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Becker SL, Kody S, Fett NM, Hines A, Alavi A, Ortega-Loayza AG. Approach to the Atypical Wound. Am J Clin Dermatol 2024; 25:559-584. [PMID: 38744780 DOI: 10.1007/s40257-024-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA.
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2
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Hess J, Barysch-Bonderer MJ, Seeli C, Laube J, Ghosh A, Deinsberger J, Weber B, Hafner J, Meier-Schiesser B. Identifying Key Drivers in the Pathogenesis of Martorell Hypertensive Ischaemic Leg Ulcer: A Comparative Analysis with Chronic Venous Leg Ulcer. Acta Derm Venereol 2024; 104:adv40090. [PMID: 38813744 PMCID: PMC11161809 DOI: 10.2340/actadv.v104.40090] [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] [Received: 02/12/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Martorell hypertensive ischaemic leg ulcer (Martorell HYTILU) is a rare but significant cause of distal leg ulcers. Although hypertension and diabetes are known factors in its development, the precise pathogenesis of Martorell HYTILU remains elusive. To reach a better understanding of Martorell HYTILU, transcriptomic analysis was conducted through RNA sequencing and immunohistochemical comparison of Martorell HYTILU (n = 17) with chronic venous ulcers (n = 4) and healthy skin (n = 4). Gene expression analysis showed a marked activation of immune-related pathways in both Martorell HYTILU and chronic venous ulcers compared with healthy skin. Notably, neutrophil activity was substantially higher in Martorell HYTILU. While pathway analysis revealed a mild downregulation of several immune pathways in Martorell HYTILU compared with chronic venous ulcers, keratinization, cornification, and epidermis development were significantly upregulated in Martorell HYTILU. Additionally, STAC2, a gene encoding for a protein promoting the expression of the calcium channel Cav1.1, was significantly upregulated in Martorell HYTILU and was detected perivascularly in situ (Martorell HYTILU n = 24; chronic venous ulcers n = 9, healthy skin n = 11). The high expression of STAC2 in Martorell HYTILU suggests that increased calcium influx plays an important role in the pathogenesis of the disease. Consequently, calcium channel antagonists could be a promising treatment avenue for Martorell HYTILU.
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Affiliation(s)
- Jamila Hess
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Corsin Seeli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Julia Laube
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Adhideb Ghosh
- Functional Genomis Center, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Jürg Hafner
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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3
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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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4
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Deinsberger J, Moschitz I, Marquart E, Manz-Varga AK, Gschwandtner ME, Brugger J, Rinner C, Böhler K, Tschandl P, Weber B. Entwicklung eines Lokalisations-basierten Algorithmus zur Vorhersage der Ätiologie von Ulcera cruris. J Dtsch Dermatol Ges 2023; 21:1339-1350. [PMID: 37946636 DOI: 10.1111/ddg.15192_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/22/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungHintergrundDie diagnostische Abklärung des Ulcus cruris ist zeit‐ und kostenintensiv. Ziel dieser Studie war es, die Ulkuslokalisation als diagnostisches Kriterium zu bewerten und einen diagnostischen Algorithmus zur Unterstützung in der Diagnostik bereitzustellen.Patienten und MethodikDie Studie umfasste 277 Patienten mit Ulcera cruris. Es wurden die folgenden fünf Gruppen definiert: Ulcus cruris venosum, arterielle Ulzera, gemischte Ulzera, Arteriolosklerose und Vaskulitis. Mittels computergestütztem Oberflächenrendering wurden die Prädilektionsstellen der verschiedenen Ulkustypen bewertet. Die Ergebnisse wurden in ein multinomiales logistisches Regressionsmodell integriert, um die Wahrscheinlichkeit einer bestimmten Diagnose in Abhängigkeit von Lokalisation, Alter, bilateraler Beteiligung und Anzahl der Ulzera zu berechnen. Zusätzlich wurde eine neuronale Netzwerk‐Bildanalyse durchgeführt.ErgebnisseDie Mehrheit der venösen Ulzera fand sich in der medialen Malleolarregion. Arterielle Ulzera waren am häufigsten auf der dorsalen Seite des Vorfußes zu finden. Arteriolosklerotische Ulzera waren zumeist im mittleren Drittel des lateralen Unterschenkels lokalisiert. Vaskulitische Ulzera schienen zufällig verteilt zu sein und waren deutlich kleiner, häufiger multilokulär und bilateral. Das multinomiale logistische Regressionsmodell zeigte eine insgesamt zufriedenstellende Leistung mit einer geschätzten Genauigkeit von 0,68 bei ungesehenen Daten.SchlussfolgerungenDer vorgestellte Algorithmus auf Grundlage der Ulkuslokalisation kann als unterstützendes Instrument zur Eingrenzung potenzieller Differenzialdiagnosen und als Hilfestellung für die Einleitung diagnostischer Maßnahmen dienen.
