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ActaDV ActaDV
Advances in dermatology and venereology Acta Dermato-Venereologica
Treatment of Oral Lesions in Dystrophic Epidermolysis Bullosa: A Case Series of Cord Blood Platelet Gel and Low-level Laser Therapy
Ezio SINDICI 1, Simona ASTESANO 1, Luigina FAZIO 2, Antonella DRAGONETTI 2, Mariateresa PUGLIESE 2, Crispian SCULLY 3, Stefano CAROSSA 1, Roberto BROCCOLETTI 1 and Paolo G. ARDUINO 1 *
1
CIR-Dental School, Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126 Turin, 2 Torino Cord Blood Bank – Immunohematology and Transfusional Medical Service, A. O. U. Città della Salute e della Scienza, Turin, Italy, and 3 World Health Organization Collaborating Centre for Oral Health-General Health, UK. * E-mail: paologiacomo. arduino @ unito. it Accepted Aug 16, 2016; Epub ahead of print Aug 18, 2016
Inherited epidermolysis bullosa( EB) is a rare group of genetically heterogeneous diseases, characterized by deficiencies in the adhesion of the connective tissue to the epithelium. Junctional EB and dystrophic EB, are the most severe types. Common clinical manifestations are mechanical fragility of the skin and mucosae, with blister formation and abnormal wound healing, the severity of the lesions depending on the distinct type( 1 – 3). The oral cavity is frequently involved, but, although bullae and erosions are common, there is only one published study of therapy, reporting that sucralfate suspension can reduce the development and duration of blisters and ulcers, reduce the associated pain, and improve indices of gingival inflammation( 4).
Autologous and allogeneic platelet( PLT) preparations, in particular a blood component termed“ platelet gel”, traditionally obtained from adult blood platelets, are rich in regenerative growth factors, which are valu able for the treatment of chronic wounds( 5). Recent findings on multiple biological properties of human umbilical cord blood( CB), and its high level of viral safety, prompted one group to produce PLT gel from CB( cord blood platelet gel; CBPG)( 6), and another to detail its effectiveness for the treatment of EB skin lesions( 7).
Low-level laser therapy( LLLT) has potential biostimulating effects, improving wound healing, and is a possible treatment for autoimmune oral erosive lesions, with a notable analgesic effect( 8).
We therefore performed a pilot evaluation of the efficacy and safety of CBPG with LLLT for the treatment of inherited EB oral mucosal lesions, over a 3-day treatment period( one application each day).
PATIENTS AND METHODS
Patients with dystrophic EB and symptomatic oral lesions were prospectively selected between June and October 2015. The ethics review board of the“ Azienda Ospedaliera Città della Salute e della Scienza of Turin”, Turin, Italy, approved the study( protocol number 0089210 _ CS / 585 / 09-2015). Participants with long-standing ulcerations were selected.
CB units not fulfilling the criteria for banking for transplant purposes were processed within 48 h of collection to obtain CBPG according to the“ Italian Cord Blood Platelet Gel project” protocol( 9)( for complete details see Appendix S1 1).
Morphological changes were measured with a 15-mm periodontal probe( PCPUNC15: Hu-Friedy ®, Chicago, IL, USA).
The symptom score( for reporting pain) was recorded using a visual analogue scale( VAS); patients were requested to mark the scale at each visit, before and after the laser session.
The primary outcome measures were lesions’ size and pain; secondary outcome measure was adverse effects. All data were collected during a 6-month follow-up period( at 1( T4), 4( T5), 12( T6) and 24( T7) weeks after the end of the therapy).
Wilcoxon’ s signed rank was used to calculate the differences of the outcome data. p-values ≤ 0.05 were considered statistically significant. SPSS for Windows( version 11, SPSS Inc., Chicago, IL, USA) statistical software was utilized.
RESULTS
Seven patients( 4 males) with dystrophic EB were included. The mean age at baseline was 19.8 years( range 8 – 34). Nineteen oral lesions were treated; the buccal mucosa was the most common site( 37 %)( Fig. 1), fol-
1 https:// www. medicaljournals. se / acta / content / abstract / 10.2340 / 00015555-2512
Fig. 1. Oral lesions in dystrophic epidermolysis bullosa. Case 3: A right buccal mucosal lesion at( a) T1 _ day1,( b) T2 _ day2,( c) T3 _ day3,( d) T4 _ day7, and( e) T7 _ 24 weeks after end of therapy.
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2512 Acta Derm Venereol 2017; 97: 383 – 384