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Conde-Montero E, Dissemond J, Protz K. Compression Therapy in Dermatology. Actas Dermosifiliogr 2024:S0001-7310(24)00156-X. [PMID: 38382747 DOI: 10.1016/j.ad.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
The benefit of lower limb compression therapy is not limited to chronic venous insufficiency or/and lymphoedema. Thanks to its anti-edema and anti-inflammatory effects, compression therapy is considered a beneficial adjuvant therapy to treat atypical wounds, inflammatory dermatoses, cellulitis, and traumatic wounds in the absence of contraindications. Strict contraindications are limited to severe peripheral arterial disease and decompensated heart failure. The variability of commercially available compression materials and systems, such as short-stretch bandages, multi-component systems, zinc oxide bandages, medical adaptive compression systems, ulcer compression stockings or medical compression stockings, facilitates the adaptation of compression therapy to the individual needs of each patient. Compared to venous leg ulcers, low pressures of 20mmHg are often sufficient to treat dermatological disorders, with higher patient tolerance and compliance.
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Affiliation(s)
- E Conde-Montero
- Servicio de Dermatología. Hospital Universitario Infanta Leonor y Virgen de la Torre, Madrid.
| | - J Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
| | - K Protz
- Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Erfurt-Berge C, Bültemann A, Gerber V, Motzkus M, Rembe JD, Dissemond J. [Importance of biopsy in the diagnostic assessment of chronic wounds-position paper of the Initiative Chronische Wunden (ICW) e. V.]. Dermatologie (Heidelb) 2024; 75:163-169. [PMID: 38038746 PMCID: PMC10824797 DOI: 10.1007/s00105-023-05259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic assessment of chronic wounds is essential for the initiation of causal therapeutic treatment. For diagnostic classification of the wound genesis, it may be necessary to take a tissue sample for histological and/or microbiological processing. If there is clinical suspicion of a specific cause of the wound such as a neoplasm, an inflammatory dermatosis or a pathogen-induced wound, a tissue sample for further diagnosis is required immediately. If the ulceration does not respond sufficiently to adequate causal therapy, a tissue sample for further evaluation is recommended after 12 weeks. The choice of the correct sampling technique, further storage, transport and processing are just as decisive for a reliable result as the specific question for the diagnostic laboratory.
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Affiliation(s)
- C Erfurt-Berge
- Hautklinik, Uniklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - A Bültemann
- Klinik für Gefäß- und Viszeralchirurgie, Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - V Gerber
- Initiative Chronische Wunden (ICW) e. V., Quedlinburg, Deutschland
| | - M Motzkus
- ZentralesWundmanagement, Evangelisches Krankenhaus Mülheim, Mülheim/Ruhr, Deutschland
| | - J-D Rembe
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Deutschland
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Dissemond J, Bültemann A, Gerber V, Motzkus M, Rembe JD, Erfurt-Berge C. [The term mixed leg ulcer should no longer be used today]. Dermatologie (Heidelb) 2023:10.1007/s00105-023-05129-2. [PMID: 36917222 DOI: 10.1007/s00105-023-05129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
A wound on the lower legs of patients with chronic venous insufficiency (CVI) and peripheral arterial disease (PAD) is today usually referred to as a mixed leg ulcer. This does not take into account the different stages of the diseases and, thus, their pathophysiological relevance. In everyday clinical practice, this often leads, among other things, to these patients not receiving compression therapy. The multidisciplinary professional association Initiative Chronische Wunden (ICW) e. V., therefore, recommends that this undifferentiated and misleading term should no longer be used. Instead, a leg ulcer with advanced CVI and concomitant PAD in stage I-IIb according to Fontaine or Rutherford category 0-3 should be classified as a venous leg ulcer, while a leg ulcer with advanced PAD in stage III or IV according to Fontaine or Rutherford category 4-6 and advanced CVI is termed an arteriovenous leg ulcer. A leg ulcer in advanced PAD stage IV according to Fontaine or Rutherford category 5 or 6 without advanced CVI is called an arterial leg ulcer. Other relevant comorbidities with an influence on wound healing should also be described separately.
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Affiliation(s)
| | | | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Deutschland.
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Stürmer EK, Dissemond J. Evidenz in der lokalen Therapie chronischer Wunden: Was ist gesichert? Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1469-7828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungChronische Wunden sind ein komplexes Symptom verschiedener Grunderkrankungen. Sie können bspw. vaskulärer, metabolischer oder immunologischer Genese sein. Auch wenn die Therapie dieser Grunderkrankungen im Vordergrund steht und zielführend ist, so beeinflussen diese Wunden die Lebensqualität der einzelnen Patienten oder Patientinnen stark. Zur Lokaltherapie chronischer Wunden steht ein breites Portfolio an Möglichkeiten zur Verfügung. Anders als in anderen Bereichen der Medizin ist die Evidenz für die verschiedenen Lokaltherapeutika meist gering. Deshalb rücken Experten-Empfehlungen und Leitlinien an ihre Stelle, die sinnvolle Behandlungspfade aufzeigen. Die wichtigsten Fragestellungen in der täglichen Praxis betreffen die Wahl und Effektivität der Wundspülung und des Wunddebridements, das Exsudatmanagement, den Einsatz von antimikrobiellen Wirkstoffen in Lösungen und Wundauflagen, die Unterdruck-Wundtherapie (NPWT) und die Indikationsstellung zur Kompressionstherapie. Trotz des Mangels an Evidenz folgt die Behandlung chronischer Wunde einigen grundlegenden Prinzipien, die im folgenden Artikel inklusive der dazugehörigen Behandlungsempfehlungen dargestellt werden.
