Neutrophilic Dermatoses in a Clinical Practice of Wound Care Professionals.

ABSTRACT: Diagnosing and treating neutrophilic dermatoses (NDs) in clinical practice can be challenging because of various presentations and stubborn treatment responses. Establishing a diagnosis is necessary, though, because many NDs are associated with underlying conditions, including malignancy. In this article, the authors provide information about Sweet syndrome, pyoderma gangrenosum, and other NDs and describe their clinical presentation, pathophysiology, diagnostic criteria, and associated conditions. The authors also present a case report describing the coexistence of two NDs and hidradenitis suppurativa in one patient and review the treatment modalities for those conditions.

Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease.

GENERAL PURPOSE: To present an evaluation of a surfactant-containing polymeric membrane foam wound dressing for use on patients with chronic pilonidal sinus disease. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1. Recall risk factors for and pathophysiology of pilonidal sinus wounds.2. Summarize the evidence-based elements of wound assessment and treatment.3. Identify the study methodology and results. ABSTRACT: To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds.This case series was conducted in an outpatient dermatology and wound clinic. Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited.Dressing changes were performed daily because of frequent contamination from bowel evacuation, sweating, or frictional forces in the perianal and intergluteal skin. Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation.Subjects were predominantly males (81% [n = 13]) with a mean age of 23 years. At study initiation, the mean wound duration was 3.2 months, and mean surface area was 3.3 cm (0.18-19.6 cm). The majority of wounds showed signs of superficial infection (63% [n = 10]) and deep infection (88% [n = 14]). At week 12, 10 wounds (63%) had closed, 1 (6%) had decreased in surface area, 2 (13%) had increased in size, and 3 (19%) of the patients were lost to follow-up. Mean pain score was 3.4 at first visit; most patients reported reduction in pain scores by weeks 4 and 12. Participants reported improved mobility and ability to self-apply dressing. No adverse reactions were observed.Use of a surfactant-containing polymeric membrane foam wound dressing with glycerin may have facilitated wound closure in 10 of 13 patients who completed the 12-week study.

Validation of the Healthy Foot Screen: A Novel Assessment Tool for Common Clinical Abnormalities.

GENERAL PURPOSE: The purpose of this learning activity is to provide information about the Healthy Foot Screen, a new tool for assessment of common foot abnormalities. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1. Recognize prevalence, causes, risk factors, signs, and types of common foot problems.2. Identify the results of this study about the new foot screening tool and its implications in primary care. ABSTRACT: Foot health is a key component of general health and well-being. Nevertheless, feet are often overlooked by healthcare providers and patients. Common foot problems include infections or inflammatory conditions, abnormal nail disorders (eg, onychomycosis), structural bony abnormalities, circulation disorders, and other conditions. The development of an easy-to-use, rapid, clinical tool to assess foot health can facilitate primary care provider recognition and treatment of common foot problems. This study ascertained interrater item reliability and validity from the preliminary version of one such tool called the Healthy Foot Screen.A total of 18 patients from a community dermatology clinic were individually screened by 11 interprofessional healthcare assessors using the preliminary tool. The assessors included a dermatologist/internist, family physicians, nurses, and podiatrists. The initial draft of the Healthy Foot Screen was created through an extensive literature review, complemented by the clinical judgment of the study team. Cronbach α was calculated for each item to determine interrater reliability. A minimum value of 0.6 was set for an item to be included in the final tool. Where applicable, scores for each item on the screen were calculated for right and left lower limbs and then averaged. Assessors were asked to complete a short survey.Interrater reliability scores for items on the screen were as follows: diabetes and smoking, 1.0; neuropathy, 0.988; palpable foot pulse, 0.916; abnormal fourth to fifth toe web space, 0.905; previous ulcer/amputation, 0.869; pitting edema, 0.872; bony abnormality, 0.804; dry bottom of foot, 0.799; toenail infection, 0.793; other spots/lesions,0.688; and red areas/blisters/pustules, 0.659. Generally, assessors found the tool easy to use, although some areas for improvement were noted.The Healthy Foot Screen can facilitate primary care provider diagnosis and treatment of common foot problems.

Case series of lower-extremity chronic wounds managed with an antibacterial foam dressing bound with gentian violet and methylene blue.

