Presentation
We present one family with both dystrophic and pruriginosa phenotypes of epidermolysis bullosa. [ncbi.nlm.nih.gov]
Entire Body System
- Inflammation
CONCLUSIONS: Our results confirm inflammation and fibrosis in recessive dystrophic epidermolysis bullosa, especially in scars, suggesting major roles for these processes in pseudosyndactyly. [ncbi.nlm.nih.gov]
- Malnutrition
symptomatic management of pain, itch, and anxiety; coordination of dressing changes; aggressive treatment of skin infections; environmental and staffing considerations; and awareness of other chronic complications that affect care, such as anemia, malnutrition [ncbi.nlm.nih.gov]
Malabsorption commonly results in a mixed anemia resulting from a lack of iron absorption, and overall malnutrition may cause failure to thrive. [raregeneticdisorder.blogspot.com]
Nutrition in CKD : 5th edition [PDF] Malnutrition in chronic kidney disease (CKD) is common but is often undiagnosed. This evidence-based clinical practice guideline summarises the main interventions that may be recommended in the... [evidence.nhs.uk]
Mucosal erosions of the esophagus can also be present, all these features and caloric need for wound healing can lead to malnutrition and growth retardation. [indianpediatrics.net]
Scarring in the mouth and esophagus can make it difficult to chew and swallow food, leading to chronic malnutrition and slow growth. [ghr.nlm.nih.gov]
- Nail Abnormality
Abnormalities Keratosis Palmoplantaris With Arrhythmogenic Cardiomyopathy Mal De Naxos Palmoplantar Keratoderma With Arrhythmogenic Right Ventricular Cardiomyopathy And Woolly Hair Woolly Hair, Palmoplantar Keratoderma, And Cardiac Abnormalities NXD [ukgtn.nhs.uk]
Fig. 42.6 Dominant dystrophic EB presenting with moderate scarring, erosions, and crusts at mechanically exposed acral sites ( a ) and with “albopapuloid” lesions, i.e., small grouped hypopigmented papules on the lower back ( b ) Nail abnormalities with [plasticsurgerykey.com]
The LOC syndrome is characterized by localized blistering and scarring, particularly on the face and neck, in association with upper airway disease activity and nail abnormalities [ 8, 9 ]. [ojrd.biomedcentral.com]
- Fatigue
They also suffer from iron-deficiency anemia of uncertain origin, which leads to chronic fatigue. Open wounds on the skin heal slowly or not at all, often scarring extensively, and are particularly susceptible to infection. [en.wikipedia.org]
Respiratoric
- Cough
Internal complications may produce a hoarse cry, cough and respiratory difficulty. There is risk of death from sepsis or other complications due to epithelial dysfunction, and they usually die in infancy. [patient.info]
Jaw & Teeth
- Dental Caries
Figure 71.25 Dental caries and blistering on the lips in severe generalized recessive dystrophic epidermolysis bullosa. (Courtesy of Professor R. A. J. Eady, St J... Figure 71.29 Poikiloderma in a 12‐year‐old Indian patient with Kindler syndrome. [rooksdermatology.com]
Dental abnormalities occur commonly in affected persons and include advanced periodontal bone loss, mild-to-severe gingivitis, dental caries, and leukokeratosis of buccal mucosa. [dermaamin.com]
Good dental hygiene and regular dental checks are recommended. Many patients with JEB and DEB develop dental caries because of enamel defects. Oral mucosal involvement can accompany severe forms of JEB and DEB. [patient.info]
Skin
- Blister
Immunomapping of a blister demonstrated collagen IV (basal membrane) in the blister roof and collagen VII in its floor, confirming dystrophic epidermolysis bullosa. [ncbi.nlm.nih.gov]
Epidermolysis bullosa is a group of genetic conditions that cause the skin to be very fragile and to blister easily. Blisters and skin erosions form in response to minor injury or friction, such as rubbing or scratching. [ghr.nlm.nih.gov]
- Skin Disease
Diseases, MAGEC 5, Saint Louis Hospital, APHP, Paris, France. 5 Reference Centre of Rare Skin Diseases, MAGEC, Necker Hospital, APHP, Institut Imagine, Paris, France. 6 Reference Centre of Rare Skin Diseases, Pellegrin Hospital, Bordeaux, France. 7 Reference [ncbi.nlm.nih.gov]
