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Smith-Magenis syndrome(SMS)

MedGen UID:
162881
Concept ID:
C0795864
Disease or Syndrome
Synonyms: Chromosome 17p11.2 deletion syndrome; SMS
SNOMED CT: Smith-Magenis syndrome (401315004)
Modes of inheritance:
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
 
Gene (location): RAI1 (17p11.2)
 
Monarch Initiative: MONDO:0008434
OMIM®: 182290
Orphanet: ORPHA819

Disease characteristics

Excerpted from the GeneReview: Smith-Magenis Syndrome
Smith-Magenis syndrome (SMS) is characterized by distinctive physical features (particularly coarse facial features that progress with age), developmental delay, cognitive impairment, behavioral abnormalities, sleep disturbance, and childhood-onset abdominal obesity. Infants have feeding difficulties, failure to thrive, hypotonia, hyporeflexia, prolonged napping or need to be awakened for feeds, and generalized lethargy. The majority of individuals function in the mild-to-moderate range of intellectual disability. The behavioral phenotype, including significant sleep disturbance, stereotypies, and maladaptive and self-injurious behaviors, is generally not recognized until age 18 months or older and continues to change until adulthood. Sensory issues are frequently noted; these may include avoidant behavior, as well as repetitive seeking of textures, sounds, and experiences. Toileting difficulties are common. Significant anxiety is common as are problems with executive functioning, including inattention, distractibility, hyperactivity, and impulsivity. Maladaptive behaviors include frequent outbursts / temper tantrums, attention-seeking behaviors, opposition, aggression, and self-injurious behaviors including self-hitting, self-biting, skin picking, inserting foreign objects into body orifices (polyembolokoilamania), and yanking fingernails and/or toenails (onychotillomania). Among the stereotypic behaviors described, the spasmodic upper-body squeeze or "self-hug" seems to be highly associated with SMS. An underlying developmental asynchrony, specifically emotional maturity delayed beyond intellectual functioning, may also contribute to maladaptive behaviors in people with SMS. [from GeneReviews]
Authors:
Ann CM Smith  |  Kerry E Boyd  |  Christine Brennan, et. al.   view full author information

Additional description

From MedlinePlus Genetics
Smith-Magenis syndrome is a developmental disorder that affects many parts of the body. The major features of this condition include mild to moderate intellectual disability, delayed speech and language skills, distinctive facial features, sleep disturbances, and behavioral problems.\n\nMost people with Smith-Magenis syndrome have a broad, square-shaped face with deep-set eyes, full cheeks, and a prominent lower jaw. The middle of the face and the bridge of the nose often appear flattened. The mouth tends to turn downward with a full, outward-curving upper lip. These facial differences can be subtle in early childhood, but they usually become more distinctive in later childhood and adulthood. Dental abnormalities are also common in affected individuals.\n\nDisrupted sleep patterns are characteristic of Smith-Magenis syndrome, typically beginning early in life. Affected people may be very sleepy during the day, but they have trouble falling asleep at night and awaken several times during the night and early morning.\n\nPeople with Smith-Magenis syndrome typically have affectionate, engaging personalities, but most also have behavioral problems. These include frequent temper tantrums and outbursts, aggression, anxiety, impulsiveness, and difficulty paying attention. Self-injury, including biting, hitting, head banging, and skin picking, is very common. Repetitive self-hugging is a behavioral trait that may be unique to Smith-Magenis syndrome. Some people with this condition also compulsively lick their fingers and flip pages of books and magazines (a behavior known as "lick and flip").\n\nOther signs and symptoms of Smith-Magenis syndrome include short stature, abnormal curvature of the spine (scoliosis), reduced sensitivity to pain and temperature, and a hoarse voice. Some people with this disorder have ear abnormalities that lead to hearing loss. Affected individuals may have eye abnormalities that cause nearsightedness (myopia) and other vision problems. Although less common, heart and kidney defects also have been reported in people with Smith-Magenis syndrome.  https://medlineplus.gov/genetics/condition/smith-magenis-syndrome

