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Kindler syndrome(KNDLRS)

MedGen UID:
96060
Concept ID:
C0406557
Disease or Syndrome
Synonyms: Bullous acrokeratotic poikiloderma of kindler and weary; Congenital bullous poikiloderma; Hereditary acrokeratotic poikiloderma of Weary; Kindler's syndrome; KNDLRS; Poikiloderma of Kindler; Poikiloderma, congenital, with bullae, weary type; Poikiloderma, hereditary acrokeratotic
SNOMED CT: Kindler syndrome (238836000); Kindler's syndrome (238836000)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Gene (location): FERMT1 (20p12.3)
 
Monarch Initiative: MONDO:0008260
OMIM®: 173650
Orphanet: ORPHA2908

Disease characteristics

Excerpted from the GeneReview: Kindler Syndrome
Kindler syndrome (KS), a rare subtype of inherited epidermolysis bullosa, is characterized by skin fragility and acral blister formation beginning at birth, diffuse cutaneous atrophy, photosensitivity (most prominent during childhood and usually decreasing after adolescence), poikiloderma, diffuse palmoplantar hyperkeratosis, and pseudosyndactyly. Mucosal manifestations are also common and include hemorrhagic mucositis and gingivitis, periodontal disease, premature loss of teeth, and labial leukokeratosis. Other mucosal findings can include ectropion, urethral stenosis, and severe phimosis. Severe long-term complications of KS include periodontitis, mucosal strictures, and aggressive squamous cell carcinomas. Manifestations can range from mild to severe. [from GeneReviews]
Authors:
Leila Youssefian  |  Hassan Vahidnezhad  |  Jouni Uitto   view full author information

Additional descriptions

From OMIM
Kindler syndrome (KNDLRS) is an autosomal recessive dermatosis characterized by congenital blistering, skin atrophy, photosensitivity, skin fragility, and scaling (summary by Jobard et al., 2003).  http://www.omim.org/entry/173650
From MedlinePlus Genetics
Kindler epidermolysis bullosa (or Kindler EB) is a rare type of epidermolysis bullosa, which is a group of genetic conditions that cause the skin to be very fragile and to blister easily.

From early infancy, people with Kindler EB have skin blistering, particularly on the backs of the hands and the tops of the feet. The blisters occur less frequently over time, although repeated blistering on the hands can cause scarring that fuses the skin between the fingers and between the toes. Affected individuals also develop thin, papery skin starting on the hands and feet and later affecting other parts of the body; changes in skin coloring; and small clusters of visible blood vessels just under the skin (telangiectases). This combination of features is known as poikiloderma. In some affected individuals, the skin on the palms of the hands and soles of the feet thickens and hardens (hyperkeratosis). Kindler EB can also cause people to be highly sensitive to ultraviolet (UV) rays from the sun and to sunburn easily.

Kindler EB can also affect the moist lining (mucosae) of the mouth, eyes, esophagus, intestines, genitals, and urinary system, causing these tissues to be very fragile and easily damaged. Affected individuals commonly develop severe gum disease that can lead to early tooth loss. The moist tissues that line the eyelids and the white part of the eyes (the conjunctiva) can become inflamed (conjunctivitis), and damage to the clear outer covering of the eye (the cornea) can affect vision. Narrowing (stenosis) of the esophagus, which is the tube that carries food from the mouth to the stomach, causes difficulty with swallowing that worsens over time. Some affected individuals develop health problems related to inflammation of the colon (colitis) or damage to the mucosa in the vagina, the anus, or the tube that carries urine from the bladder out of the body (the urethra).

