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Treatment decision-making for patients with the Herlitz subtype of junctional epidermolysis bullosa

Abstract

The Herlitz subtype of junctional epidermolysis bullosa (JEB-H) is a lethal genetic disorder characterized by recurrent and persistent erosions of the epithelial surfaces that heal with exuberant granulation tissue. In addition, respiratory distress, refractory anemia and failure to thrive are often seen. Mortality in the first year of life approaches 90%. JEB-H is caused by mutations in the genes that encode the protein laminin 5, a structural molecule involved in the adhesion of epidermis to dermis. There is currently no cure for JEB-H. Medical interventions treat complications but do not ultimately limit mortality. Ethical principles contend that offering comfort and company to the patient and family, not aggressive therapies, should comprise the mainstay of care for affected infants.

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References

  1. Fine JD, Johnson LB, Suchindran C, Bauer EA, Carter M, McGuire J et al. Premature death and inherited epidermolysis bullosa. In: Fine JD, Bauer EA, McGuire J, Moshell A (eds). Epidermolysis Bullosa: Clinical, Epidemiologic, and Laboratory Advances and the Findings of the National Epidermolysis Bullosa Registry. Johns Hopkins University Press: Baltimore, 1999, pp 206–224.

    Google Scholar 

  2. Fine JD, Eady RA, Bauer EA, Briggaman RA, Bruckner-Tuderman L, Christiano A et al. Revised classification system for inherited epidermolysis bullosa: report of the Second International Consensus Meeting on diagnosis and classification of epidermolysis bullosa. J Am Acad Dermatol 2000; 42: 1051–1066.

    Article  CAS  Google Scholar 

  3. Fine JD, Johnson LB, Suchindran C, Moshell A, Gedde-Dahl Jr T . The epidemiology of inherited epidermolysis bullosa In: Fine JD, Bauer EA, McGuire J, Moshell A (eds). Epidermolysis Bullosa: Clinical, Epidemiologic, and Laboratory Advances and the Findings of the National Epidermolysis Bullosa Registry. Johns Hopkins University Press: Baltimore, 1999, pp 101–113.

    Google Scholar 

  4. Tidman MJ, Garzon MC . Vesiculobullous disease. In: Schachner LA, Hansen RC (eds). Pediatric Dermatology. Mosby: Edinburgh, 2003, pp 683–712.

    Google Scholar 

  5. Pulkkinen L, Uitto J, Christiano AM . The molecular basis of the junctional forms of epidermolysis bullosa. In: Fine JD, Bauer EA, McGuire J, Moshell A (eds). Epidermolysis Bullosa: Clinical, Epidemiologic, and Laboratory Advances and the Findings of the National Epidermolysis Bullosa Registry. Johns Hopkins University Press: Baltimore, 1999, pp 300–325.

    Google Scholar 

  6. Darling TN, McGrath JA, Yee C, Gatalica B, Hametner R, Bauer JW et al. Premature termination codons are present on both alleles of the bullous pemphigoid antigen 2/type XVII collagen gene in five Austrian families with generalized atrophic benign epidermolysis bullosa. J Invest Dermatol 1997; 108: 463–468.

    Article  CAS  Google Scholar 

  7. Lyos AT, Levy ML, Malpica A, Sulek M . Laryngeal involvement in epidermolysis bullosa. Ann Otol Rhinol Laryngol 1994; 103: 542–546.

    Article  CAS  Google Scholar 

  8. Fine J, Smith LT . Nonmolecular diagnostic testing of inherited epidermolysis bullosa. In: Fine JD, Bauer EA, McGuire J, Moshell A (eds). Epidermolysis Bullosa: Clinical, Epidemiologic, and Laboratory Advances and the Findings of the National Epidermolysis Bullosa Registry. Johns Hopkins University Press: Baltimore, 1999, pp 48–78.

    Google Scholar 

  9. Bergman R . Immunohistopathologic diagnosis of epidermolysis bullosa. Am J Dermatopathol 1999; 21: 185–192.

    Article  CAS  Google Scholar 

  10. Heagerty AH, Kennedy AR, Eady RA, Hsi BL, Verrando P, Yeh CJ et al. GB3 monoclonal antibody for diagnosis of junctional epidermolysis bullosa. Lancet 1986; 1: 860.

    Article  CAS  Google Scholar 

  11. Schofield OM, Fine JD, Verrando P et al. GB3 monoclonal antibody for the diagnosis of junctional epidermolysis bullosa: results of a multicenter study. J Am Acad Dermatol 1990; 23: 1078–1083.

    Article  CAS  Google Scholar 

  12. Moore FD . The desperate case: CARE (costs, applicability, research, ethics). JAMA 1989; 261: 1483–1484.

    Article  CAS  Google Scholar 

  13. Ramsey P . On (only) caring for the dying. In: Ramsey P (ed). The Patient as Person; Explorations in Medical Ethics. Yale University Press: New Haven, 1970, pp 113–164.

    Google Scholar 

  14. Hippocrates. The Art translated by W.H.S. Jones. Harvard University Press: Cambridge, 1923, p 193.

  15. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment. US Government Printing Office: Washington, DC, 1983.

  16. McCormick RA . To save or let die. The dilemma of modern medicine. JAMA 1974; 229: 172–176.

    Article  CAS  Google Scholar 

  17. Paris JJ, Graham N, Schreiber MD et al. Approaches to end-of-life decision-making in the NICU: insights from Dostoevsky's The Grand Inquisitor. J Perinatol 2006; 26: 389–391.

    Article  CAS  Google Scholar 

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Correspondence to A L Bruckner.

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Yan, E., Paris, J., Ahluwalia, J. et al. Treatment decision-making for patients with the Herlitz subtype of junctional epidermolysis bullosa. J Perinatol 27, 307–311 (2007). https://doi.org/10.1038/sj.jp.7211694

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