Case Report: Topical Gel for the Treatment of a Refractory Leg Ulcer
Author(s):Israel, Alan
This case report describes the effect of a topical gel used to treat a large ulcer that had been refractory to cure for 2 years. The patient, a 55-year-old man, had fractured all the bones in his left foot and ankle in a fall; and lymphedema and a large ulcer had subsequently developed. Although he was treated over the next 2 years, the wounds did not heal. Implantation of a pump to relieve the lymphedema was unsuccessful, and the skin around the ulcer began to split. When the swollen surrounding area was lanced, the ulcer increased in size and surrounding skin split. The patient had been treated only with oral morphine sulfate for 1 month after surgery to relieve pain and oral warfarin sodium. The patient then underwent a 21-day cycle of debriding and massage and was prescribed two preparations: one was a gel base containing misoprostol 0.0024%, phenytoin 1%, metronidazole 2% and lidocaine 2%; the other was nifedipine 16% in a gel base. These were applied topically as treatment for 42 days, at which time the ulcer was 95% healed
IJPC Vol 7 # 3 May/June 2003 - Click here to request a printed copy of this article.


L-Arginine and Ascorbic Acid for Diabetic Foot Ulcers
Author(s):Gorman, Shellie
Diabetic foot ulcers are the most common cause of nontraumatic amputations and are responsible for 25% of all hospitalizations of patients with diabetes. Poor blood flow due to vascular endothelial dysfunction is considered the underlying cause of this condition. L-arginine is converted in the body to nitric oxide, a potent vasodilator, so supplementation with it may help increase vascular blood flow to ulcerated areas. Ascorbic acid has also been shown to improve endothelial-dependent vasodilation in diabetic patients. Together these nutrients may aid healing of diabetic foot ulcers. The author discusses physiology and topical treatment of diabetic foot ulcers. She then briefly describes ingredients in two sample formulations included with the article that may be of assistance, L-Arginine and Ascorbic Acid Hydrating Ulcer Gel, and L-Arginine and Ascorbic Acid in PLO (L-arginine, ascorbic acid, zinc sulfate, methylcellulose, propylene glycol, methylparaben, purified water, poloxamers, lecithin and isopropyl palmitate). She concludes that use of an appropriate topical dressing to treat diabetic foot ulcers can accelerate healing. While further studies are needed to determine the benefit from L-arginine and ascorbic acid, sufficient data exist to imply benefits for the diabetic patient.
Vol 4 # 2 March/April 2000 - Click here to request a printed copy of this article


Options in Wound Care
Author(s):Kincaid, Michele R
Wound healing is a growing area of health care to which pharmacists can contribute. This article provides a general overview of agents effective in wound care and a review of various agents used in treatment. The author discusses stages of wound healing, nutrition and wound healing and therapies for healing wounds (metronidazole or gentamicin, granulocyte macrophage-colony stimulating factor, mafenide acetate, tretinoin, nifedipine, honey, phenytoin, bufflomedil hydrochloride, pentoxifylline, misoprostol and aloe vera). A table lists factors affecting wound healing and their effects.
Vol 6 # 2 March April 2002 - Click here to request a printed copy of this article


The Rewards of Treating Decubitus Ulcers.
Author(s):Chadwick, Doug
The author is affiliated with a pharmacy that services two different hospice groups in San Angelo, TX. He describes experience with two patients treated with a compound containing ketoprofen, idocaine, aloe vera, phenytoin and misoprostol in an emollient base. The first patient was a 48-year-old woman suffering from end-stage multiple sclerosis who suffered from stage 4 decubitus ulcers on her left foot and left buttock. The second patient was a 67-year-old bedridden diabetic suffering from a large stage 4 ulcer to the left shin. Both treatments were successful in reducing the area of the ulcers. In the case of the second patient, when treatment began, the patient was a candidate for amputation. Due to the excellent results of the treatment, it was decided to surgically close the wound and finish it with a skin graft.
Vol 2 # 4 July/August 1998 - Click here to request a printed copy of this article


