BackgroundCurrent therapeutic interventions for Sickle Cell Disease (SCD) have improved patient survival; however, the clinical determinants of elevated autoantibody prevalence and related complications in patients with SCD remain insufficiently elucidated.ObjectiveThis study aimed to examine the frequency of lupus anticoagulant (LA), anticardiolipin antibody (aCL), and anti-beta2 glycoprotein I antibodies (anti- β2GPI) in patients with SCD at steady state phase to evaluate their possible correlations with hematological factors and clinical complications.MethodsThis cross-sectional study involving 92 SCD patients in a steady state phase was conducted. Blood specimens were obtained for complete blood count (CBC), in conjunction with the identification of IgG for aCL and anti-β2GPI utilizing enzyme-linked immunosorbent assay (ELISA) and the assessment of LA through the Diluted Russell Viper Venom Time (dRVVT).ResultsThe prevalence of LA, aCL, and anti-β2GPI (IgG) in SCD patients at steady state was 29.4%, 16.3%, and 5.4%, respectively. A correlation was found between LA and chronic leg ulcers, history of thrombosis, decreased platelet counts (PLT), and increased mean platelet volume (MPV) in SCD patients. Furthermore, aCL (IgG) exhibited a significant association with chronic leg ulcers, history of thrombosis, elevated Hemoglobin (Hb) levels, increased red blood cell count (RBC), and higher red cell distribution width (RDW) in SCD patients at steady state phase.ConclusionThis research elucidates the incidence of LA and aCL in SCD patients during steady state, linking these autoantibodies to hematological parameters and clinical complications; thus, prospective assessments of aPL in SCD patients are essential.

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and is most often caused by cumulative UV exposure. However, cSCC may also arise independently of UV exposure, on sites of sustained skin damage like chronic ulcers, scars, Recessive Dystrophic Epidermolysis Bullosa (RDEB), and inflammatory skin diseases such as hidradenitis suppurativa (HS). Little is known about non-UV-induced skin carcinomas. We aimed to describe the clinical, pathological, and genetic features, of non-UV-induced cSCC. We collected clinical and pathologic data corresponding to 31 patients with non-UV-induced cSCC, including 5 cSCC on HS, 4 on chronic leg ulcers and 8 on RDEB. DNA was extracted from FFPE samples and analysed using a NGS assay targeting 523 cancer genes. A comparison was performed with published genetic data obtained in non-UV-induced and UV-induced cSCC. We found that the Tumour Mutational Burden (TMB) of non-UV-induced cSCC was 6-times lower than the published TMB of UV-induced cSCC. The predominant mutational signature was a clock-wise signature. By comparing the frequency of driver mutations, we found TP53 and NOTCH1 to be significantly less frequently mutated than in UV-mutated cSCC. Interestingly, KMT2B (a histone methyl transferase) was mutated in 11/31 non-UV-induced cSCC and this proportion was significantly higher than in UV-mutated cSCC. These mutations were high impact loss-of-function mutations. We found that knocking down KMT2B expression using siRNA did not affect cell proliferation of SCC-13 and A-431 cell lines, however, it significantly increased cell migration in vitro. Taken together, this study provides a comprehensive description of non-UV-induced cSCC and identifies that KMT2B is mutated and involved in non-UV-induced cSCC carcinogenesis. © 2025 The Pathological Society of Great Britain and Ireland.

Nail alterations are rarely given significant importance in general consultation, but they are frequent especially in patients with chronic leg ulcers (CLU). We performed a cross-sectional observational study enrolling all outpatients referring to our Dermatologic Open Injury Outpatient Service between January 2024 and September 2024 with a diagnosis of chronic leg ulcer comparing the prevalence of nail disorders with a healthy population. We identified nail alterations, including onychomycosis, pachyonychia, onychogryphosis, cuticle hyperkeratosis, associated with different systemic conditions. We underlined the importance of nail examination in patients with CLU for the correct diagnosis and a best management of several vascular and/or systemic diseases.

