Epidermolysis Bullosa (EB): A Rare Genetic Skin Disorder

Epidermolysis Bullosa (EB), also called Butterfly Disease, is a rare genetic skin disorder that causes the skin to be extremely fragile and blister easily. Even minor friction can lead to painful blisters and sores.

What is Epidermolysis Bullosa (EB)?

EB is a rare disorder that causes the skin to be fragile and blister easily. Blisters can appear in response to minor injuries, such as heat, friction, scratching, or tape. In severe cases, blisters can even form inside the body, like in the lining of the mouth or stomach. Most types of EB are inherited and usually appear in infancy or early childhood, but in some individuals, symptoms may not appear until adolescence or adulthood. There is no cure for EB, although milder forms may improve with age. Treatment focuses on managing blisters and preventing new ones from forming.

Why are children with EB called butterfly children?

Children with EB are called ‘butterfly children’ because their skin is as delicate and fragile as a butterfly’s wings. Even the slightest touch can cause painful blisters that can lead to deep wounds and potentially life-threatening complications if not properly cared for.

Types of Epidermolysis Bullosa

Epidermolysis Bullosa (EB), also known as Butterfly Disease, is a rare genetic disorder that causes the skin to be extremely fragile. Even the slightest touch can cause the skin to blister or tear. Children born with this condition are often called “butterfly children” because their skin is as delicate as a butterfly’s wings. While milder forms of EB may improve over time, more severe cases can be life-threatening. There are several types of EB, each with varying degrees of severity including the following variations:

1. Epidermolysis Bullosa Simplex (EBS):

• Most common type
• Mild cases: Blisters typically appear on the hands and feet of newborns.
• Later stages: Skin may thicken and harden on the palms and soles.
• Affected layer: Outermost layer of skin (epidermis).
• Severe cases: Widespread blistering, including on the skin and inside the mouth. Nails may become rough, thick, or disappear.
• Healing: Skin tends to heal without scarring over time.

1. Dystrophic Epidermolysis Bullosa (DEB):

• Mild cases: Blisters on hands, feet, knees, and elbows.
• Severe cases: Widespread blistering, including on the skin, mouth, and esophagus.
• Feeding difficulties: May require a feeding tube.
• Scarring: Blisters often heal with scars.
• Finger and toe fusion: Repeated blistering and scarring can lead to fused fingers or toes.
• Affected layer: Middle layer of skin (dermis).
• Complications: Increased risk of fatal skin cancers.

1. Junctional Epidermolysis Bullosa (JEB):

• Affects the junction between the epidermis and dermis.
• Severe cases: Blisters can occur anywhere on the body, including the mouth, throat, and esophagus.
• Complications: Can lead to severe pain, scarring, and infections.
• Life-threatening: In severe cases, JEB can be life-threatening.

Causes and Symptoms

• Genetic mutations: EB is caused by inherited genetic mutations that affect the proteins that bind the layers of the skin. Most individuals with EB inherit the defective genes from one or both parents. In rare cases, it can arise from a new genetic mutation with no family history. Approximately 50 out of one million live births are affected by this painful and debilitating disease. EB affects people of all races and both genders equally.
• Symptoms: Generally, symptoms of EB vary depending on the type and can include fragile skin, blisters, pain, scarring, difficulty swallowing, and an increased risk of infections. However, EB manifests in various forms, ranging from mild to severe, influencing the severity of symptoms. In severe cases, not only the skin but also the mucous membranes lining internal organs can be affected, leading to ulcers and blisters in the eyes, mouth, throat, esophagus, anus, kidneys, bladder, heart, and other organs, causing significant complications for patients. The EB symptoms can be summarized as the following:
  • What are the symptoms of Epidermolysis Bullosa?
    • Fragile skin that blisters easily, especially on the hands and feet
    • Thick and misshapen nails
    • Blisters and red bumps on the skin, mouth, and throat
    • Thickened skin on the palms and soles
    • Blisters on the scalp, leading to scarring and hair loss (alopecia)
    • Thinned skin (atrophic scarring)
    • Small, white bumps (milia)
    • Dental problems such as tooth decay with weakened enamel
    • Difficulty swallowing (dysphagia)
    • Itching and skin pain
    • In some cases, blisters may not appear until a child starts walking or engages in activities that cause more friction on the feet.

Diagnosis and Treatment

• Diagnosis: A skin biopsy and genetic testing can help diagnose EB.
• Treatment: There is no cure for EB, but treatments focus on managing symptoms and improving quality of life. These may include:
  • Wound care
  • Pain management
  • Nutritional support
  • Surgery (in some cases)
  • Genetic therapies (under development)

Living with EB

Living with EB can be challenging, but with proper care and support, individuals with EB can lead fulfilling lives. Support groups and organizations can provide valuable resources and emotional support.

Is there a cure for EB?

Unfortunately, there is currently no cure for EB. Treatments focus on managing symptoms, preventing complications, and providing pain relief. Education and support for patients and their families are crucial components of care.

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