Topical sucralfate in the management of peristomal skin disease: an open study

Postoperative and Peristomal Pyoderma Gangrenosum: Subtypes of Pyoderma Gangrenosum

Postoperative pyoderma gangrenosum and peristomal pyoderma gangrenosum are 2 subtypes of pyoderma gangrenosum. The diagnosis is made as a clinicopathologic correlation when assessing a rapidly progressing ulcer with irregular and undermined borders following a surgical procedure, trauma, or the creation of a stoma. Familiarity with the associated risk factors and distinguishing features of these disorders can facilitate prompt recognition, proper diagnosis, and the initiation of treatment. Management usually involves the use of corticosteroids and steroid-sparing agents as immunomodulators to shift the inflammatory neutrophilic dermatoses to chronic noninflammatory wounds and eventual healing.

Comparison of topical sucralfate with dexpanthenol in rat wound model

Wound healing is a dynamic process initiated in response to injury. There are many factors that have detrimental effects on the wound healing process. Numerous studies have been conducted for improving wound healing processes. Dexpanthenol is widely used to accelerate wound healing. Sucralfate is used for the treatment of peptic ulcers. We aimed to compare the efficacy of topical Dexpanthenol and Sucralfate in an experimental wound model in rats via histopathological examinations and immune histochemical determinations, as well, to evaluate their effects on EGF levels. Three different groups were formed: the Control Group, the Dexpanthenol Group and the Sucralfate Group. Full-thickness skin wounds were created on the back of each rat and isotonic saline was applied to the wounds of the rats in the control group, Bepanthol^® cream was applied in Dexpanthenol Group and 10% Sucralfate cream was applied in Sucralfate Group, once a day. On the 7th, 14th and 21st days the wounds were measured and seven rats from each group were sacrificed and the wounds were excised for histopathological examination. Sucralfate increased wound healing rates by increasing neovascularization, fibroblast activation, reepithelialization and collagen density, as well as dexpanthenol. Our study revealed that the dexpanthenol and sucralfate groups were better than the control group in terms of their effects on wound healing, however there was no statistically significant difference among these two groups. Sucralfate improves EGF expression in skin wounds and has positive results on skin wound healing comparable to dexpanthenol.

Topical sucralfate for treatment of mucocutaneous conditions: A systematic review on clinical evidence

Sucralfate is an aluminum salt of sucrose octasulfate, generally considered safe in terms of adverse effects. Systemic sucralfate is FDA-approved for the treatment of duodenal ulcers. Since 1991, topical sucralfate has been used in various mucocutaneous conditions, but it is not approved by the FDA yet. In this systematic review, the online databases were searched with appropriate keywords, and the papers were screened by the authors. After screening steps, the relevant articles were selected according to the inclusions and exclusions criteria. Finally, the full texts of 18 articles were included for final evaluations. In conclusion, topical sucralfate has some clinical benefit in several mucocutaneous conditions, including mucocutaneous inflammatory conditions (e.g., post-radiotherapy reaction, diaper dermatitis, keratoconjunctivitis sicca, etc.), mucocutaneous infectious disorders (e.g., peristomal wound reaction / Infection); ulcers; burns, and also pain relief.

A Systematic Review: Topical Sucralfate for Burn Wound

BACKGROUND: Topical sucralfate has been used for burn and non-burn skin and mucosal lesion with remarkable results. The healing rate of mucosa is faster than skin lesion. AIM: A current systematic review was conducted to objectively evaluate wound healing benefits of topical sucralfate for burn wound and to show on which degree of burn wound it works compare with another topical agents of burn wound therapy. METHODS: Databases were searched for relevant studies: Google Scholar, PUBMED, and ProQuest. Data sources were searched using MeSH terms: “topical sucralfate” and “burn wound” for all publications up to December 2018. All English papers were included. Only studies performed in humans were included in this study. A total of 2437 publications were found, of which 3 studies met the inclusion criteria and were relevant to be used in this systematic review. The primary outcome was burn wound healing. DATA EXTRACTION: Data from retrieved studies were reviewed and tabulated according to year of publication, study design, human or animal studies, characteristics of the population, and outcomes. DATA SYNTHESIS: A total of 2 randomized controlled trials (RCTs) and 1 observational comparative study were found. All trials are on second degree burn wound patients. Jadad score was used to assess the methodological quality of the RCTs. One RCT and one comparative study demonstrated favorable outcomes with the use of topical sucralfate. There is one publication with no significant differences. CONCLUSIONS: This systematic review shows a noticeably beneficial effect of topical sucralfate for burn wound. It is better than other topical agent in wound healing rate, decreased infection rate and enhancement of epithelialization also granulation with no local or systemic adverse reactions. However, multicenter RCT with larger sample size are needed to make recommendation for burn wound treatment.