Immunomodulatory effects of mesenchymal stromal cell secretome accelerate repair in a sickle cell disease wound model.

This case highlights a rare and under-recognized cause of chronic leg ulcers: pathomimia, a factitious disorder in which patients deliberately produce or simulate symptoms without external incentives. We report the case of a 33-year-old Moroccan woman presenting with a painless ulcer on the lower third of her left leg, alongside severe depression, insomnia, and persecutory delusions. Despite extensive investigations including MRI, skin biopsy, and microbiological tests, no organic etiology was identified. The diagnosis of pathomimia was supported by the patient's indifference to her lesion and the psychiatric context. Treatment included sertraline, alprazolam, chlorpromazine, and daily dermatological care, resulting in significant clinical improvement. This case emphasizes the importance of considering psychiatric causes in atypical or non-healing dermatological presentations. Early multidisciplinary intervention is crucial to ensure accurate diagnosis and effective management, avoiding unnecessary investigations and prolonged morbidity.

Chronic Leg Ulcers and Skin-popping Scars from Tapentadol Abuse

Objective: To analyze the demographic features, etiological factors, clinical profiles, and treatment outcomes of patients with chronic lower extremity wounds managed at a tertiary wound care center. Materials and Methods A retrospective review was conducted on 783 patients treated for chronic lower extremity wounds between May 2014 and January 2022. Patient demographics, comorbidities, wound etiology, microbiological data, histopathological findings, and treatment modalities were evaluated. Patients with trauma-related wounds or incomplete follow-up were excluded. Results: The mean age was 62.1 years, with females comprising 32% of the cohort. Diabetes was the leading cause of chronic lower extremity wounds (68.6%), followed by PAD in non-diabetic patients (21%), venous insufficiency (5.6%), and stasis dermatitis (3%). Pyoderma gangrenosum and drug reactions represented less common etiologies. Among diabetic foot ulcer patients, 55% were Wagner Grade 1–2, while 45% were Grade 3 or higher. Smoking prevalence was 74%, and associated with longer healing times. Wound closure was achieved via skin grafting in 58% of cases, secondary intention in 21%, and amputation in 12%. Negative pressure wound therapy was employed in 15% of cases. Staphylococcus aureus, Enterococcus spp., and Pseudomonas spp. were the most commonly isolated pathogens. Pyoderma gangrenosum was histologically confirmed in 6 patients. Conclusion: Diabetes and PAD remain the predominant etiologies of chronic lower extremity wounds. High smoking prevalence, delayed referrals, and advanced Wagner grades at presentation underscore the importance of early multidisciplinary intervention and standardized treatment protocols. The judicious use of negative pressure wound therapy, tailored antibiotic stewardship, and consideration of non-infectious etiologies in non-healing wounds are vital. Nationwide multicenter prospective studies are needed to develop uniform strategies for reducing the clinical and economic burden of chronic lower extremity wounds. a multidisciplinary approach are essential to improving outcomes and reducing the risk of limb loss.

To evaluate the clinical utility of a point-of-care, artificial intelligence-enabled multispectral imaging device in guiding targeted debridement of chronic leg ulcers in patients with leprosy, using a within-person randomized controlled pilot design. Five adult male patients with lepromatous leprosy and at least 2 chronic leg ulcers each were enrolled in a split-body design. One ulcer per patient was randomized to the experimental arm (EA), where weekly debridement was guided by multispectral imaging, and the other to the control arm (CA), which received standard care. The device used autofluorescence to identify areas of suspected bacterial colonization and provided Gram-type classification. Healing was assessed by changes in wound area and Pressure Ulcer Scale for Healing scores over 18 weeks. Microbial confirmation was performed using standardized swab cultures. At 18 weeks, the mean wound size reduction was greater in the EA (84.46%) than in the CA (73.28%). Pressure Ulcer Scale for Healing scores decreased more rapidly in the EA (from 11.4 to 4.75) compared with the CA (from 11.0 to 6.75). One ulcer in each arm achieved full epithelialization, but the EA ulcer healed faster (5 vs. 9 weeks). Autofluorescence imaging enabled targeted systemic antimicrobial use in several cases. No adverse events were reported. This pilot, the first of its kind in leprosy ulcer care, demonstrates the potential of artificial intelligence-enabled multispectral imaging to enhance wound healing through guided debridement. The technology offers real-time, noninvasive infection assessment that may support more effective, individualized wound management. Larger, blinded studies are warranted to validate these findings.

