Epidermolysis bullosa

In EB there are many factors that can prevent an adequate cicatrization process. Some of which are:

• Factors related to the wound: the ones summarized in the TIME scheme (see section 2.4):
• Wound too dry or too damp: it is recommended to use adequate absorption dressings as well as protecting the skin around the wound with cream or spray barrier products. When there is excessive dampness we talk about maceration, which is a kind of injury that softens and damages the skin, making it look whiter and prone to break. This can appear as well in areas in contact with saliva, urine, faeces or around the gastrostomy if present
• Lack of blood circulation in the wound’s area: it is recommended to avoid very compressive bandages, increase the physical exercise whenever possible and smoking is discouraged.
• Temperature decrease in the wound: It is recommended to warm the water during cleaning, as well as to try to change dressings as quickly as possible, in a warm room.
• Hyper granulation in the wound. Hyper granulation is the exaggerated growth of new tissue in the wound, having the appearance of small bright reddish-pink excrescences, with a tendency to bleed. Sometimes it grows through the holes in the mesh netting. It is recommended to treat infections early, properly manage humidity and consult with the referring doctor in case it is necessary to start a topical corticosteroid.
• Keeping “dry tissue” in the wound, such as dry skin, scabs, slough, etc., can delay healing. Later we will talk about the debridement that is needed to perform an exhaustive cleaning in these cases.
• Do not apply substances that are toxic to growing cells: it is recommended to avoid the routine use of long-term antiseptic, antibiotic or corticosteroid products, but to use them with caution only when indicated by your team and for the indicated time.
• Dressings attached to the wound: it is recommended to use suitable dressings and remove them whenever possible after moistening them very well with water. In some cases, it may be helpful to use medical adhesive remover products. To remove the dressing, the edge should always be gently separated and rolled up on itself little by little, wetting and gradually removing it.
• Wound area: the areas susceptible to receiving blows, the joint areas and those that are subject to pressure have a higher risk of healing in a complicated way. It is recommended to pad the areas whenever necessary, to ensure normal mobility, to use mattresses or cushions to relieve pressure, not to tighten bandages or to wear very tight clothing.
• Nutritional deficits: the scarce intake of nutrients, like proteins and vitamins, can difficult cicatrization. In some cases and under medical indication nutritional supplements might be indicated.

• Anemia: it is, too, very related to nutrition. Anaemic states difficult proper cicatrization, so it should always be assessed and treated.
• Environmental factors: lack of sleep, pain, stress, etc., can reduce the cicatrization of the wounds as these are related to our body’s response to the external agents and damages. These symptoms should be monitored and commented to the reference team.
• Intercurrent illnesses: some common and occasional illnesses, especially infectious ones such as the flu or diarrhoea, could worsen the evolution of wounds or even increase their number. This can be due, for example, to the increase in temperature when there is a fever or to the affectation of the immune system.
• Age: there are studies which prove that wounds take longer to heal with age. When we age the communication between the skin cells and the immune cells is interrupted, so skin reparation ends up being slowed down. This is even more evident in people with epidermolysis bullosa as their skin already suffers from an alteration in their cells and is exposed during years to the wound apparition, so it is a “more punished” skin and with higher difficulty to heal in adult years than in paediatric years.