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Case Study/Series
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The Use of Silver Dressings in Atypical Inflammatory Ulcers of Lupus: A Case Report First Author: Maria Guidry Authors: Maria T. Guidry, MD, CWS INTRODUCTION: This case report examines the usefulness of a silver antimicrobial dressing* in an atypical ulcer. Effective diagnosis of atypical lower-extremity ulcers is critical. Atypical ulcers are etiologically grouped as inflammatory, infectious, metabolic, neoplastic, and vasculopathic (1,2). Treatment of the underlying cause is paramount. Moreover, topical treatment should strive to avoid secondary infection and achieve re-epithelialization (3). CASE STUDY: A 46-year-old female non-diabetic with CREST syndrome, systemic lupus erythematosus, and Sjogren's syndrome, presented to dermatology at the author's institution with erythematous papulovesicular eruptions on her left leg arising from excoriation and scratching. Biopsy revealed panniculitis and necrotizing vasculitis. The patient received high dose oral and topical steroids, and experienced modest improvement. A biopsy-site ulcer developed and progressed into in a full-thickness ulcer involving skin, subcutaneous tissue, and muscle. This was complicated by Staphylococcus aureus cellulitis of the leg. The patient was referred to wound care. The cellulitis resolved with tetracyclines. The biopsy-site ulcer was treated with enzymatic debriders, but these were discontinued due to pain. At week two, the ulcer measured 2.5 x 2.5x0.5cm, and cadexomer iodine was started. By week four, the patient was switched to a silver-impregnated foam dressing*. Sharp debridements were discontinued due to pain. Dressings were changed every three to four days. There was good exudate control; granulation increased and slough decreased. The ulcer measured 1.5x1.0x 0.3cm after three weeks and was 80% epithelialized at week 11. CONCLUSION: Silver-impregnated foam* prevented infection, reduced signs of inflammation, and increased healing rates of a vasculitic ulcer secondary to lupus. *Acticoat Moisture Control¨, Smith and Nephew, Inc., Largo, FL |
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