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March 21, 2011

Congenital Epidermolysis Bullosa Acquisita: Vertical Transfer of Maternal Autoantibody From Mother to Infant

Author Affiliations

Author Affiliations: Departments of Dermatology (Drs Abrams and Mancini) and Pediatrics (Dr Mancini), Northwestern University's Feinberg School of Medicine, and Division of Pediatric Dermatology, Children's Memorial Hospital (Drs Abrams and Mancini), Chicago, Illinois; Departments of Dermatology (Dr Smidt) and Pediatrics (Dr Smidt), University of New Mexico School of Medicine, Albuquerque; Departments of Dermatology (Dr Benjamin) and Pediatrics (Dr Benjamin), Stanford University, Palo Alto, California; and Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles (Drs Chen and Woodley).

Arch Dermatol. 2011;147(3):337-341. doi:10.1001/archdermatol.2010.317

Epidermolysis bullosa acquisita (EBA) is a rare, chronic, autoimmune bullous dermatosis that is caused by autoantibodies against the noncollagenous terminus of the α chain of type VII collagen, resulting in decreased anchoring fibrils in the lamina densa. To our knowledge, a case involving a neonate with congenital EBA has not yet been reported in the literature. We describe a newborn with transient EBA due to the passive transfer of maternal autoantibodies.

A 32-year-old gravida 4, para 3 woman delivered a girl who was noted at birth to have tense blisters and areas of denuded skin. The birth history was remarkable for the induction of labor at 36 weeks of gestation due to oligohydramnios and intrauterine growth restriction. The newborn was vigorous and active at delivery, and no intervention was required. The Apgar score was 9 at both 1 and 5 minutes. The progression of the patient's skin lesions, with the development of new bullae and poor feeding, was noted on day 1 of life. She was transferred to the neonatal intensive care unit, and the dermatology service was consulted.