Clinical features

From HPO
Abnormality of the urinary system
MedGen UID:
867444
Concept ID:
C4021821
Disease or Syndrome
An abnormality of the urinary system.
Abnormal renal morphology
MedGen UID:
1633142
Concept ID:
C4551596
Anatomical Abnormality
Any structural anomaly of the kidney.
Pes planus
MedGen UID:
42034
Concept ID:
C0016202
Anatomical Abnormality
A foot where the longitudinal arch of the foot is in contact with the ground or floor when the individual is standing; or, in a patient lying supine, a foot where the arch is in contact with the surface of a flat board pressed against the sole of the foot by the examiner with a pressure similar to that expected from weight bearing; or, the height of the arch is reduced.
Brachydactyly
MedGen UID:
67454
Concept ID:
C0221357
Congenital Abnormality
Digits that appear disproportionately short compared to the hand/foot. The word brachydactyly is used here to describe a series distinct patterns of shortened digits (brachydactyly types A-E). This is the sense used here.
Broad palm
MedGen UID:
75535
Concept ID:
C0264142
Congenital Abnormality
For children from birth to 4 years of age the palm width is more than 2 SD above the mean; for children from 4 to 16 years of age the palm width is above the 95th centile; or, the width of the palm appears disproportionately wide for the length.
Short palm
MedGen UID:
334684
Concept ID:
C1843108
Finding
Short palm.
Abnormality of the forearm
MedGen UID:
871189
Concept ID:
C4025666
Anatomical Abnormality
An abnormality of the lower arm.
Heart, malformation of
MedGen UID:
6748
Concept ID:
C0018798
Congenital Abnormality
Any structural anomaly of the heart.
Abnormality of cardiovascular system morphology
MedGen UID:
892473
Concept ID:
C4049796
Congenital Abnormality
Any structural anomaly of the heart and great vessels.
Increased body weight
MedGen UID:
12145
Concept ID:
C0043094
Finding
Abnormally increased body weight.
Short stature
MedGen UID:
87607
Concept ID:
C0349588
Finding
A height below that which is expected according to age and gender norms. Although there is no universally accepted definition of short stature, many refer to \
Constipation
MedGen UID:
1101
Concept ID:
C0009806
Sign or Symptom
Infrequent or difficult evacuation of feces.
Hearing impairment
MedGen UID:
235586
Concept ID:
C1384666
Disease or Syndrome
A decreased magnitude of the sensory perception of sound.
Abnormality of the outer ear
MedGen UID:
335428
Concept ID:
C1846460
Anatomical Abnormality
An abnormality of the external ear.
Morphological abnormality of the middle ear
MedGen UID:
387824
Concept ID:
C1857456
Anatomical Abnormality
An abnormality of the morphology or structure of the middle ear.
Head-banging
MedGen UID:
42337
Concept ID:
C0018672
Mental or Behavioral Dysfunction
Habitual striking of one's own head against a surface such as a mattress or wall of a crib.
Peripheral neuropathy
MedGen UID:
18386
Concept ID:
C0031117
Disease or Syndrome
Peripheral neuropathy is a general term for any disorder of the peripheral nervous system. The main clinical features used to classify peripheral neuropathy are distribution, type (mainly demyelinating versus mainly axonal), duration, and course.
Hyperacusis
MedGen UID:
20497
Concept ID:
C0034880
Sign or Symptom
Over-sensitivity to certain frequency ranges of sound.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterised by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Self-mutilation
MedGen UID:
19925
Concept ID:
C0036601
Injury or Poisoning
The act of injuring one''s own body to the extent of cutting off or permanently destroying a limb or other essential part of a body.
Sleep disturbance
MedGen UID:
52372
Concept ID:
C0037317
Sign or Symptom
An abnormality of sleep including such phenomena as 1) insomnia/hypersomnia, 2) non-restorative sleep, 3) sleep schedule disorder, 4) excessive daytime somnolence, 5) sleep apnea, and 6) restlessness.
EEG abnormality
MedGen UID:
56235
Concept ID:
C0151611
Finding
Abnormality observed by electroencephalogram (EEG), which is used to record of the brain's spontaneous electrical activity from multiple electrodes placed on the scalp.
Behavioral abnormality
MedGen UID:
535345
Concept ID:
C0233514
Mental or Behavioral Dysfunction
An abnormality of mental functioning including various affective, behavioural, cognitive and perceptual abnormalities.
Onychotillomania
MedGen UID:
65438
Concept ID:
C0233623
Mental or Behavioral Dysfunction
Onychotillomania is characterized by the compulsive or irresistible urge in patients to pick at, pull off, or harmfully bite or chew their nails.
Areflexia
MedGen UID:
115943
Concept ID:
C0234146
Finding
Absence of neurologic reflexes such as the knee-jerk reaction.
Hyperactivity
MedGen UID:
98406
Concept ID:
C0424295
Finding
Hyperactivity is a state of constantly being unusually or abnormally active, including in situations in which it is not appropriate.
Delayed speech and language development
MedGen UID:
105318
Concept ID:
C0454644
Finding
A degree of language development that is significantly below the norm for a child of a specified age.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Hyporeflexia
MedGen UID:
195967
Concept ID:
C0700078
Finding
Reduction of neurologic reflexes such as the knee-jerk reaction.
Impaired pain sensation
MedGen UID:
373348
Concept ID:
C1837522
Finding
Reduced ability to perceive painful stimuli.
Ventriculomegaly
MedGen UID:
480553
Concept ID:
C3278923
Finding
An increase in size of the ventricular system of the brain.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Subnormal intellectual functioning which originates during the developmental period. Intellectual disability, previously referred to as mental retardation, has been defined as an IQ score below 70.
