Joseph A. Witkowski

Cutaneous Ulcer Therapy

C ulcers are a problerii common to both the hospital and office practice of dermatology. The successful management of these often disabling conditions concerns the identification and treatment of the underlying causes and the local care of the ulcers. Physicians have long debated the proper local care of ulcers probably since treatments have been so irrational. The methodology was often determined by past authority (it has always been done that way) or by empiricism (it is not known why the treatment works, but it seems to be effective). More recently, therapeutic modies have beCome more rational, often reflecting current physiologic principles. Nowhere is this more evident than in the dressings now employed.

The Infected Decubitus Ulcer

Article decrivant la symptomatologie, la conduite a tenir, et les germes frequemment retrouves dans les surinfections des ulceres de decubitus

The Story of Lindane Resistance and Head Lice

Resistance to gamma benzene hexachloride, the active ingredient in the insecticide lindane, has been reported in head lice and body lice but not in crab lice. Because lindane shampoo is the most widely used pediculicide in the United States, a more effective treatment would probably have been introduced if head lice were truly resistant or becoming resistant to lindane. To study this question, we reviewed the available literature, including journals of entomology and detailed reports from the World Health Organization, to determine the current efficacy of lindane and to ascertain whether, in fact, resistance is a problem.

Topical metronidazole gel. The bacteriology of decubitus ulcers.

Abstract: Ten putrid‐smelling decubitus ulcers were successfully treated with metronidazole gel. Anaerobes were cultured from five ulcers and Woods light examination was positive in four ulcers before treatment. The odor was eliminated after 36 hours of therapy. All results of post‐treatment cultures of anaerobes and Woods light examinations were negative.

Clinitron Therapy and the Decubitus Ulcer: Preliminary Dermatologic Studies

ABSTRACT: Twenty‐nine patients who had decubitus ulcers and a variety of underlying diseases had good responses to the use of the Clinitron Bed, an air‐fluidized system. More research is needed to determine its place in dermatologic care.

Scabies in the extended care facility : revisited

Abstract: Infestations with Sarcoptes scabiei var hominis re‐main a problem in nursing home patients. While the traditional signs of scabies include burrows and red papules found on the fingerwebs, chest, waist, or genitalia, the elderly or infirm patient may have only a nonspecific pruritic eruption. Epidemics in skilled care facilities may be controlled and the scabies mite even eradicated from the institutions with appropriate diagnosis and adequate treatment of both patients and personnel and their contacts.

A new face for Crouzon's syndrome.

The cardinal features of Crouzons syndrome or craniofacial dysostosis are bilateral proptosis, orbital hypertelorism, external strabismus, parrot-beaked nose, high arched palate, short upper lip, and and relative prognathism (Fig. 1). Premature closure of the cranial sutures, maxillary hypoplasia and shallow orbits are responsible for the characteristic phenotype. We recently observed a patient with this syndrome.

CHRONIC WOUNDS: MYTHS ABOUT DECUBITUS ULCERS

Chronic wounds are increasing in frequency, although insufficient attention is being paid to these examples of skin failure. Far more research effort is expended for other aspects of aging, such as cancer and heart disease, despite the fact that almost every elderly patient will suffer from some type of chronic wound. In addition, many fallacies have sprung up concerning prevention, treatment, and even healing time.^ The decubitus ulcer, as a prime example of the chronic wound, is a defect that involves the skin, subcutaneous structures, and/or the adjacent tissue. It may extend to muscle, if present, or to bone. The defect may become infected, and the area may be necrotic. Other aspects of this condition are variable with definitive explanations being awaited. Despite these facts, many unproven or incorrect ideas have developed.-^

Dextranomer in dermatologic conditions.

ABSTRACT: Dextranomer, a high molecular weight dextran derivative, was evaluated in 43 patients, and found to be the treatment of choice for decubitus ulcers. It is useful in most leg ulcers and cutaneous wounds, and can aid in the nursing care of terminal patients with gangrene or ulcerating carcinoma. Dextranomer hastens the postoperative course in dermabrasion patients. Although patients with bacterial infection show no change with dextranomer, it is useful in hastening the resolution of herpes simplex and herpes zoster lesions.

Bacteriology and Acne

Were we to discuss the cause of acne a hundred years ago, it would be quite simple. Louis Duhring, Pathfinder for American Dermatology, considered the etiologies of acne. They “are numerous and are very different in their nature…. The most frequent and ordinary origin of acne is puberty…. [the] general disability of the system occupies a conspicuous place. Under this head may be grouped all those abnormal conditions arising from imperfect physical development, improper nutrition, and other defects of the economy, whether organic or functional.” So much for the 19th century.