Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes

Background: Ichthyosis is a heterogeneous group of diseases caused by genetic disorders related to skin formation. They are characterized by generalized dry skin, scaling, hyperkeratosis and frequently associated with erythroderma. Among its different types, harlequin ichthyosis (HI) stands out due...

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Autores:
Arias Pérez, Rubén Darío
Gallego Quintero, Salomón
Taborda Vanegas, Natalia Andrea
Restrepo Carvajal, Jorge Emiro
Zambrano Cruz, Renato
Tamayo Agudelo, ‪William Fernando
Bermúdez, Patricia
Duque Vélez, Constanza Elena
Arroyave, Ismael
Tejada Moreno, Johanna Alexandra
Villegas Lanau, Carlos Andrés
Mejía García, Alejandro
Zapata Builes, Wildeman
Hernández López, Juan Carlos
Cuartas Montoya, Gina Paula
Tipo de recurso:
Article of investigation
Fecha de publicación:
2021
Institución:
Tecnológico de Antioquia
Repositorio:
Repositorio Tdea
Idioma:
eng
OAI Identifier:
oai:dspace.tdea.edu.co:tdea/2725
Acceso en línea:
https://dspace.tdea.edu.co/handle/tdea/2725
Palabra clave:
skin diseases
Enfermedades de la piel
Dermatose
Ichthyosis
Ictiosis
Ictiose
Harlequin ichthyosis
Congenital ichthyosis
Case report
Rights
openAccess
License
https://creativecommons.org/licenses/by/4.0/
id RepoTdea2_8d55238648b87b7913543f1740e10697
oai_identifier_str oai:dspace.tdea.edu.co:tdea/2725
network_acronym_str RepoTdea2
network_name_str Repositorio Tdea
repository_id_str
dc.title.none.fl_str_mv Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
title Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
spellingShingle Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
skin diseases
Enfermedades de la piel
Dermatose
Ichthyosis
Ictiosis
Ictiose
Harlequin ichthyosis
Congenital ichthyosis
Case report
title_short Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
title_full Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
title_fullStr Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
title_full_unstemmed Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
title_sort Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes
dc.creator.fl_str_mv Arias Pérez, Rubén Darío
Gallego Quintero, Salomón
Taborda Vanegas, Natalia Andrea
Restrepo Carvajal, Jorge Emiro
Zambrano Cruz, Renato
Tamayo Agudelo, ‪William Fernando
Bermúdez, Patricia
Duque Vélez, Constanza Elena
Arroyave, Ismael
Tejada Moreno, Johanna Alexandra
Villegas Lanau, Carlos Andrés
Mejía García, Alejandro
Zapata Builes, Wildeman
Hernández López, Juan Carlos
Cuartas Montoya, Gina Paula
dc.contributor.author.none.fl_str_mv Arias Pérez, Rubén Darío
Gallego Quintero, Salomón
Taborda Vanegas, Natalia Andrea
Restrepo Carvajal, Jorge Emiro
Zambrano Cruz, Renato
Tamayo Agudelo, ‪William Fernando
Bermúdez, Patricia
Duque Vélez, Constanza Elena
Arroyave, Ismael
Tejada Moreno, Johanna Alexandra
Villegas Lanau, Carlos Andrés
Mejía García, Alejandro
Zapata Builes, Wildeman
Hernández López, Juan Carlos
Cuartas Montoya, Gina Paula
dc.subject.agrovoc.none.fl_str_mv skin diseases
Enfermedades de la piel
Dermatose
topic skin diseases
Enfermedades de la piel
Dermatose
Ichthyosis
Ictiosis
Ictiose
Harlequin ichthyosis
Congenital ichthyosis
Case report
dc.subject.decs.none.fl_str_mv Ichthyosis
Ictiosis
Ictiose
dc.subject.proposal.none.fl_str_mv Harlequin ichthyosis
Congenital ichthyosis
Case report
description Background: Ichthyosis is a heterogeneous group of diseases caused by genetic disorders related to skin formation. They are characterized by generalized dry skin, scaling, hyperkeratosis and frequently associated with erythroderma. Among its different types, harlequin ichthyosis (HI) stands out due to its severity. HI is caused by mutations in the ABCA12 gene, which encodes essential proteins in epidermal lipid transport, and it helps maintain the homeostasis of the stratum corneum of the epidermis. However, due to the wide spectrum of genetic alterations that can cause ichthyosis, holistic medical care, and genetic studies are required to improve the diagnosis and outcomes of these diseases. Case presentation: Here, we presented the case of a 19 years old male patient who was a premature infant and exhibited clinical features consistent with HI, including bright yellow hyperkeratotic plates with erythematous fissures that