Epidermolysis Bullosa and Chronic Wounds: A Model for Wound Bed Preparation of Fragile Skin

Pope, Elena MD, MSc, FRCPC; Lara-Corrales, Irene MD, FRCPC (Derm); Mellerio, Jemima E. BSc, MD, FRCP; Martinez, Anna E. MBBS,MRCP,MRCPCH; Sibbald, Cathryn RPh, BScPhm, ACPR; Sibbald, R. Gary BSc, MD, MEd, FRCPC (Med) (Derm), FACP, FAAD, MAPWCA, for the EB International Consensus Panel

Advances in Skin & Wound Care: April 2013 - Volume 26 - Issue 4 - p 177–188
doi: 10.1097/01.ASW.0000428864.72412.b7
Features: Clinical Management Extra

PURPOSE: To enhance the learner’s competence with information about a wound bed preparation model of fragile skin for patients with epidermolysis bullosa (EB).

TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES: After participating in this educational activity, the participant should be better able to:

1. Differentiate between the types and subtypes of EB. 2. Apply EB assessment and treatment strategies to patient care scenarios.

ABSTRACT: Epidermolysis bullosa (EB) is a group of inherited diseases with 4 subtypes. This disorder is a model for fragile skin, with some affected individuals having chronic, difficult-to-heal wounds. The care of wounds in people with EB can be guided by the Wound Bed Preparation paradigm. The treatment of chronic EB wounds is outlined with a quick reference guide of 12 consensus recommendations created by a panel of 11 experts. These recommendations were reviewed by a computer-facilitated modified Delphi process where 15 external reviewers (68.8% of whom reported having 11 or more years’ experience with EB care). Inclusion of recommendations was contingent on 80% agreement from reviewers.

This continuing education activity will help clinicians identify and treat epidermolysis bullosa and its subtypes.

Elena Pope, MD, MSc, FRCPC • Head Section of Dermatology • The Hospital for Sick Children • Toronto, Ontario, Canada

Irene Lara-Corrales, MD, FRCPC (Derm) • Assistant Professor of Pediatrics • University of Toronto • Toronto, Ontario, Canada • Pediatric Dermatologist • Interdisciplinary Clinic, The Hospital for Sick Children • Toronto, Ontario, Canada

Jemima E. Mellerio, BSc, MD, FRCP • Consultant Dermatologist and Lead for the Adult Epidermolysis Bullosa Service • St John’s Institute of Dermatology, Guy’s & St. Thomas’ NHS Foundation Trust, and Great Ormond Street Hospital for Children NHS Foundation Trust • London, United Kingdom

Anna E. Martinez, MBBS, MRCP, MRCPCH • Consultant Pediatrician and Clinical Lead for the Pediatric Epidermolysis Bullosa Service • Great Ormond Street Hospital • London, United Kingdom

Cathryn Sibbald, RPh, BScPhm, ACPR • MD Candidate 2013 • University of Toronto • Toronto, Ontario, Canada

R. Gary Sibbald, BSc, MD, MEd, FRCPC (Med) (Derm), FACP, FAAD, MAPWCA, for the EB International Consensus Panel • Professor of Public Health and Medicine • University of Toronto • Toronto, Ontario, Canada • Director • International Interprofessional Wound Care Course & Masters of Science in Community Health (Prevention & Wound Care) • Dalla Lana School of Public Health • University of Toronto • Past President • World Union of Wound Healing Societies • Clinical Editor • Advances in Skin & Wound Care • Ambler, Pennsylvania

Acknowledgments: This article is dedicated to all persons suffering from epidermolysis bullosa in an attempt to improve their quality of life. The authors thank the late Alex Melkic and Deanna Molinaro from whom we have learned so much and Mölnlycke for their unrestrictive educational grant support.

Dr Pope has disclosed that her institution received an unrestricted educational grant from Mölnlycke Health Care to host the EB International Consensus Panel. Dr Lara-Corrales has disclosed that The Hospital for Sick Children is a recipient of grant/research funding from the Canadian Dermatology Foundation Society of Pediatric Dermatology. Dr Mellerio, Dr Martinez, and Dr C. Sibbald have disclosed that they have no financial relationships related to this article. Dr R.G. Sibbald has disclosed that he is a board member of Coloplast, Covidien, J & J (Systagenix), Mölnlycke, Registered Nurses’ Association of Ontario, Hollister; and was a board member of 3M, BSN Medical, Gaymar, KCI, and Healthpoint Biotherapeutics; he was a member of the speaker’s bureau for 3M, BSN Medical, Gaymar, KCI, Coloplast, Covidien, J & J (Systagenix), and Mölnlycke; is a member of the speaker’s bureau for Galderma; was a recipient of grant/research funding from 3M, BSN Medical, Canadian International Development Agency, Coloplast, Covidien, Government of Ontario, KCI, J & J (Systagenix), Mölnlycke, and the Registered Nurses’ Association of Ontario; and is a recipient of grant/research funding from Exciton, J & J (Systagenix), Hollister, and Healthpoint Biotherapeutics.

All staff and planners, including spouses/partners (if any), in any position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity.

To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least 13 of the 18 questions correctly.

This continuing educational activity will expire for physicians on April 30, 2014.

© 2013 Lippincott Williams & Wilkins, Inc.