Keratosis Follicularis (Darier Disease)
No Results
No Results
processing….
Keratosis follicularis, also known as Darier disease (DD) or Darier-White disease, is an autosomal dominantly inherited genodermatosis characterized by greasy hyperkeratotic papules in seborrheic regions, nail abnormalities, and mucous membrane changes. See the images below. The disease was first reported independently by Darier and White in 1889. White was first to recognize the genetic nature of keratosis follicularis (Darier disease) by noticing that a mother and her daughter were affected.
Mutations in the gene ATP2A2 cause keratosis follicularis (Darier disease). ATP2A2, located on 12q23-24.1, encodes the sarcoplasmic/endoplasmic reticulum Ca2+ -ATP isoform 2 protein (SERCA2), which is a calcium pump. [1] This pump maintains a low cytoplasmic Ca2+ level by actively transporting calcium ions from the cytosol into the lumen of the endoplasmic reticulum. Although more than 120 familial and sporadic mutations in ATP2A2 have been identified in keratosis follicularis (Darier disease) patients, attempts at genotype-phenotype correlation have not been successful. Some authors have suggested that recurrent ATP2A2 p.(Pro602Leu) mutation differentiates acrokeratosis verruciformis of Hopf from the allelic condition Darier disease. [2]
Family members with confirmed identical ATP2A2 mutations can exhibit differences in the clinical severity of disease, suggesting that other genes or environmental factors affect the expression of keratosis follicularis (Darier disease). [3, 4] A wide variety of ATP2A2 mutations in Darier disease have been identified. [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21]
The mechanisms by which specific ATP2A2 mutations impact the function of the ATP2A2 protein have been investigated using an in vitro model. [22] Investigators transfected a fibroblast cell line with 51 different mutations seen in keratosis follicularis (Darier disease) pedigrees. The investigators found that the resultant transfected cells showed defects in ATP2A2 protein expression (15 mutants), ATP hydrolysis (29 mutants), calcium transport (4 mutants), and calcium binding and kinetics (3 mutants). In a different study, in which researchers systematically analyzed mutations identical to those found in patients with Darier disease, mutant SERCA2 protein aggregates were found to cause stress to the endoplasmic reticulum, subsequently inducing cell apoptosis. [7] Thus, diverse biochemical mechanisms are responsible for altered protein function.
Although expressivity is variable, penetrance of keratosis follicularis (Darier disease) is high, estimated at 95%. Because the disease-causing mutations in ATP2A2 affect functional domains of the gene, the mechanism of autosomal dominant transmission is believed to be haploinsufficiency, in which a single wild-type functioning ATP2A2 is insufficient to prevent disease. No unique phenotype for genetic homozygotes has been reported.
Abnormal keratinocyte-keratinocyte adhesion and aberrant epidermal keratinization are the primary histologic features of keratosis follicularis (Darier disease). Electron microscopy reveals loss of desmosomes (epithelial intercellular junctions formed by membrane and submembrane protein complexes), breakdown of desmosome-keratin intermediate filament attachment, and perinuclear aggregates of keratin intermediate filaments. The mechanism by which decreased activity of the SERCA2 calcium pump leads to these changes is still under investigation. [23] However, a significant correlation exists between the clinical presentation of keratosis follicularis (Darier disease) and the intensity of histologic features. [24]
Some studies of keratosis follicularis (Darier disease) have suggested that alterations in calcium regulation may affect the synthesis, folding, or trafficking of desmosomal proteins. [25] In particular, studies have revealed that keratosis follicularis (Darier disease) keratinocytes displayed abnormal trafficking of the desmosomal protein desmoplakin and abnormal expression of cytokeratins 10 and 14. [26, 27] A recent study shows that SERCA2-controlled Ca²+ -dependent keratinocyte adhesion and differentiation is mediated via the sphingolipid pathway. [28]
Alternatively, another hypothesis, based on a canine model of keratosis follicularis (Darier disease), is that keratosis follicularis (Darier disease) calcium dysregulation leads to impaired control of cell cycle checkpoints, leading to increased epidermal sensitivity to skin trauma and subsequent keratinocyte apoptosis.
