Consensus on Wound Antisepsis: Update 2018

Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment

Supporting wound infection diagnosis: advancements and challenges with electronic noses

Wound infections are a major problem worldwide, both for the healthcare system and for patients affected. Currently available diagnostic methods to determine the responsible germs are time-consuming and costly. Wound infections are mostly caused by various bacteria, which in turn produce volatile organic compounds. From clinical experience, we know that depending on the bacteria involved, a specific odor impression can be expected. For this reason, we hypothesized that electronic noses, i.e., non-invasive electronic sensors for the detection of volatile organic compounds, are applicable for diagnostic purposes. By providing a comprehensive overview of the state-of-research, we tested our hypothesis. In particular, we addressed three overarching questions: 1) which sensor technologies are suitable for the diagnosis of wound infections and why? 2) how must the (biological) sample be prepared and presented to the measurement system? 3) which machine learning methods and algorithms have already proven successful for the classification of microorganisms? The corresponding articles have critically been reviewed and are discussed particularly in the context of their potential for clinical diagnostics. In summary, it can already be stated today that the use of electronic noses for the detection of bacteria in wound infections is a very interesting, fast and non-invasive method. However, reliable clinical studies are still missing and further research is necessary

Diagnostik von Beinödemen

Ödeme der unteren Extremitäten entsprechen immer einem pathologischen Zustand, der insbesondere bei Betroffenen mit chronischen Wunden einer Therapie bedarf. Weil die Ursachen dieser Ödeme sehr unterschiedlich und teilweise auch komplex sein können, sollte zuerst eine klinische und ggf. apparative Diagnostik erfolgen. Oft kann nach einer klinischen Untersuchung mit Testung des Stemmer- und Godet-Zeichens bereits eine klinische Verdachtsdiagnose gestellt werden. Als weiterführende apparative Diagnostik kann eine sonographische Untersuchung erfolgen. Messtechniken wie beispielsweise die Wasserplethysmographie gelten derzeit zwar als Goldstandard für Volumenmessungen, sind aber sehr aufwendig und fehleranfällig, sodass sie in der klinischen Routine heute kaum angewendet werden. Zusammenfassend wird empfohlen, für die Ödemdiagnostik eine klinische Untersuchung möglichst in Kombination mit einer Sonographie durchzuführen. Insbesondere zu Beginn der Entstauungsphase sollten regelmäßig Umfangsmessungen durchgeführt und dokumentiert werden. Diese Dokumentation ist für die Bewertung des therapeutischen Erfolgs von hoher Aussagekraft. // Edema of the lower extremities is always associated with a pathological condition that should be treated, especially in patients with chronic wounds. Because the underlying causes of edema can vary greatly and sometimes be complex, clinical and, if necessary, various diagnostic tests should also be performed. Often, a suspected clinical diagnosis can already be made after clinical inspection with testing of Stemmer's and Godet's signs. Sonographic examination should then be performed as the next diagnostic test. Although measurement techniques such as water plethysmography are currently considered gold standard for volume measurements, they are very complex and prone to error, so that they are rarely used in clinical routine today. In summary, it is recommended to perform a clinical examination, if possible in combination with sonography, for edema diagnosis. Especially at the beginning of the decongestion phase, regular circumferential measurements should be performed and documented. This documentation is of high relevance for evaluation of therapeutic success

Associated factors and comorbidities in patients with pyoderma gangrenosum in Germany: a retrospective multicentric analysis in 259 patients

