The decubitus ulcer: Facts and controversies

Defining the decubitus ulcer proves as difficult as agreeing on a name for the condition. Causes include pressure over bony prominences, shearing force, destruction of skin, and compromised blood flow. Evidence is emerging of the importance of ischemia as a primary causative agent, rather than pressure, which needs further investigation. Scales, staging, and treatment and prevention guidelines should be used with caution due to their arbitrary implementation and lack of evidence-based support. Unfortunately, much of the research and expert opinion developed by the government and touted as regulation lacks appropriate strength-of-evidence. Although decubitus ulcers should be prevented and treated to the best of our abilities, recognizing the possibility that the skin, like any other organ in the body, may fail is crucial.     

Treatment of decubitus ulcer with Crilanomer and dextranomer

In a clinical study on decubital ulcers, 95 patients in 10 hospitals were treated with dextranomer and crilanomer. The size of the ulcer surface and the physician's evaluation of the healing status at the end of treatment served as the most important criteria for our assessment of the curative effect. Both preparations proved equivalent in the statistical test. Crilanomer revealed slightly better results than dextranomer with regard to the physician's overall evaluation al well as odor, exudation, and cleansing. Both modes of treatment were accompanied by local incompatibility reactions of a minor degree; there were no systemic side effects in either preparation.     

Prevention of decubitus ulcer by an elastomere matrix cushion

We have measured and compared the mechanical properties of the skin, muscles and of a cushion designed to prevent bedsores. The mechanical properties of the tested material are intermediate to those of skin and muscles. They permit an even and optimal distribution of the pressures on the skin.     

The decubitus ulcer: many questions but few definitive answers

Decubitus ulcers appear to be associated with insidious trauma. Differential diagnosis can be tricky, and etiology is controversial with sustained localized pressure which plays a significant role. Sustained pressure can stretch soft tissues and blood vessels, causing multiple microthrombi around the point of maximum compression. This leads to prolonged ischemia and produces a plaque of dead tissue surrounded by microthrombi. Prevention often includes regular movement or supports that move the patient. Good nutrition is important, but the adverse effects of fever should not be overlooked. Anti-thrombotic agents should be considered. Occlusive dressings can be used for existing ulcers, while traditional treatments are less appropriate. Pressure and other stresses theoretically should be relieved.     

Successful treatment of chronic decubitus ulcer with 0.1% dirhamnolipid ointment

BACKGROUND: Previous investigations of the biologic activities of dirhamnolipid alpha-L-rhamnopyranosyl-(1-2)alpha-L-rhamnopyranosyl-3-hydroxydecanoyl-3-hydroxydecanoic acid have demonstrated that it could be a novel therapeutic agent for wound healing and various immunologic and dermatologic conditions. OBJECTIVE: The aim of this article is to report the successful treatment of a decubitus ulcer with dirhamnolipid. METHODS: The patient was a 90-year-old woman who developed a decubitus ulcer on her right buttock. The patient was initially treated by a standard procedure using pressure reduction, wound management, surgical intervention, and nutrition. The open, full-thickness wound progressed to a size of 10 x 7 cm, with evidence of tissue deterioration. The draining ulcer reached a dimension of 1 x 1.5 x 3 cm. The 0.1% dirhamnolipid ointment was administered at regular intervals, three times daily, by applying a thin layer of ointment directly to the wound area. Photographs were taken at regular 5-day intervals. RESULTS: The standard therapy gave no improvement. Subsequently, therapy with topical dirhamnolipid ointment resulted in a completely healed wound on day 48 of the treatment. CONCLUSION: This case demonstrates that application of dirhamnolipid resulted in the healing of a chronic decubitus ulcer in an elderly, debilitated patient and might be a useful therapy to improve healing of decubitus ulcers.     

Surgical management of decubitus ulcers

Decubitus ulcers are a significant source of morbidity and mortality in those populations affected^1–3: the elderly, the neurologically impaired, and paraplegics. Health care expenditures rise because of the increased length of hospital stay for patients with pressure ulcers. Treatment modalities and staffing time are increased considerably with the management of pressure ulcers both in the United States^1,4 and abroad.⁵ The magnitude of the decubitus ulcer problem has been compared to an epidemic in the British literature,⁵ and it is considered a serious public health concern by authorities in the United States.^4,6The literature abounds with reviews focusing on the epidemiology, etiology, pathophysiology, risk factors, prevention, and treatment of decubitus ulcers.^5–12 These aspects are addressed in this article to provide a clear understanding of the populations at risk for developing decubitus ulcers and of those pathophysiologic factors responsible for their development. Subsequently, preventive measures, management, and treatment modalities are discussed.     

Controversies in cutaneous lymphomas

Recently great advances were achieved in the recognition and classification of primary cutaneous lymphomas. With this increased knowledge, one must realize that we must deal with new concepts that are sometimes confusing and controversial. The following controversial subjects are presented in this article: (1) Classification of cutaneous lymphomas; (2) Cutaneous T-cell lymphoma with small/medium-sized pleomorphic cells as a distinct entity; (3) Primary cutaneous follicle center lymphoma and marginal zone lymphoma/ immunocytoma.     

Controversies About Hypersexual Disorder and the DSM-5

Criteria for hypersexual disorder were proposed for consideration for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), but ultimately rejected by the American Psychiatric Association despite a field trial suggesting the criteria were valid and reliable. This article highlights the vast array of controversial issues surrounding the proposal for hypersexual disorder. While some criticisms covered a broader scope of general concerns about the field of psychiatric mental illness, many of these often extended to the proposal for hypersexual disorder. It is important to discuss both general concerns about psychiatric disorders and those specifically focused on hypersexuality in order to understand the challenges encountered in advancing the criteria for hypersexual disorder. This article attempts to place the controversies, criticisms, and issues about hypersexuality in context from leading experts in the field.     

Controversies in the management of the cutaneous T cell lymphomas

The primary cutaneous T cell lymphomas (CTCL) encompass all malignancies of the T cell where the skin is the primary organ of involvement. The diagnosis of a CTCL variant can be detoured by a number of obstacles including the slow evolution of the disease into a classic clinical and pathologic pattern. A realistic goal of early stage treatment is to reduce the likelihood of progression to a more advanced stage, not to achieve a cure. No studies have adequately compared the different systemic agents in patients with advanced CTCL so the clinician is left to act in the best interest of the patient with what evidence is available. When using the systemic agents, a "start low and go slow" strategy may offer patients several advantages. Dermatologists are uniquely trained to diagnose and to manage all but the most advanced stage patients with CTCL.