What Is Dominant Dystrophic Epidermolysis Bullosa?
Source: Genetic and Rare Diseases (GARD) Information Center
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Dominant Dystrophic Epidermolysis Bullosa
DDEB; Dominant DEB
Dominant dystrophic epidermolysis bullosa (DDEB) is a type of epidermolysis bullosa, a group of rare inherited conditions in which the skin blisters extremely easily. In this type, blisters occur over hands, feet, knees, and elbows. DDEB is inherited in an autosomal dominant manner, hence the name. Explore symptoms, causes and genetics of this condition.
Rare Disease: Dystrophic Epidermolysis Bullosa
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Epidermolysis bullosa (EB)
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Source: Genetic and Rare Diseases (GARD) Information Center
Genetic mutations
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Source: Genetic and Rare Diseases (GARD) Information Center
Ideogram of human chromosome 3
Image by Office of Biological and Environmental Research of the U.S. Department of Energy Office of Science, the Biological and Environmental Research Information System, Oak Ridge National Laboratory.
The COL7A1 gene provides instructions for making a protein called pro-α1(VII) chain that is used to assemble a larger protein called type VII collagen. Collagens are a family of proteins that strengthen and support connective tissues, such as skin, bone, tendons, and ligaments, throughout the body. In particular, type VII collagen plays an essential role in strengthening and stabilizing the skin.
Three pro-α1(VII) chains twist together to form a triple-stranded, ropelike molecule known as a procollagen. Cells release (secrete) procollagen molecules, and enzymes cut extra protein segments from the ends. Then the molecules arrange themselves into long, thin bundles of mature type VII collagen.
Type VII collagen is the major component of structures in the skin called anchoring fibrils. These fibrils are found in a region known as the epidermal basement membrane zone, which is a two-layer membrane located between the top layer of skin, called the epidermis, and an underlying layer called the dermis. Anchoring fibrils hold the two layers of skin together by connecting the epidermal basement membrane to the dermis.
More than 700 mutations in the COL7A1 gene have been identified in people with dystrophic epidermolysis bullosa, a condition that causes the skin to be very fragile and to blister easily. These mutations alter the structure or disrupt the production of the pro-α1(VII) chain protein, which affects the production of type VII collagen. When type VII collagen is abnormal or missing, anchoring fibrils cannot form properly. A shortage of these fibrils impairs the connection of the epidermis to the dermis. As a result, friction or other minor trauma can cause the two skin layers to separate. This separation leads to the formation of blisters, which can result in extensive scarring as they heal.
Researchers classify dystrophic epidermolysis bullosa into a few major types based on the inheritance pattern and features of the condition. The recessive types of dystrophic epidermolysis bullosa (RDEB) result from mutations in both copies of the COL7A1 gene in each cell. The most severe, classic form of this disorder is known as recessive dystrophic epidermolysis bullosa severe generalized (RDEB-sev gen). Most of the COL7A1 gene mutations responsible for RDEB-sev gen result in production of abnormally short pro-α1(VII) chains that cannot form type VII collagen. As a result, little type VII collagen is available to make anchoring fibrils. This lack of anchoring fibrils disrupts the connection between the epidermis and the dermis and causes the extreme skin fragility and other signs and symptoms of RDEB-sev gen.
Somewhat less severe forms of RDEB, grouped as the generalized and localized types (RDEB-gen and -loc), are caused by other types of mutations. Many of these genetic changes alter the structure of the pro-α1(VII) chain protein such that it cannot form normal type VII collagen. As a result, anchoring fibrils are reduced in number, or they are altered and cannot function normally. The small amount of normal or partially functional anchoring fibrils accounts for the less severe signs and symptoms of RDEB-gen and -loc.
A milder, dominant form of dystrophic epidermolysis bullosa (DDEB) results from mutations in one copy of the COL7A1 gene in each cell. In many cases, these mutations alter a part of type VII collagen known as the triple helical domain. This region gives type VII collagen its usual triple-stranded structure. It is made up of a pattern of protein building blocks (amino acids) in which every third amino acid is a glycine. Mutations that substitute other amino acids for glycine in this region can disrupt the triple-stranded structure of type VII collagen. When the abnormally shaped collagen molecules are incorporated into anchoring fibrils, they interfere with the fibrils' normal function and prevent them from effectively connecting the epidermis and the dermis. Although they are most commonly associated with DDEB, mutations that substitute glycine amino acids in the triple helical domain can also cause RDEB. DDEB can also be caused by other types of mutations, particularly changes that affect the folding of type VII collagen.