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Affiliation(s)
- Julia Deinsberger
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Irina Moschitz
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Elias Marquart
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Michael E Gschwandtner
- Klinische Abteilung für Angiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Wien, Österreich
| | - Jonas Brugger
- Zentrum für Medical Data Science, Medizinische Universität Wien, Wien, Österreich
| | - Christoph Rinner
- Zentrum für Medical Data Science, Medizinische Universität Wien, Wien, Österreich
| | - Kornelia Böhler
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Philipp Tschandl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Benedikt Weber
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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5
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Deinsberger J, Moschitz I, Marquart E, Manz-Varga AK, Gschwandtner ME, Brugger J, Rinner C, Böhler K, Tschandl P, Weber B. Development of a localization-based algorithm for the prediction of leg ulcer etiology. J Dtsch Dermatol Ges 2023; 21:1339-1349. [PMID: 37658661 DOI: 10.1111/ddg.15192] [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] [Received: 11/27/2022] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Diagnostic work-up of leg ulcers is time- and cost-intensive. This study aimed at evaluating ulcer location as a diagnostic criterium and providing a diagnostic algorithm to facilitate differential diagnosis. PATIENTS AND METHODS The study consisted of 277 patients with lower leg ulcers. The following five groups were defined: Venous leg ulcer, arterial ulcers, mixed ulcer, arteriolosclerosis, and vasculitis. Using computational surface rendering, predilection sites of different ulcer types were evaluated. The results were integrated in a multinomial logistic regression model to calculate the likelihood of a specific diagnosis depending on location, age, bilateral involvement, and ulcer count. Additionally, neural network image analysis was performed. RESULTS The majority of venous ulcers extended to the medial malleolar region. Arterial ulcers were most frequently located on the dorsal aspect of the forefoot. Arteriolosclerotic ulcers were distinctly localized at the middle third of the lower leg. Vasculitic ulcers appeared to be randomly distributed and were markedly smaller, multilocular and bilateral. The multinomial logistic regression model showed an overall satisfactory performance with an estimated accuracy of 0.68 on unseen data. CONCLUSIONS The presented algorithm based on ulcer location may serve as a basic tool to narrow down potential diagnoses and guide further diagnostic work-up.
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Affiliation(s)
- Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Irina Moschitz
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Elias Marquart
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Michael E Gschwandtner
- Division of Angiology, 2nd Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Christoph Rinner
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Kornelia Böhler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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6
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Quintana-Castanedo L, Conde-Montero E, Recarte-Marín L, Peral-Vázquez A, Pérez-Jerónimo L, de la Cueva-Dobao P. Pain control with punch grafting in ulcers with underlying arteriolosclerosis. J Wound Care 2022; 31:356-359. [DOI: 10.12968/jowc.2022.31.4.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: Martorell hypertensive ischaemic ulcers are often misdiagnosed and can be a clinical and therapeutic challenge. Controversy exists regarding both their underlying triggers and the type of treatment that should be carried out. This study was designed to compare the effectiveness of punch grafting and conventional therapy in pain reduction. Method: A single-centre retrospective study was performed, including 40 patients with a clinical diagnosis of a Martorell ulcer or post-traumatic ulcer secondary to arteriolopathy in the elderly, who were treated with punch grafting (n= 24) or conventional medical treatment (n=16). Results: There was a statistically and clinically significant reduction in pain after punch grafting. The minimal overall reduction was of three points in visual analogue pain scores. Of the patients who received punch grafting, 80% reported a VAS pain score of 0 at the third follow-up, in contrast with the 44% (n=4) patients who were treated without punch grafting. The mean time to epithelialisation was 82.1 days in patients who received conventional treatment and 43.5 days in those who received punch grafts. Conclusion: Punch grafting is a simple, validated and cost-effective technique that can be performed on an outpatient basis, promotes wound healing and reduces pain. It may control pain and stimulate epithelialisation even if the wound does not present with optimum wound bed characteristics for graft taking. Pain reduction and faster epithelialisation are associated with improvements in patients' quality of life.