Technology-Dependent Children

There are a growing number of medically complex children with implanted devices. Emergency physicians with a basic knowledge of these devices can troubleshoot and fix many of the issues that may arise. Recognition of malfunction of these devices can reduce morbidity and mortality among this special population. In this article, we review common issues that may arise in children with gastrostomy tubes, central nervous system shunts, cochlear implants, and vagal nerve stimulators.

Evaluation of sucralfate enema in experimental diversion colitis

Diversion colitis (DC) is an inflammatory disease that develops in segments with fecal diversion. Sucralfate (SCF) complex, which consists of sucrose octasulfate and polyaluminum hydroxide, has been demonstrated to be effective in the treatment of different forms of colitis. However, until now, the effects of SCF have not been evaluated in DC.

Objective to evaluate whether the use of enemas containing SFC improves histological findings in experimental DC.

Methods Thirty-six rats underwent right colon bypass procedure through the creation of a proximal colostomy and a distal mucous fistula. The animals were divided into two groups according to the euthanization procedure to be performed two to four weeks after surgery. Each experimental group was divided into three subgroups of six animals, which were submitted to daily application of enemas containing saline solution 0.9% or SCF at concentrations of 1.0 g/kg/day or 2.0 g/kg/day, respectively. The diagnosis of DC in segments with fecal diversion was established by histopathological study considering the following

variables epithelial loss, formation of crypt abscesses, the population of goblet cells, inflammatory infiltrate and presence of fibrosis. For statistical analysis, the nonparametric Mann-Whitney and Kruskal-Wallis tests were used, with a significance level of 5% (p <0.05).

Results It was observed that the daily application of SCF enemas decreased epithelial loss, formation of colon crypt abscesses, inflammatory infiltrate and tissue fibrosis (p <0.05), unrelated to time of intervention. The intervention with SCF preserves the goblet cell population. The effects of the substance on the preservation of colonic epithelium; the decrease in the inflammatory process and subsequent abscess formation in the colon crypts are associated with the concentration used, whereas tissue fibrosis decrease is associated with the concentration and time of intervention.

Conclusion Preventive application of SCF enemas reduces the inflammatory process in the colon with fecal diversion

Randomized controlled trial of topical mupirocin versus mupirocin with sucralfate combination in chronic skin ulcers

OBJECTIVES:

The objective of this study was to carry out a head-to-head comparison of topical sucralfate combined with mupirocin versus mupirocin alone in the treatment of chronic skin ulcers with respect to both effectiveness and safety.

MATERIALS AND METHODS:

A parallel-group, open-label, randomized, controlled trial (CTRI/2015/12/006443) was carried out with patients suffering from skin ulcers of Wagner grading 1 or 2 persisting for over 4 weeks. Ninety-six patients were recruited in total, and the modified intention-to-treat analysis dataset included 44 participants treated with mupirocin 2% and 46 treated with combined mupirocin 2% and sucralfate 7% ointment. Both medications were applied topically thrice daily for 6 weeks. Ulcer area assessed using millimeter graph paper and wound infection score assessed on a three-point scale were effectiveness measures. Treatment-emergent adverse reactions that were reported by patients or observed by the investigators were recorded.

RESULTS:

The median ulcer area was significantly reduced in the combined treatment group at the end of treatment. Clinically, 41.3% of the participants in the combined group showed complete ulcer healing at 6 weeks compared to 18.18% in the mupirocin alone group (P = 0.022). The wound infection score declined significantly from baseline by the end of 3 weeks of treatment in both the groups. The frequency of qualitative wound attributes, namely pain, discharge, and erythema, remained comparable between the groups except for discharge which disappeared completely from all remaining ulcers in the combined group but was still present in 11.36% of the participants treated with mupirocin alone (P = 0.025) at 6 weeks. Adverse events were few, all local, mild, and tolerable.

