[Chronic leg ulcers and Pseudomonas aeruginosa infection]. / Surinfection de plaie chronique par Pseudomonas aeruginosa.

Pseudomonas aeruginosa (PA) is a Gram-negative germ, responsible for severe infections. PA infected chronic wounds are a clinically highly relevant topic. PA has a natural resistance to many antibiotics, and there is no consensus on a first-line antibiotic to be used. In the context of chronic ulcers with an unfavorable evolution, we suggest intravenous antibiotic therapy, ideally on an in-patient basis. Given the sparse evidence from clinical trials, we heavily rely on clinical experience when it comes to managing chronic ulcers infected with PA.

[Antisepsis of wounds: when and what?]. / Antisepsie des plaies: quand et quoi?

Bacterial colonisation of a wound is a normal process and usually not dangerous. The role of micro-organisms in the healing process is not fully elucidated, however it is well known that infection interrupts healing and even worse can severely threaten the organism. We present the different types of antiseptics that are used in treating wounds as well as their interactions. We would like to remind the reader that antiseptics are more effective than antibiotics with much fewer resistances. Finally, we provide a flow chart for a reasonable treatment of chronic wounds.

L-Tryptophan as a Novel Potential Pharmacological Treatment for Wound Healing via Aryl Hydrocarbon Receptor Activation.

BACKGROUND: The aryl hydrocarbon receptor has been shown to be involved in wound healing. OBJECTIVE: The aim of this study was to assess the effect of tryptophan on wound healing in vitro and in a clinical trial. METHODS: The ability of tryptophan and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) to increase wound healing was assessed in an in vitro scratch wound model in human keratinocytes. Topical tryptophan and vehicle were assessed for 12 weeks in 51 patients with lower limb ulcers that were resistant to conventional therapies. RESULTS: TCDD 0.1 nM and tryptophan 1 µM increased the rate of scratch recovery in a culture model. Topical tryptophan induced stronger pain relief and faster re-epithelialization than its vehicle in patients with lower limb ulcers. CONCLUSION: Tryptophan shows promising potential as a novel topical treatment for wound healing.

[Heparins and skin reactions: from diagnostic to management]. / Héparines et réactions cutanées: du diagnostic a la prise en charge.

The use of heparins in the prophylaxis and treatment of thromboembolic diseases shows non-negligible risks of cutaneous lesions, which are very frequently underestimated by physicians. As this risk often originates from either delayed-type hypersensitivity reactions or life-threatening heparin-induced thrombocytopenia, a quick diagnosis and an adapted management are thus crucial. Furthermore, as most cases are emergencies, allergologic testing cannot be considered in the first place. In this context, an overview of the therapeutic as well as management recommendations is presented, taking into account the most recent treatments.

Successful treatment of hydroquinone-resistant melasma using topical methimazole.

Melasma is an acquired hyperpigmentation skin disorder in sun-exposed areas. It occurs almost exclusively over the face, and is most commonly seen in women. Several depigmenting agents have been used for the treatment of melasma among which hydroquinone has been the most widely used due to its efficacy and safety in short-term use. However, hydroquinone is recently reported to be a cytotoxic and mutagenic compound in mammalian cells and is thus banned in several countries. Hydroquinone ban has caused investigators to search for alternative depigmenting agents for the treatment of melasma in recent years. Methimazole is an antithyroid agent orally used in humans since several decades and has been shown that when applied topically, it inhibits melanin synthesis and causes skin depigmentation in lab animals as well as human subjects. Herein, we report two hydroquinone-resistant melasma patients who were successfully treated with methimazole cream. Application of 5% methimazole cream once daily resulted in significant improvement of melasma in both patients after 8 weeks. The efficacy of methimazole for melasma treatment as well as its advantages over other known depigmenting compounds (non-mutagenicity, non-cytotoxicity and high tolerability profile) suggests that topical methimazole should be added to the armamentarium of anti-melasma treatment.

[Honey: from Noe to wound care]. / Le miel: de Noé aux soins de plaies.

Honey with its high concentration of sugar constitute a hyperosmotic medium with antimicrobial properties. It contains different enzymes, including glucose-oxidase that generates hydrogen peroxide and gluconic acid in the presence of glucose and water. The viscosity and the hygroscopic qualities of honey permits its even spread on the wound bed, creating a favourable environment for wound healing. With these properties, honey when adequately prepared, is an efficient treatment of chronic wounds of the lower leg and also of abdominal wounds.