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Affiliation(s)
- E. K. Stürmer
- Universitätsklinikum Hamburg-Eppendorf, Universitäres Herz- und Gefäßzentrum, Klinik und Poliklinik für Gefäßmedizin, Hamburg
| | - J. Dissemond
- Universitätsklinikum Hamburg-Eppendorf, Universitäres Herz- und Gefäßzentrum, Klinik und Poliklinik für Gefäßmedizin, Hamburg
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Abstract
In many medical expert recommendations and guidelines, the use of compression therapy for acute erysipelas is designated as a contraindication. Due to the sometimes massive oedema, compression therapy is nevertheless used in some clinics. This led to the question whether compression therapy for erysipelas of the lower leg actually leads to complications due to the acute infection and thus represents a contraindication. For the period 01 January 2018 to 30 June 2019, the records of 56 inpatients with acute erysipelas of the lower leg who received compression therapy in addition to systemic antibiotic therapy were retrospectively evaluated. The duration of inpatient treatment, the infection parameters determined as part of the ward routine and any complications that occurred were evaluated. While treated as inpatients the blood parameters for infection clearly dropped. Compression therapy was started on admission day in 92.9% of patients and continued until discharge. None of the patients showed an increase in fever or clinical signs of sepsis during the hospital stay. In this retrospective analysis it could be shown for the first time that compression therapy does not cause a clinical worsening or trigger a septic clinical picture in patients with acute erysipelas. Therefore, the authors consider the declaration of acute erysipelas as contraindication for compression therapy as not justified.
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Affiliation(s)
- S Eder
- Klinik für Gefäßchirurgie und Gefäßmedizin, Schwarzwald-Baar Klinikum, Klinikstr. 11, 78221, Villingen-Schwenningen, Deutschland.
| | - M Stücker
- Universitätsklinik Bochum, Venenzentrum, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland
| | - S Läuchli
- Dermatologische Klinik, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz
| | - J Dissemond
- Klinik für Dermatologie, Venerologie, Allergologie, Universitätsklinik Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Affiliation(s)
- S Emmert
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland.
| | - H Stege
- Klinik für Dermatologie, Klinikum Lippe GmbH, Röntgenstr. 18, 32756, Detmold, Deutschland.
| | - J Dissemond
- Klinik für Dermatologie, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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Albrecht LJ, Moelleken M, Dissemond J. Disseminated herpes zoster infection 16 months after last intake of alemtuzumab: potential long-term adverse effects. Clin Exp Dermatol 2020; 46:550-552. [PMID: 32810347 DOI: 10.1111/ced.14426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
- L J Albrecht
- Department of Dermatology, Venerology and Allergology, University of Essen, Germany
| | - M Moelleken
- Department of Dermatology, Venerology and Allergology, University of Essen, Germany
| | - J Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Germany
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Abstract
BACKGROUND Pressure ulcers comprise serious skin and tissue damage. The correct diagnosis and classification into different categories is often difficult in daily practice. QUESTION What procedure can be recommended to correctly diagnose and classify pressure ulcers in practice? MATERIALS AND METHODS The society Initiative Chronische Wunden (ICW) e. V. established a group of experts who developed practical recommendations for the diagnosis and classification of pressure ulcers based on the current literature and their own expertise. RESULTS Pressure ulcers should only be diagnosed if skin and/or tissue damage is most likely due to prolonged pressure or pressure associated with shear forces. A complete anamnesis must be performed to detect periods of previous prolonged immobility. Pressure ulcers are usually located at typical predilection sites. For category I and "suspected deep tissue damage" the tissue damage occurs under (initially) intact skin. However, the diagnosis is uncertain and the classification should be made later. The category II pressure ulcer is usually an exclusion diagnosis. The categories III and IV are pressure ulcers in the proper sense. As long as the distinction between category III and IV is not possible, the lower category should be coded. CONCLUSIONS Currently, a relevant classification should be used uniformly for the respective setting. In accordance with the clinical picture, a most suitable diagnosis is to be made. It does not matter which classification system is used. The future WHO ICD-11 version will allow better classification of pressure ulcers.
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Affiliation(s)
- J Kottner
- Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - K Kröger
- Klinik für Angiologie, HELIOS Klinikum Krefeld GmbH, Krefeld, Deutschland
| | - V Gerber
- Initative Chronische Wunden e. V., Quedlinburg, Deutschland
| | - G Schröder
- Akademie für Wundversorgung, Göttingen, Deutschland
| | - J Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - A Bültemann
- Wundcentrum/Gefäßchirurgie, Askelpios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland
| | - V Gerber
- Schulung und Beratung im Wundmanagement, Anne-Frank-Str. 10, 48480, Spelle, Deutschland
| | - B Jäger
- Nds. Justizvollzugskrankenhaus Lingen, Kaiserstraße 5, 49809, Lingen, Deutschland
| | - C Münter
- Gemeinschaftspraxis Bramfeld, Bramfelder Chaussee 200, 22177, Hamburg, Deutschland
| | - K Kröger
- Klinik für Gefäßmedizin, Angiologie, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland
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Jockenhöfer F, Wollina U, Salva K, Benson S, Dissemond J. The PARACELSUS score: a diagnostic tool for pyoderma gangrenosum. Br J Dermatol 2019. [DOI: 10.1111/bjd.17551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jockenh€ofer F, Wollina U, Salva K, Benson S, Dissemond J. PARACELSUS 评分:坏疽性脓皮病的一个诊断工具. Br J Dermatol 2019. [DOI: 10.1111/bjd.17567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dissemond J. Zertifikat „Wundmanagement“ der DDA. Akt Dermatol 2018. [DOI: 10.1055/a-0711-9348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
ZusammenfassungIn Deutschland leiden aktuell mindestens eine Million Menschen an einer chronischen Wunde unterschiedlichster Genese. Das zentrale Ziel der immer komplexer werdenden Wundtherapie ist es, die physiologischen Prozesse der zuvor gestörten Wundheilung zu unterstützen. Dies kann nur dann gelingen, wenn die Ursachen der Wundheilungsstörungen korrekt diagnostiziert und, wenn möglich, auch therapiert werden. Aus diesem Grund wurde 2008 auf Anregung der DDA ein entsprechendes Curriculum durch eine Expertengruppe der Arbeitsgemeinschaft Wundheilung (AGW) der DDG erstellt. Der Gesamtumfang der Weiterbildung umfasst 16 Stunden, aufgeteilt in zwei Fortbildungseinheiten à 8 Stunden. Der Teil 1 hat den Schwerpunkt „Genese und Diagnostik“, der Teil 2 „Therapie“. Für den Erwerb des Zertikats „Wundmanagement“ der DDA ist es notwendig, Facharzt für Dermatologie und Venerologie zu sein und zusätzlich beide Kurse absolviert zu haben.
