Epidermolysis bullosa simplex

disease
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Also known as EBSEEBepidermolysis bullosa intraepidermic

Summary

Epidermolysis bullosa simplex (MONDO:0017610) is a disease (an umbrella term covering 20 Mondo subtypes) caused by variants in ITGB4, KRT14, and PLEC, with 4 cohort genes and 17 clinical trials. The dominant Reactome pathway is Type I hemidesmosome assembly (4 cohort genes). Top therapeutic interventions include cravacitinib, diacerein, and vehicle.

At a glance

  • Prevalence: 1-9 / 1 000 000 (Worldwide) [Orphanet-validated]
  • Causal genes: ITGB4 (GenCC Definitive), KRT14 (GenCC Definitive), PLEC (GenCC Strong)
  • Umbrella term: 20 Mondo subtypes
  • Cohort genes: 4
  • ClinVar variants: 107
  • Clinical trials: 17

Clinical features

Epidemiology

Prevalence records

4 prevalence record(s), Orphanet:

TypeClassValueGeographyValidation
Point prevalence1-9 / 1 000 0000.656WorldwideValidated
Point prevalence1-9 / 1 000 0000.58AustraliaValidated
Point prevalence1-9 / 100 0001.19NetherlandsValidated
Point prevalence1-9 / 1 000 0000.197RomaniaValidated

Identifiers

Disease identifiers

FieldValue
Canonical nameepidermolysis bullosa simplex
Mondo IDMONDO:0017610
MeSHD016110
OMIM131760
Orphanet304
DOIDDOID:4644
ICD-10-CMQ81.0
ICD-111860717527
NCITC84692
SNOMED CT67144006
UMLSC0079298
MedGen86896
GARD0010752
Is cancer (heuristic)no

Also known as: EBS · EEB · epidermolysis bullosa intraepidermic · epidermolysis bullosa simplex

Data availability: 107 ClinVar variants · 3 GenCC gene-disease records · 24 cell lines.

Disease family

An umbrella term covering 20 Mondo subtypes.

Classification path: disease › human disease › disease by body system or component › integumentary system disorder › skin disordervesiculobullous skin diseaseepidermolysis bullosainherited epidermolysis bullosaepidermolysis bullosa simplex

Related subtypes (3): epidermolysis bullosa dystrophica, Kindler syndrome, junctional epidermolysis bullosa

Subtypes (20): epidermolysis bullosa simplex 1A, generalized severe, epidermolysis bullosa simplex 1C, localized, epidermolysis bullosa simplex 1B, generalized intermediate, epidermolysis bullosa simplex 5A, Ogna type, epidermolysis bullosa simplex 2F, with mottled pigmentation, epidermolysis bullosa simplex 5B, with muscular dystrophy, epidermolysis bullosa simplex 1D, generalized, intermediate or severe, autosomal recessive, epidermolysis bullosa simplex 7, with nephropathy and deafness, epidermolysis bullosa simplex 2E, with migratory circinate erythema, epidermolysis bullosa simplex 5C, with pyloric atresia, epidermolysis bullosa simplex 4, localized or generalized intermediate, autosomal recessive, epidermolysis bullosa simplex 3, localized or generalized intermediate, with BP230 deficiency, epidermolysis bullosa simplex with nail dystrophy, epidermolysis bullosa simplex 6, generalized, with scarring and hair loss, suprabasal epidermolysis bullosa simplex, epidermolysis bullosa simplex with anodontia/hypodontia, epidermolysis bullosa simplex 2A, generalized severe, epidermolysis bullosa simplex 2B, generalized intermediate, epidermolysis bullosa simplex 2C, localized, epidermolysis bullosa simplex 2d, generalized, intermediate or severe, autosomal recessive

Genetics & variants

GWAS landscape

No GWAS associations recorded — common-variant (GWAS) studies don’t cover this disease (typical for Mendelian / rare diseases). See the curated gene cohort and Mendelian overlap below.