covered his entire body like a collodion baby. Currently, he exhibited erythroderma, photosensitivity, ectropion, auricular pavilion alterations, and musculoskeletal disorders, such as equinovarus feet, fingers, hands, and hypoplastic feet with contractures in flexion and marked difficulty in fine motor skills. In addition, he presented dyschromatopsia, Achilles reflex hyporeflexia, slight speech, dental alteration and deficient cognitive performance. After the genetic sequencing, variants were found in ABCA12 and HRNR which are related to several skin diseases, including ichthyosis. Conclusions: Although in clinical practice, ichthyosis is a common entity, a severe type of ichthyosis is presented, highlighting the importance of appropriate genetic diagnosis, given the broad spectrum of genetic alterations with similar phenotypic and clinical characteristics. These pathologies must be known to guarantee initial support measures to prevent complications and offer multidisciplinary management to those patients. Keywords: Harlequin ichthyosis, Congenital ichthyosis, Ichthyosis, Skin disease, Case report
publishDate 2021
dc.date.issued.none.fl_str_mv 2021
dc.date.accessioned.none.fl_str_mv 2023-03-30T20:50:11Z
dc.date.available.none.fl_str_mv 2023-03-30T20:50:11Z
dc.type.spa.fl_str_mv Artículo de revista
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dc.type.content.spa.fl_str_mv Text
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.eissn.spa.fl_str_mv 1755-8794
url https://dspace.tdea.edu.co/handle/tdea/2725
identifier_str_mv 1755-8794
dc.language.iso.spa.fl_str_mv eng
language eng
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dc.relation.citationvolume.spa.fl_str_mv 14
dc.relation.ispartofjournal.spa.fl_str_mv BMC medical genomics
dc.relation.references.spa.fl_str_mv Akiyama M. ABCA12 mutations and autosomal recessive congenital ichthyosis: a review of genotype/phenotype correlations and of pathogenetic conceptsa. Hum Mutat. 2010;31(10):1090–6
Hausser I, Vabres P, Hohl D, Ishida-Yamamoto A, Tadini G, Leigh I, et al. Revised nomenclature and classification of inherited ichthyoses: results of the First Ichthyosis Consensus Conference in Sorèze 2009. J Am Acad Dermatol. 2010;63(4):607–41.
Takeichi T, Akiyama M. Inherited ichthyosis: non-syndromic forms. J Dermatol. 2016;43(3):242–51
Murase C, Nakatochi M, Kanekura T, Tohyama M, Kurosawa M, Masuda K, et al. Cross-sectional survey on disease severity in Japanese patients with harlequin ichthyosis/ichthyosis: syndromic forms and quality-of-life analysis in a subgroup. J Dermatol Sci. 2018;92(2):127–33.
Schmuth M, Martinz V, Janecke AR, Fauth C, Schossig A, Zschocke J, et al. Inherited ichthyoses/generalized Mendelian disorders of cornification. Eur J Hum Genet. 2013;21(2):123–33.
Rodríguez-Pazos L, Ginarte M, Vega A, Toribio J. Ictiosis congénitas autosómicas recesivas. Actas Dermosifiliogr. 2013;104(4):270–84.
Rajpopat S, Moss C, Mellerio J, Vahlquist A, Gånemo A, Hellstrom-Pigg M, et al. Harlequin ichthyosis: a review of clinical and molecular findings in 45 cases. Arch Dermatol. 2011;147(6):681
Loo BKG, Batilando MJ, Tan EC, Koh MJA. Compound heterozygous mutations with novel missense ABCA12 mutation in harlequin ichthyosis. BMJ Case Rep. 2018;2018:bcr-2017-222025
Shruthi B, Nilgar BR, Dalal A, Limbani N. Harlequin ichthyosis: a rare case. Turk J Obstet Gynecol. 2017;14(2):138–40.
Yang S, Bayart C, Brandling-Bennett H. An atypical presentation of herpes simplex virus infection in Harlequin ichthyosis. Pediatr Dermatol. 2018;35(6):1–2.
Zhang L, Ferreyros M, Feng W, Hupe M, Crumrine DA, Chen J, et al. Defects in stratum corneum desquamation are the predominant effect of impaired ABCA12 function in a novel mouse model of harlequin ichthyosis. PLoS ONE. 2016;11(8):e0161465.
Akiyama M. The roles of ABCA12 in epidermal lipid barrier formation and keratinocyte differentiation. Biochim Biophys Acta Mol Cell Biol Lipids. 2014;1841(3):435–40.
Nayak S, Dash SP, Khatua M. Fetal harlequin ichthyosis-a case report. IOSR J Dent Med Sci . 2015;14(11):81–6.
Kurosawa M, Uehara R, Takagi A, Aoyama Y, Iwatsuki K, Amagai M, et al. Results of a nationwide epidemiologic survey of autosomal recessive congenital ichthyosis and ichthyosis syndromes in Japan. J Am Acad Dermatol. 2018;81(5):1086–92.