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Affiliation(s)
- J. Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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Dissemond J. In the future, ‘new’ categories in the evaluation of pressure ulcers should be considered. J Eur Acad Dermatol Venereol 2018; 32:1406-1407. [DOI: 10.1111/jdv.15196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Dissemond
- Department of Dermatology, Venerology and Allergology; University School of Medicine Essen-Duisburg; Essen Germany
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Affiliation(s)
- J. Dissemond
- Department of Dermatology, Venereology and Allergology; University Hospital of Essen; Hufelandstraße 55 45122 Essen Germany
| | - K. Salva
- Department of Dermatology, Venereology and Allergology; University Hospital of Essen; Hufelandstraße 55 45122 Essen Germany
| | - K. Kröger
- Department for Vascular Medicine, Angiology; HELIOS Klinikum Krefeld GmbH; Krefeld Germany
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Sondermann W, Leister L, Rompoti N, Dissemond J, Klode J, Körber A. [Insufficient tetanus vaccination protection in psoriasis and systemic immunosuppression : Results of a retrospective investigation of 101 patients]. Hautarzt 2018; 69:922-927. [PMID: 29845363 DOI: 10.1007/s00105-018-4200-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND With a prevalence of approximately 3 % worldwide, psoriasis is one of the most frequent chronic inflammatory skin diseases. Patients with moderate to severe psoriasis are treated guideline-conform with immunomodulatory or immunosuppressive agents. According to current guidelines physicians should be vigilant about the vaccination status of immunosuppressed patients. OBJECTIVE The aim of the study was to serologically objectify the tetanus vaccination status in systemically treated patients with moderate to severe psoriasis in Germany. MATERIAL AND METHODS Within the context of this retrospective study the concentration of immunoglobulin G antibodies against Clostridium tetani was determined in 101 patients with systemic immunosuppression suffering from psoriasis. RESULTS In a total of 27.7% (n = 28; 11 male, 17 female) of the patients, insufficient immunoglobulin G antibody concentrations were detected, corresponding to a higher risk of an infection with C. tetani. Group subanalyses indicated an insufficient tetanus protection especially in patients ≥65 years old (50%). CONCLUSION The tetanus immune status of psoriasis patients was shown to be comparable with the general population. The results of our investigation underline that people suffering from psoriasis have to be tested for tetanus protection and if necessary, vaccinations have to be renewed.
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Affiliation(s)
- W Sondermann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - L Leister
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - N Rompoti
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Klode
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - A Körber
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Jockenhöfer F, Wollina U, Salva KA, Benson S, Dissemond J. The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum. Br J Dermatol 2018; 180:615-620. [PMID: 29388188 DOI: 10.1111/bjd.16401] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The lack of objective diagnostic criteria renders pyoderma gangrenosum (PG) a diagnosis of exclusion. The diagnostic approaches proposed to date have not been systematically evaluated. Thus, PG remains a challenging and frequently misdiagnosed disorder. OBJECTIVES To develop and assess a comprehensive, yet clinically practicable, sensitive diagnostic scoring system for PG. METHODS Clinical history and images of a total of 60 participants with previously confirmed PG located on the lower extremity and a control cohort of 50 patients with venous leg ulcers were retrospectively evaluated by expert teams at two tertiary dermatological centres specializing in wound care using a newly developed diagnostic scoring system composed of 10 criteria. RESULTS The three major diagnostic criteria are rapidly progressing disease, assessment of relevant differential diagnoses and a reddish-violaceous wound border (prevalent in 98% of patients with PG). Minor criteria (evident in 61-95% of patients with PG) include amelioration by immunosuppressant drugs, characteristically irregular shape of ulceration, extreme pain > 4/10 on a visual analogue scale and localization of lesion at the site of the trauma. Three additional criteria (observed in up to 60% of patients with PG) encompass suppurative inflammation in histopathology, undermined wound borders and systemic disease associated. A total score value of 10 points or higher indicates a high likelihood of PG and differentiates PG from venous leg ulcers. The initial letters of the above-listed criteria form the acronym PARACELSUS. CONCLUSIONS The PARACELSUS score represents a novel, easily implementable, effective and sensitive diagnostic tool for PG.
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Affiliation(s)
- F Jockenhöfer
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Germany
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Germany
| | - K A Salva
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Germany
| | - S Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital of Essen, Germany
| | - J Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Germany
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Körber A, Jockenhöfer F, Sondermann W, Stoffels-Weindorf M, Dissemond J. [First manifestation of leg ulcers : Analysis of data from 1000 patients]. Hautarzt 2018; 68:483-491. [PMID: 28280910 DOI: 10.1007/s00105-017-3950-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than 1 million people in Germany suffer from leg ulcers. The diagnosis leg ulcer summarizes many different etiologies. The therapy of leg ulcers is an interdisciplinary and interprofessional challenge. Early identification of the cause of the leg ulcer and initiation of a causal therapy are essential for healing. OBJECTIVES The aim of this study was to investigate the initial manifestation age of patients with causally associated leg ulcers. Afterwards we calculated the most common etiologies according to decade. PATIENTS AND METHODS A prospective database at the University Hospital Essen, dermatological wound care center, was used to identify patients with chronic leg ulcers between 2002 and 2014. Clinical data of 1000 patients with chronic leg ulcers were analyzed in this monocentric study. RESULTS A total of 29 different etiologies were differentiated. Approximately 70% of etiologies were of vascular origin, while 30% were rare causes. The count of different etiologies showed significant differences related to the onset and the occurrence in individual decades of life. In particular, nonvascular etiologies such as pyoderma gangrenosum or necrobiosis lipoidica are relatively more common in younger patients than in the aged. CONCLUSION Based on the findings of our study, it is possible to limit the underlying etiology on the basis of the age of first manifestation of the leg ulcer in order to make targeted diagnostics more effective. Thus, this information can help to optimize scarce time resources in daily practice and improve the prediction probability of leg ulcers.
