Innovations in topical epidermolysis bullosa treatment: integrating advanced dressings, bioactive therapies and tissue-engineered skin

Abstract

Objectives: Epidermolysis Bullosa (EB) is a rare genetic disorder characterised by extreme skin fragility, chronic wounds, and high morbidity. Current management is largely supportive, highlighting an urgent need for innovative therapeutic strate- gies. This review synthesises recent advances in topical therapies, including wound dressings, tissue-engineered skin, and molecular therapies, and evaluates the potential of these approaches to improve clinical outcomes and bridge the gap toward disease-modifying interventions. Evidence acquisition: Key developments in EB pathophysiology, advanced wound-care technologies, topical molecular therapies, and cell- or tissue-based interventions were examined through critical appraisal of relevant preclinical and clinical studies, with emphasis on translational potential and practical application. Results: Next-generation dressings incorporating hydrogels, extracellular matrix-mimetic scaffolds, nanoparticles, and smart-responsive systems demonstrate enhanced protection, moisture balance, and localised therapeutic delivery, support- ing wound healing while minimising trauma. Topical molecular therapies—including gene therapy, repurposed drugs, and bioactive natural compounds—show proof-of-concept for symptomatic relief and potential disease modification. Cell- and tissue-based approaches, such as ex vivo gene-corrected keratinocyte grafts and cultured skin substitutes, offer durable regeneration but remain limited by cost and accessibility. Integration of these strategies, combined with patient-centred design and co-development, holds promise for improving functional outcomes and quality of life in EB. Conclusion: Advanced wound dressings, bioactive topical therapies, and tissue-engineered constructs represent comple- mentary and translationally relevant approaches to EB care. Optimising the synergy between material-based and molecular strategies, alongside standardised clinical endpoints and long-term safety evaluation, is essential for bridging supportive care and future disease-modifying therapies, ultimately improving outcomes for patients with EB