Nutritional problems of the acute and chronic burn patient. Relevance to epidermolysis bullosa

Nutritional outcome in children with severe generalized recessive dystrophic epidermolysis bullosa: a short- and long-term evaluation of gastrostomy and enteral feeding

“…[3][4][5][6][7] On the other hand, protein and calorie needs are increased by accelerated skin turnover, blood and protein losses and skin infections. 8,9 Chronic inflammation is a cause of malnutrition and growth retardation in children. The direct growth-inhibitory effects of proinflammatory cytokines are increasingly recognized in chronic paediatric in-flammatory diseases such as Crohn disease or juvenile arthritis.…”

“…In children, as in adults, the recessive dystrophic forms (RDEB) are associated with high nutritional risk 2 because of dysphagia, microstomia and teeth dystrophy, and the risk of oesophageal strictures 3–7 . On the other hand, protein and calorie needs are increased by accelerated skin turnover, blood and protein losses and skin infections 8,9 . Chronic inflammation is a cause of malnutrition and growth retardation in children.…”

Dystrophic epidermolysis bullosa: a review

“… 32 Owing to poor nutrition, chronic inflammation, and infection, the patients develop anemia, failure to thrive, delayed puberty, and osteoporosis. 33 Eye involvement in DEB patients includes abrasions, scars, and pannus of the cornea; blisters and ectropion of the eyelids; and conjunctival blisters and symblepharon. 34 Perianal involvement often leads to painful stools and, as a result, constipation.…”

Nutrition for Children with Epidermolysis Bullosa

“…As in the patient with thermal burns, nutrient needs reflect the severity of lesions 2 The degree to which oral, oropharyngeal, esophageal, and other gastrointestinal (GI) complications limit intake or affect absorption. Fecal loading and painful defecation (with or without chronic constipation) are extremely common and frequently cause apathy and secondary anorexia.…”

“…3 Research in burns and pressure ulcers suggests that it may be beneficial to supplement certain micronutrients in EB. 2 However, in the author's experience single micronutrient supplementation such as zinc is rarely appropriate. Although this is often recommended when biochemical estimation has revealed levels less than the reference range, it is not necessarily the correct course of action (see Component 3 discussed earlier).…”