A doctor may suspect epidermolysis bullosa from the appearance of the affected skin. He or she will likely have your child undergo laboratory tests to confirm the diagnosis. They may include:
- Skin biopsy for immunofluorescent mapping. With this technique, a small sample of affected skin is removed and examined with a microscope and reflected light to identify the layer or layers of skin involved. This test also identifies whether the proteins needed for skin growth are functioning.
- Genetic testing. Genetic testing is sometimes used to confirm the diagnosis because most forms of epidermolysis bullosa are inherited. A small sample of blood is taken and sent to a lab for analysis.
- Prenatal testing. Families with a history of epidermolysis bullosa may want to consider prenatal testing and genetic counseling.
If lifestyle changes and home care don't control the signs and symptoms of epidermolysis bullosa, treatments may include medications, surgery and rehabilitation. The condition often progresses despite treatment, sometimes causing serious complications and death.
Medications can help control pain and itching and treat complications such as infection in the bloodstream (sepsis). The doctor may prescribe oral antibiotics if the wounds show signs of widespread infection (fever, weakness, swollen lymph glands).
Surgical treatment may be needed. Options sometimes used for this condition include:
- Widening the esophagus. Blistering and scarring of the esophagus may lead to esophageal narrowing, making eating difficult. Surgical dilation of the esophagus can relieve this and make it easier for food to travel from the mouth to the stomach. Risks include esophageal perforation.
- Placing a feeding tube. To improve nutrition and help with weight gain, a feeding tube (gastrostomy tube) may be implanted to deliver food directly to the stomach.
- Grafting skin. If scarring has affected the function of the hand, the doctor may suggest a skin graft.
- Restoring mobility. Repeated blistering and scarring can cause fusing of the fingers or toes or abnormal bends in the joints (contractures). The doctor may recommend surgery to correct these conditions, particularly if they interfere with normal motion.
Working with a rehabilitation specialist (physical therapist, occupational therapist) can help ease the limitations on motion caused by scarring and contractures.
Potential future treatments
Researchers are studying better ways to treat and relieve the symptoms of epidermolysis bullosa, including:
- Gene therapy
- Bone marrow (stem cell) transplantation
- Protein replacement therapies
- Cell-based therapies
Lifestyle and home remedies
You can take steps at home to care for blisters and prevent new ones from forming. Learn how to care for wounds and provide good nutrition, which are essential to people with epidermolysis bullosa.
Caring for blisters
Your doctor can show you how to care for blisters properly and advise you on ways to prevent them. Talk to your doctor about safe ways to break and drain blisters before they get too large. Your doctor can also recommend products to help keep the affected areas moist, which helps promote heling and prevent infection.
In general, take these steps:
- Wash your hands. Wash your hands before touching your child's blisters or changing dressings.
- Control pain. About 30 minutes before a dressing change or other painful procedure, older children and adults may take a prescription-strength pain medication. For people who don't respond to pain relievers, other options include anti-seizure drugs such as gabapentin and pregabalin.
- Cleanse skin daily. To cleanse a wound, soak it for five to 10 minutes in a mild solution of salt and water. Other options are mild solutions of diluted vinegar or bleach. Soaking loosens stuck bandages and helps reduce the pain of changing bandages. Rinse with lukewarm water.
- Puncture new blisters. This prevents them from spreading. Use a sterile needle to puncture each new blister in two spots. But leave the roof of the blister intact to allow for drainage while protecting the underlying skin.
- Apply treated dressings. Spread petroleum jelly or other moisturizing substance on a nonstick bandage (Mepilex, Telfa, Vaseline gauze). Then gently place the bandage on the wound. Secure the pad with rolled gauze if needed.
- Wrap blistered hands and feet daily. With some severe forms of this condition, daily wraps help prevent contractures and fusion of the fingers and toes. Special wraps and gauze dressings are useful for this treatment.
- Watch for signs of infection. If you notice redness, heat, pus or a red line leading from the blister, talk with your doctor about prescription antibiotics.