Sleep-wake inversion
MedGen UID:
1644493
Concept ID:
C4703574
Finding
A reversal of sleeping habits with a tendency to sleep during the day and to be awake at night.
Polyembolokoilamania
MedGen UID:
1701959
Concept ID:
C5139392
Mental or Behavioral Dysfunction
Habitual insertion of foreign bodies into bodily orifices.
Self hugging
MedGen UID:
1702098
Concept ID:
C5139398
Mental or Behavioral Dysfunction
Involuntary, tic-like movements consisted of crossing both arms across the chest and tensing the body or clasping the hands and squeezing the arms to the sides. The movements last a few seconds and may occur in series or flurries, generally accompanied by facial grimacing and occasional grunting.
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
The presence of an abnormal lateral curvature of the spine.
Brachycephaly
MedGen UID:
113165
Concept ID:
C0221356
Congenital Abnormality
An abnormality of skull shape characterized by a decreased anterior-posterior diameter. That is, a cephalic index greater than 81%. Alternatively, an apparently shortened anteroposterior dimension (length) of the head compared to width.
Malar flattening
MedGen UID:
347616
Concept ID:
C1858085
Anatomical Abnormality
Underdevelopment of the malar prominence of the jugal bone (zygomatic bone in mammals), appreciated in profile, frontal view, and/or by palpation.
Generalized hypotonia
MedGen UID:
346841
Concept ID:
C1858120
Finding
Generalized muscular hypotonia (abnormally low muscle tone).
Abnormal tracheobronchial morphology
MedGen UID:
867271
Concept ID:
C4021631
Anatomical Abnormality
Abnormality of the larynx
MedGen UID:
867407
Concept ID:
C4021777
Anatomical Abnormality
An abnormality of the larynx.
Abnormality of the immune system
MedGen UID:
867388
Concept ID:
C4021753
Pathologic Function
An abnormality of the immune system.
Hypercholesterolemia
MedGen UID:
5687
Concept ID:
C0020443
Disease or Syndrome
An increased concentration of cholesterol in the blood.
Hypertriglyceridemia
MedGen UID:
167238
Concept ID:
C0813230
Finding
An abnormal increase in the level of triglycerides in the blood.
Hoarse voice
MedGen UID:
5602
Concept ID:
C0019825
Sign or Symptom
Hoarseness refers to a change in the pitch or quality of the voice, with the voice sounding weak, very breathy, scratchy, or husky.
Velopharyngeal insufficiency
MedGen UID:
52992
Concept ID:
C0042454
Finding
Inability of velopharyngeal sphincter to sufficiently separate the nasal cavity from the oral cavity during speech.
Abnormality of the dentition
MedGen UID:
78084
Concept ID:
C0262444
Finding
Any abnormality of the teeth.
Mandibular prognathia
MedGen UID:
98316
Concept ID:
C0399526
Finding
Abnormal prominence of the chin related to increased length of the mandible.
Wide nasal bridge
MedGen UID:
341441
Concept ID:
C1849367
Finding
Increased breadth of the nasal bridge (and with it, the nasal root).
Midface retrusion
MedGen UID:
339938
Concept ID:
C1853242
Anatomical Abnormality
Posterior positions and/or vertical shortening of the infraorbital and perialar regions, or increased concavity of the face and/or reduced nasolabial angle.
Broad face
MedGen UID:
349223
Concept ID:
C1859680
Finding
Bizygomatic (upper face) and bigonial (lower face) width greater than 2 standard deviations above the mean (objective); or an apparent increase in the width of the face (subjective).
Oral cleft
MedGen UID:
893092
Concept ID:
C4021813
Congenital Abnormality
The presence of a cleft in the oral cavity, the two main types of which are cleft lip and cleft palate. In cleft lip, there is the congenital failure of the maxillary and median nasal processes to fuse, forming a groove or fissure in the lip. In cleft palate, there is a congenital failure of the palate to fuse properly, forming a grooved depression or fissure in the roof of the mouth. Clefts of the lip and palate can occur individually or together. It is preferable to code each defect separately.
Everted upper lip vermilion
MedGen UID:
869272
Concept ID:
C4023698
Finding
Inner aspect of the upper lip vermilion (normally apposing the teeth) visible in a frontal view, i.e., the presence of an everted upper lip.
Synophrys
MedGen UID:
98132
Concept ID:
C0431447
Congenital Abnormality
Meeting of the medial eyebrows in the midline.
Abnormality of the thyroid gland
MedGen UID:
1378579
Concept ID:
C4317107
Finding
An abnormality of the thyroid gland.
Retinal detachment
MedGen UID:
19759
Concept ID:
C0035305
Disease or Syndrome
Primary or spontaneous detachment of the retina occurs due to underlying ocular disease and often involves the vitreous as well as the retina. The precipitating event is formation of a retinal tear or hole, which permits fluid to accumulate under the sensory layers of the retina and creates an intraretinal cleavage that destroys the neurosensory process of visual reception. Vitreoretinal degeneration and tear formation are painless phenomena, and in most cases, significant vitreoretinal pathology is found only after detachment of the retina starts to cause loss of vision or visual field. Without surgical intervention, retinal detachment will almost inevitably lead to total blindness (summary by McNiel and McPherson, 1971).
Deeply set eye
MedGen UID:
473112
Concept ID:
C0423224
Finding
An eye that is more deeply recessed into the plane of the face than is typical.
Abnormality of the eye
MedGen UID:
1370071
Concept ID:
C4316870
Anatomical Abnormality
Any abnormality of the eye, including location, spacing, and intraocular abnormalities.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVSmith-Magenis syndrome
Follow this link to review classifications for Smith-Magenis syndrome in Orphanet.