Incecık F, Herguner OM, Ozbek MN, Gungor S, Yılmaz M, Rizzo WB, et al. Neuro-ichthyotic syndromes: a case series. J Pediatr Neurosci. 2018;13(1):34–8.
Dufresne H, Hadj-Rabia S, Méni C, Sibaud V, Bodemer C, Taïeb C. Family burden in inherited ichthyosis: creation of a specific questionnaire. Orphanet J Rare Dis. 2013;8(1):28.
Ostrosky F, Gómez ME, Matute E, Rosselli M, Ardila APD. Neuropsi: Atención y Memoria. 3rd ed. México: Manual Moderno; 2019.
Starosta AJ, Brenner LA. Beck Anxiety Inventory. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of clinical neuropsychology. Cham: Springer; 2018. p. 521–525.
Beck AT, Steer RA, Brown GK. Beck Depression Inventory Manual. San Antonio: Psychological Corporation; 1993. p. 38.
Costa PT, McCrae RR. The NEO-PI/NEO-FFI Manual Supplement. Odessa: Psychological Assessment Resources; 1989.
Buitrago N, Monsalve C, Morales C, Ochoca C, Pizarro T. Guía De Práctica Clínica En Ortodoncia IPS CES Sabaneta. Medellín: Universidad CES; 2014.
Botero Mariaca PM, Vélez TN. Manual de historia clínica odontológica del escolar. Bogotá: Universida. Manual de historia clínica odontológica del escolar; 2016. p. 302.
Nava M, Benítez O, Onofre M, Nava J, Galdocerna P. Remodelación ósea mandibular en adultos. Rev ADM. 2009;65(4):18–22.
Shimizu Y, Ogawa Y, Sugiura K, Takeda J, Akiyama M. A Palindromic motif in the 2 2084 to 2 2078 upstream region is essential for ABCA12 promoter function in cultured human keratinocytes. Sci Rep. 2014;4(6737):1–5.
Vahlquist A. Inherited nonsyndromic ichthyoses: an update on pathophysiology, diagnosis and treatment. Am J Clin Dermatol. 2018;19:51–66.
Sugiura K, Akiyama M. Update on autosomal recessive congenital ichthyosis: mRNA analysis using hair samples is a powerful tool for genetic diagnosis. J Dermatol Sci. 2015;12:1–6.
Shibata A, Akiyama M. Epidemiology, medical genetics, diagnosis and treatment of harlequin ichthyosis in Japan. Pediatr Int. 2015;57(4):516–22.
Goldsmith T, Fuchs-Telem D, Israeli S, Sarig O, Padalon-Brauch G, Bergman R. The sound of silence: autosomal recessive congenital ichthyosis caused by a synonymous mutation in ABCA12. Exp Dermatol. 2013;22(4):251–4.
Montalván-Suárez M, Esperón-Moldes US, Rodríguez-Pazos L, Ordóñez- Ugalde A, Moscoso F, Ugalde-Noritz N, et al. A novel ABCA12 pathologic variant identified in an Ecuadorian harlequin ichthyosis patient: a step forward in genotype-phenotype correlations. Mol Genet Genomic Med [Internet]. 2019;7(5):1–15. https:// doi. org/ 10. 1002/ mgg3. 608.
Wu Z, Meyer-Hoffert U, Reithmayer K, Paus R, Hansmann B, He Y, et al. Highly complex peptide aggregates of the S100 fused-type protein hornerin are present in human skin. J Invest Dermatol. 2009;129(6):1446–58.
Chermnykh ES, Alpeeva EV, Vorotelyak EA. Transglutaminase 3: the involvement in epithelial differentiation and cancer. Cells. 2020;9:1996.
Hernández-Martín A, Cuadrado-Corrales N, Ciria-Abad S, Arias-Palomo D, Mascaró-Galy JM, Escámez MJ, et al. X-linked ichthyosis along with recessive dystrophic epidermolysis bullosa in the same patient. Dermatology. 2010;221(2):113–6.
Mashiah J, Harel A, Bitterman O, Sagi L, Gat A, Fellig Y, et al. Isotretinoin treatment of autosomal recessive congenital ichthyosis complicated by coexisting dysferlinopathy. Clin Exp Dermatol. 2016;41(4):390–3.
Ni C, Cheng RH, Zhang J, Liang JY, Wei RQ, Li M, et al. Novel and recurrent PHGDH and PSAT1 mutations in Chinese patients with Neu-Laxova syndrome. Eur J Dermatol. 2019;29(6):641–6.
Scalais E, Connerotte AC, Despontin K, Biver A, Ceuterick-de Groote C, Alders M, et al. Shwachman–Diamond syndrome presenting with early ichthyosis, associated dermal and epidermal intracellular lipid droplets, hypoglycemia, and later distinctive clinical SDS phenotype. Am J Med Genet Part A. 2016;170(7):1799–805.
Corr PJ, DeYoung CG, McNaughton N. Motivation and personality: a neuropsychological perspective. Soc Pers Psychol Compass. 2013;7(3):158–75.
Restrepo JE. Correlatos cognitivos y neuropsicológicos de los cinco grandes: una revisión en el área de la neurociencia de la personalidad. Pensando Psicol. 2015;11(18):107.
Pocnet C, Dupuis M, Congard A, Jopp D. Personality and its links to quality of life: mediating effects of emotion regulation and self-efficacy beliefs. Motiv Emot. 2017;41(2):196–208.
