Garrett's House is dedicated to the support, advice, and education of a genetic skin condition called Epidermolysis Bullosa or EB for short. Currently there is no cure or effective treatment for EB. Please take a moment to learn about EB, and how you can support others who struggle with EB everyday. Garrett's House also honors the memory of those who lost their brave fight against EB. Please check out the Garden of Angel to learn more about the precious butterfly angels.

March 9, 2025

Different Types of Moisturizers for those with EB


 
While trying to find the best moisturizer for my skin, I began researching the different types of moisturizers/creams/lotions/oils, etc.. out there.  And I was surprised at what I found. I broke it all down simply an easy-to-understand manner while providing examples relevant to EB skin. 


Categories of skin moisturizers


Occlusives- seals in hydration by providing a barrier on the skin


Pros: Provides a barrier on the skin, preventing moisture from getting in; can be smoothing; protects against bodily fluids


Cons: It can clog skin pores; it can increase skin breakdown because it prevents moisture from leaving the skin; and it can be hard to clean off the skin


Examples: Zinc Oxide, Desitin, Lanolin, Vaseline, Aquaphor, Coconut Oil





Emollients- They fill in the gaps in the skin with oils and lipids


Pros: prevents water loss by locking in moisture when applied to wet skin; softens and soothes the skin


Cons: It can clog pores and can cause an allergic reaction in some people


Examples: Plant-based oils such as olive, jojoba, sunflower, rosehip, marula, as well as beeswax and shea butter






Humectants- attract and bind water to the skin to hydrate it


Pros: Helps skin retain moisture 


Cons: can aggravate dryness in areas with low humidity


Examples: Glycerin, Aloe Vera, Manuka Honey, and products containing hyaluronic acid.



There are other products out there I didn’t list, and many of the things I did list, can be both an occlusive and emollient or an emollient and a humectant.  


I encourage others with EB to do their own research on all the different types of ointments out there. You might be surprised by what you may learn about the products you are currently using or find something that would be even better for your skin/wounds!!


October 6, 2024

EB Related Eye, Mouth and Nose issues

EB can affect all aspects of the body; including the eyes, mouth, and nose.


Here are some tips from others with EB for those areas:


MOUTH

Those with EB are often affected by wounds in the mouth that can be painful, and slow healing which makes eating, drinking, and speaking difficult.  Some find swishing with salt water can be helpful.  Others find that magic mouthwash or Carafate can provide temporary relief from the pain


EYES

Eye Issues are a common and painful complication in those with EB.  When the eyes become dry, they can become damaged easily, causing corneal abrasions.   Keeping the eyes lubricated daily, but especially at night.  It is recommended that those with EB use preservative-free eye drops or eye ointment frequently to prevent abrasions.   Everyone has their own preference on which eye drops/ointment they use.  When corneal abrasions are frequent or begin to interfere with daily life, bandage contact lenses are often used.  These lenses are just like contact lenses and not only provide immediate pain relief and protection while the abrasions heal. Many with EB wear them daily to prevent corneal abrasions.  The most common brands used in those with EB are Air Optix Day and Night Aqua 30-day lenses. 


NOSE

Just like the rest of the body, the nose can be affected in those with EB.  The inside of the nose can blister or develop wounds.  Dry weather can cause nose bleeds as well.  Using saile nose spray or saline nose gel to help keep the inside of the nose moist to help reduce wounds and nose bleeds from developing.   When wounds become chronic inside the nose, scabs can occur, along with inflammation.  Over time the opening of the nose can scab closed, interfering with breathing.  Using a humidifier while you sleep, along with saline spray/gel can help keep the inside of the nose clear.  

Infections in EB: How to prevent them and how to treat them

While skin infections in EB are common, there are many things one can do to prevent infections. The following advice was given to me by an infectious disease doctor.

