Therapy of patients with congenital epidermolysis bullosa using modern non-adherent wound dressings

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Aim. To evaluate the clinical efficacy of modern atraumatic non-adherent wound dressings in patients with congenital epidermolysis bullosa. Materials and methods. The study involved 9 patients diagnosed with congenital epidermolysis bullosa (EB), including 7 women and 2 men aged 21–50 years. All the patients underwent immunofluorescent antigenic mapping of skin biopsies to confirm the clinical diagnosis. External therapy using modern atraumatic non-adherent wound dressings was performed in all the patients. The evaluation of the clinical efficacy of the applied therapy was carried out on the 14th and 30th day in accordance with the following criteria: complete healing of erosions or ulcers; significant improvement (reduction of erosions/ulceration by at least 75 % compared with the baseline data, reduction of exudate, the presence of granulations, reduction of inflammation signs, reduction of pain); improvement (reduction of erosions/ulceration area by less than 75 %, but more than 25 % compared with the baseline data, reduction of exudate, presence of granulations, reduction of inflammation signs, reduction of pain); without change (reduction of erosions/ulceration by less than 25 % or no change compared with the baseline data, a slight decrease in the amount of exudate, no granulations, a slight decrease in inflammation signs, a slight reduction of pain); deterioration (increase in the area of erosions/ulceration, increase in the amount of exudate, the level of inflammation and subjective estimation either increases or remains the same). Results. On the 14th day, 22 out of 58 (37.9 %) erosions were epithelized. The area of 15 erosions was reduced by more than 75 %. The area of 12 erosions (20.6 %) was reduced by more than 25 %, but less than 75 %. The area of 7 (12.25 %) erosions decreased by less than 25 %. The area of 2 erosions in patients with severe generalised recessive dystrophic epidermolysis bullosa (RDEB) increased (3.45 %). Out of 36 erosions that had not been epithelized by the 14th day, 20 (55.5 %) achieved complete healing by the 30th day. The dimensions and characteristics of 5 (13.8 %) nonhealing erosive-ulcerative defects had remained unchanged by the 30th day. The share of reduction in the area of these defects did not exceed 30 %. Conclusion. The obtained results demonstrate the clinical efficacy of external therapy using modern atraumatic nonadherent wound dressings. The dynamic observation of erosive-ulcerative defects, regular documentation of changes in the parameters of erosive and ulcerative defects allows the development of standardised approaches of efficient external therapy in such conditions, including the selection of non-adherent dressings. Objective assessment of the dynamics of erosive-ulcerative skin defects contributes to the development of individualized plans for treating EB patients.

About the authors

A. A. Kubanov

State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation

Email: fake@neicon.ru
Dr. Sci. (Med.), RAS Corresponding Member, Prof. Russian Federation

A. E. Karamova

State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation

Author for correspondence.
Email: karamova@cnikvi.ru
Cand. Sci. (Med.), Departmental Head, Department of Dermatology Russian Federation

V. I. Albanova

State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation;
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation

Email: fake@neicon.ru
Dr. Sci. (Med.), Leading Researcher, Department of Dermatology, State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation; Prof., Department of Skin and Venereal Diseases, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation Russian Federation

E. S. Monchakovskaya

State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation

Email: fake@neicon.ru
Researcher, Department of Dermatology Russian Federation

References

  1. Fine J. D., Eady R. A., Bauer E. A. et al. The classification of inherited epidermolysis bullosa (EB): report of the third international consensus meeting on diagnosis and classification of EB. J Am Acad Dermatol. 2008;58:931–950.
  2. Has C., He Y. Research Techniques Made Simple: Immunofluorescence Antigen Mapping in Epidermolysis Bullosa. J Invest Dermatol. 2016;136:e65–71.
  3. Coulombe P. A., Hutton M. E., Vassar R., Fuchs E. A function for keratins and a common thread among different types of epidermolysis bullosa simplex diseases. J Cell Biol. 1991;115:1661–1674.
  4. Coulombe P. A., Kerns M. L., Fuchs E. Epidermolysis bullosa simplex: a paradigm for disorders of tissue fragility. J Clin Invest. 2009;119:1784–1793.
  5. Pope E., Lara-Corrales I., Mellerio J., Martinez A., Schultz G., Burrell R. et al. A consensus approach to wound care in epidermolysis bullosa. J Am Acad Dermatol. 2012;67:904–917.
  6. Fine J. D. Inherited epidermolysis bullosa. Orphanet J Rare Dis. 2010;5–12.
  7. Fine J. D., Johnson L. B., Suchindran C., Carter D. M., Moshell A. The National Epidermolysis Bullosa Registry: organization, goals, methodologic approaches, basic demography, and accomplishments. In: Fine J. D., Bauer E. A., McGuire J., Moshell A. (eds) Epidermolysis Bullosa: Clinical, Epidemiologic, and Laboratory Advances, and the Findings of the National Epidermolysis Bullosa Registry. Baltimore: Johns Hopkins University Press, 1999. P. 79–100.
  8. Fine J. D., Johnson L. B., Weiner M., Li K. P., Suchindran C. Epidermolysis bullosa and the risk of life-threatening cancers: the National EB Registry experience, 1986–2006. J Am Acad Dermatol. 2009;60:203–211.
  9. Mellerio J. E., Robertson S. J., Bernardis C. et al. Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines. Br J Dermatol. 2016;174:56–67.
  10. Carulli S., Contin R., De Rosa L., Pellegrini G., De Luca M. The long and winding road that leads to a cure for epidermolysis bullosa. Regen Med. 2013;8:467–481.
  11. Margolis D. J., Allen-Taylor L., Hoffstad O., Berlin J. A. The accuracy of venous leg ulcer prognostic models in a wound care system. Wound Repair Regen. 2004;12:163–168.
  12. Petrof G., Abdul-Wahab A., McGrath J. A. Cell Therapy in Dermatology. Cold Spring Harb Perspect Med. 2014;4:a015156.
  13. Schultz G., Sibbald G., Falanga V. et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11:1–28.
  14. Keast D. H., Bowering C. K., Evans A. W., Mackean G. L., Burrows C., D’Souza L. MEASURE: a proposed assessment framework for developing best practice recommendations for wound assessment. Wound Repair Regen. 2004;12(3 Suppl):S1–17.
  15. World Union of Wound Healing Societies. Principles of Best Practice: Minimising Pain at Wound Dressing-Related Procedures. A Consensus Document. London, UK: MEP Ltd, 2004. P. 1–10.
  16. Dowsett C., Ayello E. TIME principles of chronic wound bed preparation and treatment. Br J Nurs. 2004;13(Suppl 15):S16–S23.
  17. Faucher N., Safar H., Baret M., Philippe A., Farid R. Superabsorbent dressings for copiously exuding wounds. Br J Nurs. 2012;21(12):S22, S24, S26–S28.
  18. Sibbald R., Elliott J.A., Ayello E.A., Somayaji R. Optimizing the Moisture Management Tightrope with Wound Bed Preparation 2015. Adv Skin Wound Care. 2015;28:466–476.

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Copyright (c) 2019 Kubanov A.A., Karamova A.E., Albanova V.I., Monchakovskaya E.S.

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