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Affiliation(s)
| | - Elena Conde-Montero
- Department of Dermatology, Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid
| | | | | | | | - Pablo de la Cueva-Dobao
- Department of Dermatology, Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid
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7
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Collier M, Di Santolo C, Leger P, Mastronicola D, Sánchez EN, De Bellis P. Addressing the challenges of open wounds with single-use NPWT. J Wound Care 2022; 31:S1-S28. [DOI: 10.12968/jowc.2022.31.sup2a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark Collier
- Nurse Consultant and Associate Lecturer, Tissue Viability (UK); Chair of the Leg Ulcer Forum (England and Wales); European Wound Management Association (EWMA) council member
| | - Cécile Di Santolo
- Home Care Doctor, L'Hospitalisation à Domicile de l'Agglomératon Nancéienne (HADAN), Vandœuvre-lès-Nancy, France
| | - Philippe Leger
- Angiologist, Wound Ulcer Centre, Clinique Pasteur, Toulouse, France
| | - Diego Mastronicola
- Dermatologist, Outpatient Wound Healing Centre, Local Health System, Frosinone, Italy
| | - Endika Nevado Sánchez
- Medical Doctor, Department of Plastic and Reconstructive Surgery, Burgos University Hospital, Burgos, Spain
| | - Paola De Bellis
- Clinical Nurse Specialist, Outpatient Wound Healing Centre, Local Health System, Frosinone, Italy
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8
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Deinsberger J, Felhofer M, Kläger JP, Petzelbauer P, Gierlinger N, Weber B. Raman spectroscopy reveals collagen and phospholipids as major components of hyalinosis in the arteriolosclerotic ulcer of Martorell. J Eur Acad Dermatol Venereol 2021; 35:2308-2316. [PMID: 34331822 DOI: 10.1111/jdv.17573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arteriolosclerotic ulcers of Martorell are histologically characterized by hyaline arteriolosclerosis resulting in concentric occlusion of the arteriolar lumina. Although several authors have previously reported on hyaline changes in hypertensive arteriolopathies, so far, little information is available on the molecular composition of hyaline wall depositions. OBJECTIVES This study aimed at the molecular characterization of hyaline arteriolar deposits in patients with hypertensive arteriolopathy using confocal Raman spectroscopy. METHODS Samples of patients diagnosed with arteriolosclerotic ulcers of Martorell were analysed using confocal Raman spectroscopy. The findings were correlated with histological analyses. Skin samples from healthy, non-hypertensive patients served as controls. RESULTS Confocal Raman spectroscopy analysis revealed that subendothelial hyaline deposits in arteriolosclerotic ulcers are mainly composed of collagen and phospholipids, in particular phosphatidylcholine. The presence of collagen within hyaline deposits was confirmed by Masson's Trichrome and Picrosirius Red staining. Additionally, the presence of collagen could also be shown for hypertensive nephrosclerosis. Actin was markedly decreased in hyalinized compared to control vessels, corresponding to the loss of smooth muscle cells in the process of hyalinization. This was confirmed by immunofluorescence staining for α-smooth muscle actin and desmin. CONCLUSION The present findings suggest that arteriolar hyaline deposits in hypertensive arteriolopathy are mainly composed of collagen and phospholipids, in particular phosphatidylcholine. Together with the concurrent absence of actin, these findings suggest that potentially critical disease mechanisms involve pressure-induced vascular smooth muscle cell apoptosis with subsequent deposition of collagen.