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spelling Arias Pérez, Rubén Darío618d049d-aed0-4551-b674-3da8214a249bGallego Quintero, Salomón94b09429-7062-46e7-b552-4c5dd8799f10Taborda Vanegas, Natalia Andrea0bf679d8-90d7-4250-9a02-bde0c3f00995Restrepo Carvajal, Jorge Emirodc929ee8-067b-4c32-8ebc-c5b72da45ba4Zambrano Cruz, Renato3fa0cbff-8632-4d3b-a24b-a001802a8b97Tamayo Agudelo, ‪William Fernandobd972c4b-e31f-426c-8847-80ed7c329cedBermúdez, Patriciae615a2f6-9b8d-4f4e-af29-0a39e300fff4Duque Vélez, Constanza Elenaa3721172-14d9-4a89-a75a-55a44b2deb95Arroyave, Ismaelc98c929f-6839-4a13-8d44-9f9f4ea833acTejada Moreno, Johanna Alexandra6e91f324-c104-4540-aea9-6e37ce7b6ac2Villegas Lanau, Carlos Andrés6b76ff2c-511e-4643-bf7c-a363af01f1c8Mejía García, Alejandroe098d10b-2ca2-4101-b25a-7c5b9304daffZapata Builes, Wildeman50e7a24e-1d3b-40c5-b677-2c2bf7bd9eccHernández López, Juan Carlosd60a9619-7af9-4104-881a-51b2a6a80ee2Cuartas Montoya, Gina Paula863267c4-f27f-4411-a372-76f5712783222023-03-30T20:50:11Z2023-03-30T20:50:11Z2021https://dspace.tdea.edu.co/handle/tdea/27251755-8794Background: Ichthyosis is a heterogeneous group of diseases caused by genetic disorders related to skin formation. They are characterized by generalized dry skin, scaling, hyperkeratosis and frequently associated with erythroderma. Among its different types, harlequin ichthyosis (HI) stands out due to its severity. HI is caused by mutations in the ABCA12 gene, which encodes essential proteins in epidermal lipid transport, and it helps maintain the homeostasis of the stratum corneum of the epidermis. However, due to the wide spectrum of genetic alterations that can cause ichthyosis, holistic medical care, and genetic studies are required to improve the diagnosis and outcomes of these diseases. Case presentation: Here, we presented the case of a 19 years old male patient who was a premature infant and exhibited clinical features consistent with HI, including bright yellow hyperkeratotic plates with erythematous fissures that covered his entire body like a collodion baby. Currently, he exhibited erythroderma, photosensitivity, ectropion, auricular pavilion alterations, and musculoskeletal disorders, such as equinovarus feet, fingers, hands, and hypoplastic feet with contractures in flexion and marked difficulty in fine motor skills. In addition, he presented dyschromatopsia, Achilles reflex hyporeflexia, slight speech, dental alteration and deficient cognitive performance. After the genetic sequencing, variants were found in ABCA12 and HRNR which are related to several skin diseases, including ichthyosis. Conclusions: Although in clinical practice, ichthyosis is a common entity, a severe type of ichthyosis is presented, highlighting the importance of appropriate genetic diagnosis, given the broad spectrum of genetic alterations with similar phenotypic and clinical characteristics. These pathologies must be known to guarantee initial support measures to prevent complications and offer multidisciplinary management to those patients. Keywords: Harlequin ichthyosis, Congenital ichthyosis, Ichthyosis, Skin disease, Case report8 páginasapplication/pdfengBioMed CentralEnglandhttps://creativecommons.org/licenses/by/4.0/Atribución 4.0 Internacional (CC BY 4.0)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2https://bmcmedgenomics.biomedcentral.com/articles/10.1186/s12920-021-00987-yIchthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genesArtículo de revistahttp://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a858140114BMC medical genomicsAkiyama M. ABCA12 mutations and autosomal recessive congenital ichthyosis: a review of genotype/phenotype correlations and of pathogenetic conceptsa. Hum Mutat. 2010;31(10):1090–6Hausser I, Vabres P, Hohl D, Ishida-Yamamoto A, Tadini G, Leigh I, et al. Revised nomenclature and classification of inherited ichthyoses: results of the First Ichthyosis Consensus Conference in Sorèze 2009. J Am Acad Dermatol. 2010;63(4):607–41.Takeichi T, Akiyama M. Inherited ichthyosis: non-syndromic forms. J Dermatol. 2016;43(3):242–51Murase C, Nakatochi M, Kanekura T, Tohyama M, Kurosawa M, Masuda K, et al. Cross-sectional survey on disease severity in Japanese patients with harlequin ichthyosis/ichthyosis: syndromic forms and quality-of-life analysis in a subgroup. J Dermatol Sci. 2018;92(2):127–33.Schmuth M, Martinz V, Janecke AR, Fauth C, Schossig A, Zschocke J, et al. Inherited ichthyoses/generalized Mendelian disorders of cornification. Eur J Hum Genet. 