Epidermolysis bullosa (EB), pęcherzowe oddzielanie się naskórka, to choroba, która objawia się powstawaniem pęcherzy na skórze, a także na wewnętrznych narządach organizmu. Ze względu na genetyczne podłoże choroby nie ma skutecznej metody terapii. Istnieje jednak leczenie objawowe polegające na ograniczaniu tworzenia się pęcherzy i opatrywaniu ran.
Pęcherze towarzyszące Epidermolysis bullosa powstają samoistnie bądź w następstwie urazów mechanicznych. Ich występowanie powoduje ból i dyskomfort u pacjenta. Szacuje się, że na świecie na tę chorobę cierpi około 500 tys. osób. Przebieg EB może być łagodny, z występowaniem nielicznych zmian skórnych, lub ciężki, o śmiertelnych powikłaniach w postaci zagrażających życiu ran na niemal całej powierzchni ciała.
Zapobieganie powstawaniu pęcherzy
Leczenie objawowe EB polega na ograniczaniu liczby tworzących się pęcherzy. Skóra u osób chorych na EB jest bardziej wrażliwa na różne bodźce, przede wszystkim mechaniczne. Z tego względu najważniejszym aspektem profilaktyki dla pacjentów jest unikanie urazów.
Ponadto chorym zaleca się wprowadzenie następujących działań zapobiegawczych:
- dobór odpowiedniego ubioru – lekkich, miękkich, luźnych, nieprzywierających i niewywołujących nadmiernego pocenia tkanin i ubrań bez ściągaczy;
- unikanie nadmiernej ekspozycji na promieniowanie UV; stosowanie preparatów z wysokim filtrem UV;
- zapobieganie drapaniu – przycinanie paznokci u rąk i spanie w rękawiczkach;
- unikanie twardych i drażniących nawierzchni, na meblach czy pościeli;
- nawilżanie skóry za pomocą tłustych, nawilżających kremów i maści zawierających cynk lub mocznik;
- stosowanie diety bogatej w węglowodany, białko, tłuszcze, błonnik, a także w witaminy A, B, C, D oraz cynk, żelazo, selen, wapń.
Pacjenci powinni także chronić skórę wokół ran, unikać zdzierania naskórka oraz zmniejszać stopień zanieczyszczenia biologicznego w ranie. Kluczowe jest również kontrolowanie wysięku z ran. Zmiany pęcherzowe należy mechanicznie przekłuwać za pomocą grubej sterylnej igły, skalpela lub odpowiednich nożyczek, zgodnie z instrukcjami przekazanymi przez lekarza.
Pielęgnacja i opatrunki na pęcherze oraz rany
Odpowiednia pielęgnacja skóry może przyspieszyć gojenie, a także zapobiegać infekcjom i zmniejszać blizny. Należy dbać o higienę ran i pęcherzy, a także o ich odpowiednie opatrywanie.
W leczeniu ran u pacjentów z EB dużą rolę odgrywa dobór opatrunku specjalistycznego. Powinien on być delikatny i nieprzylepny, tak, by nie powodować bolesnego odrywania materiału od skóry, a także utrzymywać optymalnie wilgotne środowisko rany.
Jeżeli występuje sączenie z ran, zastosować można opatrunek o większej grubości pianki, a w przypadku ran o dużym wysięku – z dodatkowym superabsorbentem. Z kolei na rany suche i ze strupami stosuje się opatrunki nawilżające, np. żelowe. W leczeniu niegojących się nadżerek skuteczne są opatrunki antyadhezyjne.
Nie należy zapominać o odpowiedniej pielęgnacji – zastosować można nawilżające i natłuszczające kremy lub balsamy do ciała. Natomiast miejsca, które są trudne w opatrzeniu, można smarować maścią z cynkiem, który działa wysuszająco na otwarte pęcherze.
Jeżeli dojdzie do zakażenia rany, w pierwszej kolejności zalecane są antyseptyki i opatrunki antybakteryjne. Odpowiednią antybiotykoterapię należy wprowadzić w przypadku uogólnionego zakażenia.
Pacjenci z EB borykają się również z bolesnością pęcherzy, dlatego lekarz może wdrożyć terapię przeciwbólową. Pacjentom z EB, którzy mają problemy z przełykaniem, przepisuje się leki przeciwbólowe w postaci płynnej, np. w formie syropów lub kropli. Można również stosować środki przeciwbólowe w formie żelu, natomiast niezalecane są plastry przeciwbólowe.
Chirurgiczne leczenie Epidermolysis bullosa
U pacjentów, u których pęcherze i zmiany skórne są wyjątkowo oporne na leczenie, stosuje się przeszczepy skóry, np. w postaci ekwiwalentów autologicznego albo allogenicznego naskórka uzyskanych z hodowli keratynocytów – głównych komórek naskórka pełniącego funkcję bariery środowiskowej.
Zabiegi chirurgiczne konieczne są również w innych przypadkach EB, np. u pacjentów, którzy zmagają się z nawracającymi pęcherzami powodującymi rozległe blizny i deformację skóry (np. zrośnięcie palców rąk i nóg skutkujące ograniczeniem ruchomości). U pacjentów, u których EB przejawia się w okolicach przełyku, również konieczny może być zabieg chirurgiczny. Blizny powodować mogą zwężanie się przełyku, utrudniając przedostawanie się pokarmu do żołądka. Problem rozwiązać może operacja poszerzenia przełyku.
Źródła:
A. Sobczyńska-Tomaszewska, K. Wertheim, C. Kowalewski i wsp., Epidermolysis bullosa dystrophica. Od kliniki do genetyki, Przegląd Dermatologiczny, Tom 96, nr 3 (2009), str. 227-229
epidermolysisbullosanews.com
Przeczytaj także: Poznański szpital jako pierwszy w Polsce korzysta z inteligentnego stołu operacyjnego przeciw odleżynom
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