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Use of vinegar (acetic acid) to promote wound healing complicated by hypergranulation tissue
P3813
P3815
Wound healing therapy with nitric oxideereleasing nanoparticles George Han, Albert Einstein College of Medicine, Bronx, NY, United States; Adam Friedman, MD, Albert Einstein College of Medicine, Bronx, NY, United States; Joel Friedman, MD, PhD, Albert Einstein College of Medicine, Bronx, NY, United States; Manju Chacko Dawkins, MD, Albert Einstein College of Medicine, Department of Dermatology, Bronx, NY, United States
The role of interleukin-12 receptor aberrations in isolated immune deficits causing atypical mycobacterial infection in an otherwise normal host Christina Gelbard, MD, PhD, University of Texas-Houston, Department of Dermatology, Houston, TX, United States; Adelaide Hebert, MD, University of Texas-Houston, Department of Dermatology and Pediatrics, Houston, TX, United States An 11-year-old female patient with a 2-year history of recurrent abscesses, nodules, and erosions on the bilateral lower extremities was diagnosed initially with an acidfast bacterial infection. The patient was otherwise healthy, without fever, chills, or pain. There was no history of gardening, recent travel, or tuberculosis exposure. The family dog is reportedly healthy and there are no cats at home. Previous treatments for the cutaneous ulcers included topical bactroban, desonide, retin A, dilute bleach baths, and local heat treatment. Previously used oral medications included amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, clindamycin, itraconazole, clarithromycin, doxycycline, linezolid, and saturated solution of potassium iodide. Although the ulcers improved intermittently with antibiotics and heat treatment, they never completely resolved. The patient was seen by the hematology/oncology, immunology, and infectious disease services, and evaluations for immunologic impairments, NK cell lymphoma, and atypical mycobacterial and fungal infections have been negative. Multiple cultures were obtained. A single culture grew enterococcus, and all other cultures were negative. Multiple biopsies have shown deep dermal abscesses. Interleukin-12 (IL-12), a cytokine produced by macrophages, stimulates TH1 differentiation and interferon-g production. Impairments in the IL-12 signaling pathway have been identified in patients with recurrent leishmaniasis, Mycobacterium avium, and Staphylococcus aureus infections. Deficiency of IL-12 receptor b-1 has been identified as a cause of Mendelian susceptibility to mycobacterial disease, in which patients are susceptible to weakly pathogenic mycobacteria and Salmonella species. Although multiple cultures and biopsy specimens failed to demonstrate acid-fast bacteria, the patient’s history and physical examination are consistent with mycobacterial infection and raise concerns regarding an IL-12 receptor defect. The patient is to undergo additional testing, including lymphocyte receptor phenotype testing, to further evaluate this possibility.
The process of wound healing in the human body is an exceedingly complex one, involving a multitude of signaling pathways, effector molecules, response phases, and a moderated balance between all of these components. In common clinical situations, such as diabetes and malnutrition, this delicate balance is disturbed and wound healing is delayed, resulting in nonhealing wound sites that cause profound morbidity. It is estimated that between 2.5 to 4.5 million people in the United States are affected by these chronic, often disabling wounds. These wound sites also act as a point of entry for infections, which can be particularly devastating to the patient. One molecule that has a critical role in this process is nitric oxide (NO). It is involved through its antimicrobial properties, modulation of platelet/cytokine function, vasodilatory effects, and promotion of angiogenesis and matrix deposition. While attempts to administer NO to wound areas have shown some promise, the current modalities all suffer from varying drawbacks, such as administration site irritation or the burden of large, expensive equipment. We have synthesized a novel composite hydrogel/glass matrix sustained release platform for NO, where we can achieve controlled, gradual release of nitric oxide to wound sites. This biocompatible system has an inexpensive, facile preparative process and can be stored for long amounts of time while retaining functionality. In addition, we have previously demonstrated that these particles have potent antimicrobial effects against Staphylococcus aureus. Here, we present our findings evaluating NO nanoparticle impact on wound healing in both an in vitro and in vivo mouse model setting. These results, with respect to rate and quality of wound healing, suggest that our NO-releasing nanoparticles may be a promising treatment or adjuvant for wound healing therapy, particularly for problematic, slow-healing wounds that represent a challenge for the current standard of care. Commercial support: None identified.
