Treatment of a chronic skin lesion in the lower limb in Meleda disease.

Chronic venous skin lesions heal quickly with compression therapy and wound bed preparation. However, there are conditions in which the tissue repair process is more difficult, such as Meleda disease. Meleda disease is a rare genetic pathology, transmitted with an autosomal recessive gene with a prevalence of 1:100 000; it is also called palmoplantar keratoderma. In this pathology, there is a state of chronic inflammation, an alteration of the extracellular matrix and migration of fibroblasts and keratinocytes, which block the proliferative phase of the tissue repair process. Through targeted interventions and the use of bioactive dressings, it is possible to heal the venous ulcer, although this can take a long time. The authors report their experience in relation to a patient with Meleda disease and venous ulceration of seven years.

Pleiotropic effects of hyaluronic acid and silver sulfadiazine dressings in the treatment of acute and chronic skin lesions.

BACKGROUND: Hyaluronic acid (HA) is a natural unbranched polymer that belongs to a group of heteropolysaccharide glycosaminoglycans (GAGs) that are major components of the extracellular matrix (ECM), while silver sulfadiazine exerts antibacterial activity. In this study, we evaluated the efficacy and safety of dressings with hyaluronic acid and silver sulfadiazine in acute and chronic lesions, according to the wound bed preparation and TIME principles. METHODS: Thirty-two patients with acute and chronic injuries participated in the study. After collecting their personal histories and making a differential diagnosis by evaluating their ankle/arm index, patients with a Winsor Index below 0.8 underwent lower extremity color Doppler echocardiography. The dressing protocol followed the principles of wound bed preparation, identifying the prevailing clinical sign by evaluating the lesion background, margins, and perilesional skin. A product containing low molecular weight hyaluronic acid (200 kDa) and silver sulfadiazine 1% was used for the dressing. RESULTS: In the acute lesion group, the protocol we applied resulted in all injuries being healed. Of the 20 treated wounds in the chronic lesion group, 10 healed at the end of 8 weeks of treatment and 8 saw an improvement with a reduction in the lesion area. CONCLUSIONS: Consisting of a combination of hyaluronic acid and silver sulfadiazine, the dressing is widely used in the management of acute and chronic skin wounds. In the present study, the healing rate of acute wounds was 100%; in chronic wounds, healing was reported in 50% of cases while in 40% of the remainder, we found a 40% reduction in the lesion area.