EBS is caused by mutations in the KRT14 gene.
More than 60 mutations in the KRT14 gene
have been identified in people with EBS. Most
of the mutation alters single protein building blocks — amino acids — used to make ‘keratin 14’.
The most severe form of EBS — the Dowling-Meara type — usually results from mutations in
regions of the KRT14 gene which are essential for the normal
assembly of keratin intermediate filaments.
Milder forms of the disorder — the Weber-Cockayne and Koebner types — are often caused by mutations in less critical regions.
The mutations in the
KRT14 gene change the structure
and function of ‘keratin 14’, preventing it from working effectively with ‘keratin
5’ and interfering with the assembly of the keratin intermediate filament
network. A disruption in this network makes ‘keratinocytes’ fragile and prone
to rupture. Minor trauma to the skin such as rubbing or scratching can cause
these cells to break down, resulting in the formation of painful, fluid-filled
blisters.
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