Overview
Infected ulcers of the skin are open wounds that involve devitalized tissue and are often complicated by microbial invasion, leading to delayed healing and potential systemic complications 13.Diagnosis
Clinical assessment focusing on ulcer characteristics, location, and presence of devitalized tissue (slough/fibrinous exudate) 1.
Diagnostic complexity; common etiologies include infection, pyoderma gangrenosum, and exogenous causes 3.
Mast cell distribution in ulcer tissue may provide insights into wound healing processes, particularly in venous stasis ulcers 4.Management
Debridement: Removal of nonviable tissue using autolytic, enzymatic (e.g., collagenase), biologic, or mechanical methods 2.
Dressings: Selection based on exudate management; aim for moist wound environment 2.
Compression Therapy: Recommended for venous leg ulcers unless contraindicated 2.
Topical Treatments: Hyaluronic acid/collagenase ointment for safety, tolerability, and potential efficacy in various ulcer types 1.
Ketanserin: Significant improvement in granulation tissue formation and epithelialization in decubitus, venous, and ischemic ulcers 6.
Infection Management: Appropriate antibiotic therapy based on culture and sensitivity results, though specific dosing is not detailed in abstracts 13.Special Populations
Elderly: Commonly affected, with a mean age of 71 years in studied populations 1.
Comorbidities: Malnutrition is a risk factor for pressure ulcers, though intervention efficacy is unclear 2.Key Recommendations
Utilize enzymatic debridement methods for effective removal of nonviable tissue in infected ulcers (Evidence: Moderate 2).
Apply compression therapy for venous leg ulcers as part of standard management (Evidence: Moderate 2).
Consider hyaluronic acid/collagenase ointment for its safety and potential therapeutic benefits in various ulcer types (Evidence: Weak 1).
Evaluate and treat underlying infections with targeted antibiotic therapy based on microbiological data (Evidence: Expert opinion 13).References
1 Fino P, Chello C, Latini C, Occhionorelli S, Moruzzi M, Scuderi N et al.. The combination of hyaluronic acid and collagenase in the treatment of skin ulcers: an open, multicenter clinical study assessing safety and tolerability of Bionect Start®. European review for medical and pharmacological sciences 2024. link
2 Rayala BZ. Skin Ulcers: Wound Management. FP essentials 2020. link
3 Haynes D, Hammer P, Malachowski SJ, Kaffenberger B, Yi JS, Vera N et al.. Characterisation and diagnosis of ulcers in inpatient dermatology consultation services: A multi-centre study. International wound journal 2019. link
4 Bolton LL, Montagna W. Mast cells in human ulcers. The American Journal of dermatopathology 1993. link
5 Heckler FR. Current thoughts on extravasation injuries. Clinics in plastic surgery 1989. link
6 Janssen PA, Janssen H, Cauwenbergh G, De Doncker P, De Beule K, Lewi P et al.. Use of topical ketanserin in the treatment of skin ulcers: a double-blind study. Journal of the American Academy of Dermatology 1989. link70153-5)