Variant details and genetic-evidence tiers

ClinVar germline variants

107 retrieved; paginated sample, class counts are floors:

31 pathogenic, 26 uncertain significance, 24 benign, 7 conflicting classifications of pathogenicity, 7 benign/likely benign, 7 likely benign, 4 pathogenic/likely pathogenic, 1 likely pathogenic

ClinVarVariant (HGVS)GeneClassificationReview
1048024NM_000526.5(KRT14):c.1144G>T (p.Glu382Ter)KRT14Pathogeniccriteria provided, single submitter
1048025NM_000526.5(KRT14):c.1205T>G (p.Leu402Arg)KRT14Pathogeniccriteria provided, single submitter
1048026NM_000526.5(KRT14):c.1223T>A (p.Leu408Gln)KRT14Pathogeniccriteria provided, single submitter
1048027NM_000526.5(KRT14):c.1274+5G>CKRT14Pathogeniccriteria provided, single submitter
14612NM_000526.5(KRT14):c.373C>T (p.Arg125Cys)KRT14Pathogeniccriteria provided, multiple submitters, no conflicts
66316NM_000526.5(KRT14):c.1231_1233del (p.Glu411del)KRT14Pathogeniccriteria provided, single submitter
66322NM_000526.5(KRT14):c.1244A>G (p.Tyr415Cys)KRT14Pathogeniccriteria provided, single submitter
66339NM_000526.5(KRT14):c.346A>T (p.Lys116Ter)KRT14Pathogeniccriteria provided, single submitter
66353NM_000526.5(KRT14):c.385T>G (p.Tyr129Asp)KRT14Pathogeniccriteria provided, single submitter
66358NM_000526.5(KRT14):c.397G>T (p.Val133Leu)KRT14Pathogeniccriteria provided, multiple submitters, no conflicts
66375NM_000526.5(KRT14):c.749del (p.Lys250fs)KRT14Pathogeniccriteria provided, single submitter
66378NM_000526.5(KRT14):c.815T>C (p.Met272Thr)KRT14Pathogeniccriteria provided, multiple submitters, no conflicts
1047955NM_000424.4(KRT5):c.556-16C>GKRT5Pathogeniccriteria provided, single submitter
1047988NM_000424.4(KRT5):c.587T>C (p.Leu196Pro)KRT5Pathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1047989NM_000424.4(KRT5):c.771delGKRT5Pathogeniccriteria provided, single submitter
1047990NM_000424.4(KRT5):c.961A>C (p.Thr321Pro)KRT5Pathogeniccriteria provided, single submitter
1047991NM_000424.4(KRT5):c.1396G>C (p.Glu466Gln)KRT5Pathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
14639NM_000424.4(KRT5):c.1388T>C (p.Leu463Pro)KRT5Pathogeniccriteria provided, multiple submitters, no conflicts
14644NM_000424.4(KRT5):c.579C>G (p.Asn193Lys)KRT5Pathogeniccriteria provided, single submitter
14648NM_000424.4(KRT5):c.74C>T (p.Pro25Leu)KRT5Pathogeniccriteria provided, multiple submitters, no conflicts
14652NM_000424.4(KRT5):c.556G>T (p.Val186Leu)KRT5Pathogeniccriteria provided, single submitter
14655NM_000424.4(KRT5):c.1649del (p.Gly550fs)KRT5Pathogeniccriteria provided, multiple submitters, no conflicts
14657NM_000424.4(KRT5):c.508G>A (p.Glu170Lys)KRT5Pathogeniccriteria provided, multiple submitters, no conflicts
21174NM_000424.4(KRT5):c.1429G>A (p.Glu477Lys)KRT5Pathogeniccriteria provided, multiple submitters, no conflicts
66202NM_000424.4(KRT5):c.1282G>A (p.Ala428Thr)KRT5Pathogeniccriteria provided, single submitter
66203NM_000424.4(KRT5):c.1283C>T (p.Ala428Val)KRT5Pathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
66208NM_000424.4(KRT5):c.1398G>C (p.Glu466Asp)KRT5Pathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
66246NM_000424.4(KRT5):c.495G>T (p.Arg165Ser)KRT5Pathogeniccriteria provided, multiple submitters, no conflicts
66267NM_000424.4(KRT5):c.556G>A (p.Val186Met)KRT5Pathogeniccriteria provided, multiple submitters, no conflicts
66268NM_000424.4(KRT5):c.557T>A (p.Val186Glu)KRT5Pathogeniccriteria provided, single submitter

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 57 · Orphanet: 23 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

GenCC gene–disease validity (cohort genes)

the Disease column is the GenCC-asserted condition — a cohort gene’s strongest validity may be for a related predisposition syndrome.

