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Entry from
Leiber, Bernfried
Die klinischen Syndrome: Syndrome, Sequenzen und Symptomenkomplexe
[The Clinical Syndromes: Syndromes, Sequences, and Symptom Complexes]
7 th edition, completely reworked
Volume 1: Clinical pictures
Pachyonychia congenita
Syn: Jadassohn-Lewandowsky Syndrome
Def.: Autosomal dominant hereditary keratinization disorder with characteristic nail
thickening.
A 1 .: First description 1906 by the German dermatologists Josef Jadassohn, 1863-1936, and
Felix Lewandowsky, 1879-1921.
Diagnostic criteria: (1) Massive nail thickening of all fingers and toes, sometimes already
present at birth, gradually increasing. Thickening increases toward the distal end; concurrent
transversal curvature. – (2) Dirty yellow-brown discoloration of the nail. – (3) Circumscribed
symmetrical hyperkeratoses on the palms and soles. – (4) Blistering in warm conditions
(palmo-) plantar. – (5) Hyperhidrosis palmoplantaris. – (6) Follicular keratoses
predominantly on the elbows and knees with overall dry skin, occasionally signs of ichthyotic
skin. – (7) Leukoplakias of the oral mucosa. – (8) Natal teeth. – (9) Steatocystoma multiplex.
– (10) In adults, corneal dystrophy possible, cataract, reticular pigmentation. Hearing
impairment, hypotrichosis, hoarseness.
Etiology. Autosomal dominant hereditary keratinization disorder with variable expression
and incomplete penetration of the gene.
Pathog.: Unknown.
Remarks: Type 1 (Jadassohn-Lewandowsky): with leukoplakias and plantar bullae. Type II:
without leukoplakias, minor keratoses. Type III: premature dentition with natal teeth and
minor keratoses. In 3 cases, autosomal recessive transmission was claimed; however, the
clinical picture was not typical. Type IV: with spotty pigmentation on the throat, axillae,
trunk, thighs, and the backs of the knees, which, like the nail changes, recede in adulthood.
Histological: Pigmentation incontinence and subepidermal amyloid deposits.
Lit.: Jadassohn J. Lewandowsky F (1906): Pachyonychia congenita. Keratosis disseminata
circumscripta, tylomata, leucokeratosis linguae. Iconographia Dermatologica. Tab 6, Vienna,
Berlin. – Reich H (1980) Jadassohn-Lewandowsky Syndrom: Haut-Auge-Mund und Zahn-
Kehlkopf-Nervensystem. [Jadassohn-Lewandowsky Syndrom: Skin-Eye-Mouth and Tooth-
Larynx-Nervous System]. Therapiewoche 30: 6247.
1 Translator's note: Key not available. First description?