Did COVID-19 lockdown delay actually worsen melanoma prognosis?

BackgroundThe COVID-19 lockdown possibly meant a delay in the diagnosis and treatment of melanoma and therefore, worsening its prognosis. This unique situation of diagnosis deferral is an exceptional opportunity to investigate melanoma biology.ObjectivesTo evaluate the immediate and mid-term impact of diagnosis delay on melanoma.MethodsA retrospective observational study of melanoma diagnosed between March 14^th 2019 and March 13^th 2021. We compared the characteristics of melanomas diagnosed during the first 6-month period after the lockdown instauration and a second period after recovery of normal activity with the same periods of the previous year, respectively.ResultsA total of 119 melanomas were diagnosed. There were no differences in age, sex, incidence, location, presence of ulceration or mitoses, and in situ/invasive melanoma rate (p > 0.05). After the recovery of the normal activity, Breslow thickness increased in comparison with the previous year (2.4 vs 1.9 mm, p < 0.05) resulting in a significant upstaging according to the AJCC 8^th ed. (p < 0.05).Study limitationsThe main limitation is that this is a single-center study.ConclusionsThe COVID-19 lockdown implied a diagnosis delay leading to a mid-term increase in Breslow thickness and an upstaging of invasive melanomas. However, the detection deferral did not result in a higher progression of in situ to invasive melanoma, in our sample.     

Worse survival of invasive melanoma patients in men and “de novo” lesions

BackgroundThe incidence and mortality of melanoma is increasing in many countries, including Brazil. Survival studies are still scarce in our country, but much needed to know and address this problem better.ObjectiveTo analyze the disease-specific survival of patients with invasive melanoma and to correlate it with clinical and histopathological variables.MethodsRetrospective cohort analysis of 565 cases of invasive melanoma in a tertiary hospital with the objective of testing variables that could be associated with a worse prognosis, such as gender, phototype, thickness, histological type and presence of pre-existing clinical lesion at the site of the tumor.ResultsThe worst survival rates were significantly associated with thicker tumors (p < 0.001), male sex (p = 0.014), high phototype (p = 0.047), nodular melanoma (p = 0.024) and “de novo” lesions (p = 0.005). When all variables were adjusted for melanoma thickness, male patients (p = 0.011) and “de novo” melanomas (p = 0.025) remained associated with worse survival.Study limitationsRetrospective study of a single tertiary hospital.ConclusionsAlthough the causes are still unknown, melanoma-specific survival was statistically worse for males and for “de novo” melanomas even after adjustment of tumor thickness.     

CD10 expression by melanoma cells is associated with aggressive behavior in vitro and predicts rapid metastatic progression in humans

BackgroundNo biological or molecular marker of primary melanoma tumor cells has been shown to predict clinical outcome in melanoma.ObjectiveTo determine whether CD10, CD133, nestin and CD20 may evaluate the prognosis of melanoma.MethodsThe differential expression of these molecules was assessed in pairs of cell lines. We evaluated, by both immunohistochemical staining and RT-qPCR, their expression in a cohort of 32 patients (68 samples) with a history of metastatic melanoma, divided into two groups according to their clinical outcome profile.ResultsCD10 over expression in cancer cell lines was associated with more aggressive behavior in vitro. A CD10-positive staining was more frequent in patients in the “rapidly progressive” group than those in the “long survivor” group (23/35 versus 2/18, p < 10^?4). CD10 expression was associated with a lower median overall survival (1.15 year – IQR: [0.50–2.58] versus 4.27 – IQR: [1.66–6.33]; p = 10^?4). The Odds Ratio of displaying a “rapidly progressive” melanoma when tumor cells expressed CD10 was 15 (95% confidence interval: [3–78]). After adjusting for confounding factors, CD10 expression in melanoma tumor cells remained associated with an increased risk of death and more rapid disease progression (p = 6 × 10^?4; HR = 3.71).ConclusionCD10 may predict clinical outcome in melanoma patients.     

