ABSTRACT
Generalized discoid lupus erythematosus can pose a therapeutic challenge for dermatologists. Current treatment emphasizes photoprotection, topical and systemic steroids, and steroid-sparing immunosuppressive agents if necessary. Rapamycin, also known as sirolimus, selectively inhibits mammalian target of rapamycin, a regulatory kinase responsible for multiple signal transduction pathways. Mammalian target of rapamycin inhibition reduces cell division, lymphocyte proliferation, cytokine release, and downstream pathways unique from other classes of immunomodulatory drugs. Herein, we present a case of generalized discoid lupus erythematosus resistant to topical steroids, prednisone, azathioprine, mycophenolate mofetil, hydroxychloroquine, and thalidomide. The addition of rapamycin led to a positive treatment response within 6 weeks, with good tolerance of the medication and no adverse effects. The current literature supporting the use of rapamycin in the treatment of autoimmune connective tissue diseases is also briefly reviewed. For patients with severe or generalized discoid lupus erythematosus refractory to conventional treatment, rapamycin may be a useful therapeutic consideration.
Subject(s)
Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Discoid/drug therapy , Sirolimus/therapeutic use , Adult , Female , Humans , RetreatmentABSTRACT
Nail apparatus melanomas are rare and may present with a wide variety of clinical presentations. In particular, the amelanotic subtype can pose a diagnostic challenge, often leading to a poor prognosis related to a delayed diagnosis. We report a 69-year-old man with an unusual subungual amelanotic melanoma presenting as a persistent single nail dystrophy that was repeatedly treated as onychomycosis. Owing to the delayed diagnosis of the melanoma and to minimize recurrence risk, the patient underwent a partial amputation of his left thumb.
Subject(s)
Melanoma, Amelanotic/pathology , Nail Diseases/pathology , Nails/pathology , Onychomycosis/diagnosis , Skin Neoplasms/pathology , Aged , Biopsy , Diagnosis, Differential , Humans , Male , ThumbSubject(s)
Peripheral Arterial Disease/therapy , Skin Ulcer/therapy , Humans , Hyperbaric Oxygenation , Laser-Doppler Flowmetry , Negative-Pressure Wound Therapy , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnosis , Pulse Wave Analysis , Skin Ulcer/diagnosis , Skin Ulcer/etiology , Societies, Medical , Ultrasonic Therapy , Vascular Surgical ProceduresSubject(s)
Compression Bandages/statistics & numerical data , Leg Ulcer/therapy , Patient Compliance/statistics & numerical data , Self Care/psychology , Varicose Ulcer/therapy , Wound Healing , Analysis of Variance , Female , Humans , Leg Ulcer/psychology , Male , Middle Aged , Patient Compliance/psychology , Patient Education as Topic , Prevalence , Randomized Controlled Trials as Topic , Varicose Ulcer/psychologySubject(s)
Epidermis/transplantation , Pyoderma Gangrenosum/surgery , Tissue and Organ Harvesting/methods , Adult , Female , Humans , SuctionABSTRACT
Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care (p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes.
