I. Overview.
Skin ulcer is a common and frequent disease in dermatology and surgery, which is a body surface disease with skin ulcer as the main clinical manifestation and long-term failure to heal, and skin tissue defect, liquefaction, infection and necrosis up to the dermis, which refers to the long-term unhealed sores in Chinese medicine. Because the sore surface is difficult to heal and consumes a lot, it causes a lot of psychological stress and economic loss to the patient and seriously affects the patient’s health and quality of life.
Second, the etiology of the pathology.
Skin ulcers are generally limited skin tissue defects caused by traumatic microbial infections, tumor circulatory disorders and neurological dysfunction, immune function abnormalities or congenital skin defects, etc. Traumatic ulcers are often caused by physical and chemical factors acting directly on the tissue, microbial infectious diseases caused by bacteria, fungal spirochetes, viruses and other tissue destruction, nodules or tumor breakdown, immune abnormalities caused by vasculitis The ulcers are formed by necrosis of tissues due to arterial or small arteritis, circulatory or neurological dysfunction caused by nutritional disorders such as varicose veins and leprosy ulcers.
(i) Bacterial diseases.
Boils, carbuncles, cellulitis, sweat glands, skin tuberculosis, earned sores, cutaneous anthrax, rhinophyma, cutaneous diphtheria, necrotizing acne, lower barren type pyoderma, leprosy, tropical ulcers mycobacterial ulcers, swimming pool granuloma, oral tuberculosis ulcers.
(B) fungal diseases.
Sporotrichosis, cutaneous cryptococcosis, histoplasmosis, coccidioidomycosis, Aspergillosis, pediculosis actinomycosis, nocardia, ringworm, pustulosis, cutaneous trichomycosis.
(C) viral diseases.
Hand, foot and mouth disease, foot and mouth disease.
(D) parasitic diseases.
Skin amoebiasis, skin fly maggot disease.
(E) sexually transmitted diseases.
Genital sores, syphilis, subacute sores, inguinal granuloma, venereal lymphogranuloma.
(F) Allergic skin diseases.
Fixed drug rash.
(vii) vasculitis and vascular diseases.
Polyarteritis nodosa, allergic vasculitis.
Thrombo-occlusive vasculitis, papulonecrotic tuberculosis rash, sclerosing erythema, gangrenous.
Pyoderma, lethal midline granuloma, enerweg granuloma, occlusive arteriosclerosis, stasis dermatitis, Raynaud’s disease.
(H) Physical diseases.
Ray dermatitis, frostbite, decubitus ulcer,.
(ix) Occupational skin diseases.
Chromium-nickel, sodium, zinc, cobalt, hydrochloric acid sulfuric acid, hydrofluoric acid, sodium hydroxide, sodium carbonate can cause skin ulcers.
(J) autoimmune diseases.
Leukodystrophy.
(xi) Tumors.
Eczema-like carcinoma of the outer room eczema-like carcinoma, basal cell carcinoma, squamous carcinoma malignant melanoma, sebaceous gland carcinoma, chapter-like granuloma, malignant histiocytosis on kaposi sarcoma, hair sheath carcinoma fibrosarcoma, proliferative erythema, verrucous carcinoma, multiple plasmacytoma.
(XII) Others.
Continuous limb dermatitis, nodular fat necrosis, fatty granuloma, penetrating foot ulcer, aphthous stomatitis gangrenous glans, acute female genital ulcer.
Third, clinical manifestations.
1, varicose ulcers, garden-shaped or irregular-shaped, with hard sloping edges; shallow cavity, uneven base, with purulent fraction.
2.Structural ulcer, irregularly serrated, with submerged edges, pale granulation at the bottom, with thin yellowish purulent discharge and little taste.
3, pressure ulcers, decubitus ulcers are most common, most often in the caudal sac, iliac bone and ankle. The ulcers are round, with hard and tough descending edges, funnel-shaped, with loose granulation tissue on the trabecular surface, thin secretions, and foul odor.
4, malignant ulcers, irregular-shaped, with elevated edges, ectropion in the shape of cauliflower, uneven base, easy bleeding, and foul-smelling secretions.
According to clinical practice observation, chronic skin ulcers have the following characteristics.
(1) The ulcers are mostly located in areas with dense connective tissue and relatively poor blood flow, such as the front of the shin, the heel of the ankle and the foot. There are 86 cases located in this area, accounting for 71.07% of the total.
(2) Most of the causes were serious local soft tissue injury, serious local scarring or improper early treatment, even accompanied by apposed bone scarring, poor blood circulation, such as heavy contamination and incomplete debridement, etc.
(3) Most of the patients are elderly, and the ulcers themselves often do not affect their lives, so the patients and their families do not pay enough attention to the lack of formal and systematic treatment. The average age of our patients was 71 years old, and most of them came to the clinic only because of the combination of eczema and severe itching of the skin.
(4) Combined bone, joint, plate, tendon, etc. exposure, which cannot be resolved by non-surgical treatment such as drug exchange.
(5) Skin ulcers in adjacent joints and long-term chronic inflammation can cause stiffness and ankylosis of joints, or even inflammation spreading to joints and forming septic arthritis, making treatment more difficult.
