Case Report Describes Successful Treatment of JEB with Terrasil Ointment

Treatment with a wound care ointment called Terrasil reduced pain, itching, and blistering in the wound area in a patient with a long history of junctional epidermolysis bullosa (JEB), according to a new case report.

The study, “Epidermolysis bullosa: a case report,” published in the journal Chronic Wound Care Management and Research, reported the case of a 60-year-old Caucasian man with JEB who arrived at the Catholic Health Initiatives (CHI) St. Luke’s Wound Care Clinic in The Woodlands, Texas, with a history of nonhealing ulcers that covered nearly one-third of his body.

He had ulcers on his shoulders, lower abdomen, back, thighs, and knees since birth.

The patient had a positive family history of EB, and had undergone removal of a large squamous cell carcinoma (a form of skin cancer) on his left leg.

He had extensive experience in caring for his ulcers, and had tried numerous skin dressings, including PolyMem (by Ferris Manufacturing) and Xeroform (by DeRoyal).

The patient had also used various ointments, including over-the-counter products, topical steroids, and prescribed medications such as antibiotics.

The patient complained of weight loss and of unsatisfactory pain control — eight on a 0-10 scale – despite using the local anesthetic lidocaine, oral painkillers, and the antibiotic cephalexin.

An examination revealed that the ulcers were pink at the base with mild to moderate blood and serum drainage. They did not have a foul odor. The area around the wounds was inflamed. A molecular analysis revealed the presence of bacteria typical of open skin, and three different fungi —Volutella colletotrichoides, Phoma moricola, and Candida zeylanoides.

The patient was then given a sample of Terrasil (Aspiera Medical). This ointment is designed to enable durable moisturization by including jojoba seed oil and organic beeswax, while it avoids skin softening and breakdown. Studies have shown that jojoba oil increases skin penetration of active ingredients.

PolyMem and Xeroform were used as secondary dressings.

He also started taking the nutritional supplement Arginaid (Nestlé Health Science), which contains the amino acid l-arginine and vitamins C and E, and is intended for people with wounds.

Clinicians assessed the ulcers on the left shoulder blade and in the mid-back every one to two months. Their goal was to decrease the patient’s level of pain, increase the formation of granulation tissue (connective tissue formed during normal wound healing), and control bacteria.

The patient was told to wash and dry the affected area with a cotton-tip applicator before the daily application of Terrasil. Altogether, the treatment was applied 332 times.

Interestingly, the patient reported reduced pain, itching, blistering, and cracking around the wound area. Bacterial load was decreased — except for the higher level of Staphylococcus aureus — and no fungal species were detected.

By the third visit, the patient’s wound surface area in the central and distal (distant to the center) mid-back region was reduced by 96% and 92%, respectively. He also experienced a reduced wound area on the left shoulder blade by the fifth visit (by 96%).

New ulcers formed, though, a finding that was expected by the researchers. They attributed this observation to the worsening of EB.

“This case is unique in that it describes the successful use of a multivalent wound-healing ointment in a patient with a long history of junctional EB,” the researchers wrote.

“The patient showed a positive response within a few months of treatment with the wound care ointment and nutritional supplement. The healing response was most likely facilitated by the reduction in bacterial burden along with the elimination of fungal species,” they added.

According to the team, the Terrasil ointment provided a moist wound-healing environment, and reduced blistering and itching.

“This case has formed a strong basis for further research on the use of this wound care ointment as an adjunctive therapy in the management of EB,” the team concluded.