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Table 7 Patient management in the operating theater. In the latter case, protect the face from the mask with silicon foam e. Pain management Pain is constant in EB patients since birth, and its management is a major therapeutic focus conditioning the daily care. Nutritional aspects Growth and nutritional condition are major outcomes in EB patient care. In order to ensure an early diagnosis, it is necessary to perform [ 95 ]: Management of intercurrent or associated cutaneous diseases A few reports describe cutaneous infectious diseases occurring in EB patients, and even fewer data exist about associated chronic inflammatory diseases psoriasis, atopic dermatitis, etc.
Skin diseases, when manifesting in EB patients, can: Therapeutic patient education Therapeutic patient education, as defined by the World Health Organization WHO , is a continuous process of patient-centered medical care, enabling patients affected by chronic diseases, and their families, to better manage their illness [ ]. Table 8 Patient education in epidermolysis bullosa: Care of disease burden EB has a major impact on the QoL of the patient and his family, starting since birth when the baby diversity is immediately perceived by the parents and the transmitted notion of skin fragility can hamper the development of normal affective relationships within the family.
Table 9 Indications to psychological or psychotherapeutic support to the family member s and patient. Continuity of care A well-organized and structured continuity of care is important in EB like in all chronic and rare diseases. Summaries The optimization of EB patient healthcare requires the implementation of a wide range of measures. Consent Written informed consent was obtained from the participants for publication of this review and accompanying images, with additional parental written consent from those under 18 years of age. Acknowledgements We wish to thank the following experts who performed recommendation evaluation: Updated recommendations on diagnosis and classification.
J Am Acad Dermatol. Relative extent of skin involvement in inherited epidermolysis bullosa EB: Extracutaneous manifestations and complications of inherited epidermolysis bullosa: One goal, different strategies—molecular and cellular approaches for the treatment of inherited skin fragility disorders. Updated systematic review of randomized controlled trials of treatments for inherited forms of epidermolysis bullosa.
A consensus approach to wound care in epidermolysis bullosa. Oral health care for patients with epidermolysis bullosa-best clinical practice guidelines. Int J Paediatr Dent. Best practice guidelines for skin and wound care in epidermolysis bullosa. Risk of squamous cell carcinoma in junctional epidermolysis bullosa, non-Herlitz type: Epidermolysis bullosa simplex with PLEC mutations: The inversa type of recessive dystrophic epidermolysis bullosa is caused by specific arginine and glycine substitutions in type VII collagen.
Gastrointestinal complications of epidermolysis bullosa in children. Dilated cardiomyopathy in epidermolysis bullosa: Transition from paediatric to adult service in epidermolysis bullosa. Epidermolysis bullosa in France: Interdisciplinary management of epidermolysis bullosa in the public setting: Epidermolysis bullosa care in Italy.
Epidermolysis bullosa care in the United Kingdom. Epidermolysis bullosa care in the United States. Care of epidermolysis bullosa in Ireland. Epidermolysis bullosa care in Germany. Epidermolysis bullosa in Australia and New Zealand. Epidermolysis bullosa care in Canada. Management of severe blistering disorders. Management of epidermolysis bullosa in infants and children. Perioperative care of patients with epidermolysis bullosa: Reducing pain during the removal of adhesive and adherent products. Skin integrity and silicone: Appeel 'no-sting' medical adhesive remover.
A provisional list of recommendations for each topic was then prepared. Extreme care should be employed in handling the skin of any patient with EB. Nutrition is often a real challenge. In younger children, diapers may require additional padding at the legs and waist. Epidermolysis bullosa care in the United States. Pruritus may also develop in the absence of an identifiable etiology [ 8 , 10 ]. The blister roof should be left in place to facilitate re-epithelialization, to reduce infection risk and pain [ 10 , 31 , 32 , 42 ].
Assessment of mobility, activities and pain in different subtypes of epidermolysis bullosa. Main problems experienced by children with epidermolysis bullosa: Prioritization of therapy uncertainties in dystrophic epidermolysis bullosa: Medical management of epidermolysis bullosa: Podiatric management in epidermolysis bullosa. Infection and colonization in epidermolysis bullosa. Principles of wound care in patients with epidermolysis bullosa. Diagnosis and management of hyperhidrosis.
Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita. Ophthalmic involvement in inherited epidermolysis bullosa. Epidermolysis bullosa and chronic wounds: Adv Skin Wound Care. Wound management for children with epidermolysis bullosa. Dressings for acute and chronic wounds: Antibiotics and antiseptics for venous leg ulcers.
Cochrane Database Syst Rev. Dressings for chronic wounds. Honey and microbial infections: Honey as a topical treatment for wounds. Topical silver sulfadiazine-induced systemic argyria in a patient with severe generalized dystrophic epidermolysis bullosa. Grey spots in a patient with dystrophic epidermolysis bullosa. Update on topical antibiotics in dermatology. Dystrophic epidermolysis bullosa pruriginosa in Italy: New glycine substitution mutations in type VII collagen underlying epidermolysis bullosa pruriginosa but the phenotype is not explained by a common polymorphism in the matrix metalloproteinase-1 gene promoter.
European guideline on chronic pruritus. Chronic pruritus N Engl J Med. Management of generalized pruritus in dominant dystrophic epidermolysis bullosa using low-dose oral cyclosporin. Epidermolysis bullosa pruriginosa masquerading as psychogenic pruritus. Thalidomide in the management of epidermolysis bullosa pruriginosa. Successful treatment of epidermolysis bullosa pruriginosa with topical tacrolimus. Malignant melanoma and epidermolysis bullosa simplex. Percutaneous interventional radiology procedures in patients with epidermolysis bullosa: Airway management in adult patients with epidermolysis bullosa dystrophica: Epidermolysis bullosa in children: Response to review by Herod et al.