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Affiliation(s)
- J Deinsberger
- Skin and Endothelium Research Division (SERD), Department of Dermatology, Medical University of Vienna, Vienna, Austria.,Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - M Felhofer
- Department of Nanobiotechnology, University of Natural Resources and Life Sciences Vienna (BOKU), Vienna, Austria
| | - J P Kläger
- Department of Pathology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - P Petzelbauer
- Skin and Endothelium Research Division (SERD), Department of Dermatology, Medical University of Vienna, Vienna, Austria.,Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - N Gierlinger
- Department of Nanobiotechnology, University of Natural Resources and Life Sciences Vienna (BOKU), Vienna, Austria
| | - B Weber
- Skin and Endothelium Research Division (SERD), Department of Dermatology, Medical University of Vienna, Vienna, Austria.,Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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9
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Abbade LPF, Frade MAC, Pegas JRP, Dadalti-Granja P, Garcia LC, Bueno Filho R, Parenti CEF. Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:1-18. [PMID: 33371937 PMCID: PMC7772605 DOI: 10.1016/j.abd.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
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Affiliation(s)
- Luciana Patricia Fernandes Abbade
- Department of Infectious Diseases, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Marco Andrey Cipriani Frade
- Department of Internal Medicine (Dermatology Division), Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - José Roberto Pereira Pegas
- Dermatology Service, Hospital Padre Bento de Guarulhos, Guarulhos, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Universidade da Cidade de São Paulo, São Paulo, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Jundiaí, SP, Brazil
| | - Paula Dadalti-Granja
- Department of Clinical Medicine (Discipline of Dermatology), Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Roberto Bueno Filho
- Dermatology Service, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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10
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Weber B, Deinsberger J, Hafner J, Beltraminelli H, Tzaneva S, Böhler K. Localization‐mapping of arteriolosclerotic ulcers of Martorell using two‐dimensional computational rendering reveals a predominant location on the mid‐lateral lower leg. J Eur Acad Dermatol Venereol 2020; 35:e40-e42. [DOI: 10.1111/jdv.16787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. Weber
- Department of Dermatology Medical University of Vienna Vienna Austria
- Disease Modeling and Organoid Technology (DMOT) Research Group Department of Dermatology Medical University of Vienna Vienna Austria
| | - J. Deinsberger
- Department of Dermatology Medical University of Vienna Vienna Austria
- Disease Modeling and Organoid Technology (DMOT) Research Group Department of Dermatology Medical University of Vienna Vienna Austria
| | - J. Hafner
- Department of Dermatology University Hospital Zürich University of Zürich Zürich Switzerland
| | - H. Beltraminelli
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - S. Tzaneva
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - K. Böhler
- Department of Dermatology Medical University of Vienna Vienna Austria
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11
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A Novel Association of Martorell Ulcer With Liddle Syndrome. Adv Skin Wound Care 2019; 32:1-2. [PMID: 31625969 DOI: 10.1097/01.asw.0000582616.30031.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pseudohyperaldosteronism, or Liddle syndrome, is a rare, autosomal dominant condition characterized by early-onset hypertension, often associated with hypokalemia and metabolic alkalosis. Martorell hypertensive ischemic leg ulcer is a rare, underdiagnosed ulcer characterized by subcutaneous arteriolosclerosis, classically appearing over the dorsolateral lower extremity or Achilles tendon in patients with hypertension and diabetes. It presents an important diagnostic challenge because it can appear grossly similar to other entities such as pyoderma gangrenosum or venous stasis ulcers, but requires surgical intervention. This article presents a case study of surgical management of a Martorell ulcer in a 69-year-old woman with Liddle syndrome. To the authors' knowledge, this is the first case reported in the literature of this rare ulcer occurring secondary to this rare cause of hypertension.
