Epidermolysis bullosa

Below, we summarize and group the main factors that can contribute to itching in patients with BE and/or aggravate it (Figure 3):

• Temperature changes. Any change can induce itchiness.
• Changes in the humidity and dryness of the environment.
• Constant cicatrization process. The healing wounds or those which have almost cicatrized are especially pruritic. This can cause, when scratching, re-open the wound and the healing process never-ending.
• Processes of generalized skin inflammation. As we have seen, the continuous inflammation processes in the skin of people with EB can increase the secretion of disorganized pro-inflammatory defence cells, which perpetuate itching.
• Infected wounds. Very contaminated, especially the infected ones, wounds have been seen to generate higher itchiness.
• Dry skin. It is very important to have a properly hydrated skin.
• Overheating. Some people with severe EB do not sweat effectively, depending on the EB subtype and the level of skin where the lesions are located. This is due to the presence of wounds or scars associated with sweat glands, so the body's ability to sweat, cooldown and regulate its temperature is reduced. For this reason, it is very important not to overheat the body with the use of overlay dressings and bandages, especially in the summer months. This can be a challenge, as it becomes difficult to find the balance between overheating and protecting the skin from shock and excess moisture.
• Factors related to cures. When dressings stick to the skin due to poor moisture management and not choosing the right product, it can cause more irritation and itching. In addition, the use of irritating bathroom products (such as bleach without rinsing with plenty of water) and/or skin maintenance (skin creams, soaps), can cause more itching. Soaps can dry the skin more, so it is recommended to avoid gels with soap, especially in patients with more sensitive skin.
• Products in contact with the skin. It is important to pay attention to the products that are used for washing clothes, the type of fibers the clothes are made of, etc. It is recommended to avoid the use of fragrances with alcohol and perfumes or colognes.
• Emotional factors. The stress associated to the different life aspects (fear, changes, pain, etc.) can increase the itchiness sensation.
• Adverse effects of medication. This is especially important when using opioids or morphine in high doses.