- Keep cool. Blistering is often worsened by heat and warm conditions.
Providing good nutrition
A varied, nutritious diet promotes growth and development in children and helps wounds heal. If blisters in the mouth or throat make it difficult for your child to eat, here are some suggestions:
- For babies, try bottle nipples designed for premature infants, a syringe or a rubber-tipped medicine dropper.
- For older children, serve nutritious, soft foods that are easy to swallow, such as vegetable soup and fruit smoothies. Puree solid foods with broth or milk.
- Serve food and beverages lukewarm, at room temperature or cold.
- Talk with a dietitian or doctor about using supplements to minimize nutrient and vitamin deficiencies.
Coping and support
Treating and preventing blisters and complications of epidermolysis bullosa can be stressful for you, your child and family members. You may find it helpful to share concerns and information with families in similar circumstances. Ask your health care providers about epidermolysis bullosa support groups in your area. If joining a support group isn't for you, ask about counselors, clergy or social workers who work with families coping with epidermolysis bullosa.
Preparing for your appointment
You may be referred to a doctor who specializes in the diagnosis and treatment of skin conditions (dermatologist).
Specialized epidermolysis bullosa centers
Centers that specialize in the diagnosis, evaluation and treatment of people with epidermolysis bullosa may belong to a network called EB Clinet. Such centers are staffed with doctors, nurses, social workers and rehabilitation specialists who provide specialized care for people with this condition.
Visiting such a center regularly can improve quality of life and reduce hospitalizations from complications for people with epidermolysis bullosa. Ask your doctor if a specialized epidermolysis bullosa center is available to you.
No matter what type of doctor you see first, here's some information to help you prepare for the appointment.
What you can do
- List your child's signs and symptoms and how long he or she has had them.
- Note any new sources of friction around the blistering areas, if any. For example, tell your doctor if your toddler has recently started walking or your older child has begun physical activities that put new pressure on the affected areas.
- List key medical information, including other medical problems your child has received a diagnosis for. Also list the names of all over-the-counter and prescription medications he or she is taking, as well as any vitamins and supplements.
- Ask a trusted family member or friend to join you for your child's appointment. If your doctor tells you your child has epidermolysis bullosa, you may have difficulty focusing on anything else the doctor says. Take someone along who can offer emotional support and help you recall all the information.
- List the questions to ask your doctor.
Questions to ask your doctor
- What's the most likely cause of my child's signs and symptoms?
- What are other possible causes for these signs and symptoms?
- What kinds of tests does my child need?
- What treatments are available, and what types of side effects might they cause?
- What can be done to relieve my child's pain or discomfort?
- How do I take care of my child's needs, such as feeding, bathing and clothing him or her?
- What are the possible complications of this condition?
- What signs or symptoms related to this condition should prompt me to call you?
- What signs or symptoms should prompt me to call 911 or my local emergency number?
- What restrictions does my child need to follow?
- Do you think my child's symptoms will improve with age?
- If I plan to have more children, are they at increased risk of this condition?
- How can I find other people who are coping with epidermolysis bullosa?
- Where can I find additional information and resources?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:
- When did you first notice the blistering?
- What parts of the body have been affected?
- Does anything in particular seem to trigger blistering? For example, is it made worse by heat?
- Has your child developed sores where bandages and adhesive tape have been applied?
- Have you noticed other signs or symptoms in addition to blistering? For example, does your child's voice sound hoarse?
- Does eating or swallowing seem to cause your child pain?
- Has anyone in your family had a condition marked by significant blistering?
- Has your child been diagnosed with any other medical conditions?
What you can do in the meantime
In the time leading up to your appointment, you can minimize the risk of your child developing new blisters by:
- Lifting or touching him or her very gently
- Keeping your home consistently cool
- Keeping your child's skin moist with lubricants, such as petroleum jelly
- Dressing your child only in soft materials
- Keeping your child's fingernails short
Call your doctor immediately if you see signs of possible infection around a blister.