ascorbic-acid and Skin-Ulcer

Wound care is a classic example of a surgical realm with a great variation in care. The diversity in wounds and wound treatments, the limited amount of convincing evidence, and the diverging opinions among doctors and nurses involved in wound care contribute to this undesirable variation in care. For chronic wounds, such as arterial or venous ulcers, pressure sores, and diabetic foot ulcers, but also for acute wounds after surgery or trauma, international and national guidelines provide recommendations on diagnostic procedures and treatment options, but rely mostly on expert opinion. We present the available evidence from Cochrane systematic reviews for the systemic treatment (i.e., not prevention) of patients with wounds, as opposed to topical wound treatments. This evidence shows: - Venous ulcers: High-compression therapy is the classic and evidence-based treatment for treating venous ulcers. Oral pentoxifylline promotes ulcer healing with and without compression therapy. Oral zinc is not effective to heal venous ulcers. - Acute wounds: Recombinant human growth hormone accelerates healing of large burn wounds and donor sites, while high-carbohydrate feeding might reduce the risk of pneumonia. Linezolid is more effective than vancomycin for treating skin and soft tissue infections. Hyperbaric oxygen may help heal crush wounds and skin grafts. Therapeutic touch does not heal acute wounds. - Pressure sores: Air-fluidized and some low-tech devices appear effective for treating existing pressure ulcers. Oral zinc, protein, or vitamin C supplements seem ineffective. Also, evidence is lacking on the effectiveness of repositioning regimes as a treatment option. - Diabetic ulcers: Hyperbaric oxygen therapy and pressure-relieving devices may improve healing rates. - Arterial ulcers: Prostanoids and spinal cord stimulation may be effective in healing ischemic ulcers. Thus, fortunately, some high-level evidence exists for various local and systemic interventions in wound care. Caregivers should be aware of, and apply, the strongest evidence available. Only when all stakeholders (patients, physicians, wound care nurses, but also manufacturers and buyers) implement this available evidence will optimum quality of care for patients with wounds be ensured.

Topics: Ascorbic Acid; Compression Bandages; Humans; Hyperbaric Oxygenation; Skin Ulcer; Spinal Cord Stimulation; Systematic Reviews as Topic; Wound Healing; Zinc

Topics: Ascorbic Acid; Bandages; Calcium Gluconate; Humans; Levofloxacin; Male; Middle Aged; Prednisone; Sarcoidosis; Skin Ulcer

Topics: Adolescent; Antioxidants; Ascorbic Acid; Child; Chromosome Disorders; Dipeptidases; Forehead; Humans; Male; Nose Deformities, Acquired; Plastic Surgery Procedures; Postoperative Complications; Skin Transplantation; Skin Ulcer; Surgical Flaps; Syndrome; Wound Healing

Local skin necrosis after extravasation of doxorubicin hydrochloride (Adriamycin), a widely used chemotherapeutic agent, is a common problem in cancer patients. Even though several treatment options have been proposed for extravasation injury, there is still controversy regarding the management of such lesions. The aim of this study was to compare the efficacy of saline infiltration, vitamin C infiltration, suction technique, and early surgical excision as a treatment in a rat extravasation model. The authors planned their study in two stages. In stage 1, the lowest effective dose of doxorubicin at which a homogeneous skin necrosis was formed and the method of administration were investigated. Intradermal and subpannicular injections were made for six rats, using six different concentrations of doxorubicin (0.33, 0.5, 0.66, 1.0, 1.33, and 1.5 mg/ml). In stage 1, the intradermal injection produced homogeneous and uniform tissue necrosis. In stage 2, the efficacy of saline infiltration (group 1), vitamin C infiltration (group 2), suction (group 3), suction and saline washout (group 4), suction and vitamin C washout (group 5), and early surgical excision (group 6) was compared. The treatment options were applied 2 hours after doxorubicin injection. At the end of the seventh day, the presence and size of ulcers at the injection site were calculated. Fourteen days after injection, a histopathologic examination was performed for each treatment and control group. In groups 1 and 3, there was no statistically significant difference in the size of necrosis compared with the control groups. In groups 2, 4, and 5, the size of necrosis was smaller compared with the control groups, and this was statistically significant. Furthermore, in group 4 (suction and saline washout) and group 5 (suction and vitamin C washout), the calculated area of necrosis was smaller compared with other treatment groups, and this was statistically significant. The findings supported the assertion that suction and saline or vitamin C washout reduce necrotic tissue size in extravasation injury.

Topics: Animals; Antineoplastic Agents; Ascorbic Acid; Doxorubicin; Extravasation of Diagnostic and Therapeutic Materials; Injections, Intradermal; Injections, Subcutaneous; Necrosis; Rats; Rats, Wistar; Skin; Skin Ulcer; Sodium Chloride; Suction

Accidental extravasation of doxorubicin leads to skin necrosis and significant morbidity. Based on our previous work in the rat, we hypothesized that the free radical scavengers dimethyl sulfoxide (DMSO) and vitamin C prevent doxorubicin-induced skin ulcers in white swine.. Fifteen white swine were anesthetized and injected with 0.5 mg of doxorubicin (1 mg/ml) intradermally delivered in saline, 10% DMSO, 20% DMSO, vitamin C (1 mg/ml), or vitamin C in 20% DMSO. Presence of skin ulceration and ulcer size, in the two greatest dimensions, was determined weekly for 3 weeks.. Delivery of doxorubicin in DMSO and/or vitamin C lowered the ulcer incidence from 87% to 27% (p < 0.0001) when compared with delivery in saline.. We conclude that the free radical scavengers DMSO and vitamin C are capable of lowering the incidence of doxorubicin-induced skin ulcers and could significantly lessen the morbidity associated with doxorubicin extravasation.

