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Pseudosyndactyly and Musculoskeletal Contractures in Inherited Epidermolysis Bullosa: Experience of the National Epidermolysis Bullosa Registry, 1986–2002

From the National Epidermolysis Bullosa Registry, Nashville, Tennessee, the Department of Medicine (Dermatology), Vanderbilt University School of Medicine, Nashville, Tennessee, and the Departments of Epidemiology, Public Health Nursing, Dermatology, and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Correspondence: Dr Jo-David Fine, Division of Dermatology, Department of Medicine, Vanderbilt University School of Medicine, 3900 TVC, Nashville, TN 37232-5227, USA. Tel.: 615-322-0845; fax.:+ 615-343-3947. E-mail: profmoose{at}aol.com (J.-D. Fine).

Mitten deformities of the hands and feet occur in nearly every patient with the most severe subtype (Hallopeau-Siemens) of recessive dystrophic epidermolysis bullosa, and in at least 40–50% of all other recessive dystrophic epidermolysis bullosa patients. Smaller numbers of patients with dominant dystrophic, junctional, and simplex types of epidermolysis bullosa are also at risk of this complication. Surgical intervention is commonly performed to correct these deformities, but recurrence and the need for repeated surgery are common. Higher numbers of epidermolysis bullosa patients also develop musculoskeletal contractures in other anatomic sites, further impairing overall function. Lifetable analyses not only better project the cumulative risk of mitten deformities and other contractures but also emphasize the need for early surveillance and intervention, since both of these musculoskeletal complications may occur within the first year of life.

Key Words: epidermolysis bullosa • hand deformities • hand surgery

Journal of Hand Surgery (British and European Volume), Vol. 30, No. 1, 14-22 (2005)
DOI: 10.1016/J.JHSB.2004.07.006


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