2013;21(2):123–33.Rodríguez-Pazos L, Ginarte M, Vega A, Toribio J. Ictiosis congénitas autosómicas recesivas. Actas Dermosifiliogr. 2013;104(4):270–84.Rajpopat S, Moss C, Mellerio J, Vahlquist A, Gånemo A, Hellstrom-Pigg M, et al. Harlequin ichthyosis: a review of clinical and molecular findings in 45 cases. Arch Dermatol. 2011;147(6):681Loo BKG, Batilando MJ, Tan EC, Koh MJA. Compound heterozygous mutations with novel missense ABCA12 mutation in harlequin ichthyosis. BMJ Case Rep. 2018;2018:bcr-2017-222025Shruthi B, Nilgar BR, Dalal A, Limbani N. Harlequin ichthyosis: a rare case. Turk J Obstet Gynecol. 2017;14(2):138–40.Yang S, Bayart C, Brandling-Bennett H. An atypical presentation of herpes simplex virus infection in Harlequin ichthyosis. Pediatr Dermatol. 2018;35(6):1–2.Zhang L, Ferreyros M, Feng W, Hupe M, Crumrine DA, Chen J, et al. Defects in stratum corneum desquamation are the predominant effect of impaired ABCA12 function in a novel mouse model of harlequin ichthyosis. PLoS ONE. 2016;11(8):e0161465.Akiyama M. The roles of ABCA12 in epidermal lipid barrier formation and keratinocyte differentiation. Biochim Biophys Acta Mol Cell Biol Lipids. 2014;1841(3):435–40.Nayak S, Dash SP, Khatua M. Fetal harlequin ichthyosis-a case report. IOSR J Dent Med Sci . 2015;14(11):81–6.Kurosawa M, Uehara R, Takagi A, Aoyama Y, Iwatsuki K, Amagai M, et al. Results of a nationwide epidemiologic survey of autosomal recessive congenital ichthyosis and ichthyosis syndromes in Japan. J Am Acad Dermatol. 2018;81(5):1086–92.Incecık F, Herguner OM, Ozbek MN, Gungor S, Yılmaz M, Rizzo WB, et al. Neuro-ichthyotic syndromes: a case series. J Pediatr Neurosci. 2018;13(1):34–8.Dufresne H, Hadj-Rabia S, Méni C, Sibaud V, Bodemer C, Taïeb C. Family burden in inherited ichthyosis: creation of a specific questionnaire. Orphanet J Rare Dis. 2013;8(1):28.Ostrosky F, Gómez ME, Matute E, Rosselli M, Ardila APD. Neuropsi: Atención y Memoria. 3rd ed. México: Manual Moderno; 2019.Starosta AJ, Brenner LA. Beck Anxiety Inventory. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of clinical neuropsychology. Cham: Springer; 2018. p. 521–525.Beck AT, Steer RA, Brown GK. Beck Depression Inventory Manual. San Antonio: Psychological Corporation; 1993. p. 38.Costa PT, McCrae RR. The NEO-PI/NEO-FFI Manual Supplement. Odessa: Psychological Assessment Resources; 1989.Buitrago N, Monsalve C, Morales C, Ochoca C, Pizarro T. Guía De Práctica Clínica En Ortodoncia IPS CES Sabaneta. Medellín: Universidad CES; 2014.Botero Mariaca PM, Vélez TN. Manual de historia clínica odontológica del escolar. Bogotá: Universida. Manual de historia clínica odontológica del escolar; 2016. p. 302.Nava M, Benítez O, Onofre M, Nava J, Galdocerna P. Remodelación ósea mandibular en adultos. Rev ADM. 2009;65(4):18–22.Shimizu Y, Ogawa Y, Sugiura K, Takeda J, Akiyama M. A Palindromic motif in the 2 2084 to 2 2078 upstream region is essential for ABCA12 promoter function in cultured human keratinocytes. Sci Rep. 2014;4(6737):1–5.Vahlquist A. Inherited nonsyndromic ichthyoses: an update on pathophysiology, diagnosis and treatment. Am J Clin Dermatol. 2018;19:51–66.Sugiura K, Akiyama M. 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Motiv Emot. 2017;41(2):196–208.skin diseasesEnfermedades de la pielDermatoseIchthyosisIctiosisIctioseHarlequin ichthyosisCongenital ichthyosisCase reportORIGINALIchthyosis case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes.pdfIchthyosis case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes.pdfapplication/pdf1283816https://dspace.tdea.edu.co/bitstream/tdea/2725/1/Ichthyosis%20case%20report%20in%20a%20Colombian%20man%20with%20genetic%20alterations%20in%20ABCA12%20and%20HRNR%20genes.pdf125528ab1b78e1b554d31ba7b508884eMD51open accessTEXTIchthyosis case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes.pdf.txtIchthyosis case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes.pdf.txtExtracted 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name.|||https://creativecommons.org/licenses/by/4.0/open accessRepositorio Institucional Tecnologico de 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 incorporada en las Obras Colectivas.