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Affiliation(s)
- A Körber
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - F Jockenhöfer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - W Sondermann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - M Stoffels-Weindorf
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Affiliation(s)
- J M Placke
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
| | - M Moelleken
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
| | - J Dissemond
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
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Affiliation(s)
- J M Placke
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - M Moelleken
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - K A Salva
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - J Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
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Abstract
SummaryChronic leg ulcer may have various causes, which are currently not centrally recorded in Germany. It is also unclear who treats patients with chronic leg ulcers in Germany and how the basic implementation of diagnosis and treatment of these patients looks like. Patients, methods: Therefore, we started a survey of 1000 general practitioners and practising specialists in dermatology, surgery and phlebology in five different regions of Germany. We carried out the genesis of a total of 6275 patients from 62 different practising therapists, 33 specialists in dermatology, surgery or phlebology and 29 general practitioners. Results: In 66.1% of all patients we found a venous leg ulcer, in 9.1% a leg ulcer from peripheral arterial occlusive disease, and in 8.5% a mixture of both. Thus there suffered a total of 83.8% of patients on chronic venous insufficiency or peripheral arterial occlusive disease as a major factor in the genesis of the chronic leg ulcer. However, even the rarely diagnosed entities such as exogenous factors, vasculitis, pyoderma gangrenosum or infectious diseases are occur in summation in 16.2% of all patients and should therefore be known and excluded. In addition, the treatment periods and referral routes of patients with chronic leg ulcer should be identified. The analysis showed that the vast majority (86.8%) of patients with chronic ulcers who were investigated by us is treated by specialists. The treatment duration of general practitioners is 6.3 weeks (mean value) before the patient will be referred to a specialist. This treatment period is significantly shorter compared to the treatment period of the specialists, who treat their patients 14.1 weeks (mean value) before the patient will be referred to another specialist or to a clinic. Conclusion: Our results show the current aspects of aetiology and the way of treatment of patients with chronic leg ulcers in Germany.
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Wirtz M, Dissemond J. Graublaue Flecken am Körper eines Säuglings. Hautarzt 2018; 69:86-87. [DOI: 10.1007/s00105-017-4041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
ZusammenfassungHintergrund: Die konsequente Durchführung einer Kompressionstherapie stellt eine we-sentliche Säule der Behandlung bei Patienten mit Ulcus cruris venosum dar. Neben konventionellen Kurzzugbandagen sind aktuell Mehrkomponenten-Kompressionssysteme mit visuellen Kompressionsindikatoren entwickelt worden. Ziel unserer Untersuchung war es daher, den tatsächlich erzielten Ruhedruck, der mit den verschiedenen Verbandsystemen erzielt werden kann, in verschiedenen Anwenderkollektiven zu objektivieren.Methode: Die Anwendergruppen bestanden aus jeweils 5 Krankenschwestern, Ärzten und Laien. Jeder Proband musste jeweils dreimal sowohl einen Pütter-Verband als auch zwei Mehrkomponenten-Kompressionssysteme mit visuellen Kompressionsindikatoren anle-gen.Ergebnisse: Unsere Ergebnisse zeigen eine enorme individuelle Spannbreite der gemessenen Druckwerte bei Pütter-Verbänden zwischen 15–106 mmHg, während die maximalen Druckunterschiede der Binden mit visuellen Kompressionsindikatoren bei 20–81 mmHg la-gen. Die Unterschiede waren insbesondere bei den Laien am ausgeprägtesten.Schlussfolgerung: Unsere Ergebnisse zeigen, dass Kompressionsverbände mit visuellen Kompressionsindikatoren auch von weniger gut geschulten Menschen zuverlässiger in Hinblick auf den erzielten Ruhedruck angelegt werden können.
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Abstract
ZusammenfassungEs wird geschätzt, dass in Deutschland etwa 1% der erwachsenen Bevölkerung an einem Ulcus cruris unterschiedlichster Genese leidet. Auch wenn die chronische venöse Insuffizienz und die periphere arterielle Verschlusskrankheit bei etwa 80% aller Patienten mit einem Ulcus cruris pathophysiologisch relevant sind, so ist doch die Kenntnis der relevanten Differenzialdiagnosen insbesondere bei therapierefraktären Verläufen von entscheidender Be-deutung. Es existieren neben Vasculitiden auch neuropathische, metabolische, hämatologische und exogene Faktoren sowie Neoplasien, Infektionen, Medikamente, genetische Defekte und primäre Dermatosen, die ein Ulcus cruris verursachen können. Bei vielen Pa-tienten können es auch multiple Faktoren sein, die zu einem Ulcus cruris führen bzw. dessen Abheilung trotz scheinbar adäquater Behandlung verhindern. Als relevante Ko-Faktoren können hier beispielsweise Adipositas, Diabetes mellitus, Ekzeme, (Lymph-)Ödeme oder arterielle Hypertonie eine bedeutende Rolle spielen.Für eine dauerhaft erfolgreiche Behandlung der Patienten mit einem Ulcus cruris ist es so-mit von entscheidender Bedeutung alle relevanten Faktoren der Pathogenese zu diagnostizieren, um eine kausal ansetzende, dauerhaft erfolgreiche Therapie zu gewährleis-ten.
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Abstract
ZusammenfassungAnamnese, Befund: Wir berichten über einen 50-jährigen Patienten, der sich mit einem seit ca. 5 Wochen bestehenden Ulcus cruris im Bereich des linken Malleolus medialis vorstellte. In der Umgebung des Ulcus zeigte sich ein ausgeprägtes Ekzem. Anamnestisch hatte der Patient seit mehreren Wochen aufgrund diskreter Gelenkschmerzen täglich mehrfach Voltaren®-Emulgel im Bereich des Innenknöchels aufgetragen. Untersuchungen, Diagnose: Weder die serologischen, apparativen noch die dermatohistopathologischen Untersuchungen ergaben spezifische Pathologica. In der Epikutantestung konnte eine relevante Typ-IV-Sensibilisierung auf Voltaren-Emulgel nachgewiesen werden, so dass wir die Diagnose eines exulzerierten allergischen Kontaktekzems stellten. Therapie, Verlauf: Unter Allergenkarenz und einer topischen Therapie mit Glukokortikoiden und nachfolgender Wundgrundkonditionierung kam es innerhalb von 4 Wochen zu einer vollständigen Abheilung des Ulkus. Schlussfolgerung: Der Fallbericht verdeutlicht, dass ein allergisches Kontaktekzem nicht nur in der Folge eines Ulcus cruris und dessen topischer Therapie auftritt, sondern auch einen ätiologisch relevanten Faktor darstellen kann, der bisher nicht beschrieben wurde.
