References
Clinical efficacy of biocellulose, carboxymethyl cellulose and normal saline dressing in epidermolysis bullosa
Abstract
Objective:
To evaluate the efficacy of a biocellulose, a carboxymethyl cellulose and a normal saline wound dressing in the wound care management of epidermolysis bullosa (EB) skin wounds.
Methods:
This was a single-blind, randomised controlled trial involving wounds from patients with EB. Wounds were divided into three groups: group I with biocellulose wound dressing, group II with carboxymethyl cellulose wound dressing and group III with normal saline wound dressing as a control. All dressing changes and wound parameters were recorded. Observations were conducted every three days until complete wound closure or up to one month.
Results:
The outcomes of treatment of 36 wounds from four patients were evaluated in this study. Mean healing time in group I was seven days, eight days in group II and 14 days in group III. There were significant differences in healing times between group I and group III (p=0.0001) and between group II and III (p=0.001). The results showed a significant reduction in the percentage of wounds area on day three for each group: 51.7% in group I, 51.9% in group II, and 26% for group III. All wounds in groups I and II had healed at day 12 (100%) and at day 24 (100%) in group III. There were significant differences in the reduction of percentage wound area between group I and group III at day three (p=0.044) and day six (p=0.000), and between group II and III at day six (p=0.003).
Conclusion:
The study demonstrates that both the biocellulose and the carboxymethyl cellulose wound dressings significantly reduced percentage wound areas and complete healing times compared with the normal saline wound dressing in EB skin wounds, demonstrating they are both equally good for wound care management in EB patients.
Epidermolysis bullosa (EB) is a rare inherited mechanobullous blistering disorder, characterised by fragile skin and mucous membrane. The cause of EB is a mutation of various structural proteins in the skin resulting in various levels of tissue separation within the dermal-epidermal basement membrane zone.1 The presence of chronic multiple wounds makes the management of EB difficult and complex.2 In the absence of a cure, supportive wound care management is a mainstay of treating patients with EB. Patients with EB require a non-adherent dressing to avoid trauma and bleeding to the skin on removal. To date, there is a consensus about wound care management in EB, but no specific guidelines that address the wound care challenges faced by people with EB.1
Traditionally, gauze soaked with normal saline (also known as normal saline wound dressing, NSWD) has been used to treat wounds. Modern wound dressings create a moist environment to provide the optimal conditions for wound healing.3,4 The ideal dressing should be able to maintain humidity at the wound-dressing interface, remove excess exudate, permit the exchange of gases between the wounded tissue and the environment, provide thermal insulation, be impermeable to microorganisms, be biocompatible, non-toxic and be removable without causing trauma to the wound.3 Such dressings include those formed of biocellulose and carboxymethyl cellulose.3 Adequate moisture balance promotes keratinocyte and fibroblast migration that support the wound healing process.5
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