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Acticoat* Case Study MGuidry

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The use of silver dressings in atypical inflammatory ulcers of Lupus: a case report


Maria T. Guidry, MD, CWS,

Assistant Professor, Department of Orthopaedic Surgery and Rehabilitation


Introduction

This case report examines the usefulness of Acticoat * Moisture Control, an absorbent nanocrystalline† silver antimicrobial dressing in an atypical ulcer with inflammatory and infectious components.

While the majority of lower extremity ulcers are due to diabetes, pressure, or vascular insufficiency, it is important to recognize and diagnose those with atypical origins, so that they may be treated appropriately. Atypical ulcers of the lower extremities account for 1-2% of cases, and may be etiologically grouped into inflammatory, infectious, metabolic,neoplastic, and vasculopathic ulcers. 1,2 Treatment of the underlying cause, if identifiable,is paramount. Moreover, topical treatment of the ulcers should be directed toward the avoidance of secondary infection as well as re-epithelialization. 3


Case study

Stage IV pressure ulcers are a frequent complication of spinal cord injury. These frequently become complicated by chronic osteomyelitis as in this A 46-year-old female non-diabetic with CREST syndrome, systemic lupus erythematosus,and Sjogren's syndrome, was initially seen in the dermatology clinic at the author's institution due to painful erythematous papulovesicular eruptions on her left leg that arose from areas of excoriation and scratching. Biopsy of the skin lesions revealed panniculitis and necrotizing vasculitis consistent with lupus. The patient was treated with high dose oral steroids, as well as topical steroids, with modest improvement of the papulovesicular eruption. However, an ulcer developed at the biopsy site, which dramatically and disproportionately increased in size and depth, resulting to an extremely painful full-thickness ulcer involving skin, subcutaneous tissue, and muscle. This was complicated by staphylococcus aureus cellulitis of the leg. The patient was referred to the author's wound clinic for further management.

The cellulitis resolved with the administration of tetracyclines. The ulcer at the previous biopsy site was initially treated with enzymatic debriders, which the patient tolerated poorly due to the excruciating pain. At week two, the ulcer measured 2.5 x 2.5 x 0.5cm, and treatment with Iodosorb* Cadexomer Ointment with Iodine was started. By the fourth week, the patient was switched to the absorbent silver antimicrobial dressing. Sharp debridements were not tolerated due to pain. Dressings were changed every three to four days. There was good control of exudate, and the ulcer had increasing granulation with less slough. The ulcer measured 1.5 x 1.0 x 0.3cm after three weeks on the absorbent nanocrystalline silver dressing (60% improvement), and was 90% epithelialized by week 11.


Week 4: Prior to using AMC dressing, the ulcer measured 2.5 x 2.5 x 0.5 cm Week 11: The ulcer is granulating and epithelializing well

Week 4: Prior to using AMC dressing, the ulcer measured

2.5 x 2.5 x 0.5 cm

Week 11: The ulcer is granulating

and epithelializing well

Conclusion
The use of an absorbent nanocrystalline antimicrobial silver dressing increased healing rates of a vasculitic ulcer secondary to lupus, prevented infection, and reduced signs of inflammation.

References
1. Gotrup F, Karismark T. Leg Ulcers: uncommon presentations. Clinics in Dermatology. 2005;23(6):601-611.
2. Baranoski S, Ayello E. Wound Care Essentials: Practice Principles. Philadelphia: Lippincott, Williams and Wilkins. 2006:382-385.
3. Reichrath J, Bens G. Treatment recommendations for pyoderma gangrenosum: An evidence-based review of literature based on more than 350 patients. Dermatology Clinic, The Saarland University Hospital, Homburg/Saar, Germany.

Nanocrystalline Silver is a patented technology of NUCRYST Pharmaceuticals Corp.
TM SILCRYST is a trademark of NUCRYST Pharmaceuticals Corp, used under licence