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Dissemond J, Bültemann A, Gerber V, Jäger B, Kröger K, Münter C. Diagnosis and treatment of chronic wounds: current standards of Germany's Initiative for Chronic Wounds e. V. J Wound Care 2017; 26:727-732. [DOI: 10.12968/jowc.2017.26.12.727] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Dissemond
- Professor for Dermatology and Venerology, Department of Dermatology, Venerology and Allergology, University of Essen, Hufelnadstr. 55, 45147 Essen, Germany
| | - A. Bültemann
- Nurse, Askelpios Hospital Harburg, Wound care centrum in the Department of Vascular Sugery, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
| | - V. Gerber
- Nurse, Education in Wound Management, Anne-Frank-Str. 10, 48480 Spelle, Germany
| | - B. Jäger
- Nurse, Hospital in Justizvollzugsanstalt Lingen, Kaiserstraße 5, 49809 Lingen, Germany
| | - K. Kröger
- Professor for Angiology, Department for Angiology, Helios clinic, Lutherplatz 40, 47805 Krefeld, Germany
| | - C. Münter
- Doctor (GP), Gemeinschaftspraxis Bramfeld, Bramfelder Chaussee 200, 22177 Hamburg, Germany
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Stoffels-Weindorf M, Stoffels I, Jockenhöfer F, Dissemond J. [Quality of self-applied compression bandages in patients with chronic venous ulcers : Results of a prospective clinical study]. Hautarzt 2017; 69:306-312. [PMID: 29184985 DOI: 10.1007/s00105-017-4086-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND For effective compression therapy in patients with venous leg ulcers, sufficient pressure is essential. In everyday life, it is often the patients themselves who apply the compression bandages. Many of these patients have restriction in their movement and had been rarely trained adequately. Hence, there was the question of how efficient are the autonomously applied compression bandages of those patients. PATIENTS AND METHODS In all, 100 consecutive patients with venous leg ulcer were asked to apply compression bandages on their own leg. We documented both the achieved compression and formal criteria of correct performance. RESULTS A total of 59 women and 41 men with an average age of 70.3 years were included in the study. Overall 43 patients were not able to apply a compression bandage because of physical limitations. The measured pressure values in the remaining 57 patients ranged between 6 and 93 mm Hg (mean 28.3 mm Hg). Eleven patients reached the prescribed effective compression pressure. Of these, formal errors were found in 6 patients, so that only 5 patients had correctly applied the compression bandages. CONCLUSION Our data show that most patients with venous leg ulcers are not able to apply effective compression therapy with short-stretch bandages to themselves. Multilayer systems, adaptive compression bandages, and ulcer stocking systems today are possibly easier and more effective therapy options. Alternatively short-stretch bandages could be applied by trained persons but only under the control with pressure measuring probes.
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Affiliation(s)
- M Stoffels-Weindorf
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - I Stoffels
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - F Jockenhöfer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Wirtz M, Stoffels I, Dissemond J, Schadendorf D, Roesch A. Actinic keratoses treated with cold atmospheric plasma. J Eur Acad Dermatol Venereol 2017; 32:e37-e39. [DOI: 10.1111/jdv.14465] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- M. Wirtz
- Department of Dermatology; University Hospital Essen; Hufelandstr. 55 45122 Essen Germany
- German Cancer Consortium (DKTK); Essen Germany
| | - I. Stoffels
- Department of Dermatology; University Hospital Essen; Hufelandstr. 55 45122 Essen Germany
- German Cancer Consortium (DKTK); Essen Germany
| | - J. Dissemond
- Department of Dermatology; University Hospital Essen; Hufelandstr. 55 45122 Essen Germany
- German Cancer Consortium (DKTK); Essen Germany
| | - D. Schadendorf
- Department of Dermatology; University Hospital Essen; Hufelandstr. 55 45122 Essen Germany
- German Cancer Consortium (DKTK); Essen Germany
| | - A. Roesch
- Department of Dermatology; University Hospital Essen; Hufelandstr. 55 45122 Essen Germany
- German Cancer Consortium (DKTK); Essen Germany
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Renner R, Dissemond J, Goerge T, Hoff N, Kröger K, Erfurt-Berge C. Analysis of the German DRG data for livedoid vasculopathy and calciphylaxis. J Eur Acad Dermatol Venereol 2017; 31:1884-1889. [DOI: 10.1111/jdv.14190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/09/2017] [Indexed: 12/11/2022]
Affiliation(s)
- R. Renner
- Department of Dermatology; Universitätsklinikum Erlangen; Erlangen Germany
| | - J. Dissemond
- Department of Dermatology; University Hospital Essen; Essen Germany
| | - T. Goerge
- Department of Dermatology; University Hospital Münster; Münster Germany
| | - N. Hoff
- Department of Dermatology; University of Düsseldorf; Düsseldorf Germany
| | - K. Kröger
- Department of Vascular Medicine, Angiology; HELIOS Medical Center Krefeld LLC; Krefeld Germany
| | - C. Erfurt-Berge
- Department of Dermatology; Universitätsklinikum Erlangen; Erlangen Germany
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Dissemond J, Protz K, Hug J, Reich-Schupke S, Kröger K. Kompressionstherapie des chronischen Ulcus cruris. Z Gerontol Geriatr 2017; 51:799-806. [DOI: 10.1007/s00391-017-1191-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/06/2017] [Accepted: 01/16/2017] [Indexed: 11/25/2022]
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Dissemond J, Eder S, Läuchli S, Partsch H, Stücker M, Vanscheidt W. [Compression therapy of venous leg ulcers in the decongestion phase]. Med Klin Intensivmed Notfmed 2017; 113:552-559. [PMID: 28078355 DOI: 10.1007/s00063-016-0254-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/23/2016] [Indexed: 11/25/2022]
Abstract
Compression therapy is the basis for successful treatment in most patients with venous leg ulcers. Concerning compression therapy, the initial phase of decongestion and the following phase of maintenance should be differentiated. While in the maintenance phase (ulcer) stocking systems are now frequently recommended, in the decongestion phase compression bandages are mostly still used, which however are often inappropriately applied. In German-speaking countries, compression therapy with short-stretch bandages has a long tradition. However, their correct application requires good training and monitoring, which is often lacking in daily practice. Less error-prone treatment alternatives are multicomponent systems, some of which have an optical marker for the control of the correct subbandage pressure. In another new type of compression system, which is called adaptive or wrap bandages, the compression pressure can be adjusted using a Velcro fastener. Accompanying intermittent pneumatic compression therapy can also be used in the decongestion phase. Thus, there are now several different treatment options that can be used for the decongestion phase in patients with venous leg ulcers. Often bandages with short-stretch materials are very prone to errors and should in most cases be replaced by other compression systems today. The patient's preference, need, and capability should be considered when selecting the appropriate system for the individual patient.