Assessment and management of chronic venous, arterial, and diabetic wounds in older adults.

Objective: This post hoc analysis determined the correlation between wound bed preparation (WBP), defined as complete debridement of nonviable tissue and complete granulation tissue coverage, and wound closure, using data from a published, Consolidated Standards of Reporting Trials (CONSORT)-compliant randomized controlled trial that evaluated bromelain-based enzymatic debridement (BBD) compared with a placebo gel vehicle (GV) or nonsurgical standard of care (NSSOC) in patients with chronic venous leg ulcers (VLUs). Approach: Patients with chronic VLUs were randomized (3:3:2 ratio) to daily treatment with BBD, GV, or NSSOC for up to 2 weeks and followed up weekly with NSSOC for 12 weeks. Wound closure incidence was compared between those who did and did not achieve WBP by 14 days or anytime during the study. Results: Data were analyzed from 119 VLUs. Among 80 wounds that achieved WBP anytime during the study, 42% healed; among 39 wounds without WBP, only 10.3% healed (relative risk [RR] = 4.1, p = 0.0004, negative predictive value [NPV] = 90%). Among 37 wounds that achieved WBP by 14 days, 54% healed; among 78 wounds that did not achieve WBP by 14 days, only 22% healed (NPV = 78%). Wounds were 2.4 times more likely to achieve closure anytime during the study, if they achieved WBP by 14 days (RR = 2.4, p = 0.0005). Innovation: This landmark analysis confirms that WBP status is an early predictive variable of wound closure. Conclusion: WBP of chronic VLUs significantly increased the likelihood of wound closure and is a critical, though not sufficient, condition for healing.

ABSTRACTChronic leg ulcers present a significant clinical challenge due to their prolonged healing time and high recurrence rates. This prospective, multi‐centre, non‐randomised, observational study investigated the efficacy of a dermal regeneration template in improving skin graft integration for chronic leg ulcer treatment. Thirty patients were enrolled, with a control group receiving only skin grafts to evaluate the additional benefits of the template. Patients were assessed for pain levels, healing rates, wound retraction, pruritus, dressing type, analgesic use, complications, surgeon‐evaluated wound recovery using the Vancouver scale, quality of life through the EuroQol questionnaire and photographic wound documentation. At 18 months, 70.0% of patients achieved at least a 50% reduction in wound surface area and 56.7% experienced complete wound closure. Significant improvements were observed in pain and discomfort (p = 0.0125), mobility (p = 0.0267), pain levels (p = 0.0340), vascularity (p = 0.0275) and overall wound reduction (p = 0.0368). The control group demonstrated lower wound reduction and complete healing rates, reinforcing the superior effectiveness of the dermal regeneration template in combination with skin grafting. This study highlights the potential of this approach to accelerate wound healing, reduce patient discomfort and enhance quality of life compared to traditional skin grafting alone.