Commercial support: None identified.
P3814 Use of vinegar (acetic acid) to promote wound healing complicated by hypergranulation tissue Edward Prodanovic, Saint Louis University, Saint Louis, MO, United States; Scott Fosko, MD, Saint Louis University, Saint Louis, MO, United States The regeneration of dermal and epidermal tissue typically produces a scar in a predictable manner, but the process of wound healing is susceptible to disarray or disruption. A wound complicated by overabundance of granulation tissue (ie, hypergranulation or proud flesh), is one example. Traditional treatment methods have included the use of caustic substances or topical steroids that can, in fact, prolong wound closure. We present 19 cases from January 2007 through August 2007 with hypergranulation tissue after Mohs surgery that were treated with vinegar (acetic acid) soaks in an outpatient setting to aid wound healing by secondary intent. Patients were given specific instructions how to make the appropriate vinegar/acetic acid solution at home instead of buying more costly medical-grade acetic acid. The soaks were continued for 1 to 2 weeks, and all 19 patients had successful wound healing by secondary intent.
P3816
Commercial support: None identified.
Commercial support: Sponsored by Neutrogena Corporation.
MARCH 2009
Therapeutic glycerin-based ointment provides healing benefits Sidney Hornby, MD, Neutrogena Corporation, Los Angeles, CA, United States; Ronald L. Rizer, PhD, Thomas J. Stephens & Associates, Inc, Colorado Springs, CO, United States; Yohini Appa, PhD, Neutrogena Corporation, Los Angeles, CA, United States The ability of glycerin to maintain and preserve the epidermal barrier has been demonstrated in multiple studies. We have developed a therapeutic ointment featuring high levels of glycerin designed to promote healing of wounds. A carbon dioxide/erbium laser surgical wound model was used to characterize the influence of this glycerin based formulation in wound healing in this controlled doubleblinded study. Clinical and subjective assessment showed that the glycerin based treatment improved wound healing, while reducing clinical pain, tightness, stinging, and crusting. In addition, clinical assessments demonstrated reduced dryness, cracking, and swelling post surgery. These results support the use of this healing ointment in postedermal procedure care.
J AM ACAD DERMATOL
AB203
P3815
Wound healing therapy with nitric oxideereleasing nanoparticles George Han, Albert Einstein College of Medicine, Bronx, NY, United States; Adam Friedman, MD, Albert Einstein College of Medicine, Bronx, NY, United States; Joel Friedman, MD, PhD, Albert Einstein College of Medicine, Bronx, NY, United States; Manju Chacko Dawkins, MD, Albert Einstein College of Medicine, Department of Dermatology, Bronx, NY, United States
The role of interleukin-12 receptor aberrations in isolated immune deficits causing atypical mycobacterial infection in an otherwise normal host Christina Gelbard, MD, PhD, University of Texas-Houston, Department of Dermatology, Houston, TX, United States; Adelaide Hebert, MD, University of Texas-Houston, Department of Dermatology and Pediatrics, Houston, TX, United States An 11-year-old female patient with a 2-year history of recurrent abscesses, nodules, and erosions on the bilateral lower extremities was diagnosed initially with an acidfast bacterial infection. The patient was otherwise healthy, without fever, chills, or pain. There was no history of gardening, recent travel, or tuberculosis exposure. The family dog is reportedly healthy and there are no cats at home. Previous treatments for the cutaneous ulcers included topical bactroban, desonide, retin A, dilute bleach baths, and local heat treatment. Previously used oral medications included amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, clindamycin, itraconazole, clarithromycin, doxycycline, linezolid, and saturated solution of potassium iodide. Although the ulcers improved intermittently with antibiotics and heat treatment, they never completely resolved. The patient was seen by the hematology/oncology, immunology, and infectious disease services, and evaluations for immunologic impairments, NK cell lymphoma, and atypical mycobacterial and fungal infections have been negative. Multiple cultures were obtained. A single culture grew enterococcus, and all other cultures were negative. Multiple biopsies have shown deep dermal abscesses. Interleukin-12 (IL-12), a cytokine produced by macrophages, stimulates TH1 differentiation and interferon-g production. Impairments in the IL-12 signaling pathway have been identified in patients with recurrent leishmaniasis, Mycobacterium avium, and Staphylococcus aureus infections. Deficiency of IL-12 receptor b-1 has been identified as a cause of Mendelian susceptibility to mycobacterial disease, in which patients are susceptible to weakly pathogenic mycobacteria and Salmonella species. Although multiple cultures and biopsy specimens failed to demonstrate acid-fast bacteria, the patient’s history and physical examination are consistent with mycobacterial infection and raise concerns regarding an IL-12 receptor defect. The patient is to undergo additional testing, including lymphocyte receptor phenotype testing, to further evaluate this possibility.
