Pretibial pruritic papular dermatitis (PPPD) is a clinical entity first described in 2006. The etiology is uncertain; however, gentle chronic rubbing is likely to be the reason for the skin reaction. ...Pretibial pruritic lesions may reflect many different systemic diseases and dermatoses. We present a 61-year-old patient with a 2-year history of pruritic pretibial xerosis, keratotic erythematous to brownish papules, and excoriations. Differential diagnosis excluded papular mucinosis, myxoedema, stasis dermatitis, lichen simplex chronicus, prurigo nodularis, lichen amyloidosis, and lichen planus. Regarding clinical-histological correlation, we confirmed a diagnosis of PPPD. Keywords: pretibial dermatitis, pruritus, rubbing
The study was designed as observational retrospective analysis of the data from Slovenian Registry of patients with moderate and severe psoriasis treated with adalimumab, etanercept, infliximab or ...ustekinumab from 2005 to 2015. The survival rates of biologics were compared using survival analysis, and predictors of discontinuation were evaluated using a Cox regression model. All biologics have been prescribed as a first line therapy for moderate or severe psoriasis; 650 (94.9%) adalimumab, 254 (72.0%) ustekinumab, 76 (69.7%) infliximab, 68 (67.3%) etanercept. The overall biologics survival rate was 83.2% in the first line and 79.1% in the second line treatment. Drug survival for the first and second line of therapy was significantly longer for ustekinumab than for anti-TNFα agents (p < 0.001 and p = 0.014, respectively). Loss of efficacy accounted for 63% of all treatment discontinuations. Multivariate regression analysis showed that younger patients, being on etanercept, systemic conventional co-therapy, lower BSA and higher DLQI were independent predictors for treatment discontinuation. Our data showed the real-life situation in the treatment of moderate to severe psoriasis with biologics. Since longevity of drug survival is considered as a measure of treatment success, this data represents an important information when selecting a biologic treatment for individual patient.
ABSTRACT
A lack of reproducible and practical methods to assess venous leg ulcer healing is a major problem encountered by investigators evaluating various treatments. We aimed to compare a new ...laser‐based three‐dimensional (3D) measuring device with computer planimetry with photography for the assessment of venous leg ulcers, and to estimate the reliability of measurements by the methods. Sixty measurements of perimeter and area of 15 venous leg ulcers, <10 cm in diameter (eight patients; six females; mean age 71 years; range 52–90 years), were made with both methods. Two independent investigators performed the measurements at the first visit and 2–4 weeks later. The precision and accuracy of the methods were determined and compared. The accuracies for computer planimetry with photography in comparison with the laser‐based 3D measuring method were 8.4% for perimeter and 16.0% for area measurements. The precisions of ulcer area and perimeter measurements did not differ significantly between the two methods (p=0.993 and 0.201, respectively). The main advantage of the laser‐based measuring method is the 3D ulcer measurement with a precision of 7.5%, which also takes into account distortions created by the limb convexity. The system is accurate, inexpensive, user‐friendly, and appropriate for everyday practice.
Priporočila za obravnavo bolnikov z limfedemom Planinšek Ručigaj, Tanja; Kozak, Matija; Slana, Ana ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
09/2018, Letnik:
87, Številka:
7-8
Journal Article
Recenzirano
Odprti dostop
V prispevku so predstavljena priporočila za obravnavo bolnikov z limfedemom. Prikazana je klinična slika, diagnosticiranje in različni načini obravnave.
ABSTRACT
There is a need for practical methods to predict the healing time of venous leg ulcers. In a prospective cohort study of 81 patients with venous leg ulcers, we used a recently described ...laser‐based three‐dimensional measurement of the ulcers at days 0 and 28 to estimate the predictive power of horizontal (HIHR) and vertical initial healing rates (VIHR) for wound healing by week 24. The rates were calculated by Gilman's equation (A1−A2)/((p1+p2)/2)(0–4) and by its modification (V1−V2)/((A1+A2)/2)(0–4), respectively. The influence of risk factors on both the initial healing rates was also studied. The HIHR and VIHR are important predictors of healing at 24 weeks. They are not influenced by age, ulcer duration, initial ulcer area, and insufficient sapheno‐femoral junction, and/or calf perforating veins. Together with ulcer duration, they are independent predictors of the 24‐week healing (the area under ROC curve equals to 0.9). VIHR gives us additional information and significantly improves the prediction of 24‐week healing.
Chronic venous ulcers affect 1% of the adult population and are associated with a marked reduction in quality of life, especially if healing is prolonged. Several matrix metalloproteinases (MMPs) ...appear to be involved in the pathophysiology of chronic venous ulcer healing, but their exact role is still unclear. Cyclooxygenase‐2 (COX‐2) is an important enzyme in prostanoid synthesis, induced during inflammation in chronic venous ulcer. The first aim of our study was to compare the expression of MMP‐1, MMP‐2, and COX‐2 in wound tissue to that in normal skin. The second aim was to observe the expression of the above factors in 29 chronic venous ulcers in 22 patients at the beginning and 4 weeks later in relation to healing rates and final healing outcome after 24 weeks. The enrolled population was divided into two groups, healed and non‐healed wounds after 24 weeks. The intensity of expression of MMP‐1, MMP‐2 and COX‐2 was assessed for each ulcer in paired wound biopsy samples and wound size measurements using laser triangulation at the beginning and after 4 weeks of observation. Initial healing rates in the first 4 weeks were calculated and proved to be an important predictive factor of healing in 24 weeks. Decreases in MMP‐1 and MMP‐2 after 4 weeks of observation were distinct, positive predictors for ulcer healing. Healing odds were 3.7 times higher for a decrease in MMP‐1 and 2.1 times higher for a decrease in MMP‐2 compared to the healing odds for a non‐decrease in MMP‐1 and MMP‐2. In conclusion, a decrease in MMP‐1 and MMP‐2, but not COX‐2, in wound biopsy samples after 4 weeks of observation can predict better healing of chronic venous ulcer.
Skin barrier function around the ulcer is usually impaired. Additionally, the skin can be atrophic, thinned, without skin adnexa and elastic fibers, dry and prone to callus formation. Skin barrier ...function can be improved with regular use of emollients. It is important to differentiate erythema around the ulcer induced by hypostatic eczema from cellulitis or erysipelas and from allergic or toxic contact dermatitis or eczema vulgaris because therapy is completely different.
There are many causes of leg ulcer development; however, vascular etiology is most commonly involved. Venous or lymphatic causes underlay 80% and arterial or arteriovenous causes 20%-25% of cases. ...Over years, the prevalence of arteriovenous ulcers has increased due to the increased prevalence of peripheral arterial disease. Concerning metabolic reasons, diabetes is the most common underlying disease leading to ulcer formation, whereas calciphylaxis is a very rare one. In addition to the general principles of local ulcer therapy, additional therapy treating the cause of ulcer is necessary. Therapy of leg ulcers is manly interdisciplinary and should include a dermatologist, surgeon, internal medicine specialist, radiologist, general practitioner.
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