Carbapenem-resistant Pseudomonas aeruginosa exacerbates the healing of chronic leg ulcer among patients. Further, production and dissemination of the carbapenemase genes are associated with P. aeruginosa high-risk sequence types. Hence, understanding the population structure of these organisms is essential for healthcare personnel to establish effective leg ulcers care management, prevention interventions and control strategies particularly in regions with poor diagnosis. A cross-sectional study included inpatients and outpatients with chronic leg ulcers was conducted from August 2022 to April 2023 in 2 hospitals in Kilimanjaro region. Antimicrobial susceptibility testing was done by using the disc diffusion method. Further, whole genome sequencing was performed to study the genotypic characteristics of the isolates. Ten of 92 participants were positive for genus Pseudomonas isolates upon culture during the study period. Ambler class D carbapenemase genes were carried in all 8 isolates, and class B ( , ) in 2 isolates. The tree topology showed that all 8 P. aeruginosa isolates that carried any of the Ambler carbapenemase genes were in one clade with the reference strain PAO1. This study sheds light on different carbapenemase gene types (VIM-2, DIM-1, and OXA-types) harboured in the denominated global high-risk and endemic sequence types in 2 tertiary hospitals in northern Tanzania, alarming the possibility of a prolonged healing process and a high risk of treatment failure among patients because of the increased spread of antimicrobial resistance. Further, the findings underscore the need for antimicrobial surveillance to guide healthcare personnel in managing chronic leg ulcers for better patient outcomes and the implementation of antimicrobial stewardship programs.

IntroductionVenous leg ulcers (VLUs) pose significant challenges that adversely affect patients' quality of life and result in considerable economic burdens. While existing compression therapies are effective, they are often hindered by complexity, discomfort, and environmental concerns.ObjectivesThis study aimed to evaluate the performance and safety of the adjustable Velcro system Compreflex®, an alternative to traditional four-layer bandaging, for patients with chronic venous leg ulcers. The evaluation was conducted through a clinical follow-up trial.MethodsThis prospective, non-randomized, multicenter, single-arm study included 98 patients with VLUs. The Compreflex® Standard Calf and Foot device was assessed based on wound closure rates, patient satisfaction, and edema reduction. Patients were followed up at specific intervals: after 1, 12, and 26 weeks. ResultsOf the 98 enrolled patients, 19 discontinued participation. The mean ulcer area decreased from 52.9cm2 (95% CI, 35.9-69.9cm2) to 37.4cm2 (95% CI, 20.0-54.7cm2) at 26 weeks (p < .001). The wound closure rate at 26 weeks was 24.3% (95% CI, 16.6-34.9%). Challenges related to self-application were minimal, highlighting the device's usability. A patient satisfaction rate of 76.8% was reported, based on a satisfaction score of six or higher.ConclusionThis study provides valuable real-world evidence supporting the effectiveness and usability of the Compreflex® device, as demonstrated by the high patient satisfaction rate, and highlights its potential as a promising alternative in compression therapy for venous leg ulcers.

ABSTRACTThis substudy utilised data from a prospective, longitudinal study aimed to investigate associations between systemic inflammation, wound bioburden, total bacterial counts and wound healing outcomes over 8 weeks in older adults with chronic venous leg ulcers (CVLUs). Participants were receiving standardised weekly wound debridement. Blood and wound tissue samples were collected at baseline and Weeks 2, 4, 6 and 8, or until the wound was healed. Wound healing status was categorised by two parameters: healed versus nonhealed and healing versus nonhealing. A linear mixed model assessed associations among clinical and laboratory variables with wound healing status over time. Of the 117 participants, 47 (40%) had wounds that healed within the 8‐week period. In nonhealed wounds, C‐reactive protein (CRP) was positively associated with total bacterial counts (p < 0.001), wound bioburden (p = 0.01) and wound diameter (p = 0.004) over time. Total bacterial counts were positively associated with CRP (p = 0.023), interleukin‐6 (IL‐6) (p = 0.034) and tumour necrosis factor‐alpha (TNF‐α) (p < 0.001) in nonhealing wounds. The results suggest that CRP, IL‐6 and TNF‐α may be useful markers in predicting wound healing trajectories. Ongoing monitoring of inflammatory markers and bacterial counts could aid in assessing wound healing progress in older adults with CVLUs.

