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Incontinentia pigmenti

Bloch-Sulzberger syndrome; Bloch-Siemens syndrome

Incontinentia pigmenti (IP) is a rare skin condition passed down through families. It affects the skin, hair, eyes, teeth, and nervous system.

Causes

IP is caused by an X-linked dominant genetic defect that occurs on a gene known as IKBKG.

Because the gene defect occurs on the X chromosome, the condition is most often seen in females. When it occurs in males, it is usually lethal in the fetus and results in miscarriage.

Symptoms

With the skin symptoms, there are 4 stages. Infants with IP are born with streaky, blistering areas. In stage 2, when the areas heal, they turn into rough bumps. In stage 3, the bumps go away, but leave behind darkened skin, called hyperpigmentation. After several years, the skin returns to normal. In stage 4, there may be areas of lighter colored skin (hypopigmentation) that is thinner.

IP is associated with central nervous system problems, including:

  • Delayed development
  • Loss of movement (paralysis)
  • Intellectual disability
  • Muscle spasms
  • Seizures

People with IP may also have abnormal teeth, hair loss, and vision problems.

Exams and Tests

The health care provider will perform a physical exam, look at the eyes, and test muscle movement.

There may be unusual patterns and blisters on the skin, as well as bone abnormalities. An eye exam may reveal cataracts, strabismus (crossed eyes), or other problems.

To confirm the diagnosis, these tests may be done:

  • Blood tests
  • Skin biopsy
  • CT or MRI scan of the brain

Treatment

There is no specific treatment for IP. Treatment is aimed at the individual symptoms. For example, glasses may be needed to improve vision. Medicine may be prescribed to help control seizures or muscle spasms.

Support Groups

These resources can provide more information about IP:

Outlook (Prognosis)

How well a person does depends on the severity of central nervous system involvement and eye problems.

When to Contact a Medical Professional

Call your provider if:

  • You have a family history of IP and are considering having children
  • Your child has symptoms of this disorder

Prevention

Genetic counseling may be helpful for those with a family history of IP who are considering having children.

References

Islam MP, Roach ES. Neurocutaneous syndromes. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 100.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Genodermatoses and congenital anomalies. James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 27.

Thiele EA, Korf BR. Phakomatoses and allied conditions. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology: Principles and Practice. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 45.

  • Incontinentia pigmenti on the leg

    Incontinentia pigmenti on the leg - illustration

    Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

    Incontinentia pigmenti on the leg

    illustration

  • Incontinentia pigmenti on the leg

    Incontinentia pigmenti on the leg - illustration

    Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

    Incontinentia pigmenti on the leg

    illustration

    • Incontinentia pigmenti on the leg

      Incontinentia pigmenti on the leg - illustration

      Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

      Incontinentia pigmenti on the leg

      illustration

    • Incontinentia pigmenti on the leg

      Incontinentia pigmenti on the leg - illustration

      Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

      Incontinentia pigmenti on the leg

      illustration


     

    Review Date: 4/16/2019

    Reviewed By: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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