Diagnosis of necrotizing fasciitis (NF) can prove extremely challenging. The condition has many of the same characteristics as cellulitis, and is often diagnosed incorrectly as such.(1) The resulting delay in implementing appropriate treatment can prove catastrophic in such a rapidly progressing condition.

One key differentiator between NF and cellulitis  is the higher intensity of pain experienced by patients with NF.(1,2)  Excessive pain should therefore raise the…

Necrotizing fasciitis (NF), or the ‘flesh-eating bug’ as it tends to be known in the press, is an extremely rapidly progressing infection that is difficult to manage and can lead to significant morbidity and mortality.

While anyone with an infection may in theory develop NF, in practice the majority of patients with NF (82%) have an immunosuppressive condition such as diabetes mellitus or renal insufficiency,¹ have a history of alcohol abuse,¹ or are…

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection a condition, often referred to in the press as the ‘flesh-eating bug’ on account of the speed with which the infection spreads.  The condition was first described by Hippocrates around the fifth century, and the term “necrotizing fasciitis” was coined by Joseph Jones, a former Confederate Army surgeon, in 1871.(1) Some infecting organisms in NF have been reported to progress at about 3 centimeters per hour, meaning that…

Over the previous few weeks, we have looked at the condition known as vasculitis, in which the blood vessels become inflamed, leading to necrosis, hemorrhage, ischemia, and infarction. Vasculitis may either be caused by one of a number of identifiable conditions (including diseases of the connective tissue, malignancy, or a drug reaction) or can be idiopathic with no identifiable cause.

The true prevalence of vasculitis is poorly understood because epidemiological studies are…

Vasculitis is an inflammation and necrosis of the blood vessels, leading to hemorrhage, ischemia, and infarction.(1–3) Treatment of the condition is entirely dependent on the extent of the disease. In many instances, cutaneous vasculitis is a self-limited condition, relieved by leg elevation, avoidance of standing, and therapy with non-steroidal anti-inflammatory drugs (NSAIDs). However, more extensive or severe disease can prove more difficult to manage.

Treatment of…

Vasculitis, an inflammation of the blood vessel wall, is associated with multiple cutaneous manifestations as well as systemic sequelae.(1-5)

Opinion is divided over the best way to classify cutaneous vasculitis. Some prefer classification according to etiology, differentiating between primary (idiopathic) and secondary disease.(1) Approximately 50% of cases are idiopathic, while infection (15-20%), inflammatory diseases (15-20%), drugs (10-15%), and malignancy (<5%) are…

This week sees the start of a new topic as we turn our attention to the condition known as vasculitis. Vasculitis is an inflammation and necrosis of the blood vessels, leading to hemorrhage, ischemia, and infarction. While vasculitis can be triggered by a number of conditions, including diseases of the connective tissue, malignancy, or a drug reaction, the condition can often be idiopathic with no identifiable cause.(1–3)

The term vasculitis covers a range of conditions which…

Over the past few weeks we have been looking at the problem of sickle cell ulcers. Sickle cell ulcers affect around 75% of all sickle cell sufferers, and can prove extremely painful and debilitating for the patient. Management of sickle cell ulcers relies on the effective implementation of good wound care practices. However, even under optimal treatment conditions, sickle cell ulcers can prove extremely intractable, and many persist for several months or even years. One of the most important…

Sickle cell leg ulcers are a common manifestation of sickle cell disease, affecting around 75% of patients over the course of their disease.(1) Sickle cell ulcers can be both painful and debilitating, and tend to heal only slowly. It has been shown that most ulcers will eventually heal on their own following a prolonged period of bed rest,(2) but this is not practical in most situations, either at home or in a hospital environment.

The active management of sickle cell ulcers…

Sickle cell ulcers are a common characteristic of an uncommon disease. Sickle cell disease predominantly affects black individuals, often having a seriously adverse effect on quality of life. Symptoms associated with sickle cell disease include ‘crisis’ episodes of fever and pain; severe abdominal pain; bone, joint, and back pain; and fertility problems. It has also been shown that 75% of sickle cell patients experience sickle cell ulcers over the course of their…

Last week saw the end of our short series of articles on biofilms. This week we begin an entirely new topic, as we start to look at the relatively uncommon but extremely debilitating issue of sickle cell ulcers.

Sickle cell ulcers are a common manifestation of sickle cell disease, which is itself an inherited, genetic disorder of the oxygen carrying hemoglobin in red blood cells. Sickle cell disease is particularly common among people whose ancestors come from sub-Saharan…

This week marks the end of our short series looking at different aspects of biofilms and their impact on wound healing. Although biofilms, synergistic colonies of microbes, have been a recognized phenomenon for decades, we still have no definitive effective strategy to combat them.

The major difficulty in dealing with biofilms is that they are considerably more resistant to antimicrobial treatments than free living bacteria. Even individual microbes that break away from the…

As discussed over the previous two weeks’ articles, biofilms are communities of microorganisms that attach to the wound surface encasing themselves in an extracellular polysaccharide matrix.1 As biofilms can present a real barrier to wound healing, it is important that they are identified and dealt with as a matter of priority.2

The  first  step towards  managing a biofilm-related infection is achieving early  detection.1  Biofilms are less sensitive to both nutritional…

Biofilms are communities of microorganisms that attach to the wound surface encasing themselves in an extracellular polysaccharide matrix.1 Because multiple types of organism can exist synergistically within a biofilm, often displaying remarkable antibacterial resistance, biofilms can present a real barrier to wound healing.2

The complex molecular nature of a biofilm is not yet fully understood. However, considerable research into the area has shown that biofilm formation…

Our next topic for discussion within these bulletins will be the subject of biofilms. Although the term ‘biofilm’ was only coined in the 1970s, the phenomenon of microbes existing together in colonies that adhere to a surface has been recognized for decades. In 1940, Heukelekian and Heller wrote in the Journal of Bacteriology, ‘Surfaces enable bacteria to develop in substances otherwise too dilute for growth. Development takes place either as bacterial slime or colonial growth attached to…

Pyoderma gangrenosum is a rare but serious ulcerating skin disease causing painful ulcers on the legs and other parts of the body. Diagnosis of the condition is difficult due to a lack of biomarkers or other distinguishing features, and treatment can also be challenging. No single specific therapy for pyoderma gangrenosum is available and few clinical trials have been performed into the condition.

Pyoderma gangrenosum is generally managed through a stepwise approach using a…

Pyoderma gangrenosum is a rare but serious ulcerating skin disease causing painful ulcers on the legs and other parts of the body. Although pyoderma gangrenosum can affect individuals of any age, it is most common in people in their 40s and 50s. It tends to be associated with inflammatory conditions, including ulcerative colitis, Crohn's disease, rheumatoid arthritis, and hepatitis.

Diagnosis of pyoderma gangrenosum can be problematic as no specific diagnostic features can be…

Pyoderma gangrenosum is a  rare but serious ulcerating skin disease, which can present in many forms and to a variety of health professionals. This means diagnosis of the condition is often delayed, lead to serious clinical consequences for the patient.1

Pyoderma gangrenosum presents most…

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This question was posed in response to the video on Pyoderma Gangrenosum , highlighting the struggles of the patient in battling this disease. 

Q. Will  Procellera work on Pyoderma wounds? 

My answer: 

Hi Terri, 

 In my experience using Procellera for over 2 years, and now overseeing all the clinical experience with it from providers throughout  the country, I would say, that Procellera has been extremely successful in both acute and chronic, full or…