CONCLUSIONS:

The wound healing effect of topical sucralfate adds to the antimicrobial effect of mupirocin toward the overall improvement of chronic skin ulcers. The effect of combined topical treatment needs comparison with other topical medications and wound healing strategies.

Effectiveness of Topical Sucralfate in the Management of Pressure Ulcer in Hospitalized Patients: A Prospective, Randomized, Placebo-Controlled Trial

BACKGROUND

The aim of this study was to evaluate the effectiveness of topical sucralfate in the management of pressure ulcer (PU) in hospitalized patients.

METHODS

Forty hospitalized patients with stage II PU were included in this prospective, double-blind, randomized, placebo-controlled trial and were randomly divided into 2 groups receiving either sucralfate gel or placebo, on a daily basis. The patients were visited every day for 14 days, the ulcer was evaluated using the Pressure Ulcer Scale for Healing (PUSH) and changes to the measured scores over time were used as an indicator of wound healing.

RESULTS

There were no statistically significant differences in any of the demographic characteristics between both groups. Both of the interventions reduced the average PUSH score, and at the end of the trial, all but 2 patients were healed. One in each group discontinued the trial because of exacerbation of the ulcer. No significant between-group difference in the average PUSH score reduction was observed (6.36 ± 2.11 vs. 5.89 ± 1.41, P = 0.42). Although the average healing time was less in the sucralfate group (6.05 ± 2.17 vs. 7.78 ± 3.42), the difference was not statistically significant (P = 0.07).

CONCLUSIONS

Sucralfate gel does not improve healing of PU compared with placebo.

Recent advances in diaper dermatitis: etiology and treatment

Diaper dermatitis is a highly prevalent condition that causes discomfort and stress for patients and frustration for healthcare staff. Diaper technology has evolved to substantially lessen the severity of diaper dermatitis, but additional improvements are needed. Premature infants and incontinent adults are particularly at risk for developing diaper dermatitis and its potential consequences. Contributing factors include overhydration, irritants, friction, increased skin pH, diet, gestational age, antibiotic use, diarrhea and medical condition. Treatments aim to reduce hydration, provide a semipermeable ‘layer’ to facilitate skin barrier repair, shield the skin from irritants, deactivate specific fecal components and maintain skin surface contact. The published research on the effects of diaper dermatitis treatments is especially sparse. Controlled clinical trials are needed to provide definitive evidence for selection of effective treatments. This article discusses the incidence and etiology of diaper dermatitis in infants and adults. It provides the scientific basis for repair of diaper skin barrier damage and describes recent developments that will be available in the future.

Topical sucralfate decreases pain after hemorrhoidectomy and improves healing: a randomized, blinded, controlled study

PURPOSE

Oral and topical sucralfate is regularly used in ulcers of gastrointestinal tract, vaginal and perianal excoriations, and radiation burns. This study was designed to determine whether there was any advantage of topical application of sucralfate in reducing postoperative pain and promoting wound healing after open hemorrhoidectomy in patients with Grades III or IV hemorrhoids.

METHODS

A total of 116 patients were randomly assigned to receive sucralfate cream (sucralfate group) or placebo cream (control group) applied to the surgical site. Weekly pain score was evaluated by using Visual Analog Scale. The amount of analgesic tablets consumed in each week also was assessed. At the end of four weeks, two independent surgeons assessed the wound healing.

RESULTS

There was no significant difference in age, gender distribution, and number of excised hemorrhoid piles between the two groups. Patients in the topical sucralfate group experienced significantly less pain at Day 7 (Visual Analog Scale +/- standard error of the mean, 3.7+/-0.3 vs. 6.1+/-0.7; P<0.002) and at Day 14 (1.6+/-0.2 vs. 3.1+/-0.6; P<0.01). Likewise patients who received sucralfate cream used less analgesic tablets compared with the placebo group. In the sucralfate group, the overall wound healing ranked significantly better than in controls (P<0.02).

CONCLUSIONS

Topical sucralfate significantly reduces pain at Days 7 and 14 after hemorrhoidectomy and promotes faster wound healing compared with that of a placebo.