b.	Distribuir copias o fonogramas de las Obras, exhibirlas públicamente, ejecutarlas públicamente y/o ponerlas a disposición pública, incluyéndolas como incorporadas en Obras Colectivas, según corresponda.

c.	Distribuir copias de las Obras Derivadas que se generen, exhibirlas públicamente, ejecutarlas públicamente y/o ponerlas a disposición pública.
Los derechos mencionados anteriormente pueden ser ejercidos en todos los medios y formatos, actualmente conocidos o que se inventen en el futuro. Los derechos antes mencionados incluyen el derecho a realizar dichas modificaciones en la medida que sean técnicamente necesarias para ejercer los derechos en otro medio o formatos, pero de otra manera usted no está autorizado para realizar obras derivadas. Todos los derechos no otorgados expresamente por el Licenciante quedan por este medio reservados, incluyendo pero sin limitarse a aquellos que se mencionan en las secciones 4(d) y 4(e).

4. Restricciones.
La licencia otorgada en la anterior Sección 3 está expresamente sujeta y limitada por las siguientes restricciones:

a.	Usted puede distribuir, exhibir públicamente, ejecutar públicamente, o poner a disposición pública la Obra sólo bajo las condiciones de esta Licencia, y Usted debe incluir una copia de esta licencia o del Identificador Universal de Recursos de la misma con cada copia de la Obra que distribuya, exhiba públicamente, ejecute públicamente o ponga a disposición pública. No es posible ofrecer o imponer ninguna condición sobre la Obra que altere o limite las condiciones de esta Licencia o el ejercicio de los derechos de los destinatarios otorgados en este documento. No es posible sublicenciar la Obra. Usted debe mantener intactos todos los avisos que hagan referencia a esta Licencia y a la cláusula de limitación de garantías. Usted no puede distribuir, exhibir públicamente, ejecutar públicamente, o poner a disposición pública la Obra con alguna medida tecnológica que controle el acceso o la utilización de ella de una forma que sea inconsistente con las condiciones de esta Licencia. Lo anterior se aplica a la Obra incorporada a una Obra Colectiva, pero esto no exige que la Obra Colectiva aparte de la obra misma quede sujeta a las condiciones de esta Licencia. Si Usted crea una Obra Colectiva, previo aviso de cualquier Licenciante debe, en la medida de lo posible, eliminar de la Obra Colectiva cualquier referencia a dicho Licenciante o al Autor Original, según lo solicitado por el Licenciante y conforme lo exige la cláusula 4(c).