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - S Eder
- Klinik für Gefäßchirurgie und Gefäßmedizin, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Deutschland
| | - S Läuchli
- Dermatologische Klinik, UniversitätsSpital Zürich, Zürich, Schweiz
| | - H Partsch
- , Steinhäusl 126, 3033, Altlengbach, Österreich
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W Vanscheidt
- Hautarztpraxis, Paula-Modersohn-Platz 3, 79100, Freiburg, Deutschland
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Abstract
Compression therapy is well-tried treatment with only few side effects for most patients with leg ulcers and/or edema. Despite the very long tradition in German-speaking countries and good evidence for compression therapy in different indications, recent scientific findings indicate that the current situation in Germany is unsatisfactory. Today, compression therapy can be performed with very different materials and systems. In addition to the traditional bandaging with Unna Boot, short-stretch, long-stretch, or multicomponent bandage systems, medical compression ulcer stockings are available. Other very effective but far less common alternatives are velcro wrap systems. When planning compression therapy, it is also important to consider donning devices with the patient. In addition to compression therapy, intermittent pneumatic compression therapy can be used. Through these various treatment options, it is now possible to develop an individually accepted, geared to the needs of the patients, and functional therapy strategy for nearly all patients with leg ulcers.
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - K Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), CWC - Comprehensive Wound Center, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
| | | | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - K Kröger
- Klinik für Gefäßmedizin, Angiologie, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland
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Affiliation(s)
- A Körber
- Department of Dermatology, University School of Medicine Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - J Dissemond
- Department of Dermatology, University School of Medicine Essen, Hufelandstr. 55, 45122 Essen, Germany.
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Herberger K, Dissemond J, Hohaus K, Schaller J, Anastasiadou Z, Augustin M. Treatment of pyoderma gangrenosum: retrospective multicentre analysis of 121 patients. Br J Dermatol 2016; 175:1070-1072. [PMID: 27060666 DOI: 10.1111/bjd.14619] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- K Herberger
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Clinics of Hamburg-Eppendorf, Hamburg, Germany.
| | - J Dissemond
- Department of Dermatology, Venereology and Allergology, University of Essen, Essen, Germany
| | - K Hohaus
- Department of Dermatology, Venereology and Allergology, University of Essen, Essen, Germany
| | - J Schaller
- Department of Dermatology, Helios Clinics Duisburg, Duisburg, Germany
| | - Z Anastasiadou
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Clinics of Hamburg-Eppendorf, Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Clinics of Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU.
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Affiliation(s)
- K Kroeger
- Angiologie, HELIOS Kliniken Krefeld, Deutschland
| | - M Storck
- Gefäßzentrum Karlsruhe, Städt. Klinikum Karlsruhe, Deutschland
| | - P Kujath
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - E Rabe
- Klinik für Dermatologie, Universitätsklinik Bonn, Deutschland
| | - J Dissemond
- Klinik für Dermatologie, Universitätsklinik Essen, Deutschland
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Abstract
Patients with chronic wounds frequently acquire clinically relevant contact sensitization. We examined the results of the skin patch tests in patients with chronic wounds, who were treated between 1999-2004 in the Department of Dermatology, University School of Medicine, Essen, Germany. Altogether 105 patients with chronic wounds underwent patch testing. In 68 individuals, contact sensitization to at least one substance was detected. The most frequent contact allergens were to balsam of Peru, Amerchol L-101, fragrance mix, wool wax alcohols and rosins. Contact sensitization to wound dressing materials was also identified in 4 patients. Our results demonstrate the current spectrum of contact sensitization of patients with chronic wounds. Our results show the importance of paying attention to the ingredients in wound dressings and performing patch testing if there is any clinical suggestion of allergic contact dermatitis.
