Raising the Self Esteem with the Oral Rehabilitation of a Child with Incontinentia Pigmenti Syndrome

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Incontinentia pigmenti (IP) is a rare X-linked dominant syndrome that mainly affects the skin, eyes, hair, central nervous system and teeth. Although dermatologic manifestations are among the most important aspects for the diagnosis of the syndrome, oral involvement characterized by hypodontia, conoid teeth and delayed eruption are also important for the diagnosis and patient aesthetic rehabilitation. These abnormalities may cause feeding problems influencing the patient quality of life. This study reported a case of a 10-year-old girl with cutaneous manifestations and hypodontia. The child´s main complaint was related to her smile. The treatment plan was the tooth restoration (conoid) and installation of the space maintainers. This case enhances the importance of integrated dental treatment, which combines pediatric dentistry, orthodontics and conventional prosthesis. In addition, hypodontia is frequently found in incontinentia pigmenti, and dentists should be aware of this condition in order to help with the diagnosis.

Incontinentia pigmenti (IP) syndrome is a rare X-linked dominant genodermatosis which mainly affects women and is usually lethal for males when in the mother’s utero. Synonyms of IP type 2 are: Bloch-Sulzberger syndrome, Bloch-Siemens syndrome, familial incontinentia pigmenti (pigment incontinence). The incidence of the disorder is 1 case per 40,000 populations. The name of the disease reflects morphological changes of the skin seen under a microscope system. The disease is systemic and involves tissues of ectodermic and mesodermic origin including coetaneous tissue, teeth, eyes and the central nervous system (CNS), amongst other organs. In 80% of the cases other defects are seen in the form of dental, skeletal, nail anomalies, microcephaly, seizures, psychomotor retardation, strabismus, opitc nerve atrophy, retinal detachment, cataracts, etc.

Cutaneous manifestations of IP are divided into the following four stages, although not all stages may be present in some cases: stage 1-erythema, vesicles and blisters appearing in a typically linear pattern; stage 2-papulae, verrucous lesions and hyperkeratosis; stage 3-hyperpigmentation; stage 4-hypopigmentation and cutaneous atrophy. In all of these stages, the cutaneous lesions tend to follow the lines of Blaschko.The blistering stage of the lesion needs to be differentiated from Herpes simplex and Bullous Impetigo. The lesions are linear and in clusters in classical Incontenentia Pigmenti. Warty phase needs to be differentiated from linear epidermal birthmarks or warts. Hyperpigmentary stage needs to be differentiated from moles and other causes of hyperpigmentation. Hyperpigmentation of Incontenentia Pigmenti is classically in whorls. affect both the primary and permanent dentitions. The most frequent alteration is hypodontia (up to 43% of patients), followed by pegged or conically crowned teeth (30% of patients). Other dental features were also reported as delayed eruption, partial anodontia, hypomineralization and gothic palate. All these manifestations are important because they persist throughout the patient’s life, thus requiring an adequate dental treatment plan when the diagnosis of the disease to oral rehabilitation is made by a multidisciplinary team. The majority of dental anomalies in IP patients could be successfully corrected. Some of these anomalies may greatly influence the quality of life causing psychological and feeding problems. This article reports a case of a 10-year-old girl with cutaneous manifestations and hypodontia. The diagnosis of incontinentia pigmenti in this patient was based on the description of vesiculobullous lesion at birth followed by hyperpigmented lesion overlapping the previous area of the vesicobullous lesion.