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12
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Chicote-Álvarez E, Santos-Méndez N, Lizama-Gómez NG, Ortiz-Flores F. [Martorell hypertensive ischaemic leg ulcer. An uncommon complication of high blood pressure]. Semergen 2019; 45:e49-e50. [PMID: 31331764 DOI: 10.1016/j.semerg.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 11/19/2022]
Affiliation(s)
- E Chicote-Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - N Santos-Méndez
- Medicina Familiar y Comunitaria, Centro de Salud de Suances, Suances, Cantabria, España
| | - N G Lizama-Gómez
- Servicio de Farmacia Hospitalaria, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - F Ortiz-Flores
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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13
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Levels of angiogenic regulators and MMP-2, -9 activities in Martorell ulcer: a case report. UKRAINIAN BIOCHEMICAL JOURNAL 2019. [DOI: 10.15407/ubj91.01.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Fistal’ EY, Vatutin NТ, Taradin GG, Goncharuk MS, Grischenko IS, Vasilenko IV. Martorell’s ulcers. VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-3-51-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
There is description in the article of a case of hypertensive ulcer pathology of legs or Martorell’s ulcers diagnostics, which are complications of long-standing and poor-controlled essential hypertension. The patient 42 years old male presented with complaints of long-standing, non-healing and painful ulcer on the left leg, sustained blood pressure elevation (up to 230/120 mm Hg). History disease revealed blood pressure elevations since 16 years old age, but the patient sought medical advice extremely seldom and did not take antihypertensive treatment in fact. He noted when was 35 years old a painful ulcer located on anterolateral surface of the leg. Concerning it he treated by himself unsuccessfully and then — in differ ent health care centers. The condition deteriorated in 2016, when ulcer defect become larger and more painful. On admission at examination the ulcer of oval shape (size 7 × 4 cm and depth 0.6 cm) on anterolateral surface of the lower third of left leg is present. In clinical and biochemistry analyses no pathology was found. There were signs of left ventricle hypertrophy on the data of electroand echocardiographic inves tigations. No alterations during complex ultrasound examination of vessels of both lower extremities were revealed. Examination of angiosurgeon: no pathology. With the purpose to diagnosis specification path omorphologic study of tissue fragments of injured zone was performed. The results of this study showed that revealed changes are relevant for hypertensive ulcers of legs or Martorell’s ulcers. The presented case illustrates the necessity of more broad informing medical community about possibility of incidence of Martorell’s ulcers that in turn assumes application of adequate measures of local treat ment, including dermatoplasty, and effective antihypertensive therapy.
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Fıçıcıoğlu S, Can N, Tutuğ B. A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum. Dermatol Reports 2018; 10:7445. [PMID: 29887980 PMCID: PMC5962845 DOI: 10.4081/dr.2018.7445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/02/2018] [Accepted: 03/16/2018] [Indexed: 01/13/2023] Open
Abstract
The differential diagnosis of chronic ulcers covers a wide range of diseases and poses a diagnostic challenge. Subcutaneous ischemic arteriolosclerosis can lead to local ischaemia and ulceration as a result of arteriolar narrowing and reduction of tissue perfusion. This pathophysiological feature can be seen in eutrophication (nonuremic calciphylaxis) in morbid obesity, hypertensive ischemic leg ulcer (Martorell ulcer) and calciphylaxis in chronic renal insufficiency. All of the ulcers happened in this way can be wrongly diagnosed as pyoderma gangrenosum because of clinical similarity and inadequate biopsies. We report a case of chronic ulcer due to subcutaneous arteriolosclerosis in morbid obesity, wrongly diagnosed as pyoderma gangrenosum. It can be detrimental to misdiagnose the ulcers due to subcutaneous arteriolosclerosis as pyoderma gangrenosum since they need a diametrically different approach.
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Affiliation(s)
| | - Nuray Can
- Department of Pathology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Busem Tutuğ
- Department of Pathology, Trakya University Faculty of Medicine, Edirne, Turkey
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Malhi HK, Didan A, Ponosh S, Kumarasinghe SP. Painful Leg Ulceration in a Poorly Controlled Hypertensive Patient: A Case Report of Martorell Ulcer. Case Rep Dermatol 2017; 9:95-102. [PMID: 28512404 PMCID: PMC5422727 DOI: 10.1159/000468977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/07/2017] [Indexed: 11/19/2022] Open
Abstract
Martorell ulcer is a form of lower limb ulceration, preceded by a small area of excruciating pain. It often appears as a solitary lesion on the outer aspect of the lower limb, and is primarily associated with poorly controlled hypertension and diabetes. Treatment of the ulcer involves awareness and early correct diagnosis, adequate control of blood pressure, management of infection, and wound care. We describe a 77-year-old diabetic and hypertensive woman presenting with excruciating pain in her right lower lateral leg leading to a necrotic ulcer. Serial photographs of the evolution of the lesion and eventual healing of the ulcer are presented.