- Alopecia
%) ( Benign Lichenoid Keratosis, Lichen Planus-like Keratosis, Solitary Lichen Planus, Solitary Lichenoid Keratosis,) Pachyonychia Congenita (29 %) Nevus Sebaceous (29 %) ( Nevus Sebaceous Of Jadassohn, Organoid Nevus,) Follicular Mucinosis (29 %) ( Alopecia [gulfdoctor.net]
The hallmark sign is cutaneous atrophy without scarring, present at birth, nails are absent, milia may appear on the scalp and cause alopecia. [kissesforkatie.org]
[…] bullosa pseudosyndactyly (mitten-hand deformity) of the hands and feet Ectodermal dysplasia-skin fragility syndrome is a rare disorder characterized by skin erosions, skin fragility and peeling beginning at birth or infancy that may be accompanied by alopecia [raregeneticdisorder.blogspot.com]
Nail dystrophy and scarring alopecia may also be present. [dermnet.com]
[…] friction deformity or loss of fingernails and toenails (nail dystrophy) internal blistering, including on the vocal cords, oesophagus and upper airway skin thickening on the palms and the soles of the feet scalp blistering, scarring and hair loss (scarring alopecia [skinhealthinstitute.org.au]
- Hyperkeratosis
Histopathological examination showed hyperkeratosis, parakeratossis, and verrucous acanthosis and numerous large xanthoma cells in the papillary dermis. [ncbi.nlm.nih.gov]
However, in two of the three older patients, the development of severe disabling hyperkeratosis of the palms and soles has been a prominent feature. [scholars.northwestern.edu]
Involvement of these areas may cause the skin there to thicken and harden, which is called hyperkeratosis. [news-medical.net]
( Acrokeratotic Poikiloderma, Bullous Acrokeratotic Poikiloderma Of Kindler And Weary, Congenital Poikiloderma With Blisters And Keratoses, Congenital Poikiloderma With Bullae And Progressive Cutaneous Atrophy, Hereditary Acrokeratotic Poikiloderma, Hyperkeratosis [gulfdoctor.net]
[…] nigricans Hereditary benign acanthosis nigricans with insulin resistance Hereditary diffuse palmoplantar keratoderma Hereditary erythrokeratolysis Hereditary follicular keratoses Hereditary palmoplantar keratoderma Howel Evans syndrome Howel-Evans' syndrome Hyperkeratosis [icd9data.com]
- Skin Lesion
A 16-month-old boy was diagnosed with Hallopeau-Siemens recessive DEB on the basis of typical skin lesions composed of multiple blisters with moderately healed erosions, scarring on trauma-exposed body sites, including hands and feet, pseudosyndactyly [ncbi.nlm.nih.gov]
This book contains essential dermatologic diagnostic information innovatively organized around traditionally classified skin lesions. [books.google.com]
Although skin lesions can be treated with dermatologic care, the patient can also be complicated by life-threatening clinics such as nephropathy, systemic amyloidosis and skin cancers by years. [indianjnephrol.org]
Pretibial RDEB is characterized by pretibial blistering at birth or early infancy, involvement of hands and feet, lichen planus-like skin lesions, nail dystrophy [may precede skin blistering], excessive caries, and constipation. [plasticsurgerykey.com]
Workup
At present there are no universally agreed-upon protocols for the surveillance for and workup of possible extracutaneous complications in patients with RDEB, although most EB experts suggest that baseline laboratory tests be conducted in early childhood [dermatologyadvisor.com]
Treatment
As cyclosporine has been used for the treatment of RDEB we decided not to use cyclosporine for the second group of seven patients. Skin biopsies from the lesions were studied by electron microscopy before and after treatment. [ncbi.nlm.nih.gov]
Prognosis
This study will aid the molecular diagnosis, genetic counseling and prognosis prediction of RDEB patients. [ncbi.nlm.nih.gov]
This case highlights many of the typical features of this complication of RDEB including the overall poor prognosis. [karger.com]
