Dermatology's role in advancing the science of wound care

Cosmetic, medical and surgical dermatologists all play a role in the treatment and management of wounds, according to an editorial in the October issue of Archives of Dermatology, a theme issue on wound healing.

“Medical conditions as diverse as pemphigus vulgaris, primary syphilis, lupus erythematosus and sarcoidosis all either have or can have wounds as part of their initial presentation,” writes editorialist Robert S. Kirsner, M.D., Ph.D., of the University of Miami. “Dermatologists create more wounds through surgical procedures and biopsies than any other specialty. Often, wounds are treated with surgical procedures such as debridement or grafting. Finally, with regard to cosmetic dermatology, its goals and the goals of wound healing are often the same: to fill a defect or contour, to provide dermal support and to normalize epithelialization [regrowth of tissue].”

The issue contains articles about a wide variety of wounds and aspects of their healing, including a laser system to assess wounds, aspects of leg ulcers that prevent them from healing and techniques that can make skin biopsies less prone to infection. “This issue allows the Archives to celebrate dermatology's role in advancing the science of wound care,” Dr. Kirsner writes. Because wounds are common and expensive to the American health care system, these advances will have wide benefits.

(Arch Dermatol. 2007;143(10):1318-1319.)

Patients With Leg Ulcers Have Low Levels of Exercise and Compression Therapy

Many patients with venous leg ulcers—wounds in the lower legs caused by increased blood pressure in the veins—do not exercise or use compression therapy, two vital factors that can speed healing and prevent recurrence. Maud M. Heinen, Ph.D., R.N., of Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands, and colleagues interviewed 150 patients with venous leg ulcers about their exercise habits and their use of compression therapy, usually provided through elastic stockings or bandages. Participants also wore a physical activity monitor for a week before their interview. About 40 percent regularly used compression therapy. A total of 56 percent of the patients performed less than 2.5 hours of physical activity per week and 35 percent did not walk for 10 minutes at least once during the week. Also, only 35 percent performed the recommended leg exercises. “Patients should be educated and encouraged to (1) enhance physical activity through walking and leg exercises and (2) increase adherence to compression therapy,” the authors conclude.

(Arch Dermatol. 2007; 143(10):1283-1288.)

Medication Appears to Have Protective Association Against Leg Ulcers

Use of drugs known as â-adrenergic receptor agents (agonists and perhaps antagonists) appear to be associated with reduced odds of venous leg ulcers. David J. Margolis, M.D., Ph.D., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues assessed 414,887 patients who visited a general practitioner in the United Kingdom between 1987 and 2002. Of these, 62,886 were prescribed â-adrenergic receptor agonists to treat or prevent a medical condition. An additional 54,861 took â-adrenergic receptor antagonists, which work along the same pathway but through a different mechanism, with 6,620 taking both. “A protective association between â-adrenergic receptor agonists and perhaps â-adrenergic receptor antagonists and venous leg ulcers exists,” the authors write. “The evidence in this study should not be used as a rationale for treatment of venous leg ulcers with â-adrenergic receptor agents but should be compelling for the consideration of a randomized clinical trial.”

(Arch Dermatol. 2007; 143(10):1275-1280.)

Injection Drug Use Associated With Chronic Vein Disease

Users of heroin and other injection drugs commonly experience leg ulcers and other chronic vein diseases, according to a special article published in the issue. Barbara Pieper, Ph.D., A.P.R.N., B.C., C.W.O.C.N., of Wayne State University, Detroit, and colleagues outline ways in which administering drugs intravenously can harm veins, including scarring and collapse. This damage can continue to worsen even after an individual stops using drugs. “Chronic venous disease increases pain in the legs and decreases mobility, affecting one's quality of life and activity involvement,” the authors write. “Recognition of chronic venous disease as a complication of intravenous drug use is crucial.”

(Arch Dermatol. 2007; 143(10):1305-1309.)

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