Background: Pyoderma gangrenosum (PG) is a rarely diagnosed ulcerative neutrophilic dermatosis with unknown origin that has been poorly characterized in clinical studies so far. Consequently there have been significant discussions about its associated factors and comorbidities. The aim of our multicenter study was to analyze current data from patients in dermatologic wound care centers in Germany in order to describe associated factors and comorbidities in patients with PG. Methods: Retrospective clinical investigation of patients with PG from dermatologic wound care centers in Germany. Results: We received data from 259 patients with PG from 20 different dermatologic wound care centers in Germany. Of these 142 (54.8\%) patients were female, 117 (45.2\%) were male; with an age range of 21 to 95 years, and a mean of 58 years. In our patient population we found 45.6\% with anemia, 44.8\% with endocrine diseases, 12.4\% with internal malignancies, 9.3\% with chronic inflammatory bowel diseases and 4.3\% with elevated creatinine levels. Moreover 25.5\% of all patients had a diabetes mellitus with some aspects of potential association with the metabolic syndrome. Conclusions: Our study describes one of the world's largest populations with PG. Beside the well-known association with chronic bowel diseases and neoplasms, a potentially relevant new aspect is an association with endocrine diseases, in particular the metabolic syndrome, thyroid dysfunctions and renal disorders. Our findings represent clinically relevant new aspects. This may help to describe the patients' characteristics and help to understand the underlying pathophysiology in these often misdiagnosed patients

Pimecrolimus in dermatology: atopic dermatitis and beyond

Pimecrolimus is a calcineurin inhibitor developed for the topical therapy of inflammatory skin diseases, particularly atopic dermatitis (AD). Pimecrolimus selectively targets T cells and mast cells. Pimecrolimus inhibits T-cell proliferation, as well as production and release of interleukin-2 (IL-2), IL-4, interferon-γ and tumour necrosis factor-α. Moreover, pimecrolimus inhibits mast cell degranulation. In contrast to tacrolimus, pimecrolimus has no effects on the differentiation, maturation and functions of dendritic cells. In contrast to corticosteroids, pimecrolimus does not affect endothelial cells and fibroblasts and does not induce skin atrophy. Given the low capacity of pimecrolimus to permeate through the skin, it has a very low risk of systemic exposure and subsequent systemic side-effects. In different randomised controlled trials, topical pimecrolimus as cream 1% (Elidel ® ) has been shown to be effective, well tolerated and safe in both adults and children with mild to moderate AD. In addition, pimecrolimus has been successfully used in inflammatory skin diseases other than AD, including seborrheic dermatitis, intertriginous psoriasis, lichen planus and cutaneous lupus erythematosus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73190/1/j.1368-5031.2005.00587.x.pd

Cotton-hydrogel composite for improved wound healing: antimicrobial activity and anti-inflammatory evaluation - part 2

Infection is one of the major risk factors for the development of chronic wounds.Antimicrobial wound dressing has been pointed out as a viable option for the preven-tion and treatment of wound infections. Thus, we developed a composite materialbased on cotton textile substrates functionalized with cyclodextrin‐hydroxypropylmethyl cellulose‐based hydrogel. The composites' ability to encapsulate and releasegallic acid (antimicrobial phenolic acid) was evaluated, as well as their mechanicalproperties and antimicrobial and anti‐inflammatory capacity. All composites were ableto retain gallic acid in their structure, with similar loading profile. The presence of gal-lic acid on composites was confirmed by FTIR and TGA. Composites storage moduliwas reduced by the presence of gallic acid. The results suggest a straight relationbetween the swelling ability and gallic acid drug delivery profile. The drug deliverymechanism, of the developed composites, was mainly controlled by Fickian diffusion,based on the experimental data fitting to the Peppas‐Sahlin model. Gallic acid antimi-crobial and anti‐inflammatory properties were transferred to the composite materials.According to the results, the developed composites can be applied on the preventionor treatment of chronic woundsThis article is a result of the project TSSiPRO—NORTE‐01‐0145‐ FEDER‐000015—supported by the regional operational program NORTE 2020, under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund. The authors, also, acknowledge the Portuguese Foundation for Science and Technology (FCT) funding from the project UID/CTM/00264/2013 and UID/AGR/00690/2013 and FEDER funds through the COMPETE 2020–Programa Operacional Competitividade e Internacionalização (POCI) with the reference project POCI‐01‐0145‐FEDER‐007136.info:eu-repo/semantics/publishedVersio

The global impact of the COVID-19 pandemic on the management and course of chronic urticaria

Introduction: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. Materials and Methods: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. Conclusions: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation