Sporadic dystrophic epidermolysis bullosa with concomitant atopic dermatitis

Prevalence, pathophysiology and management of itch in epidermolysis bullosa

Epidermolysis bullosa (EB) is a highly diverse group of inherited skin disorders, resulting from mutations in genes encoding proteins of the dermoepidermal junction. Itch (pruritus) is one of the most common symptoms across all EB subtypes. It occurs in blistered or wounded sites, or manifests as a generalized phenomenon, thereby affecting both intact skin and healing wounds. The mechanism of pruritus in EB is unclear. It is likely that skin inflammation secondary to barrier disruption, wound healing cascades and dysregulated activation of epidermal sensory nerve endings are all involved in its pathophysiology on the molecular and cellular level. Understanding these mechanisms in depth is crucial in developing optimized treatments for people with EB and improving quality of life. This review summarizes current evidence on the prevalence, mechanisms and management of itch in EB.

An incompletely penetrant novel mutation in COL7A1 causes epidermolysis bullosa pruriginosa and dominant dystrophic epidermolysis bullosa phenotypes in an extended kindred

Epidermolysis bullosa pruriginosa (EBP) is a rare subtype of dystrophic epidermolysis bullosa (DEB) characterized by intense pruritus, nodular or lichenoid lesions, and violaceous linear scarring, most prominently on the extensor extremities. Remarkably, identical mutations in COL7A1, which encodes an anchoring fibril protein present at the dermal-epidermal junction, can cause both DEB and EBP with either autosomal dominant or recessive inheritance. We present one family with both dystrophic and pruriginosa phenotypes of epidermolysis bullosa. The proband is a 19-year-old Caucasian woman who initially presented in childhood with lichenoid papules affecting her extensor limbs and intense pruritus consistent with EBP. Her maternal grandmother saw a dermatologist for similar skin lesions that developed without any known triggers at age 47 and mostly resolved spontaneously after approximately 10 years. The proband's younger brother developed a small crop of pruritic papules on his elbows, dorsal hands, knees, and ankles at age 13. Her second cousin once removed, however, reported a mild blistering disease without pruritus consistent with DEB. Genetic sequencing of the kindred revealed a single dominant novel intron 47 splice site donor G>A mutation, c.4668 + 1 G>A, which we predict leads to exon skipping. Incomplete penetrance is confirmed in her clinically unaffected mother, who carries the same dominant mutation. The wide diversity of clinical phenotypes with one underlying genotype demonstrates that COL7A1 mutations are incompletely penetrant and strongly suggests that other genetic and environmental factors influence clinical presentation.

Epidermólise bolhosa albopapulóide (variante de Pasini)

A epidermólise bolhosa albopapulóide é doença rara, de caráter autossômico dominante, também conhecida como epidermólise bolhosa distrófica albopapulóide de Pasini. Os autores relatam o caso de uma paciente de 37 anos de idade, com início do quadro aos sete anos, com lesões bolhosas e milia nas áreas de traumatismo, além de máculas hipocrômicas e atróficas (lesões albopapulóides) no corpo. A paciente também apresenta pele apergaminhada, xerótica, e distrofia ungueal dos pés. A histopatologia da lesão bolhosa revelou clivagem subepidérmica, compatível com o diagnóstico clínico.

Atopic dermatitis: therapeutic challenge in an infant with dystrophic epidermolysis bullosa

Inherited epidermolysis bullosa (EB) manifests as blisters that usually result from minor trauma. The severity of expression ranges from mild occasional blistering to severe extensive bullae. We report an infant with dystrophic EB worsened by atopic dermatitis (AD). This concomitant skin disease exacerbated EB, because scratching induced bullae and milia. Careful management of AD provided a marked improvement in cutaneous involvement. This report shows that it is important to document and treat inflammatory skin disorders coexisting with EB, because they may influence the overall prognosis of EB.