ritual art (birch bark biting), maps (including the oldest maps of North America), torches, fans, musical instruments, clothing, and more. In Scandinavia and Finland, it was used as the substratum of sod roofs and birch-bark roofs, for making boxes, casks and buckets, fishing implements, and shoes (as used by the Egtved Girl) similar to bast shoes. In Russia, many birch bark manuscripts have survived from the Middle Ages. Birch bark knife handles are popular tools to be made currently. In India, birch-bark, along with dried palm leaves, were the primary writing supports before the widespread advent of paper in the second millennium CE. The oldest known Buddhist manuscripts (some of the Gandharan Buddhist Texts), from Afghanistan, were written on birch bark. Neanderthals used birch bark to make a tar adhesive through the process of dry or destructive distillation. Birch bark also makes an outstanding tinder, as the inner layers will stay dry even through heavy rainstorms. Medical uses Birch bark, sold under the brand name Filsuvez, is a medication that is used to treat epidermolysis bullosa (EB). The most common side effects with Filsuvez include wound complications. Other common side effects include skin reactions at the application site, wound infections, pruritus (itching), and hypersensitivity (allergic) reactions. Epidermolysis bullosa is an inherited disease of the skin that makes the skin very fragile and causes severe blistering and scarring. Filsuvez is used in two types of epidermolysis bullosa, dystrophic epidermolysis bullosa and junctional epidermolysis bullosa, to treat partial-thickness skin wounds. These are wounds where the upper layers of the skin have been damaged. Filsuvez is indicated for the treatment of partial thickness wounds associated with dystrophic and junctional epidermolysis bullosa (EB) in people aged six months of age and older. Legal status On 22 April 2022, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Filsuvez, intended for the treatment of epidermolysis bullosa (EB). The applicant for this medicinal product is Amryt Pharmaceuticals DAC. Filsuvez will be available as a gel for cutaneous use. The active substance of Filsuvez is birch bark extract (as dry extract, refined) from Betula pendula Roth/Betula pubescens Ehrh. (equivalent to 0.5‑1.0 g birch bark), including 84‑95 mg triterpenes calculated as the sum of betulin, betulinic acid, erythrodiol, lupeol and oleanolic acid. It is thought to work