) cysts known as steatocystomas. These growths begin in the skin's sebaceous glands, which normally produce an oily substance called sebum that lubricates the skin and hair. Steatocystomas are filled with sebum.\n\nIn affected individuals, steatocystomas typically first appear during adolescence and are found most often on the torso, neck, upper arms, and upper legs. These cysts are usually the only sign of the condition. However, some affected individuals also have mild abnormalities involving the teeth or the fingernails and toenails.
Palmoplantar keratoderma
MedGen UID:
1635750
Concept ID:
C4551675
Disease or Syndrome
Abnormal thickening of the skin of the palms of the hands and the soles of the feet.
Nail dystrophy
MedGen UID:
66368
Concept ID:
C0221260
Disease or Syndrome
Onychodystrophy (nail dystrophy) refers to nail changes apart from changes of the color (nail dyschromia) and involves partial or complete disruption of the various keratinous layers of the nail plate.

Professional guidelines

PubMed

Iqneibi M, Al-Khawaga S, Wafi O, Steinhoff M
J Eur Acad Dermatol Venereol 2024 Apr;38(4):e356-e358. Epub 2023 Nov 22 doi: 10.1111/jdv.19630. PMID: 37994233
Chu HT, Dinh Duong TA, Le DH, Le TV, Nguyen BB, Dang CV, Vu QV
Pediatr Neonatol 2023 Jul;64(4):405-410. Epub 2023 Jan 3 doi: 10.1016/j.pedneo.2022.09.018. PMID: 36658016
Koren A, Sprecher E, Reider E, Artzi O
Br J Dermatol 2020 Mar;182(3):671-677. Epub 2019 Sep 8 doi: 10.1111/bjd.18169. PMID: 31127950

Recent clinical studies

Etiology

Chu HT, Dinh Duong TA, Le DH, Le TV, Nguyen BB, Dang CV, Vu QV
Pediatr Neonatol 2023 Jul;64(4):405-410. Epub 2023 Jan 3 doi: 10.1016/j.pedneo.2022.09.018. PMID: 36658016
Pavlovsky M, Peled A, Samuelov L, Malki L, Malovitski K, Assaf S, Mohamad J, Meijers O, Eskin-Schwartz M, Sarig O, Sprecher E
Clin Exp Dermatol 2021 Jun;46(4):663-668. Epub 2020 Dec 20 doi: 10.1111/ced.14509. PMID: 33190296
Stewart CL, Takeshita J, Hansen CD, Rubin AI
J Cutan Pathol 2020 Apr;47(4):357-362. Epub 2020 Jan 9 doi: 10.1111/cup.13630. PMID: 31845382
Pan B, Schröder W, Jostock R, Schwartz M, Rosson G, Polydefkis M
J Peripher Nerv Syst 2018 Dec;23(4):241-248. Epub 2018 Oct 16 doi: 10.1111/jns.12288. PMID: 30255608
Feinstein A, Friedman J, Schewach-Millet M
J Am Acad Dermatol 1988 Oct;19(4):705-11. doi: 10.1016/s0190-9622(88)70226-1. PMID: 3053803

Diagnosis

O'Toole EA, Kelsell DP, Caterina MJ, de Brito M, Hansen D, Hickerson RP, Hovnanian A, Kaspar R, Lane EB, Paller AS, Schwartz J, Shroot B, Teng J, Titeux M, Coulombe PA, Sprecher E
J Invest Dermatol 2024 Apr;144(4):748-754. Epub 2023 Dec 15 doi: 10.1016/j.jid.2023.10.030. PMID: 38099888
Chu HT, Dinh Duong TA, Le DH, Le TV, Nguyen BB, Dang CV, Vu QV
Pediatr Neonatol 2023 Jul;64(4):405-410. Epub 2023 Jan 3 doi: 10.1016/j.pedneo.2022.09.018. PMID: 36658016
Goldberg I, Mashiah J, Kutz A, Derowe A, Warshauer E, Schwartz ME, Smith F, Sprecher E, Hansen CD
Br J Dermatol 2020 Mar;182(3):708-713. Epub 2019 Dec 25 doi: 10.1111/bjd.18742. PMID: 31777952
Piraccini BM, Starace M
Curr Opin Pediatr 2014 Aug;26(4):440-5. doi: 10.1097/MOP.0000000000000116. PMID: 24886951
Shah S, Boen M, Kenner-Bell B, Schwartz M, Rademaker A, Paller AS
JAMA Dermatol 2014 Feb;150(2):146-53. doi: 10.1001/jamadermatol.2013.6448. PMID: 24132595