GeneClassificationInheritanceDiseaseRecords
ITGB4DefinitiveAutosomal recessivejunctional epidermolysis bullosa with pyloric atresia14
KRT14DefinitiveAutosomal recessiveepidermolysis bullosa simplex 1D, generalized, intermediate or severe, autosomal recessive25
PLECStrongAutosomal dominantepidermolysis bullosa simplex 5A, Ogna type18

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
KRT14Orphanet:69087Naegeli-Franceschetti-Jadassohn syndrome
KRT14Orphanet:79396Autosomal dominant generalized epidermolysis bullosa simplex, severe form
KRT14Orphanet:79397Epidermolysis bullosa simplex with mottled pigmentation
KRT14Orphanet:79399Autosomal dominant generalized epidermolysis bullosa simplex, intermediate form
KRT14Orphanet:79400Localized epidermolysis bullosa simplex
KRT14Orphanet:86920Dermatopathia pigmentosa reticularis
KRT14Orphanet:89838Autosomal recessive generalized epidermolysis bullosa simplex
PLECOrphanet:1114Aplasia cutis congenita
PLECOrphanet:158684Epidermolysis bullosa simplex with pyloric atresia
PLECOrphanet:254361Plectin-related limb-girdle muscular dystrophy R17
PLECOrphanet:257Epidermolysis bullosa simplex with muscular dystrophy
PLECOrphanet:79401PLEC-related intermediate epidermolysis bullosa simplex without extracutaneous involvement
ITGB4Orphanet:1114Aplasia cutis congenita
ITGB4Orphanet:158684Epidermolysis bullosa simplex with pyloric atresia
ITGB4Orphanet:251393Localized junctional epidermolysis bullosa
ITGB4Orphanet:79402Intermediate generalized junctional epidermolysis bullosa
ITGB4Orphanet:79403Junctional epidermolysis bullosa with pyloric atresia
KRT5Orphanet:158681Epidermolysis bullosa simplex with circinate migratory erythema
KRT5Orphanet:79145Dowling-Degos disease
KRT5Orphanet:79396Autosomal dominant generalized epidermolysis bullosa simplex, severe form
KRT5Orphanet:79397Epidermolysis bullosa simplex with mottled pigmentation
KRT5Orphanet:79399Autosomal dominant generalized epidermolysis bullosa simplex, intermediate form
KRT5Orphanet:79400Localized epidermolysis bullosa simplex

Cohort genes → proteins

4 cohort genes, 4 distinct canonical proteins.

Evidence partition

SubsetGenes
multi_evidence4

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
KRT14HGNC:6416ENSG00000186847P02533Keratin, type I cytoskeletal 14gencc,clinvar
PLECHGNC:9069ENSG00000178209Q15149Plectingencc,clinvar
ITGB4HGNC:6158ENSG00000132470P16144Integrin beta-4gencc
KRT5HGNC:6442ENSG00000186081P13647Keratin, type II cytoskeletal 5clinvar

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
KRT14Keratin, type I cytoskeletal 14The nonhelical tail domain is involved in promoting KRT5-KRT14 filaments to self-organize into large bundles and enhances the mechanical properties involved in resilience of keratin intermediate filaments in vitro.
PLECPlectinInterlinks intermediate filaments with microtubules and microfilaments and anchors intermediate filaments to desmosomes or hemidesmosomes.
ITGB4Integrin beta-4Integrin alpha-6/beta-4 is a receptor for laminin.
KRT5Keratin, type II cytoskeletal 5Required for the formation of keratin intermediate filaments in the basal epidermis and maintenance of the skin barrier in response to mechanical stress.

Protein-family classification

Druggable: 1 · Difficult: 1 · Unknown: 2 · Druggable fraction: 0.25

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Antibody/Immunoglobulin17.3×0.318
Scaffold/PPI14.3×0.318
Other/Unknown20.9×0.769

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
KRT14Other/UnknownnoKeratin_I, IF_conserved, IF_rod_dom
PLECScaffold/PPInoPlectin_repeat, SH3_domain, Actinin_actin-bd_CS
ITGB4Antibody/ImmunoglobulinyesEGF, Integrin_bsu_VWA, Calx_beta
KRT5Other/UnknownnoKeratin_II, IF_conserved, Keratin_2_head

Expression context

Cohort genes with no expression data: 0.