Kindler EB increases the risk of developing a form of cancer called squamous cell carcinoma. This type of cancer arises from squamous cells, which are found in the outer layer of skin (the epidermis) and in the mucosae. In people with Kindler EB, squamous cell carcinoma occurs most often on the skin, lips, and the lining of the mouth (oral mucosa).  https://medlineplus.gov/genetics/condition/kindler-epidermolysis-bullosa

Clinical features

From HPO
Urethral stenosis
MedGen UID:
12016
Concept ID:
C0041974
Finding
Abnormal narrowing of the urethra.
Phimosis
MedGen UID:
87496
Concept ID:
C0345326
Congenital Abnormality
The male foreskin cannot be fully retracted from the head of the penis.
Palmoplantar keratosis
MedGen UID:
44017
Concept ID:
C0022596
Disease or Syndrome
Abnormal thickening of the skin localized to the palm of the hand and the sole of the foot.
Dysphagia
MedGen UID:
41440
Concept ID:
C0011168
Disease or Syndrome
Difficulty in swallowing.
Esophageal stenosis
MedGen UID:
5026
Concept ID:
C0014866
Disease or Syndrome
An abnormal narrowing of the lumen of the esophagus.
Anal stenosis
MedGen UID:
82644
Concept ID:
C0262374
Anatomical Abnormality
Abnormal narrowing of the anal opening.
Periodontitis
MedGen UID:
45815
Concept ID:
C0031099
Disease or Syndrome
Inflammation of the periodontium.
Carious teeth
MedGen UID:
8288
Concept ID:
C0011334
Disease or Syndrome
Caries is a multifactorial bacterial infection affecting the structure of the tooth. This term has been used to describe the presence of more than expected dental caries.
Gingivitis
MedGen UID:
4895
Concept ID:
C0017574
Disease or Syndrome
Inflammation of the gingiva.
Oral mucosa leukoplakia
MedGen UID:
9738
Concept ID:
C0023532
Neoplastic Process
A thickened white patch on the oral mucosa that cannot be rubbed off.
Symblepharon
MedGen UID:
509041
Concept ID:
C0152454
Pathologic Function
A partial or complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball.
Dermal atrophy
MedGen UID:
101793
Concept ID:
C0151514
Disease or Syndrome
Partial or complete wasting (atrophy) of the skin.
Fragile skin
MedGen UID:
66826
Concept ID:
C0241181
Finding
Skin that splits easily with minimal injury.
Cutaneous photosensitivity
MedGen UID:
87601
Concept ID:
C0349506
Pathologic Function
An increased sensitivity of the skin to light. Photosensitivity may result in a rash upon exposure to the sun (which is known as photodermatosis). Photosensitivity can be diagnosed by phototests in which light is shone on small areas of skin.
Poikiloderma
MedGen UID:
97905
Concept ID:
C0392777
Disease or Syndrome
Poikiloderma refers to a patch of skin with (1) reticulated hypopigmentation and hyperpigmentation, (2) wrinkling secondary to epidermal atrophy, and (3) telangiectasias.
Ridged nail
MedGen UID:
140853
Concept ID:
C0423820
Finding
Longitudinal, linear prominences in the nail plate.
Spotty hypopigmentation
MedGen UID:
812508
Concept ID:
C3806178
Finding
Spotty hyperpigmentation
MedGen UID:
812509
Concept ID:
C3806179
Finding
Telangiectasia of the skin
MedGen UID:
867629
Concept ID:
C4022018
Finding
Presence of small, permanently dilated blood vessels near the surface of the skin, visible as small focal red lesions.
Diffuse skin atrophy
MedGen UID:
870418
Concept ID:
C4024863
Disease or Syndrome
Acral blistering
MedGen UID:
1375545
Concept ID:
C4476927
Finding
Bullae (defined as fluid-filled blisters more than 5 mm in diameter with thin walls) of the skin with an acral distribution (affecting peripheral regions such as hands and feet).
Reduced epidermal kindlin-1 expression
MedGen UID:
1052666
Concept ID:
CN378057
Finding
Lower than normal amount of kindlin-1 in the epidermis.
Amniotic constriction ring
MedGen UID:
315953
Concept ID:
C1527388
Congenital Abnormality
Annular constrictions around the digits, limbs, or trunk, occurring congenitally (sometimes causing intrauterine autoamputation) and also associated with a wide variety of disorders. Constrictive amniotic bands are the result of primary amniotic rupture, which can lead to entanglement of fetal tissue (especially limbs) in fibrous amniotic strands.
Corneal erosion
MedGen UID:
97882
Concept ID:
C0392163
Disease or Syndrome
An erosion or abrasion of the cornea's outermost layer of epithelial cells.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVKindler syndrome
Follow this link to review classifications for Kindler syndrome in Orphanet.

