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

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 strategies. 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. 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. Next-generation dressings incorporating hydrogels, extracellular matrix-mimetic scaffolds, nanoparticles, and smart-responsive systems demonstrate enhanced protection, moisture balance, and localised therapeutic delivery, supporting 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. Advanced wound dressings, bioactive topical therapies, and tissue-engineered constructs represent complementary 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.