Prevention

1. ALL wounds need to be bandaged. Open wounds can easily become contaminated with bacteria causing an infection to start. Keeping wounds covered with bandages as they heal, not only prevents infections but also protects the wounds from further damage while they heal.

2. Bandages need to be changed daily and the skin needs to be cleaned daily. Some bandages need to be changed multiple times a day if there is heavy drainage.  The longer infection drainage sits on a wound, the more infected it becomes and the longer it takes to heal.

3.  Only use bleach when you have an active staph or strep infection, and no more than 3 times a week. Since it is cytotoxic it will kill both good and bad bacteria.

4.  Take showers, not baths.  Sitting in a tub of water with open wounds allows bacteria to spread to other open wounds.  A shower doesn't have to be like it sounds.  It can be sitting in an infant bathtub, making up a bowl of warm water and soap (or whatever you use in the bath) and gently pouring it over the body to clean it.  It could also be letting a toddler sit in the bathtub with just enough water to play in, and using a bowl or pitcher of warm, soapy water to clean them with.  But however you do it, clean the bathtub before and after bath/shower time.

5. Wash the clothing, bedding, towels, and blankets of those with EB separate from everyone else in the household to prevent the spreading of bacteria.

6.  Frequently clean your child's toys and other objects in the house they touch a lot- the TV remote, computer mouse/keyboard, door knobs, light switches, the toilet, fridge handle, etc.

7. Change clothing after coming home from school, work, and medical appointments.



Signs of an infection

  • red or swollen wound, sometimes it will feel hot
  • foul odor
  • excessive drainage )more than usual)
  • excessive pain and/or itching (more than usual)
  • a fever

(Greenish-blue drainage can indicate a pseudomonas infection. Cloudy, pea-green, or yellowish drainage can indicate a strep or staph infection.)



Only a wound culture performed by a doctor can tell you what type of bacteria is causing the infection. 


The typical treatment of an infection

Treatment depends on the person's age, previous history of infections, and recommendation of their medical team.

Typically skin infections are treated with topical antibiotics, such as Polysporin or Bacitracin. Sometimes a prescription-strength topical antibiotic such as Bactroban is necessary. Only use Bactroban as prescribed. Overuse of it can cause your body to become resistant to it and it will no longer work when you really need it to. The same thing applies to oral antibiotics. Use those only when necessary so your body doesn't become resistant to them either.  In addition to topical and oral antibiotics, there are other home remedies that you can do to help eliminate the bacteria. 

For Pseudomonas Infection, you will want to use an acetic solution and the most common thing to use is Vinegar. 

The acetic acid formula is: Mix 1 ounce of 5% vinegar in 19 ounces of water.

Vinegar baths or compresses can be used at any age. Be sure you rinse well with clear, clean water after a Vinegar bath, otherwise, excess itching and irritation may occur. 

For a Staph or Strep-related infection, (including MRSA) you can take a bleach bath or apply bleach compresses to the infection area to help kill the bacteria no more than 3 times a week. Bleach is cytotoxic (meaning it kills both bad and good bacteria. When you kill off the good bacteria, things like pseudomonas and yeast start to take over) 

Bleach Bath Formula for Adults and Children OVER the age of 1:

Mix 1 teaspoon bleach in 1 gallon of water.

For Children and Infants UNDER the age of 1, 

Mix 1/2 teaspoon bleach or less to 1 gallon of water.

No matter what age, rinse well with clear, clean water after a bleach bath, otherwise excessive itching and irritation may occur.

Chlorhexidine is commonly used among those with EB, but it is also cytotoxic


NEVER mix Vinegar and Bleach together in the same bath. A chemical reaction can occur and produce a toxic fume causing respiratory issues.  In addition, adding other agents such as soap, salt, or bubble bath can alter the PH levels of the bleach (or vinegar) solution making it less effective against the bacteria.  It is also vital to use the correct ratio of water to bleach, or vinegar to water.  Too much water can dilute the bleach (or vinegar) making it less effective, while too much bleach (or vinegar) can cause stinging upon contact with the open wounds


How WE treat infections.