Professional guidelines

PubMed

Guerrero-Aspizua S, Conti CJ, Escamez MJ, Castiglia D, Zambruno G, Youssefian L, Vahidnezhad H, Requena L, Itin P, Tadini G, Yordanova I, Martin L, Uitto J, Has C, Del Rio M
Orphanet J Rare Dis 2019 Jul 24;14(1):183. doi: 10.1186/s13023-019-1158-6. PMID: 31340837Free PMC Article
Maier K, He Y, Wölfle U, Esser PR, Brummer T, Schempp C, Bruckner-Tuderman L, Has C
Hum Mol Genet 2016 Dec 15;25(24):5339-5352. doi: 10.1093/hmg/ddw350. PMID: 27798104
Intong LR, Murrell DF
Clin Dermatol 2012 Jan-Feb;30(1):70-7. doi: 10.1016/j.clindermatol.2011.03.012. PMID: 22137229

Recent clinical studies

Etiology

Hon KL, Chu S, Leung AKC
Curr Pediatr Rev 2022;18(3):182-190. doi: 10.2174/1573396317666210525161252. PMID: 34036913
Has C, Castiglia D, del Rio M, Diez MG, Piccinni E, Kiritsi D, Kohlhase J, Itin P, Martin L, Fischer J, Zambruno G, Bruckner-Tuderman L
Hum Mutat 2011 Nov;32(11):1204-12. Epub 2011 Sep 20 doi: 10.1002/humu.21576. PMID: 21936020
Larizza L, Roversi G, Volpi L
Orphanet J Rare Dis 2010 Jan 29;5:2. doi: 10.1186/1750-1172-5-2. PMID: 20113479Free PMC Article
D'Souza MA, Kimble RM, McMillan JR
Dermatol Clin 2010 Jan;28(1):115-8. doi: 10.1016/j.det.2009.10.012. PMID: 19945623
White SJ, McLean WH
J Dermatol Sci 2005 Jun;38(3):169-75. Epub 2005 Mar 31 doi: 10.1016/j.jdermsci.2004.12.026. PMID: 15927810

Diagnosis

Hon KL, Chu S, Leung AKC
Curr Pediatr Rev 2022;18(3):182-190. doi: 10.2174/1573396317666210525161252. PMID: 34036913
Rayinda T, van Steensel M, Danarti R
Int J Dermatol 2021 Nov;60(11):1343-1353. Epub 2021 Mar 19 doi: 10.1111/ijd.15498. PMID: 33739439
Sawamura D, Nakano H, Matsuzaki Y
J Dermatol 2010 Mar;37(3):214-9. doi: 10.1111/j.1346-8138.2009.00800.x. PMID: 20507384
Larizza L, Roversi G, Volpi L
Orphanet J Rare Dis 2010 Jan 29;5:2. doi: 10.1186/1750-1172-5-2. PMID: 20113479Free PMC Article
Sharma RC, Mahajan V, Sharma NL, Sharma AK
Int J Dermatol 2003 Sep;42(9):727-32. doi: 10.1046/j.1365-4362.2003.01659.x. PMID: 12956691