It is unclear how COL7A1 gene mutations are associated with an increased risk of a certain cancer called squamous cell carcinoma in people with dystrophic epidermolysis bullosa, particularly RDEB-sev gen. Some research has suggested that abnormal forms of type VII collagen that retain a procollagen fragment called the NC1 domain may increase the risk of tumor formation. Other studies, however, have not found this association.
Mutations in the COL7A1 gene can also cause a rare condition called epidermolysis bullosa with congenital localized absence of skin (also known as Bart syndrome or aplasia cutis congenita type VI). Individuals with this condition have patches of missing skin at birth (aplasia cutis congenita), typically on the legs. On other parts of the body, they have the characteristic skin problems of epidermolysis bullosa. Epidermolysis bullosa is a group of conditions that cause the skin to be very fragile and to blister easily. Abnormal or absent fingernails and toenails are also common in people with epidermolysis bullosa with congenital localized absence of skin.
As in dystrophic epidermolysis bullosa (described above), COL7A1 gene mutations impair the formation of functional anchoring fibrils. A shortage of these fibrils results in skin fragility and blistering.
Some doctors believe that the aplasia cutis congenita arises from skin fragility and blisters during birth and does not signify a condition separate from epidermolysis bullosa. It is unclear why some newborns have this feature and others do not.
Source: MedlinePlus Genetics
Autosomal Dominant and baby.
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Source: Genetic and Rare Diseases (GARD) Information Center
What Is Epidermolysis Bullosa? Who Gets it? What Causes it?
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Source: Genetic and Rare Diseases (GARD) Information Center
Prenatal Testing: What to Expect During a First Prenatal Visit
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Source: Genetic and Rare Diseases (GARD) Information Center
Prenatal Panel
Also called: First Trimester Prenatal Tests, Obstetric Panel, OB Panel
A prenatal panel is a group of blood tests done early in pregnancy. The tests are used to check for conditions that can affect the health of a mother and her unborn baby. The results can guide treatments, which may help prevent serious complications.
Pregnancy Test
Also called: Human Chorionic Gonadotropin Test, HCG Test, HCG total OB
A pregnancy test can tell whether you're pregnant by checking a urine or blood sample for hCG, a hormone made during pregnancy. HCG levels can first be detected by a blood test about 11 days after conception and about 14 days after conception by a urine test.
Blood Typing Test
Also called: ABO Group and Rh Type, Blood type
A blood typing test is used to determine what type of blood you have according to what antigens you have on the surface of your red blood cells, and whether or not you have a protein called Rh factor. These variables give a total of 8 types of blood types. Usually, this test is done before a blood transfusion, or during a woman's pregnancy.
Rhesus Factor Test
Also called: Rh factors, Rh type, Rh typing
Rhesus factor, also known as Rh factor, is a protein that can be found on the surface of red blood cells. The presence of this protein means that you are Rh+ while its absence indicates you are Rh-. This result serves to detect your blood subtype.
Red Blood Cell Antibody Screen
Also called: Indirect Coombs Test, Indirect Antiglobulin Test, IAT, RBC Antibody Screen, Erythrocyte Ab
This test looks for antibodies that target red blood cells in your bloodstream. An RBC antibody screen is used to determine blood compatibility between a pregnant woman and her baby, and for compatibility in blood donations.
Iron Test
Also called: Serum Iron, Fe Test
Iron is an essential mineral for your organism. An iron deficiency will usually cause anemia, which is a condition where oxygen cannot be properly carried throughout your body. Less frequently, an iron excess can also occur.
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Hemoglobin A1C Test
Also called: A1C test, HbA1c, Glycohemoglobin, Glycated hemoglobin, Glycosylated hemoglobin
A hemoglobin A1C test is a blood test that measures the amount of glucose (sugar) attached to hemoglobin. An A1C test can show your average glucose level for the past three months. Doctors may use the A1C alone or in combination with other diabetes tests to make a diagnosis. They also use the A1C to see how well you are managing your diabetes.
