Daróczy Judit
Department of Dermatology and Lymphology, St. Stephan Hospital, Budapest, Hungary.
Dermatology. 2006;212 Suppl 1:82-7. doi: 10.1159/000089204.
The treatment of venous leg ulcers is often inadequate, because of incorrect diagnosis, overuse of systemic antibiotics and inadequate use of compression therapy. Stasis dermatitis related to chronic venous insufficiency accompanied by infected superficial ulcers must be differentiated from erysipelas, cellulitis and contact eczema.
To assess the effectiveness of (1) topical povidone-iodine with and (2) without compression bandages, (3) to compare the efficacy of systemic antibiotics and topical antimicrobial agents to prevent the progression of superficial skin ulcers.
63 patients presenting ulcerated stasis dermatitis due to deep venous refluxes were included in the study. The clinical stage of all patients was homogeneous determined by clinical, aetiological, anatomical and pathological classification. They were examined by taking a bacteriological swab from their ulcer area. Compression bandages were used in a total of 42 patients. Twenty-one patients with superficial infected (Staphylococcus aureus) ulcers were treated locally with povidone-iodine (Betadine), and 21 patients were treated with systemic antibiotics (amoxicillin). Twenty-one patients were treated locally with Betadine but did not use compression. The end point was the time of ulcus healing. The healing process of the ulcers was related to the impact of bacterial colonization and clinical signs of infection.
Compression increases the ulcer healing rate compared with no compression. Using the same local povidone-iodine (Betadine) treatment with compression bandages is more effective (82%) for ulcus healing than without compression therapy (62%). The healing rate of ulcers treated with systemic antibiotics was not significantly better (85%) than that of the Betadine group. Using systemic antibiotics, the relapse rate of superficial bacterial infections (impetigo, folliculitis) was significantly higher (32%) than in patients with local disinfection (11%).
Compression is essential in the mobilization of the interstitial lymphatic fluid from the region of stasis dermatitis. Topical disinfection and appropriate wound dressings are important to prevent wound infection. Systemic antibiotics are necessary only in systemic infections (fever, lymphangitis, lymphadenopathy, erysipelas).
由于诊断错误、全身用抗生素的过度使用以及压迫疗法使用不足，下肢静脉溃疡的治疗往往不充分。与慢性静脉功能不全相关的淤滞性皮炎伴有感染性浅表溃疡，必须与丹毒、蜂窝织炎和接触性湿疹相鉴别。
评估（1）使用和（2）不使用压迫绷带的局部聚维酮碘的有效性，（3）比较全身用抗生素和局部抗菌剂预防浅表皮肤溃疡进展的疗效。
63例因深静脉反流出现溃疡型淤滞性皮炎的患者纳入研究。所有患者的临床分期均通过临床、病因、解剖和病理分类进行统一判定。通过从溃疡区域采集细菌学拭子对患者进行检查。总共42例患者使用了压迫绷带。21例浅表感染（金黄色葡萄球菌）溃疡患者局部用聚维酮碘（碘伏）治疗，21例患者用全身用抗生素（阿莫西林）治疗。21例患者局部用碘伏治疗但未使用压迫。终点是溃疡愈合时间。溃疡的愈合过程与细菌定植的影响和感染的临床体征有关。
与不使用压迫相比，压迫可提高溃疡愈合率。使用相同的局部聚维酮碘（碘伏）治疗，使用压迫绷带对溃疡愈合的效果（82%）优于不使用压迫疗法（62%）。全身用抗生素治疗的溃疡愈合率（85%）与碘伏组相比无显著更好。使用全身用抗生素时，浅表细菌感染（脓疱病、毛囊炎）的复发率（32%）显著高于局部消毒的患者（11%）。
压迫对于从淤滞性皮炎区域动员组织间淋巴液至关重要。局部消毒和适当的伤口敷料对于预防伤口感染很重要。全身用抗生素仅在全身感染（发热、淋巴管炎、淋巴结病、丹毒）时才必要。