4 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)4
unknown0

Top tissues across cohort

TissueCohort genes
gingiva2
tibial nerve2
gingival epithelium1
upper arm skin1
hindlimb stylopod muscle1
sural nerve1
minor salivary gland1
skin of leg1
lower esophagus mucosa1
pharyngeal mucosa1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
KRT14193broadmarkergingiva, gingival epithelium, upper arm skin
PLEC283ubiquitousmarkersural nerve, hindlimb stylopod muscle, tibial nerve
ITGB4267broadmarkertibial nerve, minor salivary gland, skin of leg
KRT5211broadmarkerlower esophagus mucosa, pharyngeal mucosa, gingiva

Protein interactions among cohort

Intra-cohort edges: 5.

Hub genes (top 10 by interactor count)

SymbolInteractor count
PLEC3,529
KRT53,406
KRT143,351
ITGB42,536

Intra-cohort edges

ABSources
ITGB4KRT14string_interaction
ITGB4PLECintact, string_interaction
KRT14KRT5intact, string_interaction
KRT14PLECintact, string_interaction
KRT5PLECstring_interaction

Structural data

PDB: 4 · AlphaFold-only: 0 · No structure: 0

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
PLECQ1514914
ITGB4P1614413
KRT14P025332
KRT5P136472

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 18. Enrichment computed across 4 evidence-associated genes (4 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 4 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Type I hemidesmosome assembly41038.2×8e-12KRT14, PLEC, ITGB4, KRT5
Differentiation of Keratinocytes in Interfollicular Epidermis in Mammalian Skin3208.9×2e-06KRT14, ITGB4, KRT5
Developmental Cell Lineages3167.9×2e-06KRT14, ITGB4, KRT5
Cell junction organization3140.4×3e-06KRT14, ITGB4, KRT5
Cell-Cell communication3103.2×5e-06KRT14, ITGB4, KRT5
Developmental Lineage of Mammary Gland Myoepithelial Cells2271.9×6e-05KRT14, KRT5
Assembly of collagen fibrils and other multimeric structures2100.2×4e-04PLEC, ITGB4
Formation of the cornified envelope243.9×0.002KRT14, KRT5
Developmental Biology310.8×0.003KRT14, ITGB4, KRT5
Keratinization227.9×0.003KRT14, KRT5
Caspase-mediated cleavage of cytoskeletal proteins1237.9×0.007PLEC
Developmental Lineage of Mammary Stem Cells1190.3×0.008KRT5
Collagen formation1114.2×0.011ITGB4
Developmental Lineage of Mammary Gland Luminal Epithelial Cells1114.2×0.011KRT5
Syndecan interactions1105.7×0.011ITGB4
Laminin interactions195.2×0.012ITGB4
Non-integrin membrane-ECM interactions138.6×0.027ITGB4
Extracellular matrix organization115.8×0.062ITGB4

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 4 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
intermediate filament organization3180.6×2e-05KRT14, PLEC, KRT5
hemidesmosome assembly21203.7×3e-05PLEC, ITGB4
protein-containing complex organization14213.0×0.002PLEC
intermediate filament polymerization14213.0×0.002KRT5
actomyosin contractile ring assembly actin filament organization14213.0×0.002PLEC
epidermis development2105.3×0.002KRT14, KRT5
skeletal myofibril assembly12106.5×0.004PLEC
leukocyte migration involved in immune response11404.3×0.004PLEC
peripheral nervous system myelin formation11404.3×0.004ITGB4
cellular response to hydrostatic pressure11404.3×0.004PLEC
tight junction organization1842.6×0.006PLEC
intermediate filament bundle assembly1702.2×0.007KRT14
nail development1601.9×0.007ITGB4
trophoblast cell migration1601.9×0.007ITGB4
keratinocyte development1383.0×0.009PLEC
peripheral nervous system myelin maintenance1383.0×0.009PLEC
mesodermal cell differentiation1383.0×0.009ITGB4
skin morphogenesis1351.1×0.009ITGB4
cellular response to fluid shear stress1324.1×0.010PLEC
response to radiation1300.9×0.010KRT14
T cell chemotaxis1280.9×0.010PLEC
regulation of vascular permeability1280.9×0.010PLEC
hair cycle1234.1×0.010KRT14
intermediate filament cytoskeleton organization1234.1×0.010PLEC
fibroblast migration1210.7×0.010PLEC
respiratory electron transport chain1210.7×0.010PLEC
myoblast differentiation1210.7×0.010PLEC
cell adhesion mediated by integrin1168.5×0.012ITGB4
transmission of nerve impulse1162.0×0.012PLEC
filopodium assembly1162.0×0.012ITGB4

Therapeutics

Drugs indicated or in trials for this disease

No drug has an approved disease-direct ChEMBL indication for this disease.