Two particular ATP receptors have been reported to abnormally localize in vivo in keratosis follicularis(Darier disease) and are speculated to play a role in apoptosis as well as abnormal calcium signaling. [27] More recently, Darier keratinocytes were found to display a constitutive endoplasmic reticulum stress response, with immature adherens junctions and desmosomes, which results in decreased intercellular adhesion strength. [29]
Remarkably, an orphan drug, the α-glucosidase inhibitor miglustat, restores mature adherens junctions and desmosomes in Darier keratinocytes and increases adhesion strength. The observation that miglustat is able to restore proper localization to the plasma membrane of nonmutated proteins retained in the endoplasmic reticulum supports a misfolding mechanism. [29]
Keratosis follicularis (Darier disease) occurs worldwide. The prevalence of keratosis follicularis (Darier disease) has been estimated to range from 1 case in 30,000 population in Scotland to 1 case in 100,000 population in Denmark.
Males and females are equally affected by keratosis follicularis (Darier disease).
Keratosis follicularis (Darier disease) most commonly manifests from age 6-20 years; however, patients have presented as early as age 4 years and as late as age 70 years. Notably, the first case of congenital keratosis follicularis (Darier disease) was diagnosed by biopsy in a child with a significant positive family history for keratosis follicularis (Darier disease), in which at least the 3 proceeding generations of family members were affected. [30]
Patients with keratosis follicularis (Darier disease) experience pruritus and sometimes pain in the affected skin areas. Psychosocial consequences from the appearance and odor of the lesions also constitute the major morbidity of keratosis follicularis (Darier disease). A serious complication associated with keratosis follicularis (Darier disease) is increased susceptibility to cutaneous bacterial and viral infections, in particular herpes simplex virus, human papillomavirus, [31] and poxvirus infections. Initial misdiagnosis of keratosis follicularis (Darier disease) may lead to undertreatment of such infections and may lead to fatal outcomes. [32, 33] However, overall, patients with keratosis follicularis (Darier disease) have a life expectancy similar to that of the general population.
Neuropsychiatric abnormalities such as epilepsy, mental impairment, schizophrenia, [34] and mood disorders have been associated with keratosis follicularis (Darier disease). Several national studies suggest that genetic variability within the ATP2A2 gene that causes Darier disease also confers susceptibility for a number of neuropsychiatric disorders, [35] including bipolar disorder, [36] intellectual disability, and subclinical impairments in cognitive ability. [37]
Sakuntabhai A, Ruiz-Perez V, Carter S, et al. Mutations in ATP2A2, encoding a Ca2+ pump, cause Darier disease. Nat Genet. 1999 Mar. 21(3):271-7. [Medline].
Ronan A, Ingrey A, Murray N, Chee P. Recurrent ATP2A2 p.(Pro602Leu) mutation differentiates Acrokeratosis verruciformis of Hopf from the allelic condition Darier disease. Am J Med Genet A. 2017 May 12. [Medline].
Onozuka T, Sawamura D, Yokota K, Shimizu H. Mutational analysis of the ATP2A2 gene in two Darier disease families with intrafamilial variability. Br J Dermatol. 2004 Apr. 150(4):652-7. [Medline].
Bchetnia M, Charfeddine C, Kassar S, Zribi H, Guettiti HT, Ellouze F. Clinical and mutational heterogeneity of Darier disease in Tunisian families. Arch Dermatol. 2009 Jun. 145(6):654-6. [Medline].
Shi HJ, Li M, Zhang GL, et al. Novel splice-site and frameshift ATP2A2 mutations in Chinese patients with Darier disease. Clin Exp Dermatol. 2012. [Medline].
Folster-Holst R, Nellen RG, Jensen JM, et al. Molecular genetic support for the rule of dichotomy in type 2 segmental Darier disease. Br J Dermatol. Feb 2012. 166:464-6. [Medline].
Wang Y, Bruce AT, Tu C, et al. Protein aggregation of SERCA2 mutants associated with Darier disease elicits ER stress and apoptosis in keratinocytes. J Cell Sci. Nov 2011. 124:3568-80. [Medline].
Harboe TL, Willems P, Jespersgaard C, et al. Mosaicism in segmental Darier disease: an in-depth molecular analysis quantifying proportions of mutated alleles in various tissues. Dermatology. Jul 2011. 222:292-6. [Medline].
Pedace L, Barboni L, Pozzetto E, Amantea A, Zambruno G, Preziosi N, et al. Molecular characterization of 11 Italian patients with Darier disease. Eur J Dermatol. May-Jun 2011. 21:334-8. [Medline].
