In his yearly update on the latest in wound healing at the Maui Derm conference, Robert S. Kirsner, MD, PhD, offered several useful pearls for dermatologists to bring into their practice immediately. Dr Kirsner is chairman and Harvey Blank Chair in dermatology in the Dr. Phillip Frost department of dermatology and cutaneous surgery at University of Miami Miller School of Medicine in Florida.
In his first tip, Dr Kirsner shared that dermatologists should remember to debride the edge of a chronic, nonhealing wound. Debridement should be performed to the healthy edge. The procedure offers a number of potential benefits:
- Removal of necrotic tissue
- Removal of unresponsive or senescent cells
- Reduction in bacteria
- Reduction of the inflammatory/proteolytic environment
- Preparation for advanced modalities (eg, negative pressure therapy)
Another tip centered on using newer technology to enhance your practice. Several studies have now shown that virtual reality can act on a spectrum from distraction to pain relief, directly correlated to the level engagement from the patient. There are multiple reports of this technique in everything from vaccines, phlebotomy, and burn care.
While this approach is not necessarily new to dermatology, Dr Kirsner suggested considering repurposed drugs for supporting healing in chronic wounds. Level I evidence in the literature supports the use of statins in particular. These cholesterol-lowering drugs have a number of benefits when it comes to wound healing, including anti-inflammatory and immunomodulatory effects, increased epithelialization, and increased angiogenesis. He highlighted venous leg ulcers and scleroderma as targets for statins.
In a similar vein, beta blockers can be a useful tool for chronic wound healing, specifically for patients with burns. A double-blind randomized clinical trial by Mohammadi et al in Journal of Burn Care & Research found that beta blocker use was associated with faster healing, decreased size of the burn that needed a skin graft, and shorter hospital stay.
In an interesting pearl, Dr Kirsner suggested that dermatologists pay attention to the gastrointestinal microbiome in patients who present with a nonhealing ulcer. Some preliminary evidence shows that probiotics, such as those found in yogurt, may lead to improved healing. So far it has been demonstrated in murine models by Poutahidis et al, but a study published in Brain, Behavior, and Immunity has shown improvements in humans as well.
Kirsner RS. What’s new (and not so new) in wound healing for dermatologists. Presented at: Maui Derm Connect; January 25-29, 2021; Maui, HI.