Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology

Abstract

Background Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. Objective To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. Methods Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. Results The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. Conclusion This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.

Chronic Venous Leg Ulcer in Klinefelter Syndrome Treated with Platelet-Rich Fibrin: A Case Report

“…11 The treatment of VLUs consisted of measures to reduce the effects of venous hypertension (compression therapy, surgical treatment for venous abnormality), local treatment for the ulcer, systemic drugs, and complementary measures (leg elevated above the level of the heart, short walks). 12 Compression therapy remains as the first-line and standard treatment for VLUs, which in turn improves venous hemodynamics by applying external pressure to the ankle around 35–40 mmHg. 12 The lifelong maintenance of compression therapy is necessary to decrease the risk of ulcer recurrence.…”

“… 12 Compression therapy remains as the first-line and standard treatment for VLUs, which in turn improves venous hemodynamics by applying external pressure to the ankle around 35–40 mmHg. 12 The lifelong maintenance of compression therapy is necessary to decrease the risk of ulcer recurrence. 13 Meanwhile, for cases of VLUs associated with KS, there is no established therapy.…”

Comparative efficacy of topical Adipocyte-derived Mesenchymal Stem Cells-Conditioned Medium (ADMSC-CM) and Amniotic Membrane Mesenchymal Stem Cells-Conditioned Medium (AMSC-CM) on chronic plantar ulcers in leprosy: a randomized controlled trial

“…12 Therapeutic options for CPUL start with prevention, such as daily inspection of the feet, cleaning and drying of the interdigital, straight nail cutting, hydration, callus removal, examinations of the deformities of the feet, and others. 13 However, in patients with CPUL already ongoing, the approach must be multidisciplinary. Other than the standardized leprosy chemotherapy, novel treatment such as applying Stem Cells (SC) could be an option as described in this study.…”

Targeted Drug Delivery to the Central Nervous System Using Extracellular Vesicles

“…The role of EVs in wound healing has shown that MSC-derived EVs play a significant role in hemostasis by controlling anti-inflammatory processes, proliferation, and remodeling [ 98 , 99 , 100 ]. In clinical trial NCT02565264, the researchers are studying the effect of plasma-derived EVs on intractable cutaneous ulcers, which are common manifestations in peripheral arterial disease, rheumatic disease, burns, decubitus, and chronic venous insufficiency [ 101 ]. Dystrophic epidermolysis bullosa (DEB) is a genetic disorder marked by the mutation in COL7A1 gene and manifested by abnormal blistering of limb skin.…”