The process of wound healing in the human body is an exceedingly complex one, involving a multitude of signaling pathways, effector molecules, response phases, and a moderated balance between all of these components. In common clinical situations, such as diabetes and malnutrition, this delicate balance is disturbed and wound healing is delayed, resulting in nonhealing wound sites that cause profound morbidity. It is estimated that between 2.5 to 4.5 million people in the United States are affected by these chronic, often disabling wounds. These wound sites also act as a point of entry for infections, which can be particularly devastating to the patient. One molecule that has a critical role in this process is nitric oxide (NO). It is involved through its antimicrobial properties, modulation of platelet/cytokine function, vasodilatory effects, and promotion of angiogenesis and matrix deposition. While attempts to administer NO to wound areas have shown some promise, the current modalities all suffer from varying drawbacks, such as administration site irritation or the burden of large, expensive equipment. We have synthesized a novel composite hydrogel/glass matrix sustained release platform for NO, where we can achieve controlled, gradual release of nitric oxide to wound sites. This biocompatible system has an inexpensive, facile preparative process and can be stored for long amounts of time while retaining functionality. In addition, we have previously demonstrated that these particles have potent antimicrobial effects against Staphylococcus aureus. Here, we present our findings evaluating NO nanoparticle impact on wound healing in both an in vitro and in vivo mouse model setting. These results, with respect to rate and quality of wound healing, suggest that our NO-releasing nanoparticles may be a promising treatment or adjuvant for wound healing therapy, particularly for problematic, slow-healing wounds that represent a challenge for the current standard of care. Commercial support: None identified.
Commercial support: None identified.
P3814 Use of vinegar (acetic acid) to promote wound healing complicated by hypergranulation tissue Edward Prodanovic, Saint Louis University, Saint Louis, MO, United States; Scott Fosko, MD, Saint Louis University, Saint Louis, MO, United States The regeneration of dermal and epidermal tissue typically produces a scar in a predictable manner, but the process of wound healing is susceptible to disarray or disruption. A wound complicated by overabundance of granulation tissue (ie, hypergranulation or proud flesh), is one example. Traditional treatment methods have included the use of caustic substances or topical steroids that can, in fact, prolong wound closure. We present 19 cases from January 2007 through August 2007 with hypergranulation tissue after Mohs surgery that were treated with vinegar (acetic acid) soaks in an outpatient setting to aid wound healing by secondary intent. Patients were given specific instructions how to make the appropriate vinegar/acetic acid solution at home instead of buying more costly medical-grade acetic acid. The soaks were continued for 1 to 2 weeks, and all 19 patients had successful wound healing by secondary intent.
P3816
Commercial support: None identified.
Commercial support: Sponsored by Neutrogena Corporation.
MARCH 2009
Therapeutic glycerin-based ointment provides healing benefits Sidney Hornby, MD, Neutrogena Corporation, Los Angeles, CA, United States; Ronald L. Rizer, PhD, Thomas J. Stephens & Associates, Inc, Colorado Springs, CO, United States; Yohini Appa, PhD, Neutrogena Corporation, Los Angeles, CA, United States The ability of glycerin to maintain and preserve the epidermal barrier has been demonstrated in multiple studies. We have developed a therapeutic ointment featuring high levels of glycerin designed to promote healing of wounds. A carbon dioxide/erbium laser surgical wound model was used to characterize the influence of this glycerin based formulation in wound healing in this controlled doubleblinded study. Clinical and subjective assessment showed that the glycerin based treatment improved wound healing, while reducing clinical pain, tightness, stinging, and crusting. In addition, clinical assessments demonstrated reduced dryness, cracking, and swelling post surgery. These results support the use of this healing ointment in postedermal procedure care.
J AM ACAD DERMATOL
AB203