Netherton Syndrome Perspectives

Abstract: Netherton syndrome (NS), also known as Comèl-Netherton syndrome, is a rare disorder of cornification resulting from pathogenic variants in the Kazal type 5 (SPINK5) gene encoding serine protease inhibitor LEKTI. NS is characterized by the triad of congenital ichthyosiform erythroderma (CIE)/ichthyosis linearis circumflexa (ILC), trichorrhexis invaginata (TI), and atopic diathesis. Due to the severity of pathogenesis and variability in clinical presentations, the management of NS poses significant therapeutic challenges, which often require a multidisciplinary approach. Current treatment modalities predominantly consist of topical interventions and supportive measures. With an improved understanding of NS pathophysiology, emerging literature has suggested novel systemic therapeutic options for NS, which include repurposed biologics like targeted inhibitors and intravenous immunoglobulins, but there remains a paucity of literature regarding their clinical outcomes. Although often cited among dermatologists and allergists, the condition is rare in Hong Kong and Singapore, and most physicians have not managed any case. This review suggests that NS may be underestimated clinically. We aim to raise awareness for clinicians in the specific clinical characteristics and pathophysiology of NS to decide tailor-made treatment plans and improve patient outcomes.