Subject(s)
Ankle Joint/physiopathology , Ankle/physiopathology , Muscle, Skeletal/physiopathology , Range of Motion, Articular , Varicose Ulcer/pathology , Wound Healing , Adult , Ankle/blood supply , Ankle Joint/blood supply , Arthrometry, Articular , Female , Humans , Male , Muscle, Skeletal/blood supply , Risk Assessment , Risk Factors , Stockings, Compression , United StatesSubject(s)
Drug Prescriptions , Medication Adherence , Skin Diseases/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Insurance Coverage , Male , Middle Aged , Self Report , Time Factors , Young AdultSubject(s)
Adrenergic beta-Antagonists/therapeutic use , Timolol/therapeutic use , Ulcer/drug therapy , Wound Healing/drug effects , Administration, Topical , Adrenergic beta-Antagonists/administration & dosage , Aged , Aged, 80 and over , Female , Humans , Male , Timolol/administration & dosage , Ulcer/pathology , Venous Insufficiency/complicationsABSTRACT
Chronic cutaneous wounds are a major burden on patients, healthcare providers, and the US healthcare system. This study, carried out in part by the Wound Healing Society's Government Regulatory Committee, aimed to evaluate the current state of National Institutes of Health funding of cutaneous wound healing-related research projects. National Institutes of Health Research Portfolio Online Reporting Tools Expenditures & Results system was used to identify wound healing projects funded by the National Institutes of Health in the 2012 fiscal year. Research projects focusing on cutaneous wound prevention/education, mechanisms, complications, treatment, or imaging/monitoring were included in the analysis. Ninety-one projects were identified, totaling a collective funding of $29,798,991 and median funding of $308,941. Thirteen institutes/centers from the National Institutes of Health were responsible for awarding funds; three of which (National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases) accounted for 60.4% of the grant funding. The predominant funding mechanisms included R01 (48.3%), R43 (14.3%), and R21 (9.9%). New applications and pre-existing applications accounted for 39.6 and 55.0% of the awarded grants, respectively. Grants awarded to investigators affiliated with universities accounted for 68.1% of grants and 25.3% were to investigators in the private sector. This analysis of current National Institutes of Health funding may facilitate more transparency of National Institutes of Health-allocated research funds and serve as an impetus to procure additional support for the field of wound healing.
Subject(s)
Biomedical Research/economics , Financing, Government , Research Support as Topic , Wound Healing , Chronic Disease , Female , Financing, Government/economics , Financing, Government/statistics & numerical data , Humans , Male , National Institutes of Health (U.S.)/economics , United StatesABSTRACT
Cervical cancer is one of the most common cancers and cause of cancer-related deaths in women worldwide. Cutaneous metastasis of cervical cancer, however, is exceedingly rare. It is generally seen late in the disease course and portends a poor prognosis. Herein we report a woman with a history of recurrent cervical cancer complicated by an unusual occurrence of metastasis to the vulva.
Subject(s)
Adenocarcinoma/secondary , Skin Neoplasms/secondary , Uterine Cervical Neoplasms/pathology , Vulvar Neoplasms/secondary , Adenocarcinoma/surgery , Adenocarcinoma/therapy , Adult , Chemoradiotherapy , Cisplatin/therapeutic use , Combined Modality Therapy , Female , Humans , Hysterectomy , Lymph Node Excision , Lymphatic Metastasis , Neoplasm Recurrence, Local , Ovary/surgery , Palliative Care , Pelvic Pain/etiology , Radiotherapy, Intensity-Modulated , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/therapyABSTRACT
Chronic DFUs are a growing global health concern due to the implied high rates of morbidity and mortality. Standard-of-care modalities sometimes are not sufficient for some recalcitrant ulcers. The use of adjuvant topical therapies including advanced dressings and biologic therapies should be considered in patients whose DFU did not reduce in size after receiving standard care for a period of 4 weeks. These advanced treatments must be used in combination with standard care measures, including debridement, moist wound healing, offloading, and infection control.
Subject(s)
Anti-Infective Agents/administration & dosage , Bandages , Collagen/administration & dosage , Debridement/methods , Diabetic Foot/therapy , Administration, Topical , Combined Modality Therapy , Diabetic Foot/drug therapy , Health Knowledge, Attitudes, Practice , Humans , Treatment Outcome , Wound HealingABSTRACT
Chronic lower extremity ulcers are a significant burden on patients and health care systems worldwide. Although relatively common, these wounds can be difficult to treat and present a challenge to physicians. Treatment has often been based on anecdotal accounts; however, there is a growing emphasis on using evidence-based conclusions to guide clinical decisions. In this review article, the standard of care and adjuvant therapies of venous leg ulcers and diabetic foot ulcers are presented from an evidence-based perspective.