Professional guidelines

PubMed

Schaefer GB, Mendelsohn NJ; Professional Practice and Guidelines Committee.
Genet Med 2013 May;15(5):399-407. Epub 2013 Mar 21 doi: 10.1038/gim.2013.32. PMID: 23519317

Recent clinical studies

Etiology

Garayzábal E, Hidalgo I, Miranda de Souza ALD, da Silva NC, Giacheti CM, Pinato L
Res Dev Disabil 2022 Sep;128:104286. Epub 2022 Jun 29 doi: 10.1016/j.ridd.2022.104286. PMID: 35779287
Rive Le Gouard N, Jacquinet A, Ruaud L, Deleersnyder H, Ageorges F, Gallard J, Lacombe D, Odent S, Mikaty M, Manouvrier-Hanu S, Ghoumid J, Geneviève D, Lehman N, Philip N, Edery P, Héron D, Rastel C, Chancenotte S, Thauvin-Robinet C, Faivre L, Perrin L, Verloes A
Clin Genet 2021 Apr;99(4):519-528. Epub 2021 Jan 5 doi: 10.1111/cge.13906. PMID: 33368193
Nag HE, Nærland T
J Intellect Disabil 2021 Dec;25(4):429-440. Epub 2020 Jan 26 doi: 10.1177/1744629519901056. PMID: 31984836Free PMC Article
Trickett J, Oliver C, Heald M, Denyer H, Surtees A, Clarkson E, Gringras P, Richards C
Sleep 2020 Apr 15;43(4) doi: 10.1093/sleep/zsz260. PMID: 31630201
Trickett J, Heald M, Oliver C, Richards C
J Neurodev Disord 2018 Mar 1;10(1):9. doi: 10.1186/s11689-018-9226-0. PMID: 29490614Free PMC Article

