Current management of
epidermolysis bullosa (EB) focuses on preventing
secondary infections--a leading cause of mortality--by regularly cleaning and bandaging
blisters and erosions and preventive bandaging of high-friction areas. Unfortunately the
baths and showers used to remove bandages and clean the skin are often painful, causing lack of adherence and subsequent increases in
infections,
pain, and antimicrobial use. This study evaluates the hypothesis that bathing individuals with EB in saltwater is less painful than in normal bath water. The study also explores whether taking saltwater
baths reduces
infections as measured through skin
pruritus, odor, discharge, and nonbathing
pain. Participants recruited from the Children's Hospital Colorado Outpatient EB Clinic completed standardized questionnaires assessing the effects of the clinic's saltwater bathing recommendations; the data were analyzed using frequencies and Fisher tests. After starting saltwater
baths, patients reported a significant reduction in
pain (91%),
pain medication use (66%), skin odor (31%), and skin discharge (44%). No significant differences were found with respect to the type of EB, age, length of time using
baths, or amount of
salt added. Saltwater
baths are a noninvasive, low-cost, effective treatment that significantly reduces bathing
pain,
pain medication use, and some signs of skin
infection. This treatment can be recommended to patients with all studied EB types without regard to age, the specific amount of
salt used, bathing frequency, or
pain level. Given the central role bathing and dressing changes play in the management of EB, the use of saltwater
baths can lead to significant improvement in quality of life.