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Extracutaneous manifestations and complications of inherited epidermolysis bullosa : Part I. Epithelial associated tissues - 07/08/11

Doi : 10.1016/j.jaad.2009.03.052 
Jo-David Fine, MD, MPH, FRCP a, b, , Jemima E. Mellerio, MD, FRCP c
a The National Epidermolysis Bullosa Registry, Vanderbilt University School of Medicine, Nashville, Tennessee 
b Departments of Medicine (Dermatology) and Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 
c St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust and Great Ormond Street Hospital NHS Trust, London, United Kingdom 

Correspondence to: Jo-David Fine, MD, MPH, Vanderbilt Health One Hundred Oaks, 719 Thompson Lane, Ste 26300, Nashville, TN 37204.

Abstract

Based upon case reports and small case series, it has been known for many years that some types and subtypes of inherited epidermolysis bullosa (EB) may be at risk for developing one or more extracutaneous complications. Many of these are associated with considerable morbidity; some may result in death. Only over the past few years have there been data generated from large, well characterized cohorts. However, these data, to date, have been published almost exclusively in the nondermatologic literature. Our objective is to provide dermatologists with a comprehensive review of each major extracutaneous complication with a summary of the pertinent literature and recommendations for evaluation and optimal management. Part I highlights epithelial associated tissues, and part II addresses other organs. Based on these reviews, the readership should gain a greater understanding of the types of complications that may occur, when they are most likely to develop, and the range of medical and surgical interventions that are currently available. It should also be possible for the reader to develop surveillance strategies based on an understanding of the published evidence-based data. The breadth and range of severity of complications that arise in some EB types and subtypes within the external eye, ear, nose, upper airway, and gastrointestinal and genitourinary tracts suggest that optimal management must be multidisciplinary. Given the unique knowledge that dermatologists have of this disease, we believe that the care of the EB patient should be under the direction of his or her dermatologist, who can best assist in timely referrals to those specialists who are most experienced in the care of specific extracutaneous problems.

Learning objectives

After completing this learning activity, participants should be able to provide dermatologists with an up to date, comprehensive review of each major extracutaneous manifestation or complication of inherited epidermolysis bullosa, and recommendations for their evaluation and optimal management, have a greater understanding of the types of complications that may occur, when they are most likely to develop, and the range of medical and surgical interventions that are currently available, and be able to develop surveillance strategies based on an understanding of the published evidence-based data.

Le texte complet de cet article est disponible en PDF.

Key words : clinical, complications, epidermolysis bullosa, esophageal, extracutaneous, genitourinary, ocular, stricture, tracheolaryngeal

Abbreviations used : DDEB, DEB, EB, EBS, EBS-DM, GERD, JEB, JEB-H, JEB-nH, NEBR, RDEB, RDEB-HS, RDEB-I, RDEB-nHS


Plan


 Funding sources: None.
 Conflicts of interest: The authors, editors, and peer reviewers have no relevant financial relationships.
 Reprints not available from the authors.


© 2009  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 61 - N° 3

P. 367-384 - septembre 2009 Retour au numéro
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