Clinical Problem:

Patients with erythematosis bullosa (EB) present a unique wound care challenge.  Blistering of the skin results from minor trauma; blistering can also affect the mucous membranes, increasing the risk for malnutrition.

Description of Past Management:

The patient, a 34 year old single mother, has junctional EB (blisters occur at the dermal and epidermal junction) and celiac disease.  She had been managed by her primary care provider, calling and making appointments to be seen as needed.  Sometimes there was a delay in seeking and/or getting treatment, resulting in prolonged hospitalizations for treatment of infection.

Current Approach:

The patient is now being seen weekly at a wound clinic.  Her wound care is directed by the physician there who takes into consideration the large number of wounds, the cost of optimal dressings, and the effects of the wounds on her body as a whole.  She now has a PE tube for supplemental feedings at night and albumin is routinely monitored.

Outcomes:

The physician has been using a potent topical steroid rotating the sites and days to minimize side effects.  There has been a regression and healing of the current blisters and decreased frequency of new blisters.  Maceration continues to be a problem on the back, buttocks and upper thighs.  Albumin is now in the low normal range and the patient receives periodic blood transfusions for anemia.  The patient is getting medication to adequately manage her pain.

Conclusion:

Weekly visits to the wound clinic have improved that patient's quality of life as symptoms are treated promptly. Close monitoring of wounds by experienced professional affords the opportunity to try new treatments and to detect subtle changes that can be addressed promptly.  The patients pain is more adequately managed and she has been able to avoid hospitalization.  The principles behind the approach in this case can be considered and applied for any case.