DDEB-G has a good prognosis and manifests due to reduced collagen type VII expression. Blistering in DDEB-G is typically mild and limited to areas more prone to trauma such as the hands, elbows, knees, and feet. [news-medical.net]
This is critical for therapy, genetic counseling, and prognosis. Genetic counseling: Since these diseases are inherited, genetic counseling is essential. [dermquest.com]
PROGNOSIS AND TREATMENT CHARACTERIZATION PROGNOSIS MALIGNANCIES Epidermolysis bullosa and the risk of life-threatening cancers: the National EB Registry experience, 1986-2006. National Epidermolysis Bullosa Registry, Nashville, Tennessee, USA. [thedoctorsdoctor.com]
Etiology
[…] is characterized by generalized erosions, palmoplantar keratoderma, painful fissures, and some nail dystrophy and hair loss. [5] Molecular pathology of junctional epidermolysis bullosa Junctional epidermolysis bullosa has a highly variable molecular etiology [emedicine.medscape.com]
Life with Epidermolysis Bullosa (EB): Etiology, Diagnosis, Multidisciplinary Care and Therapy. Springer Science & Business Media. p. 242. ISBN 9783211792711. ^ a b c d e f g h i j k "Epidermolysis bullosa". rarediseases.info.nih.gov. [en.wikipedia.org]
Life with Epidermolysis Bullosa: Etiology, Diagnosis, and Multidisciplinary Care and Therapy Wien New York: Springer Verlag GmbH; 2009:258-277. [ojrd.biomedcentral.com]
Epidemiology
As will be discussed elsewhere, rigorous epidemiological case finding methods were used to identify and recruit participants throughout the United States. [dx.doi.org]
Google Scholar Fine JD: Epidemiology and the study of genetic diseases. Edited by: Grob JJ, MacKie R, Stern R, Weinstock M. Epidemiology and prevention of skin diseases London: Blackwell Science; 1996. [ojrd.biomedcentral.com]
A clinical, genetic and epidemiological study. Oslo-Bergen-Tromsö: Universitetsforlaget 1970 Google Scholar 7. Geerts, M.L., Overbeke, J., Kint, A., Cormane, R.H.: Comparative Electron Mikroscopic Study between Mendes Da Costa’s. [link.springer.com]
Epidemiology of Inherited Epidermolysis Bullosa Based on Incidence and Prevalence Estimates From the National Epidermolysis Bullosa Registry. JAMA Dermatol. 2016 Nov 1;152(11):1231-1238. doi: 10.1001/jamadermatol.2016.2473. [medlineplus.gov]
“Epidermolysis bullosa: Clinical, epidemiologic, and laboratory findings of the National Epidermolysis Bullosa Registry”. 1999. [dermatologyadvisor.com]
Pathophysiology
It is hypothesised that the higher skin temperature in the affected areas plays an important role in the pathophysiology of RDEB-I. [repository.ubn.ru.nl]
We describe the fourth confirmed case of pyloric atresia associated with the dystrophic subtype of EB diagnosed by standard pathologic measures, and discuss the clinical disease features and recent advances in the pathophysiology. [ncbi.nlm.nih.gov]
Kindler syndrome has been shown to result from mutations in the KIND1 gene on band 20p12.3 (see Pathophysiology ). [dermaamin.com]
Colocalization of kindlin-1, kindlin-2, and migfilin at keratinocyte focal adhesion and relevance to the pathophysiology of Kindler syndrome. J Invest Dermatol. 2008 Sep. 128(9):2156-65. [Medline]. Rognoni E, Ruppert R, Fässler R. [emedicine.medscape.com]
As knowledge about the pathophysiology of EB has become more advanced, new variants of EB have been identified based on their specific genetic mutation. [ 1 ] Investigations [ 11 ] Skin biopsy is required. [patient.info]
Prevention
[…] recessive dystrophic epidermolysis bullosa (RDEB); describes the phases and difficulties of dental treatment and the measures that dentists and health care providers should adopt in order to provide a safe and effective dental treatment as well as earlier prevention [ncbi.nlm.nih.gov]
To prevent blisters: Wear soft clothing made from natural fibres to avoid rubbing on and irritating the skin. Try not to get too hot. Wear soft mittens at night to prevent scratching. [skinhealthinstitute.org.au]
Patients should be advised to avoid trauma, which helps prevent blister formation. Sun avoidance and photoprotection may prevent or slow the progression of poikiloderma. [dermaamin.com]