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Affiliation(s)
- M Lehnen
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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Petri M, Stoffels I, Jose J, Leyh J, Schulz A, Dissemond J, Schadendorf D, Klode J. Photoacoustic imaging of real-time oxygen changes in chronic leg ulcers after topical application of a haemoglobin spray: a pilot study. J Wound Care 2016; 25:87, 89-91. [DOI: 10.12968/jowc.2016.25.2.87] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- M. Petri
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Germany
| | - I. Stoffels
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Germany
| | - J. Jose
- FujiFilm VisualSonics Inc., Amsterdam, The Netherlands
| | - J. Leyh
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Germany
| | - A. Schulz
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Germany
| | - J. Dissemond
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Germany
| | - D. Schadendorf
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Germany
| | - J. Klode
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Germany
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41
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Petri M, Stoffels I, Leyh J, Schadendorf D, Dissemond J, Klode J. O2-Aufnahmekapazitätmessung chronischer Ulcera nach topischer Hämoglobinapplikation mittels photooptoakustischer Tomografie -Initiale Ergebnisse einer prospektiven Studie-. Akt Dermatol 2015. [DOI: 10.1055/s-0035-1558611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Goepel L, Herberger K, Debus S, Diener H, Tigges W, Dissemond J, Gerber V, Augustin M. [Wound networks in Germany: structure, functions and objectives 2014]. Hautarzt 2015; 65:960-6. [PMID: 25339384 DOI: 10.1007/s00105-014-3527-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wound networks are structured collaborations between various professions and medical disciplines in the field of treatment of patients with chronic wounds. In view of the complex chronic courses of such wounds with many relevant underlying diseases, comorbidities and a multitude of possible therapy options, the evidence-based structured treatment of patients with wound problems is of particular importance. However, this treatment is very heterogeneous and often uncoordinated. OBJECTIVE This article describes a stocktaking of the active regional wound networks in Germany with characterization of their structures, activities and objectives. METHODS A nationwide survey was carried out targeting wound specialists and wound societies as well as already established wound networks for which an updating was carried out. All identified networks were issued with a standardized questionnaire about the size of the network, extent of regional coverage, participating medical disciplines and professional groups and activities. In addition to the preformulated questions, free text information was also encouraged. RESULTS A total of 35 wound networks could be identified. The majority of networks consisted of representatives of hospitals as well as physicians in private practice and nursing personnel. The most frequently represented medical disciplines were vascular surgeons (74%), general physicians (63%), diabetologists (60%), general surgeons (60%) and dermatologists (57%). The most frequent activities were informal meetings on further education (77%), exchange of experiences and second opinions (both 71%) and consultation on patient treatment (69%). Selective contracts were only implemented in very few cases. CONCLUSION The wound networks established in Germany on self-initiatives represent strong interdisciplinary and interprofessional-oriented specialist platforms with a high potential for structured and efficient treatment. Incentives for systematic utilization of these structures in the course of improvements in quality and remuneration of treatment of patients with chronic wounds would be desirable.
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Affiliation(s)
- L Goepel
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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43
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Risse A, Dissemond J, Engels G, Glau S, Hochlenert D, Jecht M, Kersken J, Kramer A, Kröger K, Landgraf R, Lobmann R, May M, Mohrmann M, Morbach S, Pralle K, Reuter HM, Storck M, Tonn C, Trocha A, Wozniak G. Diabetisches-Fuß-Syndrom-Register. Diabetologe 2015. [DOI: 10.1007/s11428-014-1285-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- J. Dissemond
- Professor, Department for Dermatology, Venerology and Allergology, University School of Medicine, Essen, Germany
| | - K. Kröger
- Professor, Clinic Director, Department for Vascular Medicine, HELIOS Clinic, Krefeld, Germany
| | - M. Storck
- Professor Clinic Director, Department for Vascular and Thoracic Surgery, Municipal Hospital Karlsruhe, Academic Teaching Hospital Univ. Freiburg, Germany
| | - A. Risse
- Clinic-Center North, Center for Diabetes, Dortmund, Germany
| | - P. Engels
- EngelsConsult, Bergisch Gladbach, Germany
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Sondermann W, Dissemond J. Klinische Bedeutung von Bakterien beim chronischen Ulcus cruris. Akt Dermatol 2014. [DOI: 10.1055/s-0034-1377960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- W. Sondermann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - J. Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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Meaume S, Dissemond J, Addala A, Vanscheidt W, Stücker M, Goerge T, Perceau G, Chahim M, Wicks G, Perez J, Tacca O, Bohbot S. Evaluation of two fibrous wound dressings for the management of leg ulcers: results of a European randomised controlled trial (EARTH RCT). J Wound Care 2014; 23:105-6,108-11, 114-6. [PMID: 24633056 DOI: 10.12968/jowc.2014.23.3.105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the performance (efficacy, safety and acceptability) of a new micro-adherent absorbent dressing (UrgoClean®) compared with a hydrofiber dressing (Aquacel®) in the local management of venous leg ulcers, in the debridement stage. METHOD A non-inferiority European randomised controlled clinical trial (RCT) was conducted in 37 centres, on patients presenting with venous or predominantly venous, mixed aetiology leg ulcers at their sloughy stage (with more than 70% of the wound bed covered with slough at baseline). Patients were followed over a 6-week period and assessed weekly. The primary judgement criteria was the relative regression of the wound surface area after the 6-week treatment period. Secondary endpoints were the relative reduction of sloughy tissue and the percentage of patients presenting with a debrided wound. RESULTS Altogether, 159 patients were randomised to either UrgoClean (test group; n=83) or Aquacel (control group; n=76) dressings. Regarding the wound healing process predictive factors (wound area, duration, ABPI value, recurrence), at baseline, the two groups were well balanced, for both wound and patient characteristics. Compression therapy was administered to both groups and after a median 42-day treatment period, the percentage of relative reduction of the wound surface area was very similar (-36.9% vs -35.4% in the UrgoClean and control groups, respectively). When considering the secondary criteria at week 6, the relative reduction of sloughy tissue was significantly higher in the UrgoClean group than in the control group (-65.3% vs -42,6%; p=0.013). The percentage of debrided wounds was also significantly higher in the test group (52.5% vs 35.1%; p=0.033). CONCLUSION This 'EARTH' RCT confirmed that the UrgoClean dressing has similar efficacy and safety compared to Aquacel. However, UrgoClean also showed better autolytic properties than the control group in the management of venous leg ulcers at the sloughy stage. The new UrgoClean dressing therefore represents a promising therapeutic option within the current range of autolytic dressings available. DECLARATION OF INTEREST This study was sponsored by a grant from the pharmaceutical company Laboratoires Urgo. S. Bohbot and O. Tacca are employees of Laboratoires Urgo. S. Meaume, J. Dissemond and G. Perceau have received monetary compensation as presenters for Laboratoires Urgo. Data management and statistical analyses were conducted independently by Vertical (Paris, France).