1- cover all open wounds

2- clean the wounds and change bandages at least once a day, sometimes more for heavily draining wounds.  

3- we start with topical antibiotics and/or antimicrobial dressings before we use oral antibiotics UNLESS we have multiple infected wounds and/or a fever is present.  

Some examples of antimicrobial dressings: Xeroform (NOT safe for use on Infants) Mepilex AG, Polymen AG or Biatain AG (also NOT safe for use on infants or young children) Hydrofera Blue Ready Foam,  and dressings impregnated with medical grade honey,   There are also topical antimicrobial agents: silver gel (NOT safe for use on infants or young children) MediHoney, essential oils that have been safely diluted for the age of the person.

Since we switched from baths to showers and followed the above steps, we have seen a significant reduction in the occurrence of infections. 

September 4, 2024

Blended diet 101

Whenever I tell people we did blended diet g-tube feeds for 12 years vs using pre-made, sugar filled commercial formula, they look at me like I have two heads.  I have gotten a lot of comments as well. 


The top 3


“OMG!!! that is too much work; i don’t have time to do that”


“My child can’t handle real food”


“How can this be better than scientifically made, nutritional complete out there?”


I have done previous posts on blended diet but I thought I would do an update on blended diet, providing step by step directions. 



Step one: get a blender.  For those that do blended diets, it is recommended in getting a commercial grade blender, such as a Vitamix or a Blentec.  We have a Vitamix blender.


Step two: start with basic ingredients: yogurt, applesauce (or any type of baby food), a grain (baby rice cereal or oatmeal is a great starter) and a liquid.  You can use water, milk, juice or formula.  


Step Three: combine all ingredients in the blender and blend until it becomes a liquid. Or smoothie type texture. 


Step Four: use a syringe and the bolus extension to push the blends through your child’s g tube. Then flush with a bolus of water (we used 20cc) amount will vary on your child age, weight and form of EB.  A nutritionist will help you determine how much free water your child needs per day.


Once you get comfortable with blending basic items, you can branch out.  Some people just blend up what they made for breakfast/lunch/dinner for their family, and feed that to their tubie.  The goal of a blended diet is to provide a healthy, well balanced whole food alternative to commercial formulas.  Each blend can be tailored to your child’s specific dietary needs.  


In EB, the goal is a high calorie, high protein, and low sugar diet.  Those with EB need anywhere from 100-300% more calories than a child without EB that is the same age, along with 115-200% more protein than a child without EB what is the same age,  Those with EB also need a lot of fluid in their diet to replenish what is lost from wound drainage and to aid in healthy kidney function and reduce constipation.  


A nutritionist can help you figure out what your child needs in their diet, as well as how much free fluid they need per day.


We use this calculator to determine what our child needs from a nutritional standpoint and we use the results from his previous blood work to see if we need to add any additional nutrients.  


I have done a tremendous amount of research on the nutritional content of a wide variety of food to figure out which combine of foods would get us the highest calorie, yet low volume blends (our child is volume sensitive)  Bur there are many apps out there that all your have to do is add the ingredients you are using, and it will calculate the nutritional value of those items.  One app I like is called Track.  All you have to do is add the food and quantities and the app calculates the calorie total and breakdown of the nutrients.   


For our blends we included the follow ratio in each batch:


3 cups of vegetables

3 cups of fruits

1 cup of whole grain (oatmeal, pasta, brown rice, quinoa) 

1 cup of  an animal based protein (eggs, cook chicken, cooked fish, 

1 cup of a plant based protein (seeds, tofu, lentils, beans peanut butter)

1 cup of a dairy product (yogurt, heavy cream, kefir, cottage cheese) 

A liquid base: milk (cow, goat, almond, rice) broths (chicken, vegetable, bone),  various juices (pear, prune, apple)  this amount can vary depending on how thick or thin you prefer the blends. 