Managing pain in children with epidermolysis bullosa. Anesthesia and pain management for pediatric patients with dystrophic epidermolysis bullosa. Pain management in epidermolysis bullosa.
Gabapentin as part of multimodal analgesia in a newborn with epidermolysis bullosa. Anesthesia and epidermolysis bullosa. The use of oral ketamine for analgesia with dressing change in an infant with epidermolysis bullosa: Deep sedation with intravenous infusion of combined propofol and ketamine during dressing changes and whirlpool bath in patients with severe epidermolysis bullosa.
Fluoroscopically guided dilation of esophageal strictures in patients with dystrophic epidermolysis bullosa: Esophageal stenosis in epidermolysis bullosum: Esophageal strictures in children with recessive dystrophic epidermolysis bullosa: Nutritional management in the child with epidermolysis bullosa.
Nutrition for children with epidermolysis bullosa. The challenges of meeting nutritional requirements in children and adults with epidermolysis bullosa: Vitamin and trace metal levels in recessive dystrophic epidermolysis bullosa. J Eur Acad Dermatol Venerol. Nutritional and metabolic profile of children with epidermolysis bullosa. Darbepoetin alfa and ferric gluconate ameliorate the anemia associated with recessive dystrophic epidermolysis bullosa. Gastrointestinal complications of inherited epidermolysis bullosa: J Pediatr Gastroenterol Nutr.
Blood vitamin and trace metal levels in epidermolysis bullosa. Dilated cardiomyopathy in dystrophic epidermolysis bullosa. Gastrostomy and growth in dystrophic epidermolysis bullosa. Non endoscopic percutaneous gastrostomy placement in children with recessive dystrophic epidermolysis bullosa. Nutritional outcome in children with severe generalized recessive dystrophic epidermolysis bullosa: Long-term follow-up of patients with Herlitz-type junctional epidermolysis bullosa.
Life with epidermolysis bullosa, etiology, diagnosis, multidisciplinary care and therapy. Fine JD, Hintner H, editor. Physical medicine and epidermolysis bullosa; pp. Prinz F, Weiss H. Occupational therapy in epidermolysis bullosa. A holistic concept for intervention from infancy to adult.
Treatment of skin cancers in epidermolysis bullosa. Crusted scabies in a girl with epidermolysis bullosa simplex. Successful treatment of Norwegian scabies with ivermectin in a patient with recessive dystrophic epidermolysis bullosa. Epidermolysis bullosa pruriginosa triggered by scabies infestation. Impact of inherited epidermolysis bullosa on parental interpersonal relationships, marital status and family size. The needs of parents with children suffering from lethal epidermolysis bullosa. The psychosocial impact of epidermolysis bullosa.
The psychosocial impact of chronic wounds on patients with severe epidermolysis bullosa. Cognitive function in patients with epidermolysis bullosa: Psychiatric symptoms and quality of life in patients affected by epidermolysis bullosa. J Clin Psychol Med Settings. Quality of life in patients with epidermolysis bullosa.
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Life with Epidermolysis Bullosa EB: Part I — Pathogenesis and Clinical Features. Part II — Diagnosis and Management. Extracutaneous manifestations and complications of inherited epidermolysis bullosa: J Am Acad Dermatol. Basic science of epidermolysis bullosa and diagnostic and molecular characterization: Santiago, Chile, International Journal of Dermatology. Surgical management of epidermolysis bullosa: International Journal of Dermatology.
Medical management of epidermolysis bullosa: Psychosocial aspects of epidermolysis bullosa: Caring for Someone with EB. Pfendner E, Bruckner A. Medical Genetics Information Resource database online. Copyright, University of Washington, Seattle. Accessed May 30, Pfendner E, Lucky AW.
Last Update Nov 4, Epidermolysis Bullosa with Pyloric Atresia. The content of the website and databases of the National Organization for Rare Disorders NORD is copyrighted and may not be reproduced, copied, downloaded or disseminated, in any way, for any commercial or public purpose, without prior written authorization and approval from NORD.
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About News Events Contact. Synonyms of Epidermolysis Bullosa EB. Subdivisions of Epidermolysis Bullosa dystrophic epidermolysis bullosa epidermolysis bullosa simplex junctional epidermolysis bullosa Kindler syndrome. General Discussion Epidermolysis bullosa EB is a genetic skin disorder characterized clinically by blister formation from mechanical trauma. There are four main types with additional sub-types identified.
There is a spectrum of severity, and within each type, one may be either mildly or severely affected. EB ranges from being a minor inconvenience requiring modification of some activities, to being completely disabling and, in some cases, fatal.
Friction causes blister formation. Blisters can form anywhere on the surface of the skin, within the oral cavity and in more severe forms may also involve the external surface of the eye, as well as the respiratory, gastrointestinal and genitourinary tracts. In some forms of the disease, disfiguring scars and disabling musculoskeletal deformities occur. Currently, there is no cure for EB. Supportive care includes daily wound care, bandaging, and pain management as needed.
Kindler syndrome is very rare and involves all layers of the skin with extreme fragility. Causes Inherited epidermolysis bullosa is the focus of this report. Affected Populations Some type of EB occurs in an estimated 1 out of every 50, live births. Related Disorders Any blistering disorder in the newborn period may mimic EB.