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ToRCH Test
Also called: Prenatal Infectious Disease Antibodies
This test is used to determine the infectious status of a person for toxoplasma, rubella virus, cytomegalovirus, and herpes virus (ToRCH). Pregnant women are at high risk of developing fetal malformation when infected by any of these viruses. Screening for these diseases is essential during pregnancy.
Toxoplasmosis Testing
Also called: Toxoplasmosis Antibodies, Toxoplasma gondii Ab, T. gondii Ab
Toxoplasma gondii. In healthy people the infection usually passes unnoticed; however, in people with a weakened immune system and pregnant women, it can lead to serious complications.
Cytomegalovirus (CMV) Tests
Also called: CMV Tests
Cytomegalovirus (CMV) is a common type of virus. CMV tests look for signs of the virus in blood, sputum, or other body fluids. CMV doesn't cause health problems for most people. But it can be dangerous to newborns and people with immune system disorders.
Herpes Testing
Also called: Herpes Test, HSV Test, Herpes Culture, Herpes Simplex Viral Culture, HSV-1 Antibodies, HSV-2 Antibodies, HSV DNA
A herpes (HSV) test checks a sample of your blood or fluid from a sore for a herpes simplex virus (HSV) infection. Different types of HSV cause cold sores (HSV-1) and genital herpes (HSV-2).
Hepatitis B Surface Antigen Test
Also called: HBsAg, HBV surface antigen, Hepatitis-associated Antigen, Hepatitis B surface Ag
Hepatitis B virus (HBV) produces a disease known as Hepatitis B which is characterized by liver inflammation. Hepatitis B surface antigen (HBsAg) is a protein on the surface of the hepatitis B virus and it can be used to help diagnose the status of HBV infection and to determine whether vaccination is necessary.
Syphilis Tests
Also called: Treponema pallidum Ab
Syphilis tests are used to screen for and diagnose syphilis, a bacterial infection spread by sexual contact. Syphilis is easily treatable if found in the early stages of infection.
HIV Antibody Test
Also called: HIV 1+O+2 Ab
This test is used to screen and confirm HIV-1/HIV-2 infection. Human immunodeficiency virus (HIV) destroys the white blood cells in your blood, making you more susceptible to diseases and infections. There is no cure for this virus; however, early diagnosis is important to prevent complications.
Chorionic Villus Sampling
Also called: CVS, Chorionic Villus Biopsy, Placental Biopsy
Chorionic villus sampling (CVS) is a test for pregnant women that checks cells from the placenta. It is used in the first trimester of pregnancy to diagnose certain chromosome and genetic disorders in an unborn baby.
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Pap Smear
Also called: Papanicolaou Smear, Cervical Smear, Cervical Cytology, Vaginal Cytology, Cervical Screening, Gynecologic Pap Test
A Pap smear is a routine test that looks for abnormal cells in the cervix (the uppermost portion of the vagina). Finding and treating these cells early can help prevent cervical cancer.
Prenatal Ultrasound
Also called: Fetal Ultrasound, Pregnancy Sonography, Pregnancy Sonogram, Obstetric Ultrasonography, Ultrasound - Prenatal
Prenatal ultrasound is an imaging technique that uses high-frequency sound waves to generate images of the fetus. Ultrasounds can be performed at any time; however, they are usually done and are more useful during the first trimester of pregnancy.
Prenatal Cell-Free DNA Screening
Also called: Cell-Free fetal DNA testing for fetal chromosomal abnormalities, Cell-free fetal DNA, cffDNA, Non-invasive prenatal test, NIPT, cfDNA, Cell Free DNA Screening
A prenatal cell-free DNA (cfDNA) screening is a blood test for pregnant women. It checks to see if an unborn baby is more likely to have Down syndrome or another chromosome disorder.
Complete Blood Count
Also called: CBC, Full Blood Count, Blood Cell Count, Hemotology Panel
A complete blood count (CBC) is often part of a routine exam. It is used to measure different parts and features of your blood. A CBC can help detect a variety of disorders including infections, anemia, diseases of the immune system, and blood cancers.