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Affiliation(s)
| | - Ali Didan
- bFiona Stanley Hospital, Murdoch, WA, Australia
| | - Stefan Ponosh
- cSir Charles Gairdner Hospital, Nedlands, WA, Australia
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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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Traber J, Held U, Signer M, Huebner T, Arndt S, Neff TA. Analgesic efficacy of equimolar 50% nitrous oxide/oxygen gas premix (Kalinox®) as compared with a 5% eutectic mixture of lidocaine/prilocaine (EMLA®) in chronic leg ulcer debridement. Int Wound J 2016; 14:606-615. [PMID: 27500801 DOI: 10.1111/iwj.12652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/03/2016] [Accepted: 07/08/2016] [Indexed: 11/28/2022] Open
Abstract
Chronic foot and leg ulcers are a common health problem worldwide. A mainstay of chronic ulcer therapy is sharp mechanical wound debridement requiring potent analgesia. In this prospective, controlled, single-centre, crossover design study, patients were assigned to either the administration of topical analgesia with 5% lidocaine/prilocaine cream or the inhalation of an analgesic 50% N2 O/O2 gas premix. Primary outcome parameter was level of pain at maximum wound depth during debridement as measured by a visual analogue scale. Secondary outcomes included level of pain after debridement, overall duration of treatment session, duration and completeness of debridement, and the patient's subjective perception of analgesic quality during debridement. Pain level increased from 0·60/0·94 (first/second debridement; baseline) to 1·76/2·50 (debridement) with 5% lidocaine/prilocaine and from 1·00/1·35 (baseline) to 3·95/3·29 (debridement) with 50% N2 O/O2 gas premix. Patient satisfaction was 90·48%/94·44% (first/second debridement) with topical 5% lidocaine/prilocaine analgesia and 90·48%/76·47% with the inhalation of 50% N2 O/O2 gas premix. Debridement was completed in a significantly higher percentage of 85·71%/88·89% (first/second debridement) with 5% lidocaine/prilocaine than with 50% N2 O/O2 gas premix (42·86%/58·82%) (odds ratio 6·7; P = 0·001). This study provides sound evidence that analgesia with topically administered 5% lidocaine/prilocaine cream is superior to the use of inhaled 50% N2 O/O2 gas premix in chronic leg ulcer debridement.
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Affiliation(s)
- Juerg Traber
- Department of Surgery, Venenklinik Bellevue, Kreuzlingen, Switzerland
| | - Ulrike Held
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Maria Signer
- Department of Surgery, Venenklinik Bellevue, Kreuzlingen, Switzerland
| | - Tobias Huebner
- Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Stefan Arndt
- Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Thomas A Neff
- Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
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Morton LM, Phillips TJ. Wound healing and treating wounds. J Am Acad Dermatol 2016; 74:589-605; quiz 605-6. [DOI: 10.1016/j.jaad.2015.08.068] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/03/2015] [Accepted: 08/14/2015] [Indexed: 11/26/2022]
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Lyon C, Boules E, Green J. Hypertension; an under-recognized cause of painful leg ulceration in the UK. Clin Exp Dermatol 2014; 40:447-9. [PMID: 25475161 DOI: 10.1111/ced.12525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C Lyon
- Department of Dermatology, York Teaching Hospitals Foundation Trust, York, North Yorkshire, YO31 8HE, UK.
| | - E Boules
- Department of Dermatology, York Teaching Hospitals Foundation Trust, York, North Yorkshire, YO31 8HE, UK
| | - J Green
- Department of Dermatology, York Teaching Hospitals Foundation Trust, York, North Yorkshire, YO31 8HE, UK
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