Análisis de la producción científica nacional e internacional de los dermatólogos españoles (1988-2000)

ObjectiveTo compare the scientific production in articles published in Actas Dermo-Sifiliográficas (AD) with papers published by Spanish dermatologists in international journal (IJ) included in Medline data base between 1988 and 2000. The main features studied were: type and extension of document, subject, authors’ place of work, speciality and geographical distribution.Material and methodsData were obtained by consulting the articles published in the journal AD. Also Spanish papers in dermatology were retrieved from Medline data base.ResultsA total of 1,864 articles were published in AD and 1,645 papers were retrieved from IJ. The extension of documents in AD was higher (4.46 ± 2.57) than in IJ (3.29 ± 2.33). In the journal AD there is a predominance of topics related to oncology (13.3 % vs 9.0 %) (< 0.001), pediatrics (12.7% vs 8.7%) (p < 0.001) and surgery (2.4 % vs 0.9%) (p = 0.001) compared to the papers published in IJ. In IJ there was a predominance of topics related to contact dermatitis (14.6% vs 4.5%) (p < 0.001), physiopathology (4% vs 2.3%) (p = 0.001), drug-induced reactions (6.6 % vs 4.3%) (p = 0.001) and dermatopathology (18.7 % vs 16.1 %) (p = 0.01). Andalucía (16.4% vs 8.6 %) (p < 0.001), Aragón (3.9 % vs 0.7 %) (p < 0.001), Asturias (2.1 % vs 0.2 %) (p < 0.001), Castilla-León (8.5 % vs 3.6 %) (p < 0.001), and Madrid (37.1% vs 30.6%) (p < 0.001) published more in AD than in IJ. However, Cataluña (26.3% vs 9.6 %) (p < 0.001), Navarra (5.6 % vs 1.8%) (p < 0.001) and País Vasco (4.2% vs 2.0%) (p < 0.001) published more in IJ.ConclusionWe have observed differences in the topics and the geographical distribution of papers published by Spanish researchers in dermatology.     

Registro nacional de melanoma cutáneo. Características del tumor en el momento del diagnóstico: 15 años de experiencia

Background and objectivesThe Spanish National Cutaneous Melanoma Registry (Registro Nacional de Melanoma Cutáneo [RNMC]) was created in 1997 to record the characteristics of melanoma at diagnosis. In this article, we describe the characteristics of these tumors at diagnosis.Patients and methodsThis was a cross-sectional observational study of prevalent and incident cases of melanoma for which initial biopsy results were available in the population-based RNMC.ResultsThe RNMC contains information on 14,039 patients. We analyzed the characteristics of 13,628 melanomas diagnosed between 1997 and 2011. In total, 56.5% of the patients studied were women and 43.5% were men. The mean age of the group was 57 years (95% CI, 56.4-57 years) while median age was 58 years. The most common tumor site was the trunk (37.1%), followed by the lower limbs (27.3%). The most frequent clinical-pathologic subtype was superficial spreading melanoma (n = 7481, 62.6%), followed by nodular melanoma (n = 2014, 16.8%). Localized disease was observed in 86.2% of cases (n = 10,382), regional metastasis in 9.9% (n = 1188), and distant metastasis in 3.9% (n = 479). Independently of age at diagnosis, men had thicker tumors, more ulceration, higher lactate dehydrogenase levels, and a higher rate of metastasis than women (P < .001).ConclusionsBased on our findings, melanoma prevention campaigns should primarily target men over 50 years old because they tend to develop thicker tumors and therefore have a worse prognosis.     

Evaluación de la regresión en melanomas primarios sucesivos

Introduction and objectivesIt has been suggested that patients who have had a melanoma may develop increased immunity against certain antigens expressed by tumor-associated melanocytes. Thus our objective was to review the records of patients with successive primary melanomas to ascertain whether the pattern of regression might indicate the presence of an immunization effect arising from the first melanoma.Material and methodsA review of all the cases recorded in the melanoma database of our dermatology department between 2000 and 2012 identified 19 patients who had multiple asynchronous melanomas (2.56% of all the cases recorded). We studied the presence or absence of regression in these melanomas and other clinical and histological characteristics.ResultsThe presence of regression was significantly higher in successive melanomas than in the first tumors identified (42.10% vs 21.05%, P = .018). Regression of at least 1 melanoma was observed in 42.10% of the patients studied and regression of 2 melanomas was observed in 21.05%. In no case was regression observed in the first melanoma and not in the second; however, in 21.05% of the patients there was evidence of regression in the second tumor and none in the first.ConclusionsOur findings suggest the possibility that the first melanoma produces an immunization effect in some patients who develop multiple asynchronous melanomas.     