Klausegger A, Nischler E, Wagner RN, Pletschacher F, Hintner H, Bauer JW. Seven novel mutations in the ATP2A2 gene of Austrian patients with Darier’s disease. Arch Dermatol Res. 2011 Jul. 303(5):371-4. [Medline].
Godic A, Strazisar M, Zupan A, Korosec B, Kansky A, Glavac D. Darier disease in Slovenia: spectrum of ATP2A2 mutations and relation to patients’ phenotypes. Eur J Dermatol. 2010 May-Jun. 20(3):271-5. [Medline].
Li CR, Cui PG, Jia H, et al. Identification of a novel mutation in a Chinese patient with mild Darier’s disease. Int J Dermatol. Nov 2010. 49:1286-8. [Medline].
Huo J, Liu Y, Ma J, Xiao S. A novel splice-site mutation of ATP2A2 gene in a Chinese family with Darier disease. Arch Dermatol Res. Dec 2010. 302:769-72. [Medline].
Lu FY, Xu L, Yin XG, Wan P, Zhang XD, Chen WW, et al. Identification of mutation c.632G>A (p.G211D) in the ATP2A2 gene and genotype-phenotype correlation in a large Chinese family with Darier’s disease. Int J Dermatol. 2011 Nov. 50(11):1366-70. [Medline].
Shi HJ, Li M, Zhang GL, Xu SX, Shao MH, Gu Y, et al. Novel splice-site and frameshift ATP2A2 mutations in Chinese patients with Darier disease. Clin Exp Dermatol. 2012 Aug. 37(6):677-9. [Medline].
Shi BJ, Xue M, Zhong GS, Jiang Y, Chen DY, Feng J, et al. The ATP2A2 gene in patients with Darier’s disease: one novel splicing mutation. Int J Dermatol. 2012 Sep. 51(9):1074-7. [Medline].
Ueo D, Hamada T, Hashimoto T, Hatano Y, Okamoto O, Fujiwara S. Late-onset Darier’s disease due to a novel missense mutation in the ATP2A2 gene: a different missense mutation affecting the same codon has been previously reported in acrokeratosis verruciformis. J Dermatol. 2013 Apr. 40(4):280-1. [Medline].
Green EK, Gordon-Smith K, Burge SM, Grozeva D, Munro CS, Tavadia S, et al. Novel ATP2A2 mutations in a large sample of individuals with Darier disease. J Dermatol. 2013 Apr. 40(4):259-66. [Medline].
Pengjun Z, Jianwen R, Biao Y. A novel missense mutation of ATP2A2 gene in a Chinese family with Darier disease. Int J Dermatol. 2014 Mar. 53(3):e204-5. [Medline].
Miyabe C, Mitsuhashi Y, Saito M, Tsuboi R. Novel mutation in the ATP2A2 gene in a Japanese Darier’s disease patient with extremely hyperkeratotic lesions. J Dermatol. 2012 Apr. 39(4):401-3. [Medline].
Shi BJ, Xue M, Zhu YJ, Wang SP, Du Y, Chen DY, et al. Exon 12 of the ATP2A2 gene in patients with Darier disease: one novel mutation and one previously described. J Eur Acad Dermatol Venereol. 2014 Feb 19. [Medline].
Miyauchi Y, Daiho T, Yamasaki K, Takahashi H, Ishida-Yamamoto A, Danko S. Comprehensive analysis of expression and function of 51 sarco(endo)plasmic reticulum Ca2+-ATPase mutants associated with Darier disease. J Biol Chem. 2006 Aug 11. 281(32):22882-95. [Medline].
Müller EJ, Caldelari R, Kolly C, Williamson L, Baumann D, Richard G, et al. Consequences of depleted SERCA2-gated calcium stores in the skin. J Invest Dermatol. 2006 Apr. 126(4):721-31. [Medline].
Kassar S, Tounsi-Kettiti H, Charfeddine C, Zribi H, Bchetnia M, Jerbi E, et al. Histological characterization of Darier’s disease in Tunisian families. J Eur Acad Dermatol Venereol. 2009 Oct. 23(10):1178-83. [Medline].
Dhitavat J, Fairclough RJ, Hovnanian A, Burge SM. Calcium pumps and keratinocytes: lessons from Darier’s disease and Hailey-Hailey disease. Br J Dermatol. 2004 May. 150(5):821-8. [Medline].
Dhitavat J, Cobbold C, Leslie N, Burge S, Hovnanian A. Impaired trafficking of the desmoplakins in cultured Darier’s disease keratinocytes. J Invest Dermatol. 2003 Dec. 121(6):1349-55. [Medline].
