Case and Research Letter
New Perspectives in the Treatment of Leg Ulcers
Nuevas perspectivas en el tratamiento de úlceras en las piernas
a Servicio de Dermatología, Hospital de Cabueñes, Gijón, Spain
b Dermatology Service, Veterans Affairs Medical Center, and Department of Dermatology, University of California, San Francisco, USA
c National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
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Godoy-Gijón, M. Qiang Man, J.P. Thyssen, P.M. Elias" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Godoy-Gijón" "email" => array:1 [ 0 => "e.godoy.gijon@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Qiang Man" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.P." "apellidos" => "Thyssen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "P.M." "apellidos" => "Elias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Cabueñes, Gijón, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Service, Veterans Affairs Medical Center, and Department of Dermatology, University of California, San Francisco, USA" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevas perspectivas en el tratamiento de úlceras en las piernas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After carefully reading the comprehensive review article by Velasco<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the diagnosis and treatment of leg ulcers, we write to comment further on a new therapeutic option referred to by that author. Several studies have reported the positive effect on skin and mucosal healing of the activation of β-adrenergic receptors,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> as the author of the above-mentioned review points out with a reference to the work of Margolis et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, research in the field of wound healing is now focusing on the significant impact on the healing process of glucocorticoid (GC) activity.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The presence of high GC levels is associated with delayed cutaneous wound healing and barrier recovery after mechanical disruption.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> The present group has shown the negative effect of GCs on epidermal differentiation and proliferation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Using models based on exogenous GC administration or endogenous release secondary to psychological stress, several authors have demonstrated the inhibitory action of GCs on fibroblast proliferation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In both models, systemic GC blockade improved wound healing and barrier recovery.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Because of the potential complications of systemic blockade of GC activity, current research on new treatments is focusing on both the blockade of GC receptors and on the activity of 11β-hydroxysteroid dehydrogenase-1 (11β-HSD1), the enzyme responsible for the peripheral conversion of cortisone to its active form cortisol.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8,9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the high levels of GC observed in diabetic patients and the recent suggestion of a possible association between GC activity and systemic complications in diabetes mellitus,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> topical treatments that block such activity would appear to be a promising therapeutic tool in wound healing. The dermatological application of such topical treatments could therefore be very useful in the treatment of leg ulcers. This is a field in which, as Velasco has pointed out<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>, dermatologists should play a greater role.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Godoy-Gijón E. New Perspectives in the Treatment of Leg Ulcers. Actas Dermosifiliogr. 2013;104:254–5.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspectos diagnósticos y terapéuticos de las úlceras de las piernas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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Elias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajpregu.00010.2006" "Revista" => array:6 [ "tituloSerie" => "Am J Physiol Regul Integr Comp Physiol" "fecha" => "2006" "volumen" => "291" "paginaInicial" => "R1657" "paginaFinal" => "R1662" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16857896" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "11β-Hydroxysteroid dehydrogenase-1 is a novel regulator of skin homeostasis and a candidate target for promoting tissue repair" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Terao" 1 => "H. Murota" 2 => "A. Kimura" 3 => "A. Kato" 4 => "A. Ishikawa" 5 => "K. Igawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0025039" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "e25039" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21949844" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glucocorticoid receptors, epidermal homeostasis and hair follicle differentiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatoendocrinology" "fecha" => "2011" "volumen" => "3" "paginaInicial" => "166" "paginaFinal" => "174" "itemHostRev" => array:3 [ "pii" => "S0002939412000992" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack35293" "titulo" => "Acknowledgements" "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">ISDIN S.A. provided support as a postdoctoral fellow for Elena Godoy Gijón. Mrs. Joan Wakefield provided invaluable editorial assistance.