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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Signos de dismaduración epidérmica: células disqueratósicas, con alteración del tamaño y la polaridad de los queratinocitos, algunos de ellos binucleados (HE<span class="elsevierStyleHsp" style=""></span>×10). B) Conductos ecrinos en los que se observan zonas de metaplasia escamosa junto con infiltrado neutrofílico en el interior de los ovillos, así como un moderado infiltrado inflamatorio periecrino (HE<span class="elsevierStyleHsp" style=""></span>×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Concha Garzón, M. Llamas-Velasco, J. Sánchez-Pérez, J. Fraga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Concha Garzón" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Pérez" ] 3 => array:2 [ "nombre" => "J." 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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 "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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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:5 [ "tituloSerie" => "Dermatoendocrinology" "fecha" => "2011" "volumen" => "3" "paginaInicial" => "166" "paginaFinal" => "174" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack35256" "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" => "/00017310/0000010400000003/v1_201304241344/S0001731012003109/v1_201304241344/en/main.assets" "Apartado" => array:4 [ "identificador" => "6160" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000010400000003/v1_201304241344/S0001731012003109/v1_201304241344/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012003109?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 9 | 14 |
| 2024 Octubre | 33 | 35 | 68 |
| 2024 Septiembre | 33 | 23 | 56 |
| 2024 Agosto | 54 | 48 | 102 |
| 2024 Julio | 32 | 30 | 62 |
| 2024 Junio | 51 | 30 | 81 |
| 2024 Mayo | 34 | 30 | 64 |
| 2024 Abril | 37 | 29 | 66 |
| 2024 Marzo | 39 | 23 | 62 |
| 2024 Febrero | 38 | 30 | 68 |
| 2024 Enero | 28 | 27 | 55 |
| 2023 Diciembre | 33 | 16 | 49 |
| 2023 Noviembre | 26 | 27 | 53 |
| 2023 Octubre | 33 | 22 | 55 |
| 2023 Septiembre | 21 | 27 | 48 |
| 2023 Agosto | 19 | 18 | 37 |
| 2023 Julio | 67 | 30 | 97 |
| 2023 Junio | 27 | 21 | 48 |
| 2023 Mayo | 24 | 13 | 37 |
| 2023 Abril | 25 | 18 | 43 |
| 2023 Marzo | 23 | 14 | 37 |
| 2023 Febrero | 32 | 20 | 52 |
| 2023 Enero | 20 | 23 | 43 |
| 2022 Diciembre | 29 | 30 | 59 |
| 2022 Noviembre | 35 | 30 | 65 |
| 2022 Octubre | 73 | 31 | 104 |
| 2022 Septiembre | 39 | 46 | 85 |
| 2022 Agosto | 54 | 39 | 93 |
| 2022 Julio | 58 | 34 | 92 |
| 2022 Junio | 28 | 29 | 57 |
| 2022 Mayo | 33 | 35 | 68 |
| 2022 Abril | 25 | 27 | 52 |
| 2022 Marzo | 26 | 45 | 71 |
| 2022 Febrero | 24 | 24 | 48 |
| 2022 Enero | 25 | 33 | 58 |
| 2021 Diciembre | 31 | 41 | 72 |
| 2021 Noviembre | 30 | 35 | 65 |
| 2021 Octubre | 26 | 49 | 75 |
| 2021 Septiembre | 30 | 44 | 74 |