Topics: Animals; Ascorbic Acid; Dimethyl Sulfoxide; Doxorubicin; Drug Combinations; Drug Interactions; Incidence; Injections, Intradermal; Skin Ulcer; Swine

Extravasation of doxorubicin hydrochloride during i.v. infusions can cause serious local complications due to the action of free radicals which are produced as a result of this leakage. An experiment was carried out using female Wistar rats to study the protective effect of alpha-tocopherol against the tissular necrosis produced by 0.05 mg of doxorubicin hydrochloride. alpha-Tocopherol was administered by two vehicles, one emulsified and the other gelled, with butylated hydroxytoluene and ascorbic acid used as antioxidants, respectively. No differences were observed in the diameters of the ulcers with each treatment in the various groups of animals relative to the control group. Conversely, differences were found (p < 0.05) in the period of chronic lesion between the animals treated with alpha-tocopherol and those used as a control group, irrespective of the vehicle used. These results lead to the conclusion that accidental toxicity resulting from the leakage of doxorubicin hydrochloride in the skin can be mitigated by applying alpha-tocopherol topically, due to its regenerating action in the damaged cutaneous zones. This effect is independent of the vehicle used and also of the antioxidant employed in the elaboration of the formulas.

Topics: Animals; Ascorbic Acid; Butylated Hydroxytoluene; Doxorubicin; Female; Injections, Intradermal; Necrosis; Oxidation-Reduction; Rats; Rats, Wistar; Skin Ulcer; Vitamin E

The basal level of blood ascorbic acid was studied in 70 cases of polar leprosy. The level was found to be significantly reduced in both polar types, more so in tuberculoid. In untreated cases of these two polar forms, the differences were highly significant. No significant differences were found between untreated and treated cases of either form of leprosy, indicating that dapsone (DDS) has no effect on the ascorbic acid level. In lepromatous leprosy, the level was not affected by erythema nodosum leprosum (ENL). The deficiency of ascorbic acid in leprosy might be due to the disease per se and/or associated with nutritional factors. In trophic ulcers after supplement therapy for 60 days, the low level of ascorbic acid became close to the control group with marked improvement in the healing of the ulcers clinically. In addition, lactic and pyruvic acids were also measured and found to be significantly raised. After ascorbic acid supplement, the levels fell to near the control values, indicating that ascorbic acid played a role in controlling the infection as well as possible thiamine deficiency and also checked the disturbance caused by DDS on lactate and pyruvate metabolism. The present study suggested that supplementing DDS therapy with ascorbic acid might provide a beneficial effect on the general condition of the leprosy patients and the early healing of trophic ulcers.

Topics: Ascorbic Acid; Dapsone; Erythema Nodosum; Humans; Leprosy; Skin Ulcer; Socioeconomic Factors

A safe and effective method of improving repair and controlling infection of wounds is presented. It consists of debridement daily and application topically of a balanced solution of salts, amino acids, a high-molecular weight, D-glucose polysaccharide, and ascorbic acid. Wounds of several causes were treated, namely, second- and third-degree thermal burns, decubitus, varicose, and stasis ulcers, and diabetic lesions. Local infection was controlled early and the majority of the cases responded with quick formation of highly vascular, smooth, infection-free granulation tissue and centripetal epithelial growth. Small- and medium-sized lesions healed spontaneously in 4 to 8 weeks. Larger lesions were readily managed with autografts of skin as soon as satisfactory beds were obtained.

Topics: Administration, Topical; Adolescent; Adult; Aged; Amino Acids, Essential; Ascorbic Acid; Child; Child, Preschool; Female; Glucose; Humans; Infant; Infant, Newborn; Male; Middle Aged; Salts; Skin Ulcer; Solutions; Wound Healing; Wound Infection; Wounds and Injuries

Rats fed a vitamin E-deficient diet containing 10% "stripped" corn oil had reduced growth rate and elevated platelet count by 12 weeks of age, and a normocytic anemia with elevated reticulocytes by 16 weeks of age. After 5 months, rats became emaciated and developed kyphoscoliosis. Some rats developed skin ulcers and tremors, and mortality was high. Neuromuscular lesions included a chronic necrotizing myopathy and localized axonal dystrophy. There was also a selective activation of lysosomes in the central nervous system microcirculation. Liver ascorbic acid of deficient rats was the same as in those receiving vitamin E. Urinary excretion of p-hydroxyphenylpyruvate after a tyrosine load was also the same in deficient and control rats. It was concluded that neither vitamin C synthesis or utilization was affected the E-deficient rats.

Topics: Age Factors; Anemia; Animals; Ascorbic Acid; Female; Kyphosis; Male; Muscular Diseases; Necrosis; Nervous System Diseases; Rats; Scoliosis; Skin Ulcer; Thrombocytosis; Vitamin E Deficiency

Topics: Adolescent; Ascorbic Acid; Ethacridine; Female; gamma-Globulins; Humans; Infant; Male; Oxytetracycline; Skin Ulcer; Smallpox Vaccine; Thiamine; Vaccination; Vaccinia

Topics: Acetates; Anti-Bacterial Agents; Antifungal Agents; Ascorbic Acid; Child; Child, Preschool; Colostomy; Humans; Hydrogen-Ion Concentration; Ileostomy; Ointments; Skin Ulcer; Urinary Diversion; Urine

Topics: Aerosols; Animals; Antidotes; Ascorbic Acid; Chelating Agents; Chromates; Dermatitis; Dermatitis, Occupational; Filtration; Guinea Pigs; Humans; Male; Oxidation-Reduction; Rats; Skin Ulcer; Ventilators, Mechanical

Topics: Animals; Ascorbic Acid; Chromium; Environmental Exposure; Guinea Pigs; Skin Ulcer