Epidermolysis bullosa

A wound is produced when the skin or its internal parts lose its integrity, and, therefore, disappears one of the main functions of the skin: act as a protective barrier for the body against the surroundings aggressive agents (microorganisms, extreme temperatures, humidity, etc.).

Wounds can be classified in different ways, keeping in mind its cause, its duration, its bacterial load, etc.

In people with EB, we can find both acute wounds and chronic ones. Acute wounds are generally produced due to accidents, they are usually not complex and heal quickly, typically before 3 months. Chronic wounds can last months and years, they are more complicated to heal and are considered to be contaminated, so it could be that even after some time of having cicatrized they re-open. Ideally, the latter should be assessed by an expert in EB.

On the other hand, the bacterial load of the wounds indicated the quantity of microorganisms present in it: we differentiate between clean, contaminated, colonized and infected wounds. Next, we are showing a diagram of their evolution and their main characteristics and examples (Figure 1).

To better comprehend the difference between the different types of wounds depending of its bacterial load, let us consider the following example: we can imagine the microorganisms as “conquerors” who go to a “village”, which would be the wound. At the beginning, if the village is abandoned and there are no people, we would have a clean wound (rare). The moment the “conquerors” turn up at the village, but they just cohabit with the autochthonal villagers, we would have a contaminated wound. When the conquerors start to reproduce and grow in number over the autochthonal villagers, although the villagers could defend themselves of the invasion, we would have a colonized wound. Lastly, if apart from reproducing and invading the village they start to destroy and damage the autochthonal villagers, we would have an infected wound.

Lastly, in this context we believe necessary to explain the term biofilm(Figure 2). When a wound has biofilm is because there is a microorganisms aggrupation behaving as a “community”. This wound will be very. Difficult to treat because the bacteria have been releasing substances that form a protective film. As the wounds with biofilm are resistant to treatments, they might be difficult to heal. Although it is not always easy to identify the wounds with biofilm, it is important to look for suspicious signs:

• Appearance of a shiny, translucentlayer on the surface of a non-healing wound
• Presence of jellysubstances which form again quickly after removing them, as opposed to other types of devitalized tissue which usually takes longer to form after debriding it.
• Although the treatment of wounds with biofilm is complicated, it is recommended to do it with combined strategies: intense cleaning, sharp debridement if possible (done carefully), application of local antibacterial (silver or polyhexanide, for example) and systemicantibiotic if indicated by your doctor.