Infection
The best treatment is prevention. A clean environment, especially where dressing changes take place, is essential. This includes keeping the dressing change location free from pets and sanitizing it regularly.
Good hand washing is the single most important aspect of preventing infection. Alcohol based hand sanitizers (Purell) are quite effective. They provide fast, antimicrobial efficacy against many bacteria, including the antibiotic-resistant organisms MRSA (Methicillin Resistant Staphylococcus Aureus) and VRE (Vancomycin-resistant Enterococci).
If large tubs of ointments are used, be certain to avoid double dipping during dressing changes. Transfer a small amount into a plastic container or plastic bag and if you happen to contaminate the ointment, dispose of the contaminated portion.
Everyone carries bacteria on their skin. The bacteria can live and multiply, (colonize) without causing injury or infection. Under the right circumstances, these bacteria invade the tissue, multiply and cause infection. Circumstances that "set the stage" for infection may be local or systemic:
- Wound area: larger wounds are more susceptible
- Necrotic tissue: crusts, scabs and non-viable tissue should be softened and removed
- Malnutrition: protein is required for wound healing
- Poor blood flow to wound: blood carries oxygen and nutrients
Every effort must be made to maintain good general health so that the individual will not be as susceptible to infections.
The typical features of infection are:
- Delayed healing
- Increased exudate (drainage)
- Increased redness
- Increased pain
- Increased swelling
- Increased warmth of skin compared to surrounding area
- Malodorous (unpleasant odor)
- Bleeds easily
Wound infections are common with EB. Many efforts are made to avoid the use of oral antibiotics because EB is a life-long disorder and wound infections are a life-long occurrence. If oral antibiotics are used indiscriminately, resistant bacteria may develop and the individual may ultimately require IV antibiotics to treat these events. Therefore, topical treatments are utilized as a first step.
1. Commonly prescribed topical antibiotics include:
Mupirocin (Bactroban)
This medication should be applied to the affected area three times daily for 10 days. Patients not showing improvement of the infection within 3 to 5 days should be re-evaluated and oral antibiotics should be considered. Most people with EB will not apply an ointment three times a day due to the laborious dressing changes involved. Even if applying this medication only once per day, they should seek additional medical consultation and treatment if there is no improvement in the infected area within 3-5 days.
Please note that although Mupirocin is a topical medication, it should still be considered the potent antibiotic which it is and it should NOT be used casually or indiscriminately. It should ONLY be used when an infected lesion is present. Resistant bacteria may develop from frequent, regular use of this medication.
Silver Sulfadiazine (Silvadene)
Silver sulfadiazine is an antibacterial and antifungal prescription cream. It is used by many people with EB to treat infected lesions. Application is daily with dressing changes. This medication and other silver products are appealing to people with EB because bacteria do not become resistant to silver. There are many unanswered questions about the safety of long-term use of silver products. Until clinical trials are conducted that prove these products are safe to use on a regular long-term basis, individuals should use the products cautiously and for limited periods of time.
Other topical treatments for infection:
2. Bleach is a sanitizer and disinfectant effective against a wide range of bacteria, fungi, and viruses. A dilute bleach solution (two teaspoons of bleach per gallon of water) may be mixed and used as a compress or as a soak for heavily draining wounds or infected wounds.
3. Acetic Acid compresses or soaks are particularly useful in treating pseudomonas aeruginosa infections, which are resistant to many antibiotics. These bacteria are common inhabitants of soil and water, so they are literally everywhere. This is a bacterium that thrives in warm, moist environments but is unable to survive in an acetic environment. It has a characteristic fruity odor and blue-green color. Acetic acid may be purchased or mixed at home from vinegar and water.
Formula for mixing acetic acid:
If using 3% vinegar mix a 1:12 solution (1 part vinegar, 11 parts water)
If using 5% vinegar mix a 1:20 solution (1 part vinegar, 19 parts water)
Apply compresses for 15-20 minutes, 3 times a day.
Most people with EB will not comply with a treatment regime that is to be done three times a day due to the laborious dressing changes involved. The physician should be consulted if there is no improvement in the infected area within 3 days.
When infection extends beyond the margins of the wound or when a fever is present, the Primary Care Practitioner should evaluate the individual and may prescribe an oral antibiotic. All of the antibiotic should be taken, as prescribed. If doses are skipped or the medication is discontinued because the area looks and feels better, some bacteria may survive and resist future antibiotic treatment.
4. Silver dressings and wound gels containing silver are popular because of their antibacterial and antifungal properties. Silver products are appealing to people with EB because bacteria do not become resistant to silver. There are many unanswered questions about the safety of long-term use of silver products. Until clinical trials are conducted that prove these products are safe to use on a regular long-term basis, individuals should use the products cautiously and for limited periods of time.
5. Honey is an ancient remedy for the treatment of infected wounds. It has been rediscovered in an age where conventional medicine is being challenged by the development of resistant bacteria. There are many articles published in the literature which discuss the antimicrobial action of honey against bacteria and fungi as well its wound healing properties.
Jennie Hon, an EB nurse specialist from DebRA UK, published an article in the British Journal of Nursing which detailed one patient's experience of healing a 20 year wound in only 15 weeks using a honey-impregnated gauze dressing.
There are other anecdotal reports from people with EB who have used honey on their wounds successfully; some people report that it stings when applied and that it seems to make their dressings heavier and uncomfortable.
Active Manuka Honey (www.manukahoneyusa.com) is raw honey and has not been over-heated or over-strained.
Why can't regular, store bought honey be used?
Excess heating, which is used to produce liquid honey, destroys the natural enzymes that the bees have added, including the substance producing hydrogen peroxide that gives honey part of its antibacterial activity.
Granulation or crystallization (the growth of glucose crystals) is a natural process in all honey. In grocery stores you will find most likely liquid honey that has been heated to very high temperatures. The honey may look like it has just come out of the hive, but in reality it has been highly processed.
