Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor
2015:81:1;91-92
doi: 10.4103/0378-6323.148602
PMID: 25566919

Lack of effectiveness of keratin dressings in epidermolysis bullosa

Hacer Altun Src1 , Yavuz Yesilova1 , Enver Turan1 , Mustafa Aksoy2 , Osman Tanrikulu1 , Naime Eroglu1
1 Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey
2 Department of Dermatology, Fish Lake Sanliurfa State Hospital, Sanliurfa, Turkey

Correspondence Address:
Yavuz Yesilova
Department of Dermatology, 63300, Sanliurfa
Turkey
How to cite this article:
Src HA, Yesilova Y, Turan E, Aksoy M, Tanrikulu O, Eroglu N. Lack of effectiveness of keratin dressings in epidermolysis bullosa. Indian J Dermatol Venereol Leprol 2015;81:91-92
Copyright: (C)2015 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Keratin is the fundamental protein that creates cell structure in many tissues, particularly in the skin, hair, and nails. [1],[2],[3],[4] In recent years, emphasis has been placed on the role of keratin in healing wounds. The effects of keratin on cell multiplication and replacement, epithelialization and wound closure have been observed in many cases. Molecular analysis shows that keratin proteins have a positive effect on wound healing via increasing or accelerating epithelialization. This is caused by keratinocyte activation and migration, which is, in turn, caused by increasing keratin gene expression. The synthesis of fundamental proteins such as collagen 4, collagen 7, and collagen 17 increases in active and stimulated keratinocytes. [1] Keratin 17 production increases when the skin is damaged. It has been observed that wound healing does not occur properly in patients with low amounts of keratin 17. As a result of this keratin, wound healing is hastened, and the frequency of blistering is reduced. [2]

Taking the aforementioned into consideration, the effects of applying keratin to the skin as an exogen during wound healing have been studied, and keratin-based care products have been developed in which the activity of keratin protein has been retained. Bandages with keratin content help provide keratins to wounds. They are well tolerated by patients′ tissues during rehabilitation due to their non-immunogenic characteristics. [3] A gel containing keratin obtained from sheep′s wool, has been used in the treatment of EB patients. [4]

A total of five epidermolysis bullosa (EB) patients, including three dystrophic EB (DEB) and two EB simplex (EBS) patients (case 1 = 9-year-old male with DEB; case 2 = 17-year-old female with DEB; case 3 = 3-month-old female with DEB; case 4 = 6-year-old male with EBS; case 5 = 2-month-old female with EBS), were regularly subjected to application of a thick hydrogel rich in keratin (Keragel T™, Keraplast Technologies, Lincoln, New Zealand). The gel was applied every other day. The bodies of the patients were entirely washed with lukewarm sterile water, and the gel was rubbed on after the skin dried. The skin was then wrapped with a non-stick bandage (paraffin gauze bandage, Smith Medical Limited, Hull, England) after waiting for 15 minutes. The treatment was abandoned in case 3 at the fourth month of the treatment upon the request of the family because the number of blisters had increased significantly. Clinical photos of the fourth and fifth patients were taken before and after the treatment [[Figure - 1]a and b], [[Figure - 2]a and b]

Figure 1: (a) Pre-treatment appearance: Eroded areas over left knee, mid-lateral tibial and ankles (Patient 2). (b) Post-treatment appearance: Worsening of erosions after three months of treatment
Figure 2: (a) Pre-treatment appearance; There were eroded area on the back, right thigh extensor (Patient 1). (b) Post-treatment appearance; Worsening of erosions after three months of treatment

A significant decrease in the number of blisters was observed in all of our patients within the first two months of treatment. This result boosted the morale of the patients, their relatives, and the clinic employees. However, relapses in the form of additional blistering were observed in all of the patients beginning from the third month of the treatment, and no changes were noticed in the healing period of the existing eroded areas throughout the treatment. Case 3 gave up the treatment during the fourth month upon request of her family because the treatment was ineffective. The treatment was stopped in all of the remaining patients after six months of treatment at the request of the patients and their relatives.

In another study, a keratin-based care product was applied directly to the damaged areas of the left hand and left foot, as well as the right hand and foot, of a patient with dystrophic epidermolysis bullosa as a standard-care treatment four times a week for a period of 6 weeks. [5] After treatment, it was observed that the number of blisters and the epithelialization period of the eroded areas significantly decreased in areas subjected to keratin application. Hand-based skills and quality of life of the patient were improved after keratin gel treatment. The hypothesis stating that keratin-based products affect the keratinocytes present at wounds and speed up healing is supported by these favorable results.It was also noted that the application of keratin-based products for long periods of time increases their quality of life and reduces their treatment costs. [5]

In contrast, our patients were disappointed with the results of keratin dressings.

References
1.
Rogel MR, Jaitovich A, Ridge KM. The role of theubiquitinproteasomepathway in keratin intermediate filament protein degradation. Proc Am Thorac Soc 2010;7:71-6.
[Google Scholar]
2.
Kim S, Wong P, Coulombe PA. A keratin cytoskeletal protein regulates protein synthesis and epithelial cell growth. Nature 2006;441:362-5
[Google Scholar]
3.
De Guzman RC, Merrill MR, Richter JR, Hamzi RI, Greengauz-Roberts OK, Van Dyke ME. Mechanical and biological properties of keratosebiomaterials. Biomaterials 2011;32:8205-17.
[Google Scholar]
4.
Pechter PM, Gil J, Valdes J, Tomic-Canic M, Pastar I, Stojadinovic O, et al. Keratin d ressings speed epithelialization of deep partial-thickness wounds. Wound Repair Regen 2012;20:236-42.
[Google Scholar]
5.
Kirsner RS, Cassidy S, Marsh C, Vivas A, Kelly RJ. Use of a keratin-based wound dressing in the management of wounds in a patient with recessive dystrophic epidermolysis bullosa. Adv Skin Wound Care 2012;25:400-3.
[Google Scholar]

Fulltext Views
38

PDF downloads
25
Show Sections