Leinonen PT, Hägg PM, Peltonen S, Jouhilahti EM, Melkko J, Korkiamäki T, et al. Reevaluation of the normal epidermal calcium gradient, and analysis of calcium levels and ATP receptors in Hailey-Hailey and Darier epidermis. J Invest Dermatol. 2009 Jun. 129(6):1379-87. [Medline].
Celli A, Mackenzie DS, Zhai Y, Tu CL, Bikle DD, Holleran WM, et al. SERCA2-controlled Ca²+-dependent keratinocyte adhesion and differentiation is mediated via the sphingolipid pathway: a therapeutic target for Darier’s disease. J Invest Dermatol. 2012 Apr. 132(4):1188-95. [Medline]. [Full Text].
Savignac M, Simon M, Edir A, Guibbal L, Hovnanian A. SERCA2 Dysfunction in Darier Disease Causes Endoplasmic Reticulum Stress and Impaired Cell-to-Cell Adhesion Strength: Rescue by Miglustat. J Invest Dermatol. 2014 Jul. 134(7):1961-70. [Medline].
Fong G, Capaldi L, Sweeney SM, Wiss K, Mahalingam M. Congenital Darier disease. J Am Acad Dermatol. 2008 Aug. 59(2 Suppl 1):S50-1. [Medline].
Matsumoto A, Gregory N, Rady PL, Tyring SK, Carlson JA. Brief Report: HPV-17 Infection in Darier Disease With Acrokeratosis Verrucosis of Hopf. Am J Dermatopathol. 2017 May. 39 (5):370-373. [Medline].
Okada E, Nagai Y, Motegi S, Tamura A, Ishikawa O. Fatal case of Darier’s disease with recurrent severe infections. Acta Derm Venereol. 2009. 89(4):408-9. [Medline].
Woo SM, Won CH, Cho S. Darier’s disease: variable clinical presentation and a fatal outcome. Clin Exp Dermatol. 2009 Jul. 34(5):628-9. [Medline].
Tang C, Chan M, Lee J, Hariram J. Darier’s disease and schizophrenia. East Asian Arch Psychiatry. 2010 Dec. 20(4):190-2. [Medline].
Dodiuk-Gad RP, Cohen-Barak E, Khayat M, Milo H, Amariglio-Diskin L, Danial-Faran N, et al. Darier disease in Israel: combined evaluation of genetic and neuropsychiatric aspects. Br J Dermatol. 2016 Mar. 174 (3):562-8. [Medline].
Cederlöf M, Bergen SE, Långström N, Larsson H, Boman M, Craddock N, et al. The association between Darier disease, bipolar disorder, and schizophrenia revisited: a population-based family study. Bipolar Disord. 2015 May. 17 (3):340-4. [Medline].
Cederlöf M, Karlsson R, Larsson H, Almqvist C, Magnusson PK, Nordlind K, et al. Intellectual disability and cognitive ability in Darier disease: Swedish nation-wide study. Br J Dermatol. 2015 Jul. 173 (1):155-8. [Medline].
Otley CC, Momtaz K. Induction of Darier-White disease with UVB radiation in a clinically photo-insensitive patient. J Am Acad Dermatol. 1996 May. 34(5 Pt 2):931-4. [Medline].
Bernabé DG, Kawata LT, Beneti IM, Crivelini MM, Biasoli ER. Multiple white papules in the palate: oral manifestation of Darier’s disease. Clin Exp Dermatol. 2009 Oct. 34(7):e270-1. [Medline].
Kansal NK, Hazarika N, Rao S. Familial Case of Darier Disease with Guttate Leukoderma: A Case Series from India. Indian Dermatol Online J. 2018 Jan-Feb. 9 (1):62-63. [Medline].
Matsuoka LY, Wortsman J. Renal involvement in Darier disease. J Am Acad Dermatol. 2016 Dec. 75 (6):e235. [Medline].
Mansura A, Maly A, Ramot Y, Zlotogorski A. Acantholytic dermatosis of the vulva. Dermatol Online J. 2015 May 18. 21 (5):[Medline].
Casals M, Campoy A, Aspiolea F, Carrasco MA, Camps A. Successful treatment of linear Darier’s disease with topical adapalene. J Eur Acad Dermatol Venereol. 2009 Feb. 23(2):237-8. [Medline].