| 2021 Agosto | 28 | 24 | 52 |
| 2021 Julio | 23 | 29 | 52 |
| 2021 Junio | 27 | 42 | 69 |
| 2021 Mayo | 23 | 28 | 51 |
| 2021 Abril | 86 | 63 | 149 |
| 2021 Marzo | 49 | 35 | 84 |
| 2021 Febrero | 45 | 29 | 74 |
| 2021 Enero | 33 | 15 | 48 |
| 2020 Diciembre | 31 | 12 | 43 |
| 2020 Noviembre | 17 | 18 | 35 |
| 2020 Octubre | 26 | 8 | 34 |
| 2020 Septiembre | 34 | 8 | 42 |
| 2020 Agosto | 19 | 22 | 41 |
| 2020 Julio | 38 | 14 | 52 |
| 2020 Junio | 24 | 20 | 44 |
| 2020 Mayo | 28 | 21 | 49 |
| 2020 Abril | 42 | 23 | 65 |
| 2020 Marzo | 22 | 25 | 47 |
| 2020 Febrero | 2 | 8 | 10 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 8 | 3 | 11 |
| 2019 Noviembre | 5 | 2 | 7 |
| 2019 Octubre | 0 | 6 | 6 |
| 2019 Septiembre | 6 | 2 | 8 |
| 2019 Agosto | 4 | 5 | 9 |
| 2019 Julio | 5 | 10 | 15 |
| 2019 Junio | 6 | 9 | 15 |
| 2019 Mayo | 5 | 7 | 12 |
| 2019 Abril | 2 | 3 | 5 |
| 2019 Marzo | 4 | 7 | 11 |
| 2019 Febrero | 0 | 5 | 5 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 1 | 2 | 3 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 2 | 2 | 4 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 39 | 3 | 42 |
| 2018 Enero | 85 | 4 | 89 |
| 2017 Diciembre | 35 | 9 | 44 |
| 2017 Noviembre | 28 | 7 | 35 |
| 2017 Octubre | 33 | 5 | 38 |
| 2017 Septiembre | 22 | 10 | 32 |
| 2017 Agosto | 42 | 13 | 55 |
| 2017 Julio | 31 | 2 | 33 |
| 2017 Junio | 30 | 14 | 44 |
| 2017 Mayo | 26 | 5 | 31 |
| 2017 Abril | 28 | 7 | 35 |
| 2017 Marzo | 15 | 17 | 32 |
| 2017 Febrero | 14 | 10 | 24 |
| 2017 Enero | 13 | 4 | 17 |
| 2016 Diciembre | 28 | 8 | 36 |
| 2016 Noviembre | 41 | 7 | 48 |
| 2016 Octubre | 45 | 21 | 66 |
| 2016 Septiembre | 39 | 14 | 53 |
| 2016 Agosto | 33 | 8 | 41 |
| 2016 Julio | 29 | 8 | 37 |
| 2016 Junio | 4 | 19 | 23 |
| 2016 Mayo | 10 | 12 | 22 |
| 2016 Abril | 5 | 5 | 10 |
| 2016 Marzo | 3 | 2 | 5 |
| 2016 Febrero | 7 | 12 | 19 |
| 2016 Enero | 6 | 0 | 6 |
| 2015 Diciembre | 8 | 11 | 19 |
| 2015 Noviembre | 6 | 0 | 6 |
| 2015 Octubre | 4 | 12 | 16 |
| 2015 Septiembre | 7 | 8 | 15 |
| 2015 Agosto | 9 | 6 | 15 |
| 2015 Julio | 55 | 2 | 57 |
| 2015 Junio | 73 | 6 | 79 |
| 2015 Mayo | 82 | 27 | 109 |
| 2015 Abril | 65 | 6 | 71 |
| 2015 Marzo | 34 | 1 | 35 |
| 2015 Febrero | 31 | 1 | 32 |
| 2015 Enero | 22 | 0 | 22 |
| 2014 Diciembre | 33 | 0 | 33 |
| 2014 Noviembre | 38 | 0 | 38 |
| 2014 Octubre | 52 | 0 | 52 |
| 2014 Septiembre | 28 | 0 | 28 |
| 2014 Agosto | 34 | 0 | 34 |
| 2014 Julio | 30 | 0 | 30 |
| 2014 Junio | 31 | 0 | 31 |
| 2014 Mayo | 47 | 1 | 48 |
| 2014 Abril | 23 | 0 | 23 |
| 2014 Marzo | 30 | 14 | 44 |
| 2014 Febrero | 31 | 5 | 36 |
| 2014 Enero | 30 | 3 | 33 |
| 2013 Diciembre | 33 | 20 | 53 |
| 2013 Noviembre | 20 | 8 | 28 |
| 2013 Octubre | 14 | 8 | 22 |
| 2013 Septiembre | 13 | 19 | 32 |
| 2013 Agosto | 10 | 5 | 15 |
| 2013 Julio | 14 | 16 | 30 |
| 2013 Junio | 12 | 6 | 18 |
| 2013 Mayo | 18 | 19 | 37 |
| 2013 Abril | 19 | 19 | 38 |
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