The use of tissue-engineered skin (Apligraf) to treat a newborn with epidermolysis bullosa

Background: Inherited epidermolysis bullosa (EB) is a mechanobullous disord er. The Dowling-Meara variant, a subtype of EB, is characterized by widespr ead blister formation that may include the oral cavity and nails. Many pati ents with the Dowling-Meara phenotype are at increased risk of sepsis and d eath during infancy. The treatment of EB is generally supportive. The tissu e-engineered skin used (Apligraf) is a bilayered human skin equivalent deve loped from foreskin. It is the only Food and Drug Administration-approved s kin equivalent of its kind. It is approved for the treatment of venous ulce rs of the lower extremities. It has also been used to treat acute wounds, s uch as graft donor sites and cancer excision sites. Observation: To our knowledge, we describe the first case in which a newbor n with EB, Dowling-Meara variant, was treated with bilayered tissue-enginee red skin. The areas treated with the tissue-engineered skin healed faster t han the areas treated with conventional therapy. Most of the areas treated with tissue-engineered skin have remained healed, without developing new bl isters. These areas appear to be more resistant to trauma. Conclusions: Our early success with tissue-engineered skin in this patient may have a significant impact on the future treatment of neonates with EB s implex. Future studies are needed to determine if the beneficial effects of tissue-engineered skin are reproducible in other neonates with EB simplex and in patients of all ages with different subtypes of EB.