Herpes Zoster (Shingles) Patient-Centered Wound Outcomes: A Literature Review.

GENERAL PURPOSE: To present a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs. 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 participating in this educational activity, the participant will be able to:1. Explain the importance of early diagnosis and treatment of herpes zoster (HZ).2. Identify interventions that have resulted in documented improvement of validated patient-centered outcomes in patients with HZ or postherpetic neuralgia.3. Recognize the average per patient medical costs of HZ in the US.

One in three people endure herpes zoster (HZ; also known as shingles) during their lifetime, experiencing pain, secondary infections, postherpetic neuralgia, reduced quality of life, and considerable patient costs. These patient burdens remain to be reviewed. To perform a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs. The PubMed database was searched with supplementary Google Scholar searches for Medical Subject Headings "shingles" or "post-herpetic neuralgia" to find clinical studies documenting validated patient-centered outcomes: pain, secondary infection, healing, function, depression, social isolation, treatment costs, or quality of life. Six representative case studies were examined. Pertinent original and derivative clinical study references were included. Preclinical studies, reviews, or studies of non-HZ conditions were excluded. Two authors tabulated clinical efficacy evidence for interventions affecting patient-centered outcomes. Evidence supported efficacy for systemic antiviral or topical anesthetic interventions improving pain, healing, sleep, vision, or quality of life for those with HZ or postherpetic neuralgia. Patient cases reported improved pain and/or sleep using occlusive dressings. Treatment costs and secondary infections were reported only in cases or cohort studies. Randomized clinical research focused on medications improving patient pain, healing, sleep, or vision outcomes. Research is needed measuring outcomes of adding occlusive dressings to optimal care and effects on secondary infections and treatment costs.

Treating peristomal pyoderma gangrenosum with topical crushed prednisone: a report of three cases.

The main goals of treating peristomal pyoderma gangrenosum (PPG) - ulcerations in the stomal area - are to decrease pain, increase pouch adherence, and decrease pyoderma. The literature suggests a wide variety of approaches to achieve this goal, but few studies report outcomes on the use of topical steroids. The purpose of this case study is to describe the results of a protocol developed to meet the goals of care for patients with PPG. Three patients presenting with PPG lesions were instructed to crush a 1-mg prednisone tablet for mixing with an equal part of a hydrocolloid powder. The mix was applied directly on the PPG lesions, covered with a calcium alginate (or hydrofiber) primary dressing, and secured with a hydrocolloid secondary dressing. The pouching system then was applied over the hydrocolloid dressing. Three goals of treatment were met: pain dissipated (in as quickly as 1 week); pouch adherence improved (within 0 to 3 days); and closure/healing of the lesions occurred (within 3 to 5 weeks), recurring in only one case in which the patient had a peristomal hernia. No side effects were observed. Although this self-treatment provided satisfactory results, further study is needed to evaluate its effectiveness in a larger population and longer follow-up.

The yellow-red-black bladder diary: red-yellow-black is not just for wounds.

The Red-Yellow-Black (RYB) wound classification system was introduced to the US in the late 1980s for the purpose of simplifying wound assessment and guiding treatment. Although the color system was found to have limitations for wound care, the colors (in revised order) may be useful for a bladder diary. Colored pencils are used to record fluid intake and voided output. For fluid intake, yellow signifies nonirritants (water); red, low bladder irritants (alcoholic, artificially sweetened, carbonated, or citrus beverages); and black, high bladder irritants (caffeinated beverages). For voided output, yellow denotes continent voids and red, incontinent voids. Output quantity is measured using a commode "hat". The completed diary allows the practitioner to tabulate the colored daily rows and quickly assess progress weekly or monthly and provide appropriate treatment/advice. The YRB diary was used successfully by a 78-year old woman with urge incontinence without evidence of stress incontinence. Modifications to the YRB diary can be made when additional data need to be collected. Studies to evaluate optimal usage criteria of bladder diaries are needed.