Therapy

Stewart CL, Takeshita J, Hansen CD, Rubin AI
J Cutan Pathol 2020 Apr;47(4):357-362. Epub 2020 Jan 9 doi: 10.1111/cup.13630. PMID: 31845382
Kerns ML, Hakim JMC, Zieman A, Lu RG, Coulombe PA
J Invest Dermatol 2018 May;138(5):1094-1100. Epub 2017 Dec 24 doi: 10.1016/j.jid.2017.09.054. PMID: 29277538Free PMC Article
Piraccini BM, Starace M
Curr Opin Pediatr 2014 Aug;26(4):440-5. doi: 10.1097/MOP.0000000000000116. PMID: 24886951
Gruber R, Edlinger M, Kaspar RL, Hansen CD, Leachman S, Milstone LM, Smith FJ, Sidoroff A, Fritsch PO, Schmuth M
J Am Acad Dermatol 2012 Jun;66(6):e193-9. Epub 2011 May 24 doi: 10.1016/j.jaad.2011.02.003. PMID: 21601946
Swartling C, Karlqvist M, Hymnelius K, Weis J, Vahlquist A
Br J Dermatol 2010 Nov;163(5):1072-6. doi: 10.1111/j.1365-2133.2010.09927.x. PMID: 20618323

Prognosis

Shah S, Boen M, Kenner-Bell B, Schwartz M, Rademaker A, Paller AS
JAMA Dermatol 2014 Feb;150(2):146-53. doi: 10.1001/jamadermatol.2013.6448. PMID: 24132595
Eliason MJ, Leachman SA, Feng BJ, Schwartz ME, Hansen CD
J Am Acad Dermatol 2012 Oct;67(4):680-6. Epub 2012 Jan 20 doi: 10.1016/j.jaad.2011.12.009. PMID: 22264670
Xiao SX, Feng YG, Ren XR, Tan SS, Li L, Wang JM, Shi YZ
J Invest Dermatol 2004 Apr;122(4):892-5. doi: 10.1111/j.0022-202X.2004.22408.x. PMID: 15102078

Clinical prediction guides

Lipner SR, Falotico JM, Matushansky JT, Evans H, Schwartz J, Hansen CD
Indian J Dermatol Venereol Leprol 2023 Nov-Dec;89(6):850-853. doi: 10.25259/IJDVL_939_2022. PMID: 37317732
Brill S, Sprecher E, Smith FJD, Geva N, Gruener H, Nahman-Averbuch H, Defrin R
Br J Dermatol 2018 Jul;179(1):154-162. Epub 2018 Apr 25 doi: 10.1111/bjd.16217. PMID: 29210461
Wallis T, Poole CD, Hoggart B
Clin Exp Dermatol 2016 Jan;41(1):26-33. Epub 2015 Sep 11 doi: 10.1111/ced.12723. PMID: 26358843
Eliason MJ, Leachman SA, Feng BJ, Schwartz ME, Hansen CD
J Am Acad Dermatol 2012 Oct;67(4):680-6. Epub 2012 Jan 20 doi: 10.1016/j.jaad.2011.12.009. PMID: 22264670
Smith F
Am J Clin Dermatol 2003;4(5):347-64. doi: 10.2165/00128071-200304050-00005. PMID: 12688839

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