Therapy

Shayegan LH, Levin LE, Galligan ER, Lucky AW, Bruckner AL, Pope E, Lara-Corrales I, Wiss K, McCuaig CC, Garzon MC, Eichenfield LF, Hook KP, Browning JC, Schachner LA, Perman MJ, Castelo-Soccio L, Levy ML, Glick SA, Morel KD
Pediatr Dermatol 2020 Mar;37(2):326-332. Epub 2020 Jan 15 doi: 10.1111/pde.14102. PMID: 31944391
Mehdi I, Al Bahrani BJ, Al Lawati TM, Mandhari ZA, Al Lawati FR
J Pak Med Assoc 2017 Aug;67(8):1283-1286. PMID: 28839322
Zhang X, Luo S, Wu J, Zhang L, Wang WH, Degan S, Erdmann D, Hall R, Zhang JY
J Invest Dermatol 2017 Feb;137(2):475-483. Epub 2016 Oct 7 doi: 10.1016/j.jid.2016.09.023. PMID: 27725201Free PMC Article
Maier K, He Y, Wölfle U, Esser PR, Brummer T, Schempp C, Bruckner-Tuderman L, Has C
Hum Mol Genet 2016 Dec 15;25(24):5339-5352. doi: 10.1093/hmg/ddw350. PMID: 27798104
Lai-Cheong JE, Parsons M, Tanaka A, Ussar S, South AP, Gomathy S, Mee JB, Barbaroux JB, Techanukul T, Almaani N, Clements SE, Hart IR, McGrath JA
Am J Pathol 2009 Oct;175(4):1431-41. Epub 2009 Sep 17 doi: 10.2353/ajpath.2009.081154. PMID: 19762710Free PMC Article

Prognosis

Maharana PK, Sahay P, Mandal S, Nagpal R, Sharma N
Indian J Ophthalmol 2022 Jul;70(7):2585-2587. doi: 10.4103/ijo.IJO_791_22. PMID: 35791162Free PMC Article
Hon KL, Chu S, Leung AKC
Curr Pediatr Rev 2022;18(3):182-190. doi: 10.2174/1573396317666210525161252. PMID: 34036913
Rayinda T, van Steensel M, Danarti R
Int J Dermatol 2021 Nov;60(11):1343-1353. Epub 2021 Mar 19 doi: 10.1111/ijd.15498. PMID: 33739439
Has C, Castiglia D, del Rio M, Diez MG, Piccinni E, Kiritsi D, Kohlhase J, Itin P, Martin L, Fischer J, Zambruno G, Bruckner-Tuderman L
Hum Mutat 2011 Nov;32(11):1204-12. Epub 2011 Sep 20 doi: 10.1002/humu.21576. PMID: 21936020
Wiebe CB, Petricca G, Häkkinen L, Jiang G, Wu C, Larjava HS
J Periodontol 2008 May;79(5):961-6. doi: 10.1902/jop.2008.070167. PMID: 18454678Free PMC Article

Clinical prediction guides

Hon KL, Chu S, Leung AKC
Curr Pediatr Rev 2022;18(3):182-190. doi: 10.2174/1573396317666210525161252. PMID: 34036913
Yıldırım TT, Kaya FA, Taşkesen M, Dündar S, Bozoğlan A, Tekin GG, Akdeniz S
Turk J Pediatr 2017;59(1):56-61. doi: 10.24953/turkjped.2017.01.009. PMID: 29168364
Has C, Castiglia D, del Rio M, Diez MG, Piccinni E, Kiritsi D, Kohlhase J, Itin P, Martin L, Fischer J, Zambruno G, Bruckner-Tuderman L
Hum Mutat 2011 Nov;32(11):1204-12. Epub 2011 Sep 20 doi: 10.1002/humu.21576. PMID: 21936020
Shimizu H, Sato M, Ban M, Kitajima Y, Ishizaki S, Harada T, Bruckner-Tuderman L, Fine JD, Burgeson R, Kon A, McGrath JA, Christiano AM, Uitto J, Nishikawa T
Arch Dermatol 1997 Sep;133(9):1111-7. PMID: 9301588
Haber RM, Hanna WM
Arch Dermatol 1996 Dec;132(12):1487-90. doi: 10.1001/archderm.132.12.1487. PMID: 8961879

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