Identifying germs living in ‘biofilms’ on EB wounds will allow the development of targeted treatments to help chronic wounds heal. These approaches are already in use in other diseases and could be adapted very rapidly for EB wound care, potentially transforming EB wound management.

Woman in white lab coat smiling at the camera.


Dr Hirschfeld is an associate professor working at the University of Birmingham on the microorganisms that can live on wounds in a thin layer of slimy substance called a ‘biofilm.’ Bacteria within a biofilm are hard to detect and are protected from immune system cells and antibiotic treatments. This project will involve swabbing wounds that do not appear to be infected but haven’t healed after three months of care. Genetic tests will be used to reveal the types of microorganisms that are present in wound biofilms from different types of EB so future treatments can be designed specifically to help chronic wounds heal. 

Read more in our researcher's blog.




 About our funding:

Research leader Dr Josefine Hirschfeld
Institution University of Birmingham, UK
Type of EB EBS, DEB and JEB
Patient involvement Swabs from EB patients and family members
Funding amount £14,954.60
Project length 1 year
Start date 1 October 2023
DEBRA internal ID GR000041


Latest progress summary:

Due 2025.


About our researchers:

Lead researcher: 

Dr Josefine Hirschfeld is an associate professor and honorary consultant at the University of Birmingham Dental School and Hospital. She specialises in restorative dentistry with a particular focus on gum diseases and immune cells called neutrophils and their role in diseases including EB.


Dr Hadeer Ibrahim is an assistant lecturer of Dermatology at the Suez Canal University in Egypt and has been awarded a highly competitive scholarship to fund her PhD degree on EB at the University of Birmingham where she focuses her research on improving the quality of life of patients with EB of different subtypes.

Prof Iain Chapple is Head of Research for the Institute of Clinical Sciences, Head of Periodontology with the School of Dentistry and Honorary Consultant in Restorative Dentistry with Birmingham Community Health Trust.

Prof Adrian Heagerty is a Consultant Dermatologist and Honorary Professor of Dermatology at the University of Birmingham with a particular interest in EB. He leads several active research groups and heads the half-national EB service at University Hospitals Birmingham NHS Foundation Trust.

Dr Sarah Kuehne is a senior lecturer in oral microbiology and the lead of the Oral Microbiology Research Group at the University of Birmingham. Her research group holds close links to the world-renowned Institute of Microbiology and Infection (IMI) led by Prof Ian Henderson.


Dr Annika Therese Kroeger, at the School of Dentistry, University of Birmingham, has extensive experience in metagenomics and transcriptomics. 

Prof Moritz Kebschull, at the School of Dentistry, carried out award-winning translational research linking the clinical features and molecular foundations of periodontal and peri-implant diseases and is a co-investigator at the newly funded NIHR Biological Research Centre.


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Why this research is important:

We aim to confirm our initial exciting discovery that biofilms are present in chronic EB wounds that fail to heal, whereas they are not present in younger wounds. We will explore how common biofilms are in chronic wounds, the microbes within, and whether those differ between different types of EB. This is critically important because biofilms are resistant to traditional antibiotic treatments, and they may be a strong driver of the failure of chronic wounds to heal. Importantly, biofilm-related diseases, such as those in the mouth (gum disease) that we have studied for over 20-years, are treated very differently to traditional wound infections. The biofilm itself must be physically disrupted and there are several simple approaches to achieving this, depending on their composition. These approaches are already in use in other diseases and could be adapted very rapidly for EB wound care, potentially transforming EB wound management. This will be part of a larger research project we are conducting, paving the road for further research on how such biofilms interact with the patient’s immune system. In the future, we will apply different non-invasive anti-biofilm measures including use of agents to break down the biofilm matrix and the use of light therapy that will be specific to the types of microbes detected.

Dr Hirschfeld


Researcher’s abstract:

Grant title: Use of highly sensitive and specific gene analytical techniques to identify microorganisms that may play a role in the chronicity of EB wounds.

Non-healing wounds in EB patients present significant morbidity and lower quality of life. Complications include: the need for protracted wound care, itch, pain, skin cancer and fusion of fingers forming so-called “mitten hands”.

We understand how and why EB blisters form, but we do not know why some blisters fail to heal for months or years despite good wound care. We believe that the underlying cause may be the presence of “biofilms” on the wound surface.

Biofilms are aggregates of different microbes living within a self-produced slimy matrix, which is attached to a surface such as skin and is often resistant to traditional treatments.

Biofilms are known to disturb wound healing and wounds harbouring biofilms frequently show no signs of infection like pus and inflammation/redness. Moreover, biofilms cannot be detected by traditional wound swabbing methods, and do not respond to regular wound care and antibiotic use. However, wounds with biofilms studied in other diseases including diabetes, burn and venous wounds, can respond well to anti-biofilm measures resulting in improved healing. Our preliminary research using different imaging techniques has shown, for the first time, the presence of biofilms on chronic wounds of different EB subtypes.

This proposal aims to confirm our observational results by genetic analysis of these biofilms to reveal the types of microbes present as well as possible differences between EB subtypes.

This has never been studied, it will involve the use of new techniques and will be a multi-disciplinary collaborative project. This will help us develop new therapies in a more targeted way, as we will have strong indications as to why wounds fail to heal. This will lead to a more personalised approach to therapy, resulting in better wound management strategies and help proper healing of chronic wounds in EB patients.


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Researcher’s progress update:

Due 2025.