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Current Dermatology Reports
Published in: Current Dermatology Reports 4/2016

01-12-2016 | Wound Care and Healing (A Friedman, Section Editor)

Vasculitic Diseases and Prothrombotic States Contributing to Delayed Healing in Chronic Wounds

Author: Victoria K. Shanmugam

Published in: Current Dermatology Reports | Issue 4/2016

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Abstract

Purpose

Autoimmune diseases are a common cause of delayed wound healing and should be considered in patients with chronic wounds who do not respond to local wound care or who fail skin grafting in the absence of infection.

Recent Findings

Epidemiologic studies have shown that, of patients with chronic wounds evaluated in specialized wound healing clinics, 20–23 % have autoimmune etiologies for their wounds including vasculitis, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, pyoderma gangrenosum, and other autoimmune diseases.

Summary

In this article, autoimmune diseases known to be associated with chronic wounds and delayed wound healing are reviewed and the importance of a multidisciplinary approach for patients with chronic wounds, with involvement of rheumatology and dermatology, is highlighted. This approach allows for investigation of underlying systemic disease and improves clinical outcomes for many of these challenging patients.
Literature
1.
Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17(6):763–71.CrossRefPubMedPubMedCentral
2.
Escandon J, Vivas AC, Tang J, Rowland KJ, Kirsner RS. High mortality in patients with chronic wounds. Wound Repair Regen. 2011;19(4):526–8.CrossRefPubMed
3.
Price P, Harding K. The impact of foot complications on health-related quality of life in patients with diabetes. J Cutan Med Surg. 2000;4(1):45–50.PubMed
4.
Körber A, Klode J, Al-Benna S, Wax C, Schadendorf D, Steinstraesser L, et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2011;9(2):116–21.PubMed
5.
6.•
Shanmugam VK, Schilling A, Germinario A, Mete M, Kim P, Steinberg J, et al. Prevalence of immune disease in patients with wounds presenting to a tertiary wound healing centre. International Wound Journal. 2011:1–9. Important article demonstrating prevalence of autoimmune disease in patients presenting to a wound clinic .
7.
8.
Shanmugam V, DeMaria D, Attinger C. Lower extremity ulcers in rheumatoid arthritis: features and response to immunosuppression. Clin Rheumatol. 2011;30(6):849–53.CrossRefPubMedPubMedCentral
9.
Oien RF, Hakansson A, Hansen BU. Leg ulcers in patients with rheumatoid arthritis—a prospective study of aetiology, wound healing and pain reduction after pinch grafting. Rheumatology. 2001;40(7):816–20.CrossRefPubMed
10.•
Jebakumar AJ, Udayakumar PD, Crowson CS, Gabriel SE, Matteson EL. Occurrence and effect of lower extremity ulcer in rheumatoid arthritis—a population-based study. J Rheumatol. 2014;41(3):437–43 .Important epidemiologic study demonstrating the prevalence and morbidity of leg ulceration in patients with rheumatoid arthritis.CrossRefPubMedPubMedCentral
11.
Makol A, Matteson EL, Warrington KJ. Rheumatoid vasculitis: an update. Curr Opin Rheumatol. 2015;27(1):63–70.CrossRefPubMed
12.
Assmann G, Pfreundschuh J, Voswinkel J. Rituximab in patients with rheumatoid arthritis and vasculitis-associated cutaneous ulcers. Clin Exp Rheumatol. 2010;28(1 Suppl 57):81–3.PubMed
13.
Sayah A, English Iii JC. Rheumatoid arthritis: a review of the cutaneous manifestations. J Am Acad Dermatol. 2005;53(2):191–209.CrossRefPubMed
14.•
Shanmugam VK, Fernandez S, Evans KK, McNish S, Banerjee A, Couch K, et al. Postoperative wound dehiscence: predictors and associations. Wound Repair and Regeneration. 2015:n/a-n/a. Important large epidemiologic study investigating predictors of post-operative wound dehiscence.
15.
Tuffaneilli DL, Dubois EL. Cutaneous manifestations of systemic lupus erythematosus. Arch Dermatol. 1964;90:377–86.CrossRef
16.
Chia HY, Tang MB. Chronic leg ulcers in adult patients with rheumatological diseases—a 7-year retrospective review. Int Wound J. 2014;11(6):601–4.CrossRefPubMed