Clinicopathologic analysis of trichoblastoma and comparison with nodular basal cell carcinoma

BackgroundTrichoblastoma (TB) is an uncommon benign follicular tumour for which clinical data is limited since most reports originate from pathology studies.ObjectiveTo describe the clinical aspects of TB.MethodsThis is an ancillary study of a prospective multicentre cohort of 2710 clinically suspected basal cell carcinoma (BCC), including 935 nodular BCCs. Sixty-two cases were TB: they were analysed and compared to 935 nodular BCCs.ResultsTB mostly occurred in females (61% vs. 43% for BCC, P < 0.01) of mean age 63 years. They were located on the head and neck, mainly on the nose and forehead, in 87% of cases. The mean size was 8.1 mm, 77% were < 10 mm (55% of BCCs, P < 0.001), 8% were ulcerated (vs. 21% of BCCs, P < 0.02), and 47% persisted for more than 1 year (34% of BCCs, P < 0.05). Most cases had a clinical presentation similar to nodular BCC, except for 5 small, flat, white papules and 1 anfractuous plaque.LimitationsCases originated from a series of tumours clinically suspected as BCCs.DiscussionSome 2.6% of tumours clinically diagnosed as BCC are in fact TB. TB occurs on the head, are more frequent in women, and are smaller and of longer duration than BCC. In most cases, clinical diagnosis on clinical grounds is difficult.     

Pain and Late-Onset of Hidradenitis Suppurativa Can Have a Negative Influence on Occupational Status and Educational Level. A Cross-Sectional Study

Background and objectivesHidradenitis suppurativa is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with hidradenitis suppurativa.MethodsCross-sectional study of patients with hidradenitis suppurativa seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status.ResultsNinety-eight patients were included. Patients with non-university studies had more frequently ≥ 3 affected areas (22.5% [16/73] vs 4.8% [1/22], p = 0.049), a higher number of painful days (8.5 [SD 8.8] vs 4.6 [SD 4.8], p = 0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs 5.0 [3.3], p = 0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs 5.7 [SD 6.2], p = 0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs 27.4% [17/62], p = 0.002) and a higher mean BMI (32.3 [9.1] vs 28.4 [6.4], p = 0.016). Late disease onset was significantly associated with being “inactive” (26.7% [8/31] vs 6.5% [4/62], p = 0.026). No significant differences between severity scales of hidradenitis suppurativa and educational level or occupational status were found. Limitations: cross-sectional and single center study.ConclusionsPain, ≥3 affected areas, history of depression, higher mean BMI, and late onset of hidradenitis suppurativa, are associated with low education level and inactive occupational status.     

Serum irisin level,insulin resistance,and lipid profiles in patients with hidradenitis suppurativa: a case-control study

BackgroundHidradenitis suppurativa is a chronic inflammatory skin disease of terminal follicular acroinfundibulum.ObjectivesThis study aimed to evaluate serum irisin, plasma glucose, insulin, and lipid levels in hidradenitis suppurativa, and elucidate possible associations with disease activity, inflammatory, or metabolic parameters.MethodsThis case-control study included 37 patients (M/F: 9/28) and 37 sex-, age- and body mass index -matched healthy controls (M/F: 11/26). Demographic data, Hurley stage of disease, fasting glucose, insulin, total cholesterol, high density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, C-reactive protein levels, erythrocyte sedimentation rate, hematologic parameters, and serum irisin were assessed.ResultsThe hidradenitis suppurativa group had significantly higher waist circumference than controls (p < 0.001). Insulin resistance, defined as a homeostatic model assessment for insulin resistance value greater than 2.5, was observed in 45.9% of patients and 8.1% of controls (p = 0.003), whereas metabolic syndrome was observed in 32.4% of patients and 5.4% of controls (p < 0.001). Furthermore, plasma triglycerids, glucose, and insulin levels were significantly higher in the hidradenitis suppurativa (p = 0.013, p = 0.001, and p = 0.004), respectively. Mean irisin level was insignificantly higher in the hidradenitis suppurativa group (37.4 ± 32.6) than in controls (26.2 ± 24.7, p = 0.217).Study limitationPhysical activity and the exercise levels of participants were not documented.ConclusionThis study indicates that hidradenitis suppurativa patients have higher serum irisin, fasting plasma glucose, insulin, and triglycerides levels than healthy controls. Thus, the authors suggest that hidradenitis suppurativa patients should be evaluated for insulin resistance and metabolic syndrome, and monitored accordingly.     

