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Stasis Dermatitis
Published in Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld, Atopic Dermatitis and Eczematous Disorders, 2014
Stasis dermatitis is a common inflammatory condition, typically affecting the lower legs of middle-aged and elderly patients (Farber and Barnes 1956). It presents as an eczematous dermatitis of the lower legs and ankles against a background of chronic venous insufficiency and lower extremity edema. The severity of stasis dermatitis varies widely from mild, asymptomatic, cutaneous pigmentary alteration to severe eczematous dermatitis with fibrosis and ulceration. The prevalence of stasis dermatitis is around 6–7% in patients aged over 50 years (Beauregard and Gilchrest 1987). This means that more than 15 million people in the USA may have this condition.
Optimization of process parameters for fabrication of electrospun nanofibers containing neomycin sulfate and Malva sylvestris extract for a better diabetic wound healing
Published in Drug Delivery, 2022
Mohammed Monirul Islam, Varshini HR, Penmetsa Durga Bhavani, Prakash S. Goudanavar, N. Raghavendra Naveen, B. Ramesh, Santosh Fattepur, Predeepkumar Narayanappa Shiroorkar, Mohammed Habeebuddin, Girish Meravanige, Mallikarjun Telsang, Nagaraja Sreeharsha
Neomycin sulfate (NS) is one of the most commonly used topical antibiotics. It is the sulfate salt of neomycin B and C. It is an aminoglycoside antibiotic produced by the growth of Streptomyces fradiae (Nitanan et al., 2013; Geszke-Moritz and Moritz, 2016). It stops proteins from being made by binding to ribosomal RNA, which causes the bacterial genetic code to be read wrong. Except for P. aeruginosa, it kills most Gram-negative bacteria but does not affect anaerobes. Some Gram-positive bacteria, such as staphylococci, are killed by it, but streptococci are not. Neomycin is sold as 20% NS in petrolatum, and it is often mixed with other topical antimicrobials to make it more effective against Gram-positive bacteria. It can be used to treat superficial infections, prevent infections in minor wounds and postsurgery wounds, help treat burns, and deal with secondary infections in long-term skin conditions (Madan et al., 2014; Daneshmand et al., 2018; Paliwal et al., 2020). Even though it is often used to treat stasis dermatitis and chronic leg ulcers, it should be used with care because putting it on skin that is already damaged can cause sensitization, systemic absorption, and possibly systemic toxicity. Another harmful side effect of neomycin is allergic contact dermatitis, which affects 1% to 6% of the population with healthy skin and even more people with damaged skin. Contact dermatitis has been reported in as many as 30% of people with stasis dermatitis or leg ulcers. Neomycin can also cause delayed hypersensitivity, reactions caused by IgE, and anaphylactic reactions. The fact that neomycin could cause resistance is another drawback. Resistance can be caused by plasmids and has been seen in both Gram-positive cocci (like staphylococci) and Gram-negative cocci (like Escherichia coli, Klebsiella, and Proteus) (Madgulkar et al., 2011).
Clinical and immunologic differences in cellulitis vs. pseudocellulitis
Published in Expert Review of Clinical Immunology, 2021
Michael Goldenberg, Henry Wang, Trent Walker, Benjamin H Kaffenberger
Stasis dermatitis occurs when the dermis becomes inflamed because of venous insufficiency [74]. This condition affects 7% of patients 50 years and older and is responsible for nearly 50% of chronic leg ulcers [75]. Acute stasis dermatitis can result from compartment syndrome in the setting of an arterial bypass, gastrocnemius muscle rupture, and deep venous thrombosis [76]. Meanwhile, chronic stasis dermatitis is associated with venous insufficiency and may be related to systemic conditions including advanced prostatic carcinoma, benign prostatic hyperplasia, ovarian carcinomas, and certain medications such as calcium channel blockers [76]. In the acute phase, it can present with edema, erythema, scaling, pruritus, and exematous papules and plaques. In the chronic phase it can present with the above changes, hyperpigmentation, and possibly LDS [74]. In stasis dermatitis, interstitial fluid has low protein content and fluids extravasate through the capillaries due to venous insufficiency beyond what the lymphatic system can drain. This contrasts with lymphedema, in which interstitial fluid has high protein content secondary to lymphatic insufficiency [74]. The exodus of plasma, proteins, macrophages, and erythrocytes into the interstitial space leads to purpura and hemosiderin deposition [77]. Acute stasis dermatitis can present with minimal perivascular lymphocytic infiltrate and limited epidermal changes [78]. Biopsies reveal hemosiderin laden macrophages, fibrosis, and papillary dermal blood vessel wall thickening [79]. Hemosiderin breakdown in extravasated macrophages can lead to reactive inflammation [78]. Stasis dermatitis can be distinguished from cellulitis by its bilateral nature, slower onset of symptoms, hyperpigmentation, superficial desquamation [40], afebrile course, medial malleolar swelling, and improvement with limb compression, elevation, and application of topical corticosteroids [