b.	Usted no puede ejercer ninguno de los derechos que le han sido otorgados en la Sección 3 precedente de modo que estén principalmente destinados o directamente dirigidos a conseguir un provecho comercial o una compensación monetaria privada. El intercambio de la Obra por otras obras protegidas por derechos de autor, ya sea a través de un sistema para compartir archivos digitales (digital file-sharing) o de cualquier otra manera no será considerado como estar destinado principalmente o dirigido directamente a conseguir un provecho comercial o una compensación monetaria privada, siempre que no se realice un pago mediante una compensación monetaria en relación con el intercambio de obras protegidas por el derecho de autor.

c.	Si usted distribuye, exhibe públicamente, ejecuta públicamente o ejecuta públicamente en forma digital la Obra o cualquier Obra Derivada u Obra Colectiva, Usted debe mantener intacta toda la información de derecho de autor de la Obra y proporcionar, de forma razonable según el medio o manera que Usted esté utilizando: (i) el nombre del Autor Original si está provisto (o seudónimo, si fuere aplicable), y/o (ii) el nombre de la parte o las partes que el Autor Original y/o el Licenciante hubieren designado para la atribución (v.g., un instituto patrocinador, editorial, publicación) en la información de los derechos de autor del Licenciante, términos de servicios o de otras formas razonables; el título de la Obra si está provisto; en la medida de lo razonablemente factible y, si está provisto, el Identificador Uniforme de Recursos (Uniform Resource Identifier) que el Licenciante especifica para ser asociado con la Obra, salvo que tal URI no se refiera a la nota sobre los derechos de autor o a la información sobre el licenciamiento de la Obra; y en el caso de una Obra Derivada, atribuir el crédito identificando el uso de la Obra en la Obra Derivada (v.g., "Traducción Francesa de la Obra del Autor Original," o "Guión Cinematográfico basado en la Obra original del Autor Original"). Tal crédito puede ser implementado de cualquier forma razonable; en el caso, sin embargo, de Obras Derivadas u Obras Colectivas, tal crédito aparecerá, como mínimo, donde aparece el crédito de cualquier otro autor comparable y de una manera, al menos, tan destacada como el crédito de otro autor comparable.

d.	Para evitar toda confusión, el Licenciante aclara que, cuando la obra es una composición musical:

i.	Regalías por interpretación y ejecución bajo licencias generales. El Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública o la ejecución pública digital de la obra y de recolectar, sea individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), las regalías por la ejecución pública o por la ejecución pública digital de la obra (por ejemplo Webcast) licenciada bajo licencias generales, si la interpretación o ejecución de la obra está primordialmente orientada por o dirigida a la obtención de una ventaja comercial o una compensación monetaria privada.

ii.	Regalías por Fonogramas. El Licenciante se reserva el derecho exclusivo de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, los consagrados por la SAYCO), una agencia de derechos musicales o algún agente designado, las regalías por cualquier fonograma que Usted cree a partir de la obra (“versión cover”) y distribuya, en los términos del régimen de derechos de autor, si la creación o distribución de esa versión cover está primordialmente destinada o dirigida a obtener una ventaja comercial o una compensación monetaria privada.

e.	Gestión de Derechos de Autor sobre Interpretaciones y Ejecuciones Digitales (WebCasting). Para evitar toda confusión, el Licenciante aclara que, cuando la obra sea un fonograma, el Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública digital de la obra (por ejemplo, webcast) y de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, ACINPRO), las regalías por la ejecución pública digital de la obra (por ejemplo, webcast), sujeta a las disposiciones aplicables del régimen de Derecho de Autor, si esta ejecución pública digital está primordialmente dirigida a obtener una ventaja comercial o una compensación monetaria privada.

