Clinical and molecular features in a cohort of Middle Eastern patients with epidermolysis bullosa
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Pediatr Dermatol. 2023 Oct 12. doi: 10.1111/pde.15440. Epub ahead of print. PMID: 37827535.

Clinical and molecular features in a cohort of Middle Eastern patients with epidermolysis bullosa

Authors: Shir Bergson 1 2Daniel Daniely 1David Bomze 1Janan Mohamad 1 2Kiril Malovitski 1 2Odile Meijers 1Valeria Briskin 1Ofer Bihari 1Natalia Malchin 1Shirli Israeli 1Jacob Mashiah 1 2Tzipora Falik-Zaccai 3 4Emily Avitan-Hersh 5 6Marina Eskin-Schwartz 7 8Stavit Allon-Shalev 6 9Ofer Sarig 1Eli Sprecher 1 2Liat Samuelov 1 2


  1. Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
  2. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  3. Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel.
  4. The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
  5. Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.
  6. Bruce and Ruth Rappaport Faculty of Medicine, Haifa, Israel.
  7. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
  8. Genetics Institute, Soroka University Medical Center, Beer-Sheva, Israel.
  9. The Genetic Institute, Emek Medical Center, Afula, Israel.


ackground: Epidermolysis bullosa (EB) features skin and mucosal fragility due to pathogenic variants in genes encoding components of the cutaneous basement membrane. Based on the level of separation within the dermal-epidermal junction, EB is sub-classified into four major types including EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), and Kindler EB (KEB) with 16 EB-associated genes reported to date.

Methods: We ascertained a cohort of 151 EB patients of various Middle Eastern ethnic backgrounds.

Results: The cohort was comprised of EBS (64%, 97/151), DEB (21%, 31/151), JEB (12%, 18/151), and KEB (3%, 5/151). KRT14 and KRT5 variants were most common among EBS patients with 43% (42/97) and 46% (45/97) of EBS patients carrying mutations in either of these two genes, respectively. Truncal involvement was more common in KRT14-associated EBS as compared to EBS due to KRT5 mutations (p < .05). Mutations in COL17A1 and laminin 332-encoding genes were identified in 55% (10/18) and 45% (8/18) of JEB patients. Scarring alopecia, caries, and EB nevi were most common among JEB patients carrying COL17A1 mutations as compared to laminin 332-associated JEB (p < .05). Abnormal nails were evident in most DEB and JEB patients while poikiloderma was exclusively observed in KEB (p < .001).

Conclusions: EB patients of Middle Eastern origin were found to feature specific phenotype-genotype correlations of relevance to the diagnosis and genetic counseling of patients in this region.

Keywords: epidemiology; epidermolysis bullosa; genetics; genodermatoses