Diagnosis

Onesimo R, Delogu AB, Blandino R, Leoni C, Rosati J, Zollino M, Zampino G
Am J Med Genet A 2022 Jul;188(7):2184-2186. Epub 2022 Apr 4 doi: 10.1002/ajmg.a.62740. PMID: 35373511
Rinaldi B, Villa R, Sironi A, Garavelli L, Finelli P, Bedeschi MF
Genes (Basel) 2022 Feb 11;13(2) doi: 10.3390/genes13020335. PMID: 35205380Free PMC Article
Agar G, Bissell S, Wilde L, Over N, Williams C, Richards C, Oliver C
Orphanet J Rare Dis 2022 Feb 4;17(1):35. doi: 10.1186/s13023-021-02159-8. PMID: 35120534Free PMC Article
Müller AR, Zinkstok JR, Rommelse NNJ, van de Ven PM, Roes KCB, Wijburg FA, de Rooij-Askes E, Linders C, Boot E, van Eeghen AM
Orphanet J Rare Dis 2021 Sep 8;16(1):380. doi: 10.1186/s13023-021-02003-z. PMID: 34496899Free PMC Article
Rive Le Gouard N, Jacquinet A, Ruaud L, Deleersnyder H, Ageorges F, Gallard J, Lacombe D, Odent S, Mikaty M, Manouvrier-Hanu S, Ghoumid J, Geneviève D, Lehman N, Philip N, Edery P, Héron D, Rastel C, Chancenotte S, Thauvin-Robinet C, Faivre L, Perrin L, Verloes A
Clin Genet 2021 Apr;99(4):519-528. Epub 2021 Jan 5 doi: 10.1111/cge.13906. PMID: 33368193

Therapy

Müller AR, Zinkstok JR, Rommelse NNJ, van de Ven PM, Roes KCB, Wijburg FA, de Rooij-Askes E, Linders C, Boot E, van Eeghen AM
Orphanet J Rare Dis 2021 Sep 8;16(1):380. doi: 10.1186/s13023-021-02003-z. PMID: 34496899Free PMC Article
Polymeropoulos CM, Brooks J, Czeisler EL, Fisher MA, Gibson MM, Kite K, Smieszek SP, Xiao C, Elsea SH, Birznieks G, Polymeropoulos MH
Genet Med 2021 Dec;23(12):2426-2432. Epub 2021 Jul 27 doi: 10.1038/s41436-021-01282-y. PMID: 34316024Free PMC Article
Kaplan KA, Elsea SH, Potocki L
CNS Drugs 2020 Jul;34(7):723-730. doi: 10.1007/s40263-020-00733-5. PMID: 32495322
Spruyt K, Braam W, Smits M, Curfs LM
CNS Neurosci Ther 2016 Nov;22(11):928-935. Epub 2016 Oct 14 doi: 10.1111/cns.12653. PMID: 27743421Free PMC Article
Nijim Y, Adawi A, Bisharat B, Bowirrat A
Medicine (Baltimore) 2016 Jan;95(3):e2362. doi: 10.1097/MD.0000000000002362. PMID: 26817868Free PMC Article

