Autologous platelet-rich plasma for treatment of venous leg ulcers: a prospective controlled study

Venous leg ulcers (VLUs) are chronic difficult-to-treat wounds which affect around 1-2% of the world population. Conventional methods for treatment such as mechanical debridement, occlusive dressings and local antibiotics in case of infection, often lack effectiveness. Autologous platelet-rich plasma (PRP) is an alternative method in the treatment of chronic wounds. PRP contains inflammatory mediators, growth factors, and cytokines that modulate the wound microenvironment to create a better chance for healing. The aim of this prospective clinical study was to evaluate the efficacy of intralesional injection of PRP in the management of VLUs. This study included 23 patients with VLUs. For each patient, two ulcers located in the same anatomical zone and at the same clinical stage were selected. One was treated with a single application of autologous PRP. The other ulcer was used as a control and was treated by conventional methods. The size of the ulcers was assessed at baseline (visit 0), 15 days (visit 1) and 30 days after the procedure (visit 2). Results showed a significant reduction of the size of the ulcer both in the group treated with PRP (mean surface 1368.2 mm2 at visit 0 and 596.3 mm2 at visit 2) and in the control group (mean surface 880.3 mm2 at visit 0 and 582.8 mm2 at visit 2). Statistical analysis showed a significant change in the size of the ulcer between visit 0 and visit 2 in both groups (p less than 0.0001). The application of PRP in difficult-to-treat venous leg ulcers may be a promising new method for therapy of this condition. The results of this study correlate with the data from the majority of previous studies and confirm the effectiveness of PRP. Nevertheless further research in the area is needed to evaluate the therapeutic significance of the method and eventually show its superiority to conventional treatments in larger cohorts.

Complications of injected vitamin E as a filler for lip augmentation: case series and therapeutic approach

The strive for proficient cosmetic facial appearance is growing in the past decades. Fillers for tissue augmentation are gaining wide popularity. Uncertified products based on oleic solutions are applied by untrained staff, thus growing the risk for certain complications such as infections, allergic and irritant contact dermatitis, and lipogranuloma formation. We present a series of three cases lipogranuloma after liquid vitamin E injection for lip augmentation. In all cases, painful edema at the injected area followed the procedure. The patients were presented with erythema, firm indurations of the lips and the perioral skin, and tenderness. Histological examination of skin biopsies showed round-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with a lipogranuloma. In this paper, we propose a protocol for treatment of this specific complication with systemic corticosteroids and a broad spectrum antibiotics.

Oil-soluble vitamins: illegal use for lip augmentation

Fillers for lip augmentation have become more and more popular in recent years and seem to be indispensable in the cosmetic market nowadays. A series of six young females is presented who developed massive swellings and pain after vitamins A and/or E lip augmentation. The vitamins were extracted from gelatinous capsules (Gericaps [Adipharm EAD, Sofia, Bulgaria], Geritamins [Actavis EAD, Balkanpharma-Dubnitsa AD, Bulgaria], or vitamin E yellow gel capsules) and injected by unprofessional physicians and beauticians in different cosmetic centers. Physical examination revealed firm indurations of the lips and perioral skin, tenderness, erythema, and hard dermal nodules. Histological analysis revealed numerous round-to-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with lipogranulomas. The patients were treated with systemic and intralesional triamcinolone injections and broad-spectrum antibiotics with good clinical response. In conclusion, these cases demonstrate the danger of the use of unregistered products as fillers injected by unprofessional physicians and beauticians.

Drug-induced lupus erythematosus

Among the numerous idiopathic immune-mediated diseases that can be drug-induced, such as pemphigus, psoriasis, lichen, etc, drug-induced lupus is the most widely commented upon and investigated. The terms drug-induced lupus (DIL) and drug-induced lupus erythematosus (DILE) are preferred, but other ones are also used--drug-related lupus, lupus-like syndrome, and lupus erythematosus medicamentosus. This review discusses the general issues in DILE, such as pathogenic mechanisms, clinical forms, and diagnostic criteria, and provides more detailed information for some of the implicated drugs: minocycline, statins, terbinafine, etc.