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Karppinen JJ, Kallio M, Lappalainen K, Lagus H, Matikainen N, Isoherranen K. Clinical characteristics of Martorell hypertensive ischaemic leg ulcer. J Wound Care 2023; 32:797-804. [PMID: 38060417 DOI: 10.12968/jowc.2023.32.12.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE We sought to characterise the clinical picture of Martorell hypertensive ischaemic leg ulcer (HYTILU) by describing the ulcer borders with three clinical features: 'the red lipstick sign'; purple border; and livedo racemosa. We also aimed to characterise comorbidities and determinants of healing time. METHOD A single-centre, retrospective cohort study was conducted between 2015-2020. We scrutinised ulcer photographs for relevant clinical signs. Data on comorbidities, medication and ulcer treatments, as well as method of diagnosis and healing time, were collected from patients' electronic medical records. RESULTS In total, 38 female patients and 31 male patients (mean age 73 years) were assessed, with a mean follow-up time of 174 days. The 'red lipstick-like' margin covered 0-50% of the ulcer margin in 56.5% of the ulcers, and 51-100% of the ulcer margin in 43.5% of the ulcers. Purple border or livedo racemosa was observed in 70.5% of the ulcers. All patients had hypertension and 52.2% of patients had type 2 diabetes. A heavy cardiovascular disease burden and frequent concomitant vascular pathologies were found. Infections requiring systemic antibiotics, ulcer size and duration of symptoms before diagnosis were strongly associated with healing time. We also found that use of systemic corticosteroids and severity of hypertension (measured by the number of antihypertensive medications used) delayed healing. CONCLUSION Our data suggest that 'the red lipstick sign' could be a novel diagnostic feature in HYTILUs alongside purple border, livedo racemosa and necrotic/fibrinous ulcer bed. The results also elucidated HYTILU comorbidities, and showed that infections and delay in diagnosis impeded healing.
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Affiliation(s)
- Jesse Jm Karppinen
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Hospital, University of Helsinki, Finland
| | - Milla Kallio
- Vascular Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Finland
| | - Katriina Lappalainen
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Hospital, University of Helsinki, Finland
| | - Heli Lagus
- Wound Center, Department of Plastic and Reconstructive Surgery, Helsinki University Hospital, University of Helsinki, Finland
| | - Niina Matikainen
- Endocrinology, Abdominal Center, Helsinki University Hospital and Research Program for Clinical and Molecular Metabolism, University of Helsinki, Finland
| | - Kirsi Isoherranen
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Hospital, University of Helsinki, Finland
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Dardari D, Lequint C, Jugnet AC, Bénard T, Bouly M, Penfornis A. Curing Necrotic Angiodermatitis with an Intact Fish Skin Graft in a Patient Living with Diabetes. Medicina (B Aires) 2022; 58:medicina58020292. [PMID: 35208615 PMCID: PMC8876191 DOI: 10.3390/medicina58020292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives: We describe a case of necrotic angiodermatitis. Materials and Methods: We used an intact fish skin graft to treat a patient living with diabetes, which was complicated by end-stage renal failure and arterial hypertension. The entire therapeutic procedure was carried out in ambulatory care without requiring the hospitalization of the patient. Results: The patient experienced a marked reduction in pain and complete epithelization of the lesion after 10 weeks of treatment. Conclusion: Our experience presents a new therapeutic approach to necrotic angiodermatitis.