Prognosis

Shayota BJ, Elsea SH
Curr Opin Psychiatry 2019 Mar;32(2):73-78. doi: 10.1097/YCO.0000000000000474. PMID: 30557269Free PMC Article
Nag HE, Nordgren A, Anderlid BM, Nærland T
Mol Autism 2018;9:1. Epub 2018 Jan 8 doi: 10.1186/s13229-017-0184-2. PMID: 29321841Free PMC Article
Yang J, Chandrasekharappa SC, Vilboux T, Smith AC, Peterson EJ
J Clin Rheumatol 2014 Aug;20(5):291-3. doi: 10.1097/RHU.0000000000000118. PMID: 25036569Free PMC Article
Adams DR, Yuan H, Holyoak T, Arajs KH, Hakimi P, Markello TC, Wolfe LA, Vilboux T, Burton BK, Fajardo KF, Grahame G, Holloman C, Sincan M, Smith AC, Wells GA, Huang Y, Vega H, Snyder JP, Golas GA, Tifft CJ, Boerkoel CF, Hanson RW, Traynelis SF, Kerr DS, Gahl WA
Mol Genet Metab 2014 Nov;113(3):161-70. Epub 2014 Apr 13 doi: 10.1016/j.ymgme.2014.04.001. PMID: 24863970Free PMC Article
Sloneem J, Oliver C, Udwin O, Woodcock KA
J Intellect Disabil Res 2011 Feb;55(2):138-51. Epub 2011 Jan 4 doi: 10.1111/j.1365-2788.2010.01371.x. PMID: 21199049

Clinical prediction guides

Garayzábal E, Hidalgo I, Miranda de Souza ALD, da Silva NC, Giacheti CM, Pinato L
Res Dev Disabil 2022 Sep;128:104286. Epub 2022 Jun 29 doi: 10.1016/j.ridd.2022.104286. PMID: 35779287
Gandhi A, Zhou D, Alaimo J, Chon E, Fountain MD, Elsea SH
J Autism Dev Disord 2021 Jun;51(6):1852-1865. doi: 10.1007/s10803-020-04666-2. PMID: 32845423
Nag HE, Nærland T
J Intellect Disabil 2021 Dec;25(4):429-440. Epub 2020 Jan 26 doi: 10.1177/1744629519901056. PMID: 31984836Free PMC Article
Vetrini F, McKee S, Rosenfeld JA, Suri M, Lewis AM, Nugent KM, Roeder E, Littlejohn RO, Holder S, Zhu W, Alaimo JT, Graham B, Harris JM, Gibson JB, Pastore M, McBride KL, Komara M, Al-Gazali L, Al Shamsi A, Fanning EA, Wierenga KJ, Scott DA, Ben-Neriah Z, Meiner V, Cassuto H, Elpeleg O, Holder JL Jr, Burrage LC, Seaver LH, Van Maldergem L, Mahida S, Soul JS, Marlatt M, Matyakhina L, Vogt J, Gold JA, Park SM, Varghese V, Lampe AK, Kumar A, Lees M, Holder-Espinasse M, McConnell V, Bernhard B, Blair E, Harrison V; DDD study., Muzny DM, Gibbs RA, Elsea SH, Posey JE, Bi W, Lalani S, Xia F, Yang Y, Eng CM, Lupski JR, Liu P
Genome Med 2019 Feb 28;11(1):12. doi: 10.1186/s13073-019-0623-0. PMID: 30819258Free PMC Article
Trickett J, Heald M, Oliver C, Richards C
J Neurodev Disord 2018 Mar 1;10(1):9. doi: 10.1186/s11689-018-9226-0. PMID: 29490614Free PMC Article

Recent systematic reviews

Hutchison DM, Duffens A, Yale K, Park A, Cardenas K, Mesinkovska NA
J Eur Acad Dermatol Venereol 2022 Apr;36(4):536-546. Epub 2021 Dec 31 doi: 10.1111/jdv.17877. PMID: 34919300
Shah M, Sachdeva M, Melendez-Gonzalez M, Piguet V, Sayed C
Int J Dermatol 2021 Mar;60(3):261-271. Epub 2020 Aug 9 doi: 10.1111/ijd.15111. PMID: 33599294
Woodford EC, McLay L, France KG, Blampied NM, Gibbs R, Swan CE, Eggleston M
Sleep Med Rev 2021 Jun;57:101433. Epub 2021 Jan 17 doi: 10.1016/j.smrv.2021.101433. PMID: 33561678

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