Oral antibiotics, especially tetracyclines, are commonly used to treat moderate to moderately severe acne vulgaris. There are hints suggesting that a combination treatment with oral tetracyclines and topical retinoids can cause a greater and prompter improvement of acne than monotherapy with tetracyclines. We evaluated the clinical activity of a 12-week combined therapy with oral lymecycline (300mg/day for 2 weeks and then 150mg/day) and topical adapalene (gel or cream) in 419 patients with inflammatory acne. A significant reduction in the number of acne lesions was noted at 4 and 12 weeks (P<0.0001). Thereafter, 400 patients underwent a maintenance treatment with adapalene alone for 12 weeks. At week 24 a relevant improvement of acne lesions still persisted (P<0.0001) in most patients. Only 16 patients relapsed and required additional use of oral lymecycline which proved again successful. No substantial differences were noted in the magnitude of clinical response between patients treated with adapalene gel and those treated with cream formulation. Treatment was well tolerated. Local adverse reactions occurred in 11.7 % of patients and resulted in premature discontinuation of treatment in 1.4 %. Systemic (gastrointestinal) untoward effects developed in 1.2 % of patients and caused treatment interruption in 0.7 % of cases. No serious adverse events occurred.
Le lesioni da decubito, le ulcere vascolari e il piede diabetico rappresentano le lesioni cutanee croniche maggiormente diffuse in età geriatrica. La lesione cutanea cronica presenta un elevato rischio infettivo ed un management complesso che richiede terapie mirate ed un iter di trattamento specifico. Il metodo TIME (Tissue management control of Infection and inflammation Moisture imbalance advancement of the Epithelial edge of the wound), costituisce il gold standard per il trattamento delle lesioni cutanee croniche poiché consente di controllare l’infezione e il grado di macerazione della ferita anche nei margini epiteliali. La soluzione di ipoclorito di sodio alla concentrazione dello 0,05%, oggetto di numerosi studi in letteratura, grazie ad un ampio spettro germicida ed alla sua elevata compatibilità tissutale rappresenta il metodo di disinfezione d’elezione per il trattamento delle lesioni cutanee croniche. La qualità di vita (Quality of Life, QoL) di un paziente affetto da lesione cutanea cronica può essere fortemente compromessa. La formazione di un team sanitario multidisciplinare per la gestione del patient journey può favorire il percorso di guarigione, facilitare la gestione della lesione nella quotidianità e migliorare la QoL del paziente. La telemedicina spicca tra le modalità innovative di gestione del wound care sperimentate da un’equipe di specialisti del territorio ligure negli ultimi mesi a seguito della pandemia COVID-19. La pratica della telemedicina si è rivelata particolarmente utile nel follow up della lesione cronica a fronte di un adeguato impiego di strumenti tecnologici che permettano un’elevata qualità di immagini.
Liguria is one of the Italian regions with the highest percentage of elderly people. The European Union declared the region as a “reference site”, for experimenting cutting-edge solutions and assistance models in health management of elderly people. Chronic ulcers become a problem of considerable importance looking at the number of involved elderly patients and of the necessary resources for their care, as well for the impact on the patient’s quality of life, due to the painful and limiting nature of the pathology. This study aims to evaluate the appropriate wound management in older people affected by chronic ulcers. A group of wound care experts operating in the Liguria region met with the aim of reviewing the epidemiology of chronic skin lesions, analyzing the diagnostic/therapeutic approach currently in use, focusing on the importance of the antisepsis in wound management. In Liguria region general practitioners reported a 3.9% prevalence of chronic skin lesions in 2018, and up to 7.35% in women over 85 years; about 90% of the lesions managed at home were pressure lesions. An overall assessment of the patient and the lesion, appropriate cleansing and antisepsis phases and a multidisciplinary management are essential to facilitate the wound’s healing process among the elderly.
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