2 drugs in clinical trials for this disease (phase 2–3, investigational): efficacy not established — a trial record, not an indication.

DrugHighest phase
DiacereinPhase 2
OnabotulinumtoxinaPhase 2

Drug target analysis

Approved (phase 4): 0 · Phase ≥3: 0 · Phased (≥1): 0 · Undrugged: 4

Druggability breadth: 2 of 4 evidence-associated genes (50%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
KRT1400
PLEC00
ITGB400
KRT500

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
PLEC12Binding:12
ITGB42Binding:2

Pharmacogenomics

Cohort genes with a PharmGKB record: 4; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

0 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)0
BPhased (≥1) drug, not yet approved0
CDruggable family + PDB, no drug1ITGB4
DDruggable family + AlphaFold only, no drug0
EDifficult family or no structure, no drug3KRT14, PLEC, KRT5

Undrugged target profiles

4 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
KRT140
PLEC12
ITGB42
KRT50

Clinical trials & evidence

Clinical trials

Clinical trials: 17.

Phase distribution (across all retrieved trials)

PhaseTrials
PHASE210
PHASE13
Not specified3
PHASE2/PHASE31

Top trials by phase / activity

NCTPhaseStatusTitle
NCT03453632PHASE2/PHASE3UNKNOWNInjections of Botulinic Toxin in Plantar Lesions of Localized Epidermolysis Bullosa Simplex
NCT06136403PHASE2RECRUITINGA 44-week Monocentric Open Study Assessing the Efficacy and Safety of Deucravacitinib in Adults With Inflammatory Genodermatoses
NCT06509984PHASE2RECRUITINGA 20-Week Study Assessing the Efficacy of Apremilast in Patients with EB Simplex Generalized
NCT07027345PHASE2RECRUITINGA Phase II, Placebo Controlled, Clinical Trial of Topical TolaSure Targeting Aggregated Mutant Keratin in Epidermolysis Bullosa Simplex
NCT00936533PHASE2UNKNOWNBotulinumtoxin A Treatment in Epidermolysis Bullosa Simplex and Pachyonychia Congenita
NCT02470689PHASE2UNKNOWNDiacerin for the Treatment of Epidermolysis Bullosa Simplex
NCT02960997PHASE2COMPLETEDUsing Topical Sirolimus 2% for Patients With Epidermolysis Bullous Simplex (EBS) Study
NCT03016715PHASE2UNKNOWNUsing Topical Sirolimus 2% for Patients With Epidermolysis Bullous Simplex (EBS) Study
NCT03154333PHASE2TERMINATEDSafety and Efficacy of Diacerein 1% Ointment for Subjects With Epidermolysis Bullosa Simplex (EBS)
NCT03389308PHASE2COMPLETEDLong Term Open-label Study Evaluating Safety of Diacerein 1% Ointment Topical Formulation in Subjects With Epidermolysis Bullosa Simplex
NCT04908215PHASE2COMPLETEDINM-755 (Cannabinol) Cream for Treatment of Epidermolysis Bullosa
NCT02592954PHASE1COMPLETEDEffect of Broccoli Sprout Extract on Keratinocyte Differentiation in Normal Skin
NCT03472287PHASE1COMPLETEDTo Evaluate the Pharmacokinetic of Diacerein and Rhein After Maximum Use in Patients With Epidermolysis Bullosa (EB)
NCT05062070PHASE1COMPLETEDSafety and Efficacy of Topical TolaSure Targeting Aggregated Mutant Keratin in Severe Epidermolysis Bullosa Simplex
NCT03269474Not specifiedUNKNOWNComputational Drug Repurposing for All EBS Cases
NCT04213703Not specifiedWITHDRAWNA Pilot Study to Explore the Role of Gut Flora in Epidermolysis Bullosa
NCT05033574Not specifiedUNKNOWNThe State of Sexual Development in Children With Inherited Epidermolysis Bullosa

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
CRAVACITINIB43
DIACEREIN34
VEHICLE03
CHEMBL47516501