The Role of Skin Replacements in Autoimmune Skin Disease: A Comprehensive Overview of Treatment

Autoimmune and other rare skin diseases pose a particular challenge to the wound care physician due to their pathergic response to debridement and injury, and poor wound healing. Examples include pyoderma gangrenosum (PG), Hailey-Hailey disease, lipodermatosclerosis, Sjogren’s, scleroderma, polyethylene glycol allergy, and calciphylaxis.

A single wound care surgeon gives their two-year experience with the treatment of rare skin disorders. Topics of special interest include optimal dressing,s including whether to use negative pressure wound therapy, surgical and enzymatic debridement, when and how to use skin replacements, and when to consider other surgical management.

A series of patients with rare skin disorders are presented from 2017 to 2019. Examples include a complex patient with Hailey-Hailey disease diagnosed after acoustic neuroma resection and surgical dehiscence with pathergic response treated with amniotic tissue therapy. A patient with persistent skin sloughing of bilateral lower extremities for >1 year after allergic reaction to polyethylene glycol who cannot tolerate most dressings is treated with a novel fish-skin-based wound therapy. A PG patient is treated with human dermal matrix.

In conclusion, each skin disorder has its own idiosyncrasies in treatment selection, but all are treatable and wound healing can be potentiated with the use of novel wound care modalities like skin replacement therapy.