Transdermal Nifedipine for Wound Healing: Case Reports
Author(s):Torsiello, Michael J.; Kopacki, Matthew H.
The authors present two case reports demonstrating their success with adding transdermal nifedipine to conventional therapy to treat difficult-to-heal wounds refractory to standard forms of treatment. In the first, a 43-year-old woman with a history of juvenile diabetes mellitus presented with a nonhealing wound on her right heel, among other problems. After it was debrided, a limb salvage procedure was performed; during the process of follow-up, the patient became dialysis dependent. Wound healing time was so extended that it was decided to use transdermal nifedipine to accelerate healing by inducing localized vasodilation without systemic effects. Wound healing time was decreased from 4 to 5 months to 6 to 8 weeks, and no adverse effects were observed with therapy. The patient now awaits kidney and pancreas transplant and continues to experience repeated tissue breakdowns, which are also being treated with nifedipine and routine therapy. In the second case, an 8-year-old boy with a clubfoot had developed problems after a foot-straightening procedure 2 years earlier. When the inserted expander was removed, the area was treated with transdermal nifedipine to accelerate wound healing and prevent the formation of another hypertrophic scar so that a second tissue expander could be inserted in the same area. A nifedipine Pluronic lecithin gel was prescribed, in addition to daily whirlpool therapy. After 3 weeks of this regimen, complete healing was observed. The authors conclude
Vol 4 # 5 September/October 2000 - Click here to request a printed copy of this article
J Int Med Res. 2004 Mar-Apr;32(2):201-5.


Phenytoin-induced lymphocytic chemotaxis, angiogenesis and accelerated healing of decubitus ulcer in a patient with stroke.
Pitiakoudis M, Giatromanolaki A, Iliopoulos I, Tsaroucha AK, Simopoulos C, Piperidou C.
Second Department of Surgery, Medical School, Democritus University of Thrace, Alexandoupolis, Greece.
Cent Afr J Med. 2002 Sep-Oct;48(9-10):105-8.

A comparison of topical Phenytoin with Silverex in the treatment of superficial dermal burn wounds.
Carneiro PM, Rwanyuma LR, Mkony CA.
Department of Surgery, Faculty of Medicine, Muhimbili University College of Health Sciences, Dar-es-Salaam, Tanzania.

Ann Pharmacother. 2001 Jun;35(6):675-81.
Topical phenytoin treatment of stage II decubitus ulcers in the elderly.
Rhodes RS, Heyneman CA, Culbertson VL, Wilson SE, Phatak HM.
Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Pocatello, ID, USA.

Am J Clin Dermatol. 2003;4(11):737-43.
Potential role of estrogens in wound healing.
Ashcroft GS, Ashworth JJ.
School of Biological Sciences, University of Manchester, UK. Gillian.s.ashcroft@man.ac.uk

Arch Facial Plast Surg. 2001 Apr-Jun;3(2):111-4.
Effect of tamoxifen on transforming growth factor beta1 production by keloid and fetal fibroblasts.
Mikulec AA, Hanasono MM, Lum J, Kadleck JM, Kita M, Koch RJ.
Division of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5328, USA.

Ann Plast Surg. 1998 May;40(5):490-3.
Tamoxifen downregulates TGF-beta production in keloid fibroblasts.
Chau D, Mancoll JS, Lee S, Zhao J, Phillips LG, Gittes GK, Longaker MT.
Department of Surgery, New York University Medical Center, NY 10016, USA.

Int J Pharm. 2004 Mar 1;271(1-2):305-9.
Simultaneous permeation of tamoxifen and gamma linolenic acid across excised human skin. Further evidence of the permeation of solvated complexes.
Karia C, Harwood JL, Morris AP, Heard CM.
Welsh School of Pharmacy, Cardiff University, Cardiff CF10 3XF, UK.


IJPC VOL 3 # 5 SEPTEMBER/OCTOBER 1999
Tamoxifen Citrate - A Potential Therapy for the Treatment of Keloids
Author(s):Glasnapp, Andrew
Keloid scar formation is a significant problem affecting millions of patients annually. Proposed management or prevention of keloids includes three distinctly different therapeutic approaches: correction of abnormal collagen metabolism when the equilibrium between collagen synthesis and degradation has been destroyed, alteration of the immune/inflammatory response and manipulation of the mechanical properties of wound repair. There currently is no universally accepted treatment modality resulting in permanent keloid scar ablation. The author discusses the pathology of keloids and tamoxifen citrate (efficacy and description). He also provides a Formula for Tamoxifen Citrate Cream 0.1% (100 g). Click here to request a printed copy of this article