Oxandrolone for treatment of lipodermatosclerosis: case report

Scleroderma and scleroderma-like syndromes

Systemic sclerosis is a systemic connective tissue disease whose main pathophysiological mechanism is a progressive fibrosis of internal organs and skin leading to thickening and induration. Blood vessels may also be involved. However, systemic scleroderma is not the only disease causing cutaneous sclerosis. There is a group of diseases that mimic scleroderma in their clinical presentation - these are scleroderma-like syndromes. A distinction can be made between syndromes of inflammatory/autoimmune, genetic, metabolic, toxic, drug-induced, occupational, paraneoplastic and syndromes caused by deposition disorders. In the following paper, we have reviewed the literature on scleroderma-like syndromes. We have outlined the factors predisposing to the development of each disease, its pathogenesis, clinical presentation, diagnostic and treatment process and the differences between each syndrome and systemic scleroderma.

The effect of percutaneous drainage using tiny incisions on the inflammatory factors in chronic venous insufficiency combined with lipodermatosclerosis of the lower extremities

OBJECTIVE

To explore the efficacy of percutaneous drainage with tiny incisions in chronic venous insufficiency (CVI) combined with lipodystrophy syndrome (LDS) of the lower extremities and its effect on the inflammatory factors.

METHODS

Sixty patients with CVI and LDS hospitalized for surgical treatment in Jiading District Central Hospital were recruited as the study cohort and randomly divided into a control group and an experimental group. The control group (n = 30) underwent varicose vein stripping in the lower extremities, while the experimental group (n = 30) was additionally treated with percutaneous drainage with tiny incisions for LDS. The efficacy of the two treatments, the mRNA expressions of collagen type I alpha 1 chain 1 (COL1A1), the lower limb circumferences, the subcutaneous thicknesses, the transcutaneous partial pressure of oxygen (TcPO₂), the venous clinical severity scores (VCSS), the serum i TGF-β1, TNF-α, IL-2R, and IL-1β levels, the soluble intercellular adhesion molecule-1 (sICAM-1) levels, the soluble vascular cell adhesion molecule-1 (sVCAM-1) levels, and the quality of life scores (CIVIQ) were compared.

RESULTS

The total effective rate in the experimental group was 93.33% (28/30), which was higher than the rate of 73.33% (22/30) in the control group (P < 0.05). The experimental group exhibited shorter ankle circumferences and calf circumferences, smaller subcutaneous thicknesses, lower VCSS scores, lower sICAM-1, sVCAM-1, TGF-β1, TNF-α, IL-1β, IL-2R, and COL1A1 levels, and higher ABI and TcPO₂ levels, and higher CIVIQ scores than the control group at 6 months after the treatment (P < 0.05).

CONCLUSION

Percutaneous drainage with tiny incisions has a high efficacy for CVI with LDS, and it can relieve the condition, inhibit the expression of adhesion molecules as well as the inflammatory response, improve the microcirculation of the lower extremities, reduce COL1A1 expression, and improve the quality of life.

Comparative efficacy and safety of traditional Chinese medicine for lipodermatosclerosis: A protocol for systematic review and network meta-analysis

BACKGROUND

Lipodermatosclerosis (LDS) is a severe skin change accompanied by the development of chronic venous disease of the lower extremities. Its main clinical manifestations are erythema, induration, hyperpigmentation, and rough and thickened skin. It may also eventually lead to refractory ulcers, skin necrosis and even cancer. Conventional treatment methods mainly include the intake of oral anabolic hormones or androgen and pressure therapy. However, patients often refuse due to their drug resistance and intolerance. As a clinical irreplaceable treatment method for LDS, traditional Chinese medicine (TCM) has not been compared of the safety and effectiveness so far. Therefore, we cannot wait to use a method to compare the efficacy of TCM for LDS systematically, such as network meta-analysis (NMA).

METHODS

We will retrieve the relevant Chinese and English databases comprehensively. All the randomized controlled trials of TCM for LDS from January 2015 to September 2020 will be included. Under the guidance of inclusion criteria, 2 researchers will screen the literature, then assess the risk of bias and extract data. We will use Bayesian NMA to evaluate all available evidence in STATA 14.0 and WinBUGS software.

RESULTS

This study will use Bayesian NMA to evaluate the efficacy and safety of TCM for LDS.

CONCLUSION

This study provide a reliable theoretical basis for the clinical application of TCM in the treatment of LDS, and contribute to the formulation of treatment guidelines for LDS.