5. Representaciones, Garantías y Limitaciones de Responsabilidad.
A MENOS QUE LAS PARTES LO ACORDARAN DE OTRA FORMA POR ESCRITO, EL LICENCIANTE OFRECE LA OBRA (EN EL ESTADO EN EL QUE SE ENCUENTRA) “TAL CUAL”, SIN BRINDAR GARANTÍAS DE CLASE ALGUNA RESPECTO DE LA OBRA, YA SEA EXPRESA, IMPLÍCITA, LEGAL O CUALQUIERA OTRA, INCLUYENDO, SIN LIMITARSE A ELLAS, GARANTÍAS DE TITULARIDAD, COMERCIABILIDAD, ADAPTABILIDAD O ADECUACIÓN A PROPÓSITO DETERMINADO, AUSENCIA DE INFRACCIÓN, DE AUSENCIA DE DEFECTOS LATENTES O DE OTRO TIPO, O LA PRESENCIA O AUSENCIA DE ERRORES, SEAN O NO DESCUBRIBLES (PUEDAN O NO SER ESTOS DESCUBIERTOS). ALGUNAS JURISDICCIONES NO PERMITEN LA EXCLUSIÓN DE GARANTÍAS IMPLÍCITAS, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.

6. Limitación de responsabilidad.
A MENOS QUE LO EXIJA EXPRESAMENTE LA LEY APLICABLE, EL LICENCIANTE NO SERÁ RESPONSABLE ANTE USTED POR DAÑO ALGUNO, SEA POR RESPONSABILIDAD EXTRACONTRACTUAL, PRECONTRACTUAL O CONTRACTUAL, OBJETIVA O SUBJETIVA, SE TRATE DE DAÑOS MORALES O PATRIMONIALES, DIRECTOS O INDIRECTOS, PREVISTOS O IMPREVISTOS PRODUCIDOS POR EL USO DE ESTA LICENCIA O DE LA OBRA, AUN CUANDO EL LICENCIANTE HAYA SIDO ADVERTIDO DE LA POSIBILIDAD DE DICHOS DAÑOS. ALGUNAS LEYES NO PERMITEN LA EXCLUSIÓN DE CIERTA RESPONSABILIDAD, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.

7. Término.

a.	Esta Licencia y los derechos otorgados en virtud de ella terminarán automáticamente si Usted infringe alguna condición establecida en ella. Sin embargo, los individuos o entidades que han recibido Obras Derivadas o Colectivas de Usted de conformidad con esta Licencia, no verán terminadas sus licencias, siempre que estos individuos o entidades sigan cumpliendo íntegramente las condiciones de estas licencias. Las Secciones 1, 2, 5, 6, 7, y 8 subsistirán a cualquier terminación de esta Licencia.

b.	Sujeta a las condiciones y términos anteriores, la licencia otorgada aquí es perpetua (durante el período de vigencia de los derechos de autor de la obra). No obstante lo anterior, el Licenciante se reserva el derecho a publicar y/o estrenar la Obra bajo condiciones de licencia diferentes o a dejar de distribuirla en los términos de esta Licencia en cualquier momento; en el entendido, sin embargo, que esa elección no servirá para revocar esta licencia o que deba ser otorgada , bajo los términos de esta licencia), y esta licencia continuará en pleno vigor y efecto a menos que sea terminada como se expresa atrás. La Licencia revocada continuará siendo plenamente vigente y efectiva si no se le da término en las condiciones indicadas anteriormente.

8. Varios.

a.	Cada vez que Usted distribuya o ponga a disposición pública la Obra o una Obra Colectiva, el Licenciante ofrecerá al destinatario una licencia en los mismos términos y condiciones que la licencia otorgada a Usted bajo esta Licencia.

b.	Si alguna disposición de esta Licencia resulta invalidada o no exigible, según la legislación vigente, esto no afectará ni la validez ni la aplicabilidad del resto de condiciones de esta Licencia y, sin acción adicional por parte de los sujetos de este acuerdo, aquélla se entenderá reformada lo mínimo necesario para hacer que dicha disposición sea válida y exigible.

c.	Ningún término o disposición de esta Licencia se estimará renunciada y ninguna violación de ella será consentida a menos que esa renuncia o consentimiento sea otorgado por escrito y firmado por la parte que renuncie o consienta.

d.	Esta Licencia refleja el acuerdo pleno entre las partes respecto a la Obra aquí licenciada. No hay arreglos, acuerdos o declaraciones respecto a la Obra que no estén especificados en este documento. El Licenciante no se verá limitado por ninguna disposición adicional que pueda surgir en alguna comunicación emanada de Usted. Esta Licencia no puede ser modificada sin el consentimiento mutuo por escrito del Licenciante y Usted.