17.
18.
Sakakibara K, Matsumoto M, Motohashi S, Suzuki S. Recurrent refractory arterial thromboembolism in a patient with anti-phospholipid antibody syndrome. Intern Med. 2013;52(10):1145–6.CrossRefPubMed
19.
Manzi S, Sánchez-Guerrero J, Merrill JT, Furie R, Gladman D, Navarra SV, et al. Effects of belimumab, a B lymphocyte stimulator-specific inhibitor, on disease activity across multiple organ domains in patients with systemic lupus erythematosus: combined results from two phase III trials. Ann Rheum Dis. 2012;71(11):1833–8.CrossRefPubMedPubMedCentral
20.
Shanmugam V, Price P, Attinger C, Steen V. Lower extremity ulcers in systemic sclerosis: features and response to therapy. Int J Rheumatol. 2010.
21.
Hafner J, Schneider E, Burg G, Cassina PC. Management of leg ulcers in patients with rheumatoid arthritis or systemic sclerosis: the importance of concomitant arterial and venous disease. J Vasc Surg. 2001;32(2):322–9.CrossRef
22.
Deguchi J, Shigematsu K, Ota S, Kimura H, Fukayama M, Miyata T. Surgical result of critical limb ischemia due to tibial arterial occlusion in patients with systemic scleroderma. J Vasc Surg. 2009;49(4):918–23.CrossRefPubMed
23.
Braswell SF, Kostopoulos TC, Ortega-Loayza AG. Pathophysiology of pyoderma gangrenosum (PG): an updated review. J Am Acad Dermatol. 2015;73(4):691–8.CrossRefPubMed
24.
Kaur MR, Lewis HM. Severe recalcitrant pyoderma gangrenosum treated with infliximab. Br J Dermatol. 2005;153(3):689–91.CrossRefPubMed
25.
Guenova E, Teske A, Fehrenbacher B, Hoerber S, Adamczyk A, Schaller M, et al. Interleukin 23 expression in pyoderma gangrenosum and targeted therapy with ustekinumab. Arch Dermatol. 2011;147(10):1203–5.CrossRefPubMed
26.
Perniciaro CV, Winkelmann RK, Hunder GG. Cutaneous manifestations of Takayasu’s arteritis. A clinicopathologic correlation. J Am Acad Dermatol. 1987;17(6):998–1005.CrossRefPubMed
27.
Boudny C, Nievergelt H, Braathen LR, Simon D. Wegener’s granulomatosis presenting as pyoderma gangrenosum. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2008;6(6):477–9.CrossRefPubMed
28.
Carlson JA. The histological assessment of cutaneous vasculitis. Histopathology. 56(1):3–23.
29.
Kawakami T, Okano T, Soma Y. Rituximab therapy for deep toe ulcer with microscopic polyangiitis refractory to corticosteroids and cyclophosphamide. J Dermatol. 2014;41(2):191–2.CrossRefPubMed
30.
Patel FB, Couch KS, McNish S, Miller JD, Siegel R, Easley S, et al. A 66 year-old woman with hemoptysis. Arthritis Care Res (Hoboken). 2015.
31.
32.
Sneller MC, Hu Z, Langford CA. A randomized controlled trial of rituximab following failure of antiviral therapy for hepatitis C virus-associated cryoglobulinemic vasculitis. Arthritis Rheum. 2012;64(3):835–42.CrossRefPubMedPubMedCentral
33.
Dammacco F, Sansonno D. Therapy for hepatitis C virus-related cryoglobulinemic vasculitis. N Engl J Med. 2013;369(11):1035–45.CrossRefPubMed
34.
De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: a contemporary overview. Autoimmunity Reviews.
35.
Raju RM, Raju SM, Zhao Y, Rubin EJ. Leveraging advances in tuberculosis diagnosis and treatment to address nontuberculous mycobacterial disease. Emerg Infect Dis. 2016;22(3):365–9.CrossRefPubMedPubMedCentral
36.
Chan MP. Neutrophilic panniculitis: algorithmic approach to a heterogeneous group of disorders. Archives of Pathology & Laboratory Medicine. 2014;138(10):1337–43.CrossRef
37.
Koshy M, Entsuah R, Koranda A, Kraus A, Johnson R, Bellvue R, et al. Leg ulcers in patients with sickle cell disease [see comments]. Blood. 1989;74(4):1403–8.PubMed
38.
Chaine B, Neonato M, Girot R, Aractingi S. Cutaneous adverse reactions to hydroxyurea in patients with sickle cell disease. Arch Dermatol. 2001;137(4):467–70.PubMed
39.
Sirieix M, Debure C, Baudot N, Dubertret L, Roux M, Morel P, et al. Leg ulcers and hydroxyurea: forty-one cases. Arch Dermatol. 1999;135(7):818–20.CrossRefPubMed
40.
Best PJ, Daoud MS, Pittelkow MR, Petitt RM. Hydroxyurea-induced leg ulceration in 14 patients. Ann Intern Med. 1998;128(1):29–32.CrossRefPubMed
41.
