Advances in Skin & Wound Care最新文献

Abstract: Pyoderma gangrenosum is a rare ulcerative condition that poses diagnostic and therapeutic challenges. Diagnosis and appropriate management are often delayed due to its rarity and the presence of numerous clinical variants. In this case report, the authors present the case of a 36-year-old man who had long-standing and nonhealing ulcers that did not respond to multiple antibiotics and serial wound debridement. The patient was promptly initiated on oral corticosteroids and dapsone as an adjunctive steroid agent. After 6 months, the patient reported complete resolution of the lesions. This rare case underscores the potential value of combining prednisone and dapsone as a treatment option for pyoderma gangrenosum, particularly in resource-limited settings.

Background: Infective and noninfective dermatoses of the lower leg and foot can be attributed to factors such as infections, blood stagnation, chemical contact, and abnormal mechanics. These factors make the lower leg and foot more susceptible to microbial infections, contact dermatitis, stasis eczema, ulcers, corns, and calluses.

Objective: To identify the patterns of infective and noninfective dermatoses on the lower leg and foot.

Methods: This study took place between September 2020 and August 2021 at an outpatient dermatology clinic. All patients with lower leg and foot dermatoses were included in the study, irrespective of age, sex, or occupation. Patients with generalized lesions all over the body were excluded.

Results: Of the 42,527 patients who presented to the outpatient dermatology clinic during the study period, 424 patients (1%) had lower leg and foot dermatoses. The ratio of male to female patients was 2.3:1. Patients ranged in age from 4 to 76 (mean, 44.8 ± 15) years. A total of 152 patients had infective dermatoses, and 272 patients had noninfective dermatoses. Fungal infection (21.7%) was most common among patients with infective dermatoses, followed by bacterial infections (8.25%) and viral infections (7.07%). Lichen simplex chronicus (29.3%) and dermatoses due to venous stasis (19%) were most common among patients with noninfective dermatoses. The most commonly involved site was the shin, followed by the dorsum and sole of the foot.

Conclusions: The identification of high-risk patients is key in taking preventive measures to avoid complications.

Objective: To analyze the risk factors for peristomal skin complications (PSCs) in patients with colorectal cancer and an ostomy, construct a prediction model, and verify its effectiveness.

Methods: In this cross-sectional study, researchers recruited 265 patients with an ostomy at the stoma clinic of a tertiary hospital, from May 2022 to August 2023. Patients were divided into two groups: complications group (n = 81) and no complications group (n = 184). Researchers constructed a logistic regression prediction model using univariate and multivariate analyses. From May 2023 to August 2023, a validation group of 135 patients with an ostomy was selected for external validation of the model.

Results: The incidence of PSCs was 30.57% in the modeling group and 30.37% in the validation group. The predictor variables were preoperative and postoperative health education, tumor therapy within 3 months, preoperative stoma positioning, stoma height, stoma type, and excrement state. The Hosmer-Lemeshow test yielded a P value of .513, the area under the ROC curve was 0.872, the Youden index was 0.561, and the sensitivity and specificity were 0.827 and 0.734. For external validation, the Hosmer-Lemeshow test yielded a P value of .835, the area under the ROC curve was 0.887, and the sensitivity and specificity were 0.905 and 0.720, respectively.

Conclusions: The prediction model demonstrates good predictive efficacy and can serve as a reference for clinical caregivers in identifying patients at high risk of PSCs.

Objective: To present a full scope of detailed and engaging laboratory activities recommended by physical therapist clinicians and educators from across the US to assist health professions faculty to develop new or improve current integumentary/wound management (IWM) instruction.

Methods: A three-round Delphi survey was conducted to update IWM curriculum recommendations for entry-level doctor of physical therapy education. First-round participants provided ideas for laboratory activities. Activity responses were discussed, edited for redundancy, and clarified. Missing information (eg, estimated cost and time required) was added to increase usability.

Results: A total of 139 laboratory activities were recommended by survey participants. Many of the suggestions included inexpensive and readily available, do-it-yourself wound models requiring food or other moulage techniques. These simulations are elucidated to facilitate translation of ideas into classroom and community laboratory activities to promote student learning.

Conclusions: The literature supports that most entry-level healthcare profession programs report limited IWM education, emphasizing the need for effective and efficient use of IWM contact hours. Developing engaging and meaningful hands-on laboratory activities is vital to increasing student knowledge and skill in this area of clinical practice.

Objective: To identify markers associated with pressure injury (PrI) history in individuals with spinal cord injury (SCI) using two approaches: skin blood flow (SBF) response toward localized heating, and serum marker for insulin resistance.