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Red Blood Cell (RBC) Count
Also called: Erythrocyte Count, RBC Count, Red Blood Count, Red Blood Cell Count, Red Count
A red blood cell (RBC) count is a blood test that measures the number of red blood cells in your blood. Red blood cells carry oxygen from your lungs to the rest of your body. An abnormal RBC count can be a sign of a serious health problem.
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White Blood Count (WBC)
Also called: WBC, WBC Blood Test, White Blood Count, White Blood Cell Count, Leukocyte Count, Leukopenia Test, Leukocytosis Test
A white blood count measures the number of white cells in your blood. White blood cells are part of the immune system. A count that is too high or too low can indicate an infection, immune system disorder, or another health problem.
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Platelet Count
Also called: Platelets, PLT Count, Platelet Adequacy, Thrombocyte Count, Thrombocytopenia Test, Thrombocytosis Test, Platelet count
A platelet count test measures the number of platelets in your blood. Platelets, also known as thrombocytes, are small blood cells that are essential for blood clotting. Platelets may be counted to monitor or diagnose diseases, or to look for the cause of too much bleeding or clotting.
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Hemoglobin Blood Test
Also called: Hemoglobin, Hgb
A hemoglobin test measures the levels of hemoglobin in your blood. Hemoglobin is an iron-rich protein in red blood cells that carries oxygen. Abnormal levels may mean you have anemia or another blood disorder.
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Hematocrit Blood Test
Also called: Hematrocit, HCT, Crit, Packed Cell Volume, PCV
Hematocrit is a blood test that measures how much of a person's blood is made up of red blood cells. Hematocrit levels that are too high or too low can be a sign of a blood disorder, dehydration, or other medical conditions that affect your blood.
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MCV (Mean Corpuscular Volume) Test
Also called: MCV, MCV Blood Test, Mean Corpuscular Volume, Mean RBC Volume
A mean corpuscular volume (MCV) blood test measures the size of your red blood cells. If blood cells are too small or too large, it may indicate a blood disorder.
Glucose in Urine Test
Also called: Urine sugar test, Urine glucose test, Glucosuria test, Glucose urine dipstick
A glucose in urine test measures the amount of glucose (sugar) in your urine. The test is used to monitor both type 1 and type 2 diabetes.
Treatment and Prognosis varies depending on the type of condition and the age of symptom onset.
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There is currently no cure for all types of dystrophic epidermolysis bullosa (DEB). Treatment generally focuses on managing signs and symptoms. For some individuals, such as those that have a mild form of dominant dystrophic epidermolysis bullosa (DDEB), dystrophic nails may be the only manifestation. However, other individuals may have much more severe problems that need to be managed. Management typically focuses on treating blisters and avoiding or treating infections.
Wound care usually included treatment of new blisters by lancing and draining. Additionally in most cases, wounds are then dressed with a non-adherent material, covered with padding for stability and protection, and secured with an elastic wrap for integrity. Due to the increased risk of bacterial resistance, topical antibiotic ointments and antimicrobial dressings should be reserved for those wounds that are colonized with bacteria and fail to heal, referred to as “critical colonization."
Individuals with epidermolysis bullosa (EB) have increased caloric and protein needs due to the increased energy utilized in wound healing. Involvement of the digestive system in some forms of EB may limit nutritional intake. Infants and children with more severe forms of EB and failure to thrive usually require attention to fluid and electrolyte balance and may require nutritional support, including a gastrotomy feeding tube. Anemia is typically treated with iron supplements and transfusions as needed. Other nutritional supplements may include calcium, vitamin D, selenium, carnitine, and zinc.
Surveillance is important for individuals with DEB. Biopsies of abnormal-appearing wounds that do not heal may be recommended in some types of DEB due to predisposition to squamous cell carcinoma, beginning in the second decade of life. Screening for deficiencies of iron, zinc, vitamin D, selenium, and carnitine is typically recommended after the first year of life. Routine echocardiograms are recommended to identify dilated cardiomyopathy, and bone mineral density studies are recommended to identify osteoporosis. Activities and bandages that may traumatize the skin (including all adhesives) should typically be avoided.
Recent treatment advancements and therapies under investigation include but are not limited to:
Source: Genetic and Rare Diseases (GARD) Information Center
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