Epidermolysis bullosa (EB) is a group of inherited diseases that are characterised by blistering lesions on the skin and mucous membranes. These may occur anywhere on the body but most commonly appear at sites of friction and minor trauma such as the feet and hands.
What is epidermolysis bullosa simplex?
In epidermolysis bullosa simplex (EBS), the site of blister formation within skin is the epidermis, ie the uppermost layer of skin cells (keratinocytes). There are localised and generalised forms of EBS.
Who gets epidermolysis bullosa simplex?
EBS is a rare inherited disease. Most subtypes of EBS are of dominant inheritance. This means they are passed down from an affected parent to half of his or her children. EBS occurs equally in males and females.
What are the clinical features of epidermolysis bullosa simplex?
The table below describes the features of the differing subtypes of EBS.
EBS Subtypes
Features
Localised EBS
Previously known as Weber-Cockayne
Most common and localised form of EBS
Blisters develop on hands and feet in response to friction
Usually presents in infancy as child is starting to crawl and walk
Wounds heal without scarring but there may be thickening of the skin on soles and palms
Generalised EBS
Previously known as Koebner
Generalised EBS where blisters develop all over the body but commonly on hands, feet and extremities
Presents at birth or early in infancy
May be mild involvement of mucous membranes and nails
Thickening of skin and plaques develop on palms and soles
Generalised severe EBS
Previously known as Dowling Meara
Generalised and severe form of EBS
Present at birth with blistering on the face, trunk and limbs
Thickened skin may cause calluses that limit or interfere with joint movement
Nails often affected
May involve other organs including inside the mouth, gastrointestinal and respiratory tract
Widespread involvement may cause death in infancy but usually there is significant improvement with age
How is epidermolysis bullosa simplex diagnosed?
In the dominant subtypes of EB, where an informative family tree is known, it is often acceptable for a clinical diagnosis to be made by a specialist dermatologist based on the presenting signs. Diagnostic tests are also available in some countries and include immunofluorescenceantigen mapping (IFM) and/or transmission electron microscopy (EM) of a skin biopsy of a newly induced blister.
Mutational analysis (blood testing of genes) is also available in some countries
What is the treatment of epidermolysis bullosa simplex?
Prevention of friction with particular attention to footwear.
Attempt to avoid heat and humidity, as this exacerbates EBS.
Some people find light-weight, ventilated shoes and cotton socks help.
Lance blisters to prevent them getting larger and dress to promote healing/prevent infection.
A wide range of suitable wound care products is available, including low-adherent silicone dressings.
Those with a low tolerance to dressings, may prefer to dust and dry the wound with cornflour.
What is the outcome for people with epidermolysis bullosa simplex?
People with EBS learn to manage their condition very well on their own. Even those with severe generalised EBS subtype, (having survived infancy) will have normal life expectancy.
Dermatologic Clinics Volume 28, Issue 1, Pages 1–196 (January 2010) Epidermolysis Bullosa: Part I – Pathogenesis and Clinical Features. Journal
Dermatologic Clinics Volume 28, Issue 2, Pages 197–452 (April 2010) Epidermolysis Bullosa: Part II – Diagnosis and Management. Journal
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