OBJECTIVE: To evaluate an antibacterial dressing for the management of lower-extremity chronic wounds with critical colonization. DESIGN: A case series of n = 15 patients with lower-extremity chronic wounds were treated with an antibacterial foam dressing consisting of polyvinyl alcohol (PVA) foam bound with gentian violet and methylene blue (Hydrofera Blue; Hydrofera, LLC, Willimantic, Connecticut). SETTING: An outpatient clinic in Ontario, Canada. PATIENTS: The dressing was applied to diabetic foot ulcers (n = 8) and other venous/leg wound etiologies (n = 7). The study population was clinically challenging due to high mean body weight, extended wound durations, and high diabetes prevalence. MAIN OUTCOME MEASURES: Wounds were assessed for clinical signs of superficial and deep/surrounding bacterial burden using the validated NERDS and STONEES mnemonic and with semiquantitative bacterial swabs. Changes in wound size, pain, and other clinical parameters were also recorded. MAIN RESULTS: Improvements in surface critical colonization and pain score at the end of the study period were noted in some patients, especially in patients with diabetic foot ulcers. A decreasing wound size was observed in 8 of the 14 patients (57%) at week 4. One patient was excluded from wound size change analysis. CONCLUSIONS: An antibacterial foam dressing consisting of PVA foam bound with gentian violet and methylene blue showed encouraging results in a clinically challenging study population. This dressing may be a suitable option for lower-extremity chronic wounds demonstrating an increased superficial bacterial burden. Further investigation focused on identifying the characteristics of patients who are most responsive to the dressing is warranted.

Necrobiotic xanthogranuloma as an unusual cause of refractive chronic bilateral leg ulceration.

Necrobiotic xanthogranuloma is a progressive histiocytic granulomatous disease with frequent extracutaneous involvement. We have documented an unusual case of necrobiotic xanthogranuloma in a 58-year-old man with a history of recalcitrant and chronic arm and leg ulcerations in the absence of characteristic periorbital involvement. Our patient demonstrates a therapeutic challenge and may display a new necrobiotic inflammatory disorder not previously characterized.

Continuous topical oxygen for the treatment of chronic wounds: a pilot study.

Oxygen is essential for all stages of wound healing. Previous research has shown topical administration of oxygen to have positive effects on wound healing. In this study, the application of transdermal continuous topical oxygen therapy (TCOT) was evaluated for its effect on chronic wound healing in 9 patients. After 4 weeks of treatment, mean wound surface area and wound infection checklist scores were significantly reduced. Signs of bacterial damage were also reduced. Findings from this study suggest TCOT may be beneficial in promoting chronic wound healing.

A randomized controlled trial to evaluate an antimicrobial dressing with silver alginate powder for the management of chronic wounds exhibiting signs of critical colonization.

OBJECTIVE: The primary objective of this study was to evaluate if a topical silver dressing that consists of silver alginate powder is effective in managing chronic wounds that exhibit signs of critical colonization and promoting wound healing. METHOD: This was a prospective, open-label, 4-week randomized controlled trial. The primary end points of the study were changes in signs associated with critical colonization and in wound surface areas. All subjects were evaluated at weeks 0, 2, and 4 at the end of the study. SUBJECT AND SETTINGS: Participants between 18 and 85 years of age were recruited from 2 wound care clinics in Canada. The study was reviewed and approved by research ethics boards. DATA ANALYSIS: Analyses of this study were carried out based on intent-to-treat principle; t tests were used to determine if the means were statistically different between treatment groups. RESULTS: Thirty-four subjects participated and completed in the study. In the control group, the mean infection checklist score was 2.2 at baseline and 2.3 at week 4 (t9 = -0.36, P = .73). In the silver alginate powder group, the infection score reduced from 3.3 at baseline to 1.3 at week 4; the result was significant (t23 = 7.62, P < .00). The difference in average surface reduction over time between the 2 groups was statistically significant (t32 = 3.56, P < .001). Subjects randomized to the silver group achieved a greater surface reduction than those who were randomized to the use of foam dressing as the control. CONCLUSION: Silver alginate powder is an effective treatment option for wounds with increased bacterial burden.

Peristomal skin complications and management.

PURPOSE: : To provide the wound care practitioner with an overview of practical approaches to prevent and treat common peristomal skin conditions. TARGET AUDIENCE: : This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: : After participating in this educational activity, the participant should be better able to:

A randomized crossover investigation of pain at dressing change comparing 2 foam dressings.

INTRODUCTION: Pain at dressing change is the result of several factors including trauma and skin stripping caused by the repeated removal of adhesive dressings. GOALS: To evaluate pain during dressing changes comparing a soft silicone foam dressing (Mepilex Border; Mölnlycke Health Care AB, Gothenburg, Sweden) with an adhesive hydrocellular polyurethane foam dressing (Allevyn Adhesive; Smith & Nephew, Hull, United Kingdom). METHODS: In this randomized crossover study, subjects were randomized to 1 of the 2 foam dressings for the first 2 scheduled follow-up visits. At visit 3, local wound treatment was switched to the alternate dressing until the end of the study (visits 4 and 5). Pain was measured with a visual analog scale and the Short-Form McGill Pain Questionnaire. The characteristics of the wound and the occurrence of adverse events were documented at each scheduled visit. RESULTS: A total of 32 patients entered into the study, and 26 patients completed all 5 follow-up study visits. Results indicated lower levels of pain at dressing removal and less periwound maceration in patients who were randomized to the silicone dressings. CONCLUSIONS: The results of this study indicate that soft silicone dressing is associated with less pain before and during dressing changes along with decreased periwound maceration.