L-tryptophane un nouveau potentiel traitement pour la cicatrisation des plaies via l'activation de la voie AhR

Des études in vitro et in vivo ont montré que des agonistes du récepteur cytoplasmique aryl hydrocarbon receptor (AhR) modulent la cicatrisation des plaies. L'acide aminé essentiel L-tryptophane pouvant être métabolisé en agonistes AhR, nous avons étudié in vitro son mécanisme d'action puis évalué sa tolérance et son efficacité comme traitement des ulcères chroniques des membres inférieurs. L'analyse in vitro montra que L-tryptophane semble moduler la cicatrisation via la oie AhR. L'étude prospective pseudo-randomisée fut réalisée sur 60 patients présentant des ulcères chroniques des membres ifnérieurs. Le traitement consista à une application d'un gel d'alginate de sodium contenant ou non 1% de L-tryptophane pendant 12 semaines. Le L-tryptophane induisit une plus forte réduction de douleur et une plus rapide réépithélialisation qui conduisit à une cicatrisation complète chez 19% des patients alors qu'aucun cas ne fut reporté dans le groupe contrôle. Ainsi, L-tryptophane apparaît comme un potentiel traitement des plaies

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: Aryl hydrocarbon receptor (AhR) has been shown to be involved in wound healing. Objective: The aim of the 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 10 µM increased the rate of scratch recovery in a culture model. Topical tryptophan induced a stronger pain relief and a faster reepithelialization than its vehicle in patients with lower limb ulcers. Conclusion: Tryptophan shows promising potential as a novel topical treatment for wound healing

Héparines et réactions cutanées : du diagnostic à 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

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