Chronic non-healing trophic ulcers of the lower extremities remain a pressing issue in modern medicine. According to epidemiological studies, 1–2% of the adult population in developed countries suffers from chronic leg ulcers, with prevalence increasing to 4–5% among individuals over 65 years old. Current treatment protocols often focus on isolated aspects of the pathological process, neglecting the necessity of a comprehensive rehabilitation approach. The management of such patients requires the implementation of a three-stage rehabilitation system ensuring continuity between inpatient and outpatient care.Systematization of modern rehabilitation approaches enables the recommendation of individualized rehabilitation programs that consider both medical and psychosocial aspects of the disease. Such an approach enhances treatment effectiveness and improves patients’ quality of life. The development of an effective social support system that ensures access to necessary resources and services is a crucial task in organizing care for this patient population.Keywords:foot ulcer, rehabilitation, peripheral artery disease, quality of life, interdisciplinary communication, patient care planning, disease management.

Polydeoxyribonucleotide (PDRN), a highly purified salmon‑sperm–derived DNA polymer, exhibits potent regenerative and anti-inflammatory effects. This review critically explores the dual mechanisms of PDRN—namely, adenosine A2A receptor activation and nucleotide provision via the salvage pathway—and synthesizes the current clinical evidence regarding its applications in dermatology and wound healing. Preclinical and clinical studies have shown that PDRN enhances angiogenesis, modulates cytokine profiles, and accelerates tissue repair processes, resulting in improved healing rates in chronic diabetic foot ulcers, pressure ulcers, and venous leg ulcers as well as faster epithelial regeneration in surgical donor sites and corneal wounds. Adjunctive benefits have also been reported in lichen sclerosis, osteoarthritis, and aesthetic dermatology. Furthermore, PDRN demonstrates excellent safety profile, with minimal adverse events reported across multiple trials and real-world applications. Emerging delivery platforms and combination therapies have further expanded the therapeutic potential. This review highlights the potential of PDRN as a versatile and safe regenerative agent by integrating mechanistic insights with robust clinical data.

Investigating lipid profiles and oxidised phospholipids in samples from patients with chronic venous leg ulcers

Medicinal leech therapy and grated unripe papaya bandage for the treatment of chronic leg ulcer: A case report

BackgroundRetrograde venous perfusion (RVP) is a minimally invasive procedure in which the limb circulation is isolated by the application of a proximal limb tourniquet, followed by the administration of specific medications through a distal limb vein. This allows these drugs to pass in the reverse direction to reach the ulcerated area of the affected limb. The aim of this study was to evaluate the safety, feasibility, and efficacy of RVP, for the management of long-standing intractable chronic venous leg ulcers (CVLUs).MethodsA 4-year retrospective study took place from January 2021 to January 2025. All patients who underwent the RVP technique were included in the study. These patients had chronic, intractable, long-standing, nonhealing, venous leg ulcers. They were classified into two groups. Group I included those who underwent RVP (treated group). However, group II was treated with standard compression therapy (control group). A paired-samples t test was performed to compare the studied groups. Kaplan–Meier survival analysis was performed for patients who were free from ulcer recurrence or nonhealing after the RVP technique.ResultsDuring the 4-year study period, 384 patients were retrospectively analyzed. A total of 75% (n = 288) of the participants were females, and 25% were males (n = 96). The median age was 37.26 ± 4.2 years. Ulcers ranged between 30cm2 and near circumferential. The median ulcer duration was 18 ± 14.4 months. The mean number of RVP sessions was 26.78 ± 7.6, whereas the mean session time was 213 ± 49 min. A reduction in ulcer size/complete healing was achieved in 96.9% of the patients in group I vs. 68.8% of those in group II.ConclusionsCompared with the standard compression technique, RVP therapy may be considered an effective and feasible technique for treating intractable venous leg ulcers. It offers shorter periods of therapy with a high success rate in reducing ulcer size/complete wound healing within a short period of time. This therapeutic option may provide essential evidence to reduce the negative social and economic impact on affected populations.

A review on grafting new ways in the management of chronic leg ulcers on an outpatient basis