[Translated article] Oral Lesions in Patients With Psoriasis: Prevalence and Association With Its Clinical and Epidemiological Characteristics

Background and objectivePsoriasis is a multisystem disease associated with an increased prevalence of oral lesions. The aim of this study was to determine the prevalence of oral lesions in patients with psoriasis and examine associations with clinical and patient characteristics.Material and methodsWe conducted a cross-sectional study of patients with psoriasis and healthy controls seen between December 2019 and February 2020. We recorded biometric data, comorbidities associated with psoriasis, oral examination findings, and clinical characteristics of psoriasis.ResultsWe studied 100 patients with psoriasis and 100 controls. Oral lesions were more common in the psoriasis group (74% vs 46%, P < .001). The most common lesions were fissured tongue (39% vs 16%, P < .001) and periodontitis (28% vs 16%, P = .04). Geographic tongue was uncommon in both the study and the control group (4% vs 2%, P = .68). In the psoriasis group, patients with fissured tongue had a higher prevalence of cardiovascular disease (23.1% vs 4.9%), diabetes mellitus (28.2% vs 8.2%), and psoriatic arthritis (15.4% vs 1.6%) than those without this condition. Periodontitis was also associated with a higher prevalence of cardiovascular disease (28.6% vs 5.6%). Type of psoriasis, location, and time since onset were not significantly associated with oral lesions. Patients with oral lesions, however, had more severe disease (Psoriasis Area Severity Index [PASI], 3.9 vs 2.4; P = .05). Mean PASI was also higher in patients with fissured tongue (4.7 vs. 2.7, P = .03) and periodontitis (5.1 vs. 2.9, P = .04).ConclusionsThe prevalence of oral lesions, especially fissured tongue and periodontitis, is higher in patients with psoriasis than in healthy controls. Oral lesions were associated with more severe psoriasis and a higher prevalence of associated comorbidities. We recommend examining the oral cavity of patients with psoriasis, especially those with more severe disease and comorbidities, irrespective of type of psoriasis, location, or time since onset.     

Manifestaciones orales en pacientes con psoriasis. Prevalencia y asociación con sus características clínicas y epidemiológicas

Background and objectivePsoriasis is a multisystem disease associated with an increased prevalence of oral lesions. The aim of this study was to determine the prevalence of oral lesions in patients with psoriasis and examine associations with clinical and patient characteristics.Material and methodsWe conducted a cross-sectional study of patients with psoriasis and healthy controls seen between December 2019 and February 2020. We recorded biometric data, comorbidities associated with psoriasis, oral examination findings, and clinical characteristics of psoriasis.ResultsWe studied 100 patients with psoriasis and 100 controls. Oral lesions were more common in the psoriasis group (74% vs 46%, P < .001). The most common lesions were fissured tongue (39% vs 16%, P < .001) and periodontitis (28% vs 16%, P = .04). Geographic tongue was uncommon in both the study and the control group (4% vs 2%, P = .68). In the psoriasis group, patients with fissured tongue had a higher prevalence of cardiovascular disease (23.1% vs 4.9%), diabetes mellitus (28.2% vs 8.2%), and psoriatic arthritis (15.4% vs 1.6%) than those without this condition. Periodontitis was also associated with a higher prevalence of cardiovascular disease (28.6% vs 5.6%). Type of psoriasis, location, and time since onset were not significantly associated with oral lesions. Patients with oral lesions, however, had more severe disease (Psoriasis Area Severity Index [PASI], 3.9 vs 2.4; P = .05). Mean PASI was also higher in patients with fissured tongue (4.7 vs. 2.7, P = .03) and periodontitis (5.1 vs. 2.9, P = .04).ConclusionsThe prevalence of oral lesions, especially fissured tongue and periodontitis, is higher in patients with psoriasis than in healthy controls. Oral lesions were associated with more severe psoriasis and a higher prevalence of associated comorbidities. We recommend examining the oral cavity of patients with psoriasis, especially those with more severe disease and comorbidities, irrespective of type of psoriasis, location, or time since onset.     