Methods: For this cross-sectional, observational study of adults with chronic traumatic SCI at T12 and above, researchers recruited two groups of participants: with history of PrI (group 1), and without history of PrI (group 2). The study protocol included obtaining fasting blood samples and measurement of SBF at bilateral heels with localized heating of 42 °C for 30 minutes from all participants. Primary SBF outcomes were initial peak and plateau SBF normalized to baseline SBF. The primary outcome for insulin resistance was Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), calculated from fasting plasma glucose and insulin. Secondary outcomes included demographic and SCI information. Researchers used the Fisher exact test and Wilcoxon-Mann-Whitney test to compare the intergroup difference of categorical and continuous variables, respectively.

Results: Sixteen adults completed this study (group 1, n = 7; group 2, n = 9). In comparison with group 2, group 1 had significantly higher HOMA-IR (3.90 ± 0.71 vs 1.45 ± 0.71), suggesting higher insulin resistance, and longer duration of injury (22.54 ± 7.24 vs 7.98 ± 6.58 years). There were no between-group differences in SBF or other secondary outcomes.

Conclusions: HOMA-IR is a novel serum index associated with PrI history in persons with chronic SCI. Future longitudinal study is warranted to examine the role of insulin resistance in increasing PrI risk for the SCI population.

Objective: To investigate the incidence of skin changes at life's end (SCALE) among hospice patients and identify associated factors.

Methods: The authors conducted a retrospective chart review of demographic data, medical history, Braden Scale assessment scores, Charlson Comorbidity Index, symptom records, and medical treatments of patients admitted to a local teaching hospital's hospice unit between May 2019 and April 2021.

Results: Most (79%) of the 300 hospice patients included in the study had cancer. Of the 181 patients who died, 49 (60.3%) had SCALE. Logistic regression analysis revealed that greater variations in Braden Scale scores from admission to predeath (odds ratio, 1.188; 95% CI, 1.014-1.392; P = .033), higher Eastern Cooperative Oncology Group grades (odds ratio, 1.965; 95% CI, 1.241-3.109; P = .004), and elevated Charlson Comorbidity Index scores (odds ratio, 1.514; 95% CI, 1.237-1.854; P < .001) significantly increased the likelihood of developing SCALE.

Conclusions: The findings suggest that the occurrence of SCALE may serve as a valuable clinical indicator for healthcare professionals to recognize that a patient is approaching the end of life. Consequently, the care approach should prioritize pain relief and promote comfort rather than wound healing in this patient population. These results provide evidence to support the integration of SCALE-related training programs for hospice care, which can increase healthcare professionals' awareness and understanding of SCALE. Ultimately, the implementation of such training programs may lead to more appropriate care for hospice patients with SCALE, enhancing their quality of life at the end of life.

Abstract: Brown recluse spider bites may cause symptoms ranging from local cutaneous reactions to systemic visceral loxoscelism. Most bites are self-limiting, but some can lead to necrotic ulcerations with severe complications and soft tissue defects. Necrotizing ulcers are uncommon and have various clinical presentations, so no standard treatment exists. A 68-year-old man required medical attention after getting a spider bite while traveling in Tanzania. After returning to Italy, the patient presented with a posterior lower limb black papule, local edema, and fever. The lesion quickly ulcerated with an eschar. Medical history and symptoms suggested a brown recluse spider bite. Ulcer management was conservative, with careful surgical debridement and a two-step reconstruction using a split-thickness skin graft and a bilayer porous collagen matrix. Treatment resulted in functional recovery and acceptable aesthetics.

Objective: To assess the competency of oncology/hematology nurses in evaluating the lower extremities of patients with cancer for skin conditions and edema.

Methods: This prospective and descriptive observational study was conducted with patients in a university hospital's 48-bed oncology/hematology service. Patients with cancer admitted to the oncology/hematology service were examined independently by three evaluators (two nurse researchers and the patient's primary nurse) daily. Interrater reliability for assessing patients' right and left legs was determined using Fleiss κ statistics for categorical variables.

Results: The study revealed a high degree of agreement among the three evaluators in the assessment of skin surface, skin color, and presence of petechiae and rashes on the right and left leg, as well as itching on the left leg. However, only moderate agreement was found for temperature assessment, ecchymoses edema on the left and right leg, and itching on the right leg. The reliability of the two researcher nurses' assessment of edema on the right and left legs was excellent.

Conclusions: Although the agreement between the two researcher nurses was near excellent, only moderate agreement was observed among all evaluators in the edema assessment. The result underscores the importance of healthcare providers' knowledge and enhancing clinical skills through innovative training strategies.