RESUMO
We recently identified the efficacy and safety of a botulinum toxin (BTX)-A/B in Raynaud's phenomenon (RP) and digital ulcers (DU) in Japanese patients with systemic sclerosis (SSc). Detailed assessments of peripheral vascular disorder using angiography and dermoscopic images of nail fold capillaries have not been performed previously. This study aimed to evaluate the effect of BTX-B on SSc-associated peripheral vascular disorder. Two SSc patients who suffered with RP and DU were treated with a BTX-B injection, and thereafter the symptoms of RP were improved and DU healed in both patients. Furthermore, angiography showed an increased blood flow to the palm and fingers, and dermoscopic images of nail fold capillary changes showed improvement. These results suggest that a BTX-B injection may increase peripheral blood flow and improve RP and DU in SSc patients.
Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Doença de Raynaud/tratamento farmacológico , Escleroderma Sistêmico/complicações , Úlcera Cutânea/tratamento farmacológico , Adulto , Idoso , Angiografia , Capilares/diagnóstico por imagem , Dermoscopia/métodos , Feminino , Dedos/irrigação sanguínea , Dedos/diagnóstico por imagem , Humanos , Injeções , Angioscopia Microscópica , Doença de Raynaud/diagnóstico por imagem , Doença de Raynaud/etiologia , Úlcera Cutânea/diagnóstico por imagem , Úlcera Cutânea/etiologia , Resultado do TratamentoRESUMO
Laser speckle contrast analysis (LASCA) is a good tool to evaluate the variation in peripheral blood perfusion during long-term follow-up and is able to safely monitor digital ulcer evolution in scleroderma patients. It evaluates blood perfusion in different areas within the skin lesions and surrounding them during standard treatment.
Assuntos
Dedos/diagnóstico por imagem , Doença de Raynaud/diagnóstico por imagem , Escleroderma Sistêmico/diagnóstico por imagem , Úlcera Cutânea/diagnóstico por imagem , Bosentana , Feminino , Dedos/irrigação sanguínea , Humanos , Iloprosta/uso terapêutico , Lasers , Metotrexato/uso terapêutico , Microcirculação , Angioscopia Microscópica , Pessoa de Meia-Idade , Doença de Raynaud/etiologia , Espalhamento de Radiação , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/tratamento farmacológico , Úlcera Cutânea/etiologia , Sulfonamidas/uso terapêutico , Tramadol/uso terapêutico , Resultado do Tratamento , para-Aminobenzoatos/uso terapêuticoRESUMO
The accuracy of radionuclide angiography and blood-pool imaging using [99mTc]-phosphate to assess skin ulcer perfusion as an indicator of healing capacity was determined in 50 studies performed on 45 patients with nonhealing ulcers of the lower extremities. Two nuclear medicine physicians without clinical bias, graded the perfusion of the ulcer on the images as normal, increased or reduced with respect to the opposite limb. Patients were followed closely with aggressive local wound care for at least 14 days. Of the 31 ulcers which healed, the radionuclide study correctly predicted 30; of the 19 ulcers which did not heal, 14 were correctly predicted. Eight patients had osteomyelitis; four of those healed and four did not. The radionuclide study predicted healing in seven. Excluding those patients with osteomyelitis, the sensitivity for the radionuclide angiogram and blood-pool image in predicting healing was 96%, specificity was 87%, and accuracy was 93%. This technique is a simple, reliable way to predict the microcirculatory adequacy for ulcer healing. Specificity is diminished in the presence of osteomyelitis.