Características clínico-patológicas de los melanomas cutáneos diagnosticados en un hospital terciario mediterráneo entre 1990 y 2004: comparación entre sexos,por grupos de edad y evolución a lo largo del tiempo

BackgroundThe incidence of malignant melanoma has increased over recent decades. Early diagnosis continues to be essential for effective treatment. Our objective was to analyze cutaneous malignant melanomas diagnosed over a 15-year period in a tertiary hospital for trends towards earlier diagnosis and to identify subgroups with poorer prognosis.Material and methodsRetrospective analysis of primary cutaneous melanomas analyzed in the pathology department of Hospital La Paz, Madrid, Spain, between 1990 and 2004.ResultsIn total, 526 melanomas were diagnosed. The mean (SD) Breslow thickness was 2.63 (4.84) mm and the median thickness was 0.98 mm (range, 0-65 mm). The mean size (widest point) was 16.59 (12.11) mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. Melanomas detected in men were generally larger and thicker than in women (P = 0.05). Individuals aged over 60 years consulted for significantly thicker and larger tumors than younger individuals. The incidence of malignant melanomas has increased steadily over the years whereas the mean Breslow thickness and size have decreased.ConclusionsDiagnosis of melanoma in Spain is made increasingly earlier, although locally advanced tumors are still sometimes seen in men and in individuals aged over 60 years.     

Histopathologic and immunohistochemical distinction of condyloma and seborrheic keratosis in the genitofemoral area

BackgroundMaking a clinical and histological distinction between condyloma and seborrheic keratosis in the genitofemoral area can be difficult. This study aimed to find reliable histological and immunohistological criteria to diagnose these entities.MethodsWe retrospectively studied genitofemoral skin biopsy specimens obtained between January 2004 and December 2007 that had been diagnosed as showing condyloma or seborrheic keratosis. The histological findings were assessed and immunohistochemical stains were performed for human papillomavirus, Ki-67, and p21. DNA was extracted from paraffin sections and amplified by polymerase chain reaction to detect the presence and type of human papillomavirus.ResultsDNA extraction was successfully performed for 58 lesions. The final diagnoses were condyloma in 41 and seborrheic keratosis in 17. The diagnosis of condyloma rather than seborrheic keratosis was likely in the presence of broad, evenly distributed reticulated acanthosis (p < 0.0001), koilocytosis (p < 0.001), a fascicular arrangement of keratinocytes (p < 0.01), and an absence of horn cysts (p < 0.01). Immunohistochemical staining supported the diagnosis of condyloma when positive for human papillomavirus (p < 0.0001), Ki-67 (p < 0.0001), and p21 (p < 0.0001).ConclusionA combination of histological and immunohistochemical findings is useful to distinguish condyloma from seborrheic keratosis in the genitofemoral area.     

The relationship between history of hormonal contraceptive use and iron status among women in Tanzania: A population-based study

ObjectivesApproximately 30% of the Tanzanian women in the reproductive age group are iron deficient. At population-level, there is a dearth of research on the relationship between hormonal contraceptive use and iron deficiency. The study objective was to examine the relationship between history of hormonal contraceptive use and iron status among women in Tanzania.Study designWe conducted a cross-sectional study analysis including 4186 women who participated in the population-based 2010 Tanzania Demographic and Health Survey.Main outcome measureIron status determined by iron deficiency, anemia, and iron deficiency anemia.ResultsAlmost 19.0% women reported history of hormonal contraceptive use. Nearly, 30.0%, 39.5%, and 14.3% women had iron deficiency, anemia and iron deficiency anemia respectively. History of hormonal contraceptive use was negatively associated with iron deficiency, anemia and iron deficiency anemia, independent of potential confounders. Compared to non-users, the multivariable-adjusted odds ratio OR (95% CI) among hormonal contraceptive users was 0.73 (0.56–0.94, p < 0.05) for iron deficiency, 0.58 (0.46–0.72, p < 0.001) for anemia, and 0.53 (0.37–0.74; p < 0.001) for iron deficiency anemia. Longer duration of hormonal contraceptive use (>2 years) had lesser odds of iron deficiency 0.63 (0.43–0.91, p for trend 0.005), anemia 0.51 (0.36–0.73, p for trend <0.001) and iron deficiency anemia 0.35 (0.19–0.65, p for trend <0.001).ConclusionOur finding has important implications for educating healthcare providers and women about additional nutritional benefits of the use of hormonal contraceptives.     

