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Living with Epidermolysis bullosa simplex 4, localized or generalized intermediate, autosomal recessive

A mild inherited form of EB simplex with scaly crusts and occasional blisters that improve with age.

Understanding Epidermolysis bullosa simplex 4, localized or generalized intermediate, autosomal recessive

Epidermolysis bullosa simplex 4 is a rare inherited form of EB simplex with mild, injury-triggered scaly crusts and blisters.

Blisters come and go and may heal with slight scarring and darker skin patches. It often starts in childhood. Symptoms improve with age.

Signs & symptoms

Symptoms vary from person to person. GARD lists these among the most common:

  • Skin blisters
  • Fragile skin
  • Thickened skin (hyperkeratosis)
  • Thickening of the upper layer of skin (acanthosis)

Not everyone has every symptom. GARD's list comes from the Human Phenotype Ontology.

Diagnosis

  1. Talk with your doctor

    Share the symptoms you've noticed, when they started and your family health history. Notes and photos can help.

  2. See a specialist

    Specialists who may be involved include genetic specialists and skin, hair, and nail specialists.

  3. Consider genetic testing

    Changes in EXPH5 are linked to this condition. Genetic testing and counseling can help confirm a diagnosis and explain what it means for your family.

  4. Connect with expert centers

    DEBRA of America may keep lists of experts for this condition.

Care & treatment

Care team
Genetic specialists (geneticists); Skin, hair, and nail specialists (dermatologists)
Expert care
Expert lists: DEBRA of America
Treatment
GARD doesn't list specific treatments for this condition. Your care team will tailor care to your symptoms.
Research
Clinical trials and observational studies may be options. See the research section below.

General information, not medical advice. Your care team makes the decisions.

Everyday life

Living with a rare condition is easier with support.

  • Connect with DEBRA of America and other patient organizations
  • Keep notes on symptoms, changes and questions for appointments
  • Ask about patient registries that help research
  • Look into financial aid and travel resources for care visits
Bring these questions to your next doctor visit
Can genetic testing for the EXPH5 gene confirm this diagnosis?
How can we protect the skin from injury?
Will the skin symptoms keep improving with age?

Quick facts

Symptoms usually startChild
InheritanceAutosomal Recessive
GenesEXPH5

Changes in the EXPH5 gene cause this condition. It is autosomal recessive, which means a child inherits a changed copy of the gene from each parent.

GeneticSkin

Also known as: ebs due to exophilin 5 deficiency; ebs-ar exophilin 5; epidermolysis bullosa simplex due to exophilin 5 deficiency; epidermolysis bullosa, nonspecific, autosomal recessive

Patient organizations

Source: NIH GARD · Epidermolysis bullosa simplex 4, localized or generalized intermediate, autosomal recessiveGARD ID 17691 · GARD page updated September 2026 · Plain-language summary by Know Rare; editorial review pending. General information, not medical advice.

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