Ostomy care and the consultant pharmacist

Many long-term care residents have ostomies. Three types of ostomy are most common: ostomies of the small bowel (ileostomies/jejunostomies), ostomies of the large bowel (colostomy), and urostomies. Ostomates (people who have had an ostomy) must deal with their physical and psychological repercussions. Complications may include dermatological problems, short-bowel syndrome, and vitamin deficiencies. When the ostomy involves the bowel, medication absorption may be affected. Pharmacists should be aware of contraindicated medications, as well as those that change the color or odor of effluent or stool.

[Analysis of medical/surgical complications of cutaneous ileostomy]

OBJECTIVE

Our objective is to carried out a descriptive study about medical-surgical complications and alterations about quality of life in stoma patients secondary to bladder tumour.

PATIENTS AND METHOD

The series are composed of 67 patients. The mean age was 70.3 years. We analyse the following variable: early and late medical-surgical complications, the body mass index (BMI) change and the alteration of quality of life.

RESULTS

The most frequent early complication is the ischemic necrosis (7%) without posterior repercussion. The late complications in frequency order are: peristomal dermatitis (18%), plane stoma (12%), peristomal hernia (12%), stenosis (9%) and granuloma (6%). The BMI changes don't conditionate a increase in the complications. The psychological adaptation is good in 92%, although the majority affirm a little changes in life-style, but they don't have a repercussion on quality of life.

CONCLUSIONS

In this series we estimate a low incidence of complications. The preoperative counsel and the posterior following by the stoma care nurse-surgeon team, play a fundamental role on psychological adaptation after surgery.

Wound healing: a multidisciplinary approach for dermatologists

This article has provided a review of common and some less common approaches to wound healing. Chronic wound healing is one of the more challenging areas of medicine, with a nice balance of the science and art of medicine. An evidence-based, patient-centered approach can be used to effectively improve the care of many difficult to heal ulcers in often frustrated patients. The multidisciplinary wound clinic concept can work to improve the outcomes of patients with leg ulcers.

Clinical management of pyoderma gangrenosum

Pyoderma gangrenosum is a noninfectious neutrophilic dermatosis that usually starts with sterile pustules which rapidly progress to painful ulcers of variable depth and size with undermined violaceous borders. In 17 to 74% of cases, pyoderma gangrenosum is associated with an underlying disease, most commonly inflammatory bowel disease, rheumatological or hematological disease or malignancy. Diagnosis of pyoderma gangrenosum is based on a history of an underlying disease, typical clinical presentation and histopathology, and exclusion of other diseases that would lead to a similar appearance. Randomized, double-blinded prospective multicenter trials investigating the treatment of pyoderma gangrenosum are not available. The treatments with the best clinical evidence are systemic corticosteroids (in the initial phase usually 100 to 200 mg/day) and cyclosporine (mainly as a maintenance treatment). Combinations of corticosteroids with cytotoxic drugs such as azathioprine, cyclophosphamide or chlorambucil are used in patients with disease that is resistant to corticosteroids. The combination of corticosteroids with sulfa drugs, such as dapsone, or clofazimine, minocycline and thalidomide, has been used as a corticosteroid-sparing alternative. Limited experience has been documented with methotrexate, colchicine, nicotine, and mycophenolate mofetil, among other drugs. Alternative treatments include local application of granulocyte-macrophage colony-stimulating factor, intravenous immunoglobulins and plasmapheresis. Skin transplants (split-skin grafts or autologous keratinocyte grafts) and the application of bioengineered skin is useful in selected cases in conjunction with immunosuppression. Topical therapy with modern wound dressings is useful to minimize pain and the high risk of secondary infection. The application of topical antibacterials cannot be recommended because of their potential to sensitize and their questionable efficacy, but systemic antibacterial therapy is mandatory when infection is present. Despite recent advances in therapy, the prognosis of pyoderma gangrenosum remains unpredictable.

Treating peristomal skin problems in the community

Adaptation to life with a stoma depends to a large extent on the health of the peristomal skin. This area of skin can become damaged in various ways, and the resulting discomfort or pain can make the use of a stoma appliance difficult. Problems such as these can be one of the major factors facing a community nurse in her/his care of the stoma patient. If the community nurse is able to recognize and correct these problems, this will enable the patient to carry on with a normal and productive life. Failure to correct stoma-related problems can have significant negative effects on patients' psychosocial well-being. This article discusses the causes and management of the commonest stoma-related skin problems.