Higher incidence of metabolic syndrome components in vitiligo patients: a prospective cross-sectional study

Background/ObjectivesTo investigate the association between vitiligo and metabolic syndrome.MethodsA prospective cross-sectional study was conducted between 2014 and 2016. Study (n = 155) and control groups (n = 155) were evaluated for metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation criteria. Study group was divided into three groups according to their vitiligo area severity index and vitiligo disease activity score values (Group 1: 6.89 for VASI score, Group A: −1–0, Group B: 1–2 and Group C: 3–4 for vitiligo disease activity score respectively). MetS rates according to both criteria were compared between the vitiligo disease activity score and vitiligo area severity index groups.ResultsMetabolic syndrome rates were 37.4% and 40% in the study group and 19.4% and 26.5% in the control group according to National CholesterolEducation Program Adult Treatment Panel III and International Diabetes Federation criteria, respectively (p < 001 and p = 0.011). Metabolic syndrome was more frequent in vitiligo area severity index Groups 2 and 3 compared to vitiligo area severity index Group 1, and in vitiligo disease activity score Group C compared to vitiligo disease activity score Groups A and B.Study limitationsSingle center experience, absence of more specific oxidative-stress markers and lack of long-term follow-up of the patients.ConclusionsFrequency of metabolic syndrome was higher in patients with non-segmental vitiligo and the rate was higher in active/severe form of the disease.     

Care seeking during the latent phase of labour – Frequencies and birth outcomes in two delivery wards in Sweden

ObjectiveTo explore the frequency of women seeking care during the latent phase of labour at two delivery wards. Also, to investigate interventions during labour and birth outcomes in relation to parity and remaining in hospital or not during the latent phase.MethodsA retrospective, population-based cohort study in two delivery wards in Sweden. The sample was based on electronic childbirth records of all births with spontaneous onset.ResultsOf 5797 women, 17.6% (n = 1023) sought care during the latent phase. Of these, 57.8% (n = 591) remained at the hospital, and 50.5% (n = 517) had a prolonged latent phase. Nulliparae remaining in hospital had a lower rate of spontaneous vaginal births (p = 0.007), more emergency Caesarean sections (CSs) (p < 0.001) and more babies with Apgar <7 at 5 min (p = 0.045) compared with those returning home. Nulliparae having a prolonged latent phase and remaining in hospital had fewer spontaneous vaginal births (p = 0.045), more emergency CSs (p = 0.002) and more babies with Apgar <7 at 5 min (p = 0.023) compared with those returning home. For multiparous women with a previous vaginal birth, with or without prolonged latent phase, mode of delivery was not influenced by remaining in hospital or not.ConclusionThese findings indicate a need for different guidelines for nulliparous and multiparous women seeking hospital care during the latent phase, and for special attention to be given to nulliparous with a prolonged latent phase remaining in hospital during the latent phase.     

A pilot randomised controlled trial comparing reactive air and active alternating pressure mattresses in the prevention and treatment of pressure ulcers among medical ICU patients

BackgroundData on the prevention and treatment of pressure ulcers (PU's) among ICU patients is sparse.ObjectiveTo compare PU outcomes in medial ICU patients nursed on either a reactive mattress overlay (ROHO^®, ROHO Inc, Belleville, IL, USA) or an active alternating pressure mattress (NIMBUS^®3, ArjoHuntleigh, Luton Bedfordshire, UK).DesignPilot prospective single blind randomised controlled clinical trial.InterventionTwo types of pressure redistributing mattress.PatientsTwo groups of eight patients.MethodsPatients included in the study were those at high risk (Norton scale <8) or with a PU on admission.ResultsThe two groups had similar patient characteristics. However, the NIMBUS 3 group presented with more ulcers per patient on admission (62.5%) and more severe ulcers (20% category 3) while four patients (50%) presented with a single superficial ulcer in the ROHO group.HealingThe progress of the ulcers showed significant decreases in PU surface area (p = 0.05), total PUSH tool score (p = 0.01) in the NIMBUS 3 group compared to the ROHO group. In the NIMBUS 3 group 82% of the ulcers improved versus none in the ROHO group (p = 0.002) and 18% remained stable versus 33%. None of the ulcers deteriorated in the NIMBUS 3 group versus 67% in the ROHO group (p = 0.006). Full thickness wounds (Category 3) were present in 22% of the NIMBUS 3 group versus 0% of the ROHO group on admission and in 0% versus 66.7% (p = 0.008) respectively at the end of the pilot study.PreventionNon-blanching erythema occurred equally in both arms at baseline; skin remained intact for the NIMBUS 3 group while 50% in the ROHO group worsened with superficial tissue loss.ConclusionThis small pilot study suggests that ‘active’ alternating therapy is a useful adjunct in the care of highly vulnerable patients, while the outcomes may be less favourable when using ‘reactive’, constant low pressure devices.