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000590/v1_201304241622/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000003/v1_201304241622/S1578219013000590/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000590?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 16 | 32 |
| 2024 October | 60 | 41 | 101 |
| 2024 September | 57 | 27 | 84 |
| 2024 August | 94 | 39 | 133 |
| 2024 July | 60 | 32 | 92 |
| 2024 June | 57 | 27 | 84 |
| 2024 May | 55 | 26 | 81 |
| 2024 April | 45 | 20 | 65 |
| 2024 March | 55 | 29 | 84 |
| 2024 February | 42 | 28 | 70 |
| 2024 January | 42 | 34 | 76 |
| 2023 December | 42 | 22 | 64 |
| 2023 November | 49 | 21 | 70 |
| 2023 October | 54 | 25 | 79 |
| 2023 September | 46 | 31 | 77 |
| 2023 August | 35 | 14 | 49 |
| 2023 July | 28 | 31 | 59 |
| 2023 June | 49 | 23 | 72 |
| 2023 May | 36 | 24 | 60 |
| 2023 April | 27 | 23 | 50 |
| 2023 March | 17 | 20 | 37 |
| 2023 February | 35 | 21 | 56 |
| 2023 January | 29 | 22 | 51 |
| 2022 December | 33 | 34 | 67 |
| 2022 November | 18 | 27 | 45 |
| 2022 October | 16 | 25 | 41 |
| 2022 September | 26 | 37 | 63 |
| 2022 August | 16 | 31 | 47 |
| 2022 July | 17 | 40 | 57 |
| 2022 June | 23 | 23 | 46 |
| 2022 May | 21 | 36 | 57 |
| 2022 April | 26 | 28 | 54 |
| 2022 March | 37 | 52 | 89 |
| 2022 February | 24 | 24 | 48 |
| 2022 January | 23 | 30 | 53 |
| 2021 December | 29 | 38 | 67 |
| 2021 November | 29 | 35 | 64 |
| 2021 October | 47 | 62 | 109 |
| 2021 September | 21 | 41 | 62 |
| 2021 August | 58 | 28 | 86 |
| 2021 July | 28 | 34 | 62 |
| 2021 June | 23 | 29 | 52 |
| 2021 May | 29 | 51 | 80 |
| 2021 April | 52 | 57 | 109 |
| 2021 March | 44 | 19 | 63 |
| 2021 February | 38 | 27 | 65 |
| 2021 January | 34 | 19 | 53 |
| 2020 December | 20 | 9 | 29 |
| 2020 November | 20 | 17 | 37 |
| 2020 October | 19 | 6 | 25 |
| 2020 September | 26 | 15 | 41 |
| 2020 August | 23 | 16 | 39 |
| 2020 July | 18 | 16 | 34 |
| 2020 June | 17 | 21 | 38 |
| 2020 May | 15 | 9 | 24 |
| 2020 April | 21 | 26 | 47 |
| 2020 March | 23 | 11 | 34 |
| 2020 February | 3 | 2 | 5 |
| 2020 January | 0 | 2 | 2 |
| 2019 December | 4 | 2 | 6 |
| 2019 November | 0 | 1 | 1 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 4 | 1 | 5 |
| 2019 July | 0 | 1 | 1 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 1 | 19 | 20 |
| 2019 April | 0 | 1 | 1 |
| 2019 March | 2 | 7 | 9 |
| 2019 January | 1 | 0 | 1 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 2 | 0 | 2 |
| 2018 March | 0 | 2 | 2 |
| 2018 February | 16 | 3 | 19 |
| 2018 January | 23 | 7 | 30 |
| 2017 December | 23 | 6 | 29 |
| 2017 November | 24 | 6 | 30 |
| 2017 October | 12 | 9 | 21 |
| 2017 September | 16 | 2 | 18 |
| 2017 August | 15 | 5 | 20 |
| 2017 July | 14 | 7 | 21 |
| 2017 June | 23 | 8 | 31 |
| 2017 May | 27 | 6 | 33 |
| 2017 April | 24 | 10 | 34 |
| 2017 March | 13 | 43 | 56 |
| 2017 February | 7 | 12 | 19 |
| 2017 January | 9 | 11 | 20 |
| 2016 December | 22 | 1 | 23 |
| 2016 November | 21 | 6 | 27 |
| 2016 October | 25 | 3 | 28 |
| 2016 September | 24 | 5 | 29 |
| 2016 August | 24 | 5 | 29 |
| 2016 July | 15 | 2 | 17 |
| 2016 June | 8 | 6 | 14 |
| 2016 May | 5 | 7 | 12 |
| 2016 April | 4 | 5 | 9 |
| 2016 March | 3 | 3 | 6 |
| 2016 February | 3 | 2 | 5 |
| 2016 January | 4 | 2 | 6 |
| 2015 December | 6 | 0 | 6 |
| 2015 November | 6 | 3 | 9 |
| 2015 October | 2 | 4 | 6 |
| 2015 September | 9 | 3 | 12 |
| 2015 August | 6 | 4 | 10 |
| 2015 July | 35 | 111 | 146 |
| 2015 June | 22 | 13 | 35 |
| 2015 May | 36 | 12 | 48 |
| 2015 April | 31 | 6 | 37 |
| 2015 March | 9 | 8 | 17 |
| 2015 February | 5 | 4 | 9 |
| 2015 January | 7 | 3 | 10 |
| 2014 December | 8 | 5 | 13 |
| 2014 November | 2 | 5 | 7 |
| 2014 October | 12 | 8 | 20 |
| 2014 September | 8 | 4 | 12 |
| 2014 August | 5 | 6 | 11 |
| 2014 July | 8 | 5 | 13 |
| 2014 June | 15 | 5 | 20 |
| 2014 May | 12 | 7 | 19 |
| 2014 April | 15 | 2 | 17 |
| 2014 March | 13 | 5 | 18 |
| 2014 February | 20 | 5 | 25 |
| 2014 January | 20 | 3 | 23 |
| 2013 December | 15 | 5 | 20 |
| 2013 November | 9 | 6 | 15 |
| 2013 October | 12 | 2 | 14 |
| 2013 September | 7 | 1 | 8 |
| 2013 August | 5 | 1 | 6 |
| 2013 July | 3 | 4 | 7 |
| 2013 June | 2 | 1 | 3 |
| 2013 May | 2 | 1 | 3 |
| 2013 April | 2 | 2 | 4 |
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