In Roenigk's review of the EBA world literature (Roenick et al. 1971), it was noted that there were many anecdotal reports of EBA associated with sytemic diseases such as SLE, diabetes, inflammatory bowel disease, amyloidosis, autoimmune thyroiditis, multiple endocrinopathy syndrome, rheumatoid arthritis, pulmonary fibrosis, chronic lymphocytic leukemia, thymoma, diabetes, and others (Woodley et al. 1998). However, EBA is a relatively rare disease, and most of these are anecdotal reports. It appears that the most frequently associated disease with EBA is inflammatory bowel disease, with an estimate of 25% of 50 EBA patients reviewed by Chan and Woodley (1996). It has also been shown that patients with inflammatory bowel disease, especially Crohn's disease, have a high prevalence of circulating antibodies against type VII collagen (Chen et al. 1997). In addition, type VII collagen was recently shown to be present in the intestinal epithelium (Lohi et al. 1996). Because type VII collagen is the antigenic target for autoantibodies in patients with EBA, we speculate that autoimmunity to type VII collagen which exists in both gut and skin, may explain why these patients frequently have inflammatory bowel disease. The presence of type VII collagen antibodies in Crohn's disease patients may be an epitope spreading phenomenon whereby inflammation originally invoked by Crohn's disease could perturb the intestinal epithelial
BMZ such that BMZ components could be altered, resulting in an ongoing autoimmunity to type VII collagen (Chan et al. 1998).
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