Here - EWMA 2013

ORAL PRESENTATIONS
136
Free Paper Session: Miscellaneous
CANCER AS A COMPLICATION OF EPIDERMOLYSIS BILLOSA IN BRAZIL
Vania Declair Cohen 1 , Luiz Gustavo Balaguer Cruz 2
1 V.Declair Dermatology (São Paulo, Brazil);
2 Hospital 9 de Julho (São Paulo, Brazil).
Introduction: Cancer is the most severe complication that arises in patient with
inherited EB. They usually present as a scaly nodules, oftentimes with irregular or
indistinct borders. An extensive literature exists on squamous cell carcinomas, as well
as malignant melanoma and basal carcinoma, arising in this particular clinical setting.
Cancer in EB appears as non-healing, crusted erosions with or no palpable dermal
component can mimic areas of granulation tissue similar to other wounds on their skin.
Aim: The aim of this study is to report four cases of cancer in patient with EB in Brazil.
Methods: We have been following 83 patients with EB in Brazil for 4 years. All these
patients have high risk of develop cancer as we explained at our introduction.
Results:
L.A. 26, DREB developed a Malignant Infiltrative Melanoma (MM) at lombar area with
bone infiltration.
F.S 29, DREB, Squamous Cell Carcinoma (SCC) at right hand and after 1 years
recedence at right feet.
L.M.N, 19, DREB, Squamous Cell Carcinoma (SCC) at left arm
I. S, 5, DREB, Basal Cell Carcinoma (BCC) at face and thorax.
Conclusion: As a result of chronic recurrent injury of basal layer of the epidermis and
that repeated blistering within basal keratinocytes might predispose to premalignant
transformation of these specific cells, leading to the eventual development of BCC.
Melanomas arose in intact skin rather than in areas of chronically scarred non-healing
wounds or within EB nevi. Doctors and nurses who take care of EB patients, should pay
attention at these complication.
FREE PAPER SESSION: MISCELLANEOUS
137
Free Paper Session: Miscellaneous
PAIN CONTROL AT DRESSING CHANGE IN RECESSIVE DYSTROPHYC
EPIDERMOLYSIS BULLOSA CHILDREN
Vania Declair Cohen 1 , Luiz Gustavo Balaguer Cruz 2
1 V.Declair Dermatology (São Paulo, Brazil);
2 Hospital 9 de Julho (São Paulo, Brazil).
Introduction: Epidermolysis bullosa (EB) is a congenital disease characterized by
fragility of the skin and mucosa. Blisters and erosions formation are response to a
minimal trauma.These patients feel much pain during the dressing changing performed
during the bath or under the water. Generally, these dressings have adhered to the
wound and cause pain and trauma in the exchanges leaving patients dependent of
analgesia. The concern in the assessment of these patients is to control the pain by
implementing an appropriate skin care without pain and to deduct the use of analgesia.
Objective: To report the experience of pain control at dressing change in 52 patients
with DREB.
Methods: During the period of one year was established the use of soft silicone dressing
in 52 patients with DREB in Brazil. Before this period, these patients used conventional
dressing and used tramadol twice a day. All patients were evaluated on the pain scale
with an average score of 7. All mothers reported that bath time was traumatic for the
child, manifested by intense crying, screaming, body movements and voluntary muscle
stiffness. Dressings were changed 3 times a week and removal of all the soft silicone
products were atraumatic.
Results: After revaluated the pain scale the average score decrease to 3. 83 % and use
of tramadol before dressing changing also decreased.
Conclusion: Silicone dressings are a good option to be used on the treatment of DREB,
which helped to control the pain at the dressing changing and improve the quality of the
life of these patients.
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