Elsevier

Dermatologic Clinics

Volume 28, Issue 2, April 2010, Pages 267-269
Dermatologic Clinics

Infection and Colonization in Epidermolysis Bullosa

https://doi.org/10.1016/j.det.2010.01.004Get rights and content

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Wounds and bacteria: contamination, colonization, and infection

Ulceration of the skin in epidermolysis bullosa (EB) invariably leads to the presence of bacteria, although the extent to which this happens and its clinical implications vary greatly.1 It is useful to consider bacterial load in a wound as a continuum (Fig. 1).2 At one end there is contamination, with bacteria over the wound surface, usually as a result of inoculation from hands, fomites, or airborne contamination: in this situation bacteria do not impede healing of the wound and no treatment

Colonization and infection in EB

There are no good data concerning the incidence of critical colonization or wound infection in EB but, anecdotally, this is a sizeable problem, particularly for patients with more severe and generalized forms who have large numbers of chronic wounds.1, 6 These wounds cause considerable morbidity, including pain, exudate and odor, and may demand many hours of dressing changes on a daily basis; they are also responsible for a significant economic burden, necessitating large quantities of often

Investigation of wound infections in EB

Although the gold standard for identifying pathogens in an infected wound is a skin biopsy for culture and sensitivity, this is rarely indicated in clinical practice. Instead, a swab should be taken from the wound bed after any necrotic debris or exudate has been cleaned off. If the wound is dry, the swab should first be moistened with sterile saline or transport medium. Light pressure should be applied to the tip of the swab as it is passed across the wound bed in a zig-zag pattern and at the

Management of colonization and infection of EB wounds

Contamination of EB wounds can be considered inevitable and, because it does not generally interfere with healing, no specific treatment is required beyond using an appropriate atraumatic dressing (Fig. 2). Once a wound becomes critically colonized and fails to heal, steps should be taken to try and reduce the bioburden, usually with topical antimicrobials or specialized dressings.6 Frank infection almost always requires systemic antibiotic therapy, often in conjunction with topical measures (

Summary

Contamination and colonization of EB wounds is extremely common and is not generally a problem requiring treatment unless healing is becoming impaired, suggesting critical colonization. Topical measures are often sufficient to keep colonization down to a level at which exudate and odor are controlled and wound healing is not impaired. The diagnosis of infection of an EB wounds should be made clinically, and usually requires systemic treatment.

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There are more references available in the full text version of this article.

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The author acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust.

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