.  


I blended all those items together then divided it up into the serving sizes we give per feed (this will vary from person to person).  For us it was 6oz.   I then continued to blend that ratio of those items until I had enough to make 7 days worth of feeds.  You can use Tupperware containers or Ziploc bags or breast milk bags to store each serving.   Once the blends are diving into individual servings, I then add one or more high calorie, low volume additions to EACH servicing size to increase the calories for that serving size.  I kept 2 days worth in the fridge and froze the rest, pulling out a day's worth at a time. 


*High calories low volume additions: peanut butter powder, flaxseed oil, olive oil, heavy cream, (benecalorie, duocal or liquidCal or beneprotein- these are all commercial made additives that can be easily mixed into blends.) 


One of the benefits of blending food is you can pick and choose what you want to use.  We used either fresh or frozen fruits and vegetables, depending on what was in season, and what his need was based on his blood work.  We aimed for using things high in iron, vitamin D, vitamin C and foods known to reduce inflammation.  I created a spreadsheet of how many calories, and which vitamin/nutrients each food was high in.  My favorites were kale, spinach, sweet potatoes, cooked apples, blueberries, mangos,  bananas, boiled chicken, hard boiled eggs, bone broth, kefir, brown rice, tofu, almond milk, prune juice, and peanut butter.  But I tried to use a variety of each category of food.  It is easy to make it a vegetarian diet, or a diary free diet as well. 


We saw consistent weight gain, quicker wound healing, less inflammation/pain and no issues with constipation.  He had more energy as well.  It also allowed him to eat anything he wanted, because he was getting all the good, nutritious food through his tube. No more fighting at meals to get him to eat fruits and vegetables.  



I’ll be honest, this is a lot of work, especially in the beginning when I was trying to figure out what to use, how much, etc.  But once I figured out how many calories he needed per day and the ratio of vitamins, minerals and nutrients, it became much easier and was just a part of my weekly routine.   But overall it was worth the extra work. I made our child MUCH healthier by being on a blended diet.

May 6, 2024

Hospital Guidelines

STOP!!! 

PLEASE READ BEFORE TOUCHING ME!!


I have Epidermolysis Bullosa.  It is a connective tissue disorder that causes fragile skin, internally and externally.


Here are the ways you can SAFELY care for me


  1.  If you have not worked with an EB patient before, please ask my parents how to care for me,


  1. I CAN NOT have ANY tape, even paper or hypoallergenic tape used on my skin.  Mepitac tape the ONLY safe tape that can be used on my skin.


  1.  A Blood Pressure Cuff MUST be used over clothing or bandages, otherwise the pressure will rip my skin


  1.  When taking blood, the tourniquets MUST be placed over clothing or bandages because the pressure will rip my skin.  Blood draws may be difficult and  can only be taken by an EXPERIENCED NICU nurse or while using IV radiology to find the best vein and avoid multiple sticks.   Do not rub the skin with alcohol wipes.  Gently dab the skin with an alcohol pad.  


  1. DO NOT slide me during bed transfers.  Lift me by rolling me from side to side into your arms or let me parents show you how to move me.


  1. For diaper changes, it usually takes two people.  DO NOT grab my feet or ankles.  Instead, one person should lift me with one arm under the back of my knees, and the other should change the diaper.  DO NOT rub the skin with wipes.  Use warm water to clean the area and gently pat dry. 


  1. Coat exam gloves and any tubing that comes into contact with the skin, externally and internally with a non-petroleum-based lubricant.  


  1.  Temperatures CAN NOT be taken rectally or in the ear.  Under the arm is the safest method, using a non-petroleum-based lubricant.  Infrared Thermometers can also be used, but are not always accurate in EB patients due to temperature regulation issues. 


  1. PLEASE USE common sense and ask questions if you are unsure about my care.  



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