Abe M, Inoue C, Yokoyama Y, Ishikawa O. Successful treatment of Darier’s disease with adapalene gel. Pediatr Dermatol. 2011 Mar-Apr. 28(2):197-8. [Medline].
Burkhart CG, Burkhart CN. Tazarotene gel for Darier’s disease. J Am Acad Dermatol. 1998 Jun. 38(6 Pt 1):1001-2. [Medline].
Oster-Schmidt C. The treatment of Darier’s disease with topical tazarotene. Br J Dermatol. 1999 Sep. 141(3):603-4. [Medline].
Dicken CH, Bauer EA, Hazen PG, Krueger GG, Marks JG Jr, McGuire JS, et al. Isotretinoin treatment of Darier’s disease. J Am Acad Dermatol. 1982 Apr. 6(4 Pt 2 Suppl):721-6. [Medline].
Schmidt H, Ochsendorf FR, Wolter M, Geisslinger G, Ludwig RJ, Kaufmann R. Topical 5-fluorouracil in Darier disease. Br J Dermatol. 2008 Jun. 158(6):1393-6. [Medline].
Yoon TY, Kim JW, Kim MK. Successful treatment of Darier disease with topical 5-fluorouracil. Br J Dermatol. 2006 Jun. 154(6):1210-2. [Medline].
Abe M, Yasuda M, Yokoyama Y, Ishikawa O. Successful treatment of combination therapy with tacalcitol lotion associated with sunscreen for localized Darier’s disease. J Dermatol. 2010 Aug. 37(8):718-21. [Medline].
Pérez-Carmona L, Fleta-Asín B, Moreno-García-Del-Real C, Jaén-Olasolo P. Successful treatment of Darier’s disease with topical pimecrolimus. Eur J Dermatol. 2011 Mar-Apr. 21(2):301-2. [Medline].
Millán-Parrilla F, Rodrigo-Nicolás B, Molés-Poveda P, Armengot-Carbó M, Quecedo-Estébanez E, Gimeno-Carpio E. Improvement of Darier disease with diclofenac sodium 3% gel. J Am Acad Dermatol. 2014 Apr. 70(4):e89-90. [Medline].
Kontochristopoulos G, Katsavou AN, Kalogirou O, Agelidis S, Zakopoulou N. Letter: Botulinum toxin type A: an alternative symptomatic management of Darier’s disease. Dermatol Surg. 2007 Jul. 33(7):882-3. [Medline].
Letulé V, Herzinger T, Ruzicka T, Molin S. Treatment of Darier disease with oral alitretinoin. Clin Exp Dermatol. 2013 Jul. 38(5):523-5. [Medline].
Zamiri M, Munro CS. Successful treatment with oral alitretinoin in women of childbearing potential with Darier’s disease. Br J Dermatol. 2013 Sep. 169(3):709-10. [Medline].
Farb RM, Lazarus GS, Chiaramonti A, Goldsmith LA, Gilgor RS, Balakrishnan CV. The effect of 13-cis retinoic acid on epidermal lysosomal hydrolase activity in Darier’s disease and pityriasis rubra pilaris. J Invest Dermatol. 1980 Aug. 75(2):133-5. [Medline].
Liang J, Chen P, Chen H, Tian X, Wu Z, Zhang S, et al. Long-term safety and efficacy of continuous acitretin monotherapy for three children with different severe hyperkeratotic disorders in China. J Dermatol. 2018 May 14. [Medline].
Suzuki K, Aoki M, Kawana S. Localized Darier’s disease of the scalp: successful treatment with oral etretinate. Dermatology. 2004. 208(1):83-4. [Medline].
Kamijo M, Nishiyama C, Takagi A, Nakano N, Hara M, Ikeda S, et al. Cyclooxygenase-2 inhibition restores ultraviolet B-induced downregulation of ATP2A2/SERCA2 in keratinocytes: possible therapeutic approach of cyclooxygenase-2 inhibition for treatment of Darier disease. Br J Dermatol. 2012 May. 166(5):1017-22. [Medline].
Wheeland RG, Gilmore WA. The surgical treatment of hypertrophic Darier’s disease. J Dermatol Surg Oncol. 1985 Apr. 11(4):420-3. [Medline].
Toombs EL, Peck GL. Electrosurgical treatment of etretinate-resistant Darier’s disease. J Dermatol Surg Oncol. 1989 Dec. 15(12):1277-80. [Medline].
