Courivaud D, Ségard M, Darras S, Carpentier O, Thomas P
Clinique Dermatologique, Hôpital Huriez, CHRU, 1, place de Verdun, 59000 Lille.
Ann Dermatol Venereol. 2005 Mar;132(3):225-9. doi: 10.1016/s0151-9638(05)79251-6.
Necrotic angiodermatitis is a variety of leg ulcer, characterized by very painful and rapidly spreading lesions. Healing takes time, a mean of 4 to 11 months. Current treatment is difficult and rarely satisfactory. Only early skin grafts lead to rapid sedation of pain and stop the lesion from extending. However, this technique, performed during a progressive phase, enhances the risk of losing a certain number of grafts. We wanted to confirm the efficacy of local auto-haemo-therapy proposed in 2 non-controlled studies.
Eleven patients with necrotic angiodermatitis were included in our non-controlled prospective study. The topical hemotherapy was applied three times a week for one month, with initial hospitalization for 15 days. The criteria of assessment were: evolution of pain, surface of the ulcer, colorimetric scale and the date of disappearance of the purple halo.
Ten patients were relieved by the treatment, with progressive withdrawal of the analgesics. The progression of the lesion had stopped and the purple halo had disappeared in general by D6 (range: 2 to 21 days). The percentage of granulation tissue with regard to the surface of the ulcer was of 45.4 p. 100 on D0, 80 p. 100 on D14 and 85 p. 100 on D28.
Topical hemotherapy applied during the initial phase of treatment would reduce the pain and prepare the lesion for a secondary skin graft.
坏死性血管皮炎是腿部溃疡的一种，其特征为病变疼痛剧烈且迅速蔓延。愈合需要时间，平均为4至11个月。目前的治疗困难且效果欠佳。只有早期进行皮肤移植才能迅速缓解疼痛并阻止病变扩展。然而，在病变进展期进行此项技术会增加一定数量移植失败的风险。我们希望证实两项非对照研究中提出的局部自血疗法的疗效。
11例坏死性血管皮炎患者纳入我们的非对照前瞻性研究。局部血液疗法每周应用3次，持续1个月，最初需住院15天。评估标准包括：疼痛的演变、溃疡面积、比色量表以及紫色晕环消失的日期。
10例患者经治疗后疼痛缓解，镇痛药逐渐停用。病变进展停止，一般在第6天（范围：2至21天）紫色晕环消失。溃疡表面肉芽组织的百分比在第0天为45.4%，第14天为80%，第28天为85%。
在治疗初期应用局部血液疗法可减轻疼痛，并为二期皮肤移植做好准备。