(6) Longer duration of disease, poor general condition or other complications. This combination and had 62 cases of varicose veins in the lower limbs, 35 cases of diabetes mellitus, 65 cases of cardiac hypertension, and 81 cases of anemia or hypoproteinemia. Due to the presence of these diseases, the healing of ulcers or the effectiveness of treatment were seriously affected.
IV. Treatment of diseases.
We apply helium-neon laser, wet compress of raw earth and four yellow soup plus local acupoint injection to manage refractory skin ulcers (including cancerous ulcers) with remarkable efficacy, and the specific methods can come to our hospital for consultation and treatment.
The following are the common treatment methods in general.
1.Cause treatment: such as allergic (drug rash) to cut off the allergens; diabetic foot, pay attention to the control of blood sugar; physical and chemical injuries, pay attention to away from the source of disease; occupational diseases, try to eliminate the conditions that cause disease, etc.
2, supportive treatment: including good local braking, elevation of the affected part, good care, etc., pay attention to the water-electrolyte balance, give high protein and high energy and vitamin diet. Improve the immunity of the patient.
3.Medication: anti-allergic drugs, anti-parasitic drugs, antibiotics (, anti-infection, protection of trauma), and drugs to promote ulcer healing, etc.
4.Surgical treatment: For tumor caused or with skin malignancy, cancer, etc. should be dealt with in a timely manner.
Local treatment.
(1) Ulcer debridement and dressing exchange; remove necrotic tissue, scar, old granulation tissue, foreign body, etc. until relatively healthy and blood-rich tissue. For chronic ulcers with bone and joint exposure that require flap repair, good or bad wound treatment is one of the keys to successful flap grafting. The skin is covered with hydrogen peroxide, neosporin, saline, iodophor and rinse for 5 min. and pivotal iodine gauze. for severe local edema, use 3% hypertonic saline wet dressing, or add antibiotics and antifungal drugs according to bacterial and fungal culture and examination results.
(2) Treatment of skin eczema: fully follow the principles of dermatological topical drugs: in the acute phase, with more exudation, apply 3% boric acid solution wet dressing, and use glucocorticoid cream after less exudation; in the chronic phase, use halometasone cream or Bactrim ointment.
(3) Local physical therapy: local irradiation with helium-neon laser, ultrashort wave, infrared light, etc.
(4) Surgical treatment: For those with large ulcers, unhealed long-term drug changes or with exposed bones, joints, tendons or plates, surgical treatment should be considered. In this group, 72 cases were treated surgically (47 cases with simple implants and 25 cases with flap repair) and 49 cases were treated non-surgically.
Systemic treatment aims at anti-inflammation, antipruritic and improving the body resistance.
(1) Application of antibacterial or antifungal drugs, intravenous application of antibiotics and antifungal drugs according to bacterial and fungal culture and examination results.
(2) Application of antihistamines, calcium, vitamin C, etc.
(3) Drugs to improve the body’s resistance: such as uti-linus, etc.
(4) Correction of anemia or hypoproteinemia.
Treatment of other concomitant diseases: For combined varicose veins of the lower limbs, diabetes, heart disease hypertension, etc., ask the relevant specialist to consult and carry out formal and systematic treatment.
Four kinds of drug treatment methods.
(1) Comfrey oil.
Soak 100g of comfrey in sesame oil heated to 60℃～70℃ and leave it for 24 hours, then filter out the oil and use it. Use 75% alcohol to disinfect the affected surface (with necrotic tissue scrubbed with 30% hydrogen peroxide, then rinse and dry with salt water), and then apply comfrey oil twice a day until healing.
(2) Ruyi Jinhuang San.
Make a thin paste of this medicine with vinegar and put it on the affected area twice a day. You can also make a paste of Ruyi Jinhuang San and petroleum jelly in the ratio of 2 to 8 and apply it externally. If there are many ulcers or secretions, clean the wound first and then use this medicine.
(3) Ma Yinglong musk hemorrhoid cream.
Although it is a hemorrhoid medicine, it is very effective for skin ulcers. Method: Disinfect the area with 75% alcohol, dry it with a dry cotton swab, apply an appropriate amount of this cream, cover with sterile gauze, and change the medicine once a day or every other day.
(4) Compounded Furfurylite topical dispersion.
After local disinfection, sprinkle this medicine on the affected area 1 to 2 times a day.
Honey for skin ulcers Honey has high nutritional value and can be used internally to treat and relieve various diseases of the gastrointestinal tract, and in surgery and dermatology, honey has no small use. Honey contains antibiotic substances, which are antibacterial and antiseptic, and can inhibit the growth of septic bacteria, and molds, and is astringent, anti-inflammatory, pain relieving, muscle building and plus, speedy wound healing, and skin protection. It is suitable for burns, burns,, frostbite, wounds and lower limb ulcers, pediatric thrush, etc. The reason why honey can promote wound healing is that honey contains 40% glucose, 40%, fructose and a variety of amino acids, vitamins and trace elements, which have the effect of nourishing the wound and mouth. At the same time honey has hygroscopic and astringent effect, which can reduce edema of flesh and bud tissue and constitute a viscous protective barrier to prevent wound infection,, decubitus ulcers, lower limb ulcers, etc. It can make the wound crust quickly and the epithelium heal well.