Brown VL, Kelly SE, Burge SM, Walker NP. Extensive recalcitrant Darier disease successfully treated with laser ablation. Br J Dermatol. 2010 Jan. 162(1):227-9. [Medline].
McElroy JA, Mehregan DA, Roenigk RK. Carbon dioxide laser vaporization of recalcitrant symptomatic plaques of Hailey-Hailey disease and Darier’s disease. J Am Acad Dermatol. 1990 Nov. 23(5 Pt 1):893-7. [Medline].
Minsue Chen T, Wanitphakdeedecha R, Nguyen TH. Carbon dioxide laser ablation and adjunctive destruction for Darier-White disease (keratosis follicularis). Dermatol Surg. 2008 Oct. 34(10):1431-4. [Medline].
Beier C, Kaufmann R. Efficacy of erbium:YAG laser ablation in Darier disease and Hailey-Hailey disease. Arch Dermatol. 1999 Apr. 135(4):423-7. [Medline].
Roos S, Karsai S, Ockenfel HM, Raulin C. Successful treatment of Darier disease with the flashlamp-pumped pulsed-dye laser. Arch Dermatol. 2008 Aug. 144(8):1073-5. [Medline].
Katz TM, Firoz BF, Goldberg LH, Friedman PM. Treatment of Darier’s disease using a 1,550-nm erbium-doped fiber laser. Dermatol Surg. 2010. 36(1):142-6. [Medline].
Krakowski AC, Nguyen TA, Eichenfield LF. Treatment of segmental keratosis follicularis (Darier disease) using ablative fractional laser resurfacing. Dermatol Surg. 2015 Apr. 41 (4):516-8. [Medline].
Minsue Chen T, Wanitphakdeedecha R, Nguyen TH. Carbon dioxide laser ablation and adjunctive destruction for Darier-White disease (keratosis follicularis). Dermatol Surg. 2008 Oct. 34(10):1431-4. [Medline].
Kittridge A, Wahlgren C, Fuhrer R, Zirwas M, Patton T. Treatment of recalcitrant Darier’s disease with electron beam therapy. Dermatol Ther. 2010 May-Jun. 23(3):302-4. [Medline].
Exadaktylou D, Kurwa HA, Calonje E, Barlow RJ. Treatment of Darier’s disease with photodynamic therapy. Br J Dermatol. 2003 Sep. 149(3):606-10. [Medline].
Avery HL, Hughes BR, Coley C, Cooper HL. Clinical improvement in Darier’s disease with photodynamic therapy. Australas J Dermatol. 2010 Feb. 51(1):32-5. [Medline].
Ahcan U, Dolenc-Voljc M, Zivec K, Zorman P, Jurcic V. The surgical treatment of hypertrophic intertriginous Darier’s disease. J Plast Reconstr Aesthet Surg. 2009 Nov. 62(11):e442-6. [Medline].
Pui-Yan Kwok, MD, PhD Henry Bachrach Distinguished Professor, Department of Dermatology and Cardiovascular Research Institute, University of California, San Francisco, School of Medicine
Pui-Yan Kwok, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Association for the Advancement of Science, American Society of Human Genetics, Dermatology Foundation, Society for Investigative Dermatology
Disclosure: Nothing to disclose.
Jillian Wong Millsop, MD, MS Resident Physician, Department of Dermatology, University of California, Davis, School of Medicine
Jillian Wong Millsop, MD, MS is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Womens Association
Disclosure: Nothing to disclose.
Tina Bhutani, MD Clinical Research Fellow, Department of Dermatology, University of California School of Medicine, San Francisco
Tina Bhutani, MD is a member of the following medical societies: American Medical Association, American Medical Womens Association, American Association of Physicians of Indian Origin, National Psoriasis Foundation, Indian Medical Association
Disclosure: Nothing to disclose.
Wilson Liao, MD Associate Professor, Department of Dermatology, University of California, San Francisco, School of Medicine
Wilson Liao, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology, National Psoriasis Foundation
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine
Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology
Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine
Disclosure: Nothing to disclose.
The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Sarah Fitzmaurice, MD, Jillian Wong Millsop, MD, MS, Tina Bhutani, MD, and Wilson Liao, MD, to the development and writing of this article.
Keratosis Follicularis (Darier Disease)
Research & References of Keratosis Follicularis (Darier Disease)|A&C Accounting And Tax Services
Source
0 Comments