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Affiliation(s)
- Dured Dardari
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
- Correspondence: ; Tel.: +33-6-61-54-28-09
| | - Corinne Lequint
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Anne Christine Jugnet
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Tatiana Bénard
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Marie Bouly
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Alfred Penfornis
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
- Paris-Sud Medical School, Paris-Saclay University, 91100 Corbeil-Essonnes, France
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Fertitta L, Vignon-Pennamen MD, Frazier A, Guibal F, Caumes E, Bagot M, Bouaziz JD, Frumholtz L. Necrobiosis lipoidica with bone involvement successfully treated with infliximab. Rheumatology (Oxford) 2020; 58:1702-1703. [PMID: 30877774 DOI: 10.1093/rheumatology/kez055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Aline Frazier
- Department of Rheumatology, Hôpital Lariboisière, AP-HP
| | | | - Eric Caumes
- Department of Infectious Diseases, Hôpital Pitié - Salpétrière AP-HP, Paris, France
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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Nicol P, Bernard P, Nguyen P, Durlach A, Perceau G. Étude rétrospective des angiodermites nécrotiques au CHU de Reims : données épidémiologiques, cliniques, évolutives et rôle des antivitamine K. Ann Dermatol Venereol 2017; 144:37-44. [DOI: 10.1016/j.annder.2016.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/06/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022]
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Apollonio A, Antignani PL, Di Salvo M, Failla G, Guarnera G, Mosti G, Ricci E. A large Italian observational multicentre study on vascular ulcers of the lower limbs (Studio Ulcere Vascolari). Int Wound J 2016; 13:27-34. [PMID: 24618175 PMCID: PMC7949669 DOI: 10.1111/iwj.12216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/15/2013] [Accepted: 12/19/2013] [Indexed: 11/28/2022] Open
Abstract
An observational study of 2 years was promoted by the Italian Association for Cutaneous Ulcers (AIUC) in order to monitor the epidemiology of leg ulcers, the trend of healing and the more frequent therapeutic approaches in lower limb ulcers. Fifty-nine sites in 14 different Italian regions involved in the study, with 1333 enrolled patients (1163 patients fully evaluated and followed up for 9 months). A prevalence of females (62%) was observed with a mean age of 70 years and a high rate of hypertension (62%), diabetes (38%) and obesity (29%). Venous ulcer was most frequent (55%), followed by mixed (25%) and diabetic (8·3%) ulcers. Basically, all patients received a local therapy (LT) (compression and advanced local therapies), while 63% of patients have an associated systemic pharmaceutical treatment. Ulcer healing rates progressively increased throughout the study and despite the type of observational study does not allow conclusions on the treatment, it was observed that the patients receiving additional systemic drugs were associated with a more rapid acceleration of healing rates of ulcers compared to LT alone (3 months: 39·7% versus 29·2%; 6 months: 62·0% versus 47·0%; 9 months: 74·7% versus 63·8%). In particular, the Studio Ulcere Vascolari (SUV) study showed that a combination treatment with sulodexide and compression therapy allows for a greater increase in the healing rates in venous ulcers.
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Éditorial. Ann Dermatol Venereol 2015; 142:467-8. [DOI: 10.1016/j.annder.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 11/22/2022]
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Abstract
Leg and foot ulcers are symptoms of very different diseases. The aim of this paper is to demonstrate the differential diagnosis of leg ulcers. The majority of leg ulcers occur in the lower leg or foot. In non-venous ulcers the localization in the foot area is more frequent. The most frequent underlying disease is chronic venous disease. In 354 leg ulcers, Koerber found 75.25% venous leg ulcers, 3.66% arterial leg ulcers, 14.66% ulcers of mixed venous and arterial origin and 13.5% vasculitic ulcers. In the Swedish population of Skaraborg, Nelzen found a venous origin in 54% of the ulcer patients. Each leg ulcer needs a clinical and anamnestic evaluation. Duplex ultrasound is the basic diagnostic tool to exclude vascular anomalies especially chronic venous and arterial occlusive disease. Skin biopsies help to find a correct diagnosis in unclear or non-healing cases. In conclusion, chronic venous disease is the most frequent cause of leg ulcerations. Because 25% of the population have varicose veins or other chronic venous disease the coincidence of pathological venous findings and ulceration is very frequent even in non-venous ulcerations. Leg ulcers without the symptoms of chronic venous disease should be considered as non-venous.
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Affiliation(s)
- F Pannier
- Department of Dermatology, University of Cologne, Cologne, Germany.
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Lorette G. [Can we still speak of necrotic angiodermatitis?]. Ann Dermatol Venereol 2012; 139:344-5. [PMID: 22578336 DOI: 10.1016/j.annder.2012.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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