Lucy K. Martin

Pilot study of the safety and efficacy of myobloc (botulinum toxin type B) for treatment of axillary hyperhidrosis

Background  Botulinum toxin type B (BTX‐B, Myobloc™, San Francisco, CA, USA) was FDA‐approved for the treatment of cervical dystonia in December 2000. It has since been used off‐label for the treatment of axillary hyperhidrosis. However, there are sparse data in the medical literature evaluating the safety and efficacy of Myobloc™ (botulinum toxin type B) for this indication.

Cutaneous Wegener's granulomatosis (malignant pyoderma) in a patient with Crohn's disease

We report a case of an unusual presentation of Wegeners granulomatosis (WG) in a patient with Crohns disease (CD). She presented to our Wound Care Center with 7th cranial nerve palsy and facial pyoderma‐like ulcerations. Although WG has a predilection for the lung, kidney, and eyes, cutaneous involvement can be seen in 50% of the cases, and it can be the presenting sign in 9–14%. Because of the lethality of WG if not properly treated, the diagnosis is imperative.

Ulcers caused by bullous morphea treated with tissue-engineered skin

Bullous morphea is an uncommon form of localized scleroderma. The exact pathogenesis is unknown and treatment of the accompanying ulcers is problematic. We report a patient with bullous morphea with long‐standing ulcers whom we successfully treated with the tissue‐engineered skin Apligraf (Organogenesis Inc., Canton, MA). The patient experienced rapid improvement in granulation tissue and the ulcers healed 4 months after a single application. The rationale for the use of Apligraf is based on experience with patients with venous ulcers who have surrounding peri‐ulcer fibrosis. This condition, termed lipodermatosclerosis, has been reported as a poor prognostic factor for healing, yet many ulcers associated with lipodermatosclerosis may respond to treatment with tissue‐engineered skin. Taken in concert, these results suggest a role for tissue‐ engineered skin in the treatment of chronic wounds with surrounding fibrosis.

Use of a meshed bilayered cellular matrix to treat a venous ulcer.

The treatment of venous ulcers is often complicated by the refractory nature of these chronic wounds and the considerable morbidity and significant financial cost associated with them. An estimated 500,000 to 1 million Americans have venous ulcers,1,2 with an annual cost of care as much as

Telangiectasia macularis eruptiva perstans with an associated myeloproliferative disorder

1 billion.3 Between 30% and 50% of venous ulcers fail to respond to standard therapy4; therefore, a treatment modality that enhances wound healing could be beneficial for these patients. New treatment options, including recombinant growth factors and living skin equivalents, have been developed to treat venous ulcers. Bilayered cellular matrix (BCM) (OrCel, Composite Cultured Skin; Ortec International Inc, New York, NY) is composed of a bovine collagen sponge in which human allogenic skin cells are cultured.5 Donor fibroblasts are cultured within the porous collagen matrix; keratinocytes are subsequently cultured on the surface of the nonporous side. This culture process takes 10 to 14 days. The final result is a bilayered composite of human cultured skin containing minimally stratified proliferating keratinocytes and fibroblasts.5 The concept for BCM dates back to 1971 in Sydney, Australia, when Mark Eisenberg, MD, began researching skin equivalents aimed at treating epidermolysis bullosa (EB), a rare genetic disorder that had afflicted his newborn son.5 In 2001, BCM was approved by the Food and Drug Administration (FDA) for the treatment of acute surgical excisions, such as contracture release sites and donor sites, in patients undergoing reconstructive hand surgery related to EB. BCM was also approved by the FDA for donor sites in burn victims undergoing excision and autografting.5 Accelerating healing of these donor sites allows for more rapid reharvesting of skin. Although the exact mechanism by which BCM improves healing is unknown, it is thought that the allogenic keratinocytes and fibroblasts provide growth factors and cytokines that are capable of promoting wound healing. This is consistent with published reports and studies that have concluded that allograft dressings have a beneficial role in promoting wound closure in chronic venous ulcers.6-9 This case report presents the first use of BCM in the treatment of a venous ulcer. For the venous ulcer in this case report, BCM was meshed at various ratios (1.5:1 and 3:1) to expand its size and cover a larger wound surface area.

Double-Blind, Randomized, Placebo-Controlled Pilot Study of the Safety and Efficacy of Myobloc (Botulinum Toxin Type B) for the Treatment of Palmar Hyperhidrosis

Telangiectasia macularis eruptiva perstans (TMEP) is a cutaneous form of mastocytosis. It has been rarely associated with an underlying myeloproliferative disorder. We report the case of a patient, while receiving treatment for thrombocytosis, with both platelet production and function inhibitors presented with TMEP. TMEP is often refractory to therapy; however, our patient responded to treatment with PUVA.