The Butterfly Effect

February – August 2021

Epidermolysis bullosa (EB) is a rare genetic disease that causes the skin to become as fragile as butterflies’ wings. The minimum touch can destroy the skin and cause blisters. This installation presents artworks developed around the understanding of EB and how the skin is affected by the condition. Unique quilling artworks were made in response to pictures of people with EB, and images of skin with and without EB observed under the microscope.

Scientists Dario L. Balacco from the School of Dentistry, University of Birmingham and Ajoy Bardhan from the Birmingham Medical School worked with quilling artist Dandy Vitelli to develop the project.

Epidermolysis bullosa (EB) is the name for a group of rare genetic skin disorders that cause the skin to become very fragile, as butterflies’ wings1. The skin is like layered sheets of papers glued together to form a barrier to protect us from the outside world. It comprises layers of skin cells (sheets of papers) and proteins (the glue)2 . When there is a change in the proteins (mutations), the glue is not adhesive anymore, and this causes the sheets of papers (skin cells) to peel off and detach, causing EB.

The human skin is inhabited by many microbes such as bacteria, fungi, eukaryotes, and viruses, most of which are harmless and friendly, and live in harmony with us3. When trauma causes a blister, these microbes may behave differently, causing infections, slowing wound healing, and creating scars. The human body has specialised immune cells, the neutrophils that protect us from infections and help us fight them. In some diseases, the immune cells do not behave as they should and can over-react to certain microbes, causing a delay in wound healing and damaging our tissues as a side effect4.

Our project aims to discover the microbes inhabiting the skin in EB, and if a particular type of immune cells, the neutrophils, work correctly in people with EB.

The effects of EB can be seen in our exhibition in the portrait “Girl” showing blisters on a woman’s body affected by the skin disorder. Healthy skin and skin with blisters photomicrographs are beautifully captured by the artist Dandy Vitelli (@dandy_vitelli) in the artworks “Magnifications”. Scientists Dario L. Balacco (University of Birmingham’s School of Dentistry) and Ajoy Bardhan (Birmingham Medical School) identify the many microbes living on the skin using swabs and extracting their DNA.

The work emerges from research carried out by Dario Balacco, Ajoy Bardham, Melissa Grant, Sarah Kuehne, Josefine Hirschfeld, Adrian Heagerty, and Iain Chapple from the EB Research Group at the Birmingham Dental Hospital and Solihull Hospital.

1.             Bardhan, A. et al. Epidermolysis bullosa. Nature Reviews Disease Primers vol. 6 (2020).

2.             Wong, R., Geyer, S., Weninger, W., Guimberteau, J.-C. & Wong, J. K. The dynamic anatomy and patterning of skin. Exp. Dermatol. 25, 92–98 (2016).

3.             Byrd, A. L., Belkaid, Y. & Segre, J. A. The human skin microbiome. Nature Reviews Microbiology vol. 16 143–155 (2018).

4.             Summers, C. et al. Neutrophil kinetics in health and disease. Trends in Immunology vol. 31 318–324 (2010).

The work by the research group is funded by DEBRA.