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Affiliation(s)
- S Meaume
- MD, Geriatric Department, Rotschild Hospital, Paris, France
| | - J Dissemond
- MD, Department of Dermatology, Venereology and Allergology, University Hospital, Essen, Germany
| | - A Addala
- MD, Vascular Medicine Department, Edouard Herriot Hospital, Lyon, France
| | | | - M Stücker
- MD, Head, Vein Centre of the Department of Dermatology and Vascular Surgery. Ruhr University, Bochum, Germany
| | - T Goerge
- MD, Department of Dermatology, University Hospital, Münster, Germany
| | - G Perceau
- MD, Department of Dermatology, Robert Debré Hospital, Reims, France
| | - M Chahim
- MD, Department of Vascular Medicine, Corentin Celton Hospital, Issy les Moulineaux, France
| | - G Wicks
- RN, Leg Ulcer Clinic, Trowbridge Community Hospital, Trowbridge, UK 10 Geriatric Department, Orsay Hospital, Orsay, France
| | - J Perez
- MD, Geriatric Department, Orsay Hospital, Orsay, France
| | - O Tacca
- PhD, Clinical Study Manager, Laboratoires Urgo, Chenôve, France
| | - S Bohbot
- MD; Medical Director, Laboratoires Urgo, Chenôve, France
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Humbert P, Faivre B, Véran Y, Debure C, Truchetet F, Bécherel PA, Plantin P, Kerihuel JC, Eming SA, Dissemond J, Weyandt G, Kaspar D, Smola H, Zöllner P. Protease-modulating polyacrylate-based hydrogel stimulates wound bed preparation in venous leg ulcers--a randomized controlled trial. J Eur Acad Dermatol Venereol 2014; 28:1742-50. [PMID: 24612304 PMCID: PMC4263240 DOI: 10.1111/jdv.12400] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/14/2014] [Indexed: 01/10/2023]
Abstract
Background Stringent control of proteolytic activity represents a major therapeutic approach for wound-bed preparation. Objectives We tested whether a protease-modulating polyacrylate- (PA-) containing hydrogel resulted in a more efficient wound-bed preparation of venous leg ulcers when compared to an amorphous hydrogel without known protease-modulating properties. Methods Patients were randomized to the polyacrylate-based hydrogel (n = 34) or to an amorphous hydrogel (n = 41). Wound beds were evaluated by three blinded experts using photographs taken on days 0, 7 and 14. Results After 14 days of treatment there was an absolute decrease in fibrin and necrotic tissue of 37.6 ± 29.9 percentage points in the PA-based hydrogel group and by 16.8 ± 23.0 percentage points in the amorphous hydrogel group. The absolute increase in the proportion of ulcer area covered by granulation tissue was 36.0 ± 27.4 percentage points in the PA-based hydrogel group and 14.5 ± 22.0 percentage points in the control group. The differences between the groups were significant (decrease in fibrin and necrotic tissue P = 0.004 and increase in granulation tissue P = 0.0005, respectively). Conclusion In particular, long-standing wounds profited from the treatment with the PA-based hydrogel. These data suggest that PA-based hydrogel dressings can stimulate normalization of the wound environment, particularly in hard-to-heal ulcers.
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Affiliation(s)
- P Humbert
- Research and Studies Center on the Integument (CERT), Clinical Investigation Center (CIC BT506), Department of Dermatology, University Hospital, Besançon, France; INSERM UMR, University of Franche-Comté, Besançon, France
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Jockenhöfer F, Gollnick H, Herberger K, Isbary G, Renner R, Stücker M, Valesky E, Wollina U, Weichenthal M, Karrer S, Stoffels-Weindorf M, Dissemond J. W.A.R. scores in patients with chronic leg ulcers: Results of a multicentre study. J Wound Care 2014; 23:5-6, 8, 10-2. [DOI: 10.12968/jowc.2014.23.1.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F. Jockenhöfer
- Department of Dermatology, venereology and Allergology, University Hospital Essen, Germany
| | - H. Gollnick
- Department of Dermatology and venereology, University Hospital Magdeburg, Germany
| | | | - G. Isbary
- Department of Dermatology, Allergology and Environmental Medicine, University Hospital Munich-Schwabing, Germany
| | - R. Renner
- Department of Dermatology and venereology, University Hospital Erlangen, Germany
| | - M. Stücker
- vein Centre, St. Maria-Hilf Hospital, Ruhr University Bochum, Germany
| | - E. Valesky
- Department of Dermatology and venereology, University Hospital Frankfurt am Main, Germany
| | - U. Wollina
- Department of Dermatology, Hospital Dresden Friedrichstadt, Germany
| | - M. Weichenthal
- Department of Dermatology and venereology, University Hospital Kiel, Germany
| | - S. Karrer
- Department of Dermatology and venereology, University Hospital Regensburg, Germany
| | | | - J. Dissemond
- Department of Dermatology, venereology and Allergology, University Hospital Essen, Germany
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Becker A, Stoffels-Weindorf M, Schimming T, Dissemond J. [Recurrent leg ulcers due to livedoid vasculopathy: successful treatment with low-molecular-weight heparin]. Dtsch Med Wochenschr 2013; 138:1458-62. [PMID: 23821447 DOI: 10.1055/s-0033-1343293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 50-year-old women had suffered from recurrent and extremely painful ulcerations of both legs and the back of her feet for about 3 weeks. The clinical examination showed multiple hemorrhagic and bizarre configured ulcerations with a surrounding livid-erythematous discoloration, hyperpigmentation and extensive atrophie blanche. INVESTIGATIONS Neither instrument-based nor serological tests revealed specific pathological findings. Histological results from the border area of the ulceration confirmed the diagnosis of livedoid vasculopathy. TREATMENT AND COURSE A systemic treatment with low-molecular-weight heparin was initiated, resulting in a rapid pain reduction and complete healing of the ulcerations after some weeks of therapy. CONCLUSION This case report demonstrates that unusual entities like livedoid vasculopathy should be considered as rare causes for recurrent leg ulcers because different underlying etiologies need different specific treatment strategies. Until now treatment for patients with livedoid vasculopathy has not been standardized but anticoagulative therapy with low-molecular-weight heparin is considered to be one treatment of first choice.
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Affiliation(s)
- A Becker
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie der Universitätsklinik Essen, Germany
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