Shanmugam VK, McNish S, Shara N, Hubley KJ, Kallakury B, Dunning DM, et al. Chronic leg ulceration associated with polycythemia vera responding to ruxolitinib (Jakafi®). The Journal of Foot and Ankle Surgery. (0).
42.
Alavi A, Hafner J, Dutz JP, Mayer D, Sibbald RG, Criado PR, et al. Atrophie Blanche: is it associated with venous disease or livedoid vasculopathy? Adv Skin Wound Care. 2014;27(11):518–24.CrossRefPubMed
43.
Acland KM, Darvay A, Wakelin SH, Russell-Jones R. Livedoid vasculitis: a manifestation of the antiphospholipid syndrome? Br J Dermatol. 1999;140(1):131–5.CrossRefPubMed
44.
Callen JP. Livedoid vasculopathy: what it is and how the patient should be evaluated and treated. Arch Dermatol. 2006;142(11):1481–2.CrossRefPubMed
45.
Cardoso R, Gonçalo M, Tellechea O, Maia R, Borges C, Silva JAP, et al. Livedoid vasculopathy and hypercoagulability in a patient with primary Sjögren’s syndrome. Int J Dermatol. 2007;46(4):431–4.CrossRefPubMed
46.
Frances C, Barete S. Difficult management of livedoid vasculopathy. Arch Dermatol. 2004;140(8):1011.CrossRefPubMed
47.
48.
Mimouni D, Ng PP, Rencic A, Nikolskaia OV, Bernstein BD, Nousari HC. Cutaneous polyarteritis nodosa in patients presenting with atrophie blanche. Br J Dermatol. 2003;148(4):789–94.CrossRefPubMed
49.
Tran M, Becherel P, Cordel N, Piette JC, Frances C. “Idiopathic” livedoid vasculitis. Ann Dermatol Venerol. 2001;128:1003–7.
50.
Wakelin SH, Ellis JP, Black MM. Livedoid vasculitis with anticardiolipin antibodies: improvement with danazol. Br J Dermatol. 1998;139(5):935–7.CrossRefPubMed
51.
Winkelmann R, Schroeter A, Kierland R, Ryan T. Clinical studies of livedoid vasculitis: (segmental hyalinizing vasculitis). Mayo Clin Proc. 1974;49(10):746–50.PubMed
52.
Hairston BR, Davis M, Pittelkow MR, Ahmed I. Livedoid vasculopathy: further evidence for procoagulant pathogenesis. Arch Dermatol. 2006;142(11):1413–8.CrossRefPubMed
53.
Charabaty S, Shanmugam V. A 65-year-old man with longstanding seropositive rheumatoid arthritis and lower extremity ulceration. Arthritis Care & Research. 2009;61(9):1275–80.CrossRef
54.
Falanga V, Fine MJ, Kapoor WN. The cutaneous manifestations of cholesterol crystal embolization. Arch Dermatol. 1986;122(10):1194–8.CrossRefPubMed
55.
Weenig RH, Sewell LD, Davis MDP, McCarthy JT, Pittelkow MR. Calciphylaxis: natural history, risk factor analysis, and outcome. J Am Acad Dermatol. 2007;56(4):569–79.CrossRefPubMed
56.
Malbos S, Ureña-Torres P, Bardin T, Ea H-K. Sodium thiosulfate is effective in calcific uremic arteriolopathy complicating chronic hemodialysis. Joint Bone Spine. 2016;83(1):89–92.CrossRefPubMed
57.
Lonowski S, Martin S, Worswick S. Widespread calciphylaxis and normal renal function: no improvement with sodium thiosulfate. Dermatology online journal. 2015;21(5).
58.
Francès C, Niang S, Laffitte E. Pelletier Fl, Costedoat N, Piette JC. Dermatologic manifestations of the antiphospholipid syndrome: two hundred consecutive cases. Arthritis & Rheumatism. 2005;52(6):1785–93.CrossRef
59.
Wiszniewski A, Bykowska K, Bilski R, Jaśkowiak W, Proniewski J. Prevalence rate for inherited thrombophilia in patients with chronic and recurrent venous leg ulceration. Wound Repair Regen. 2011;19(5):552–8.CrossRefPubMed
60.
Shanmugam VK, McNish S, Duncan J, Root B, Tassi E, Wellstein A, et al. Late failure of a split-thickness skin graft in the setting of homozygous factor V Leiden mutation: a case report and correlative animal model from the Wound Etiology and Healing (WE-HEAL) study. International Wound Journal. 2013:n/a-n/a.
61.
62.
Weishaupt C, Strölin A, Kahle B, Kreuter A, Schneider SW, Gerss J, et al. Anticoagulation with rivaroxaban for livedoid vasculopathy (RILIVA): a multicentre, single-arm, open-label, phase 2a, proof-of-concept trial. The Lancet Haematology. 3(2):e72–e9.
Metadata
Title
Vasculitic Diseases and Prothrombotic States Contributing to Delayed Healing in Chronic Wounds
Author
Victoria K. Shanmugam
Publication date
01-12-2016
Publisher
Springer US
Published in
Current Dermatology Reports / Issue 4/2016
Electronic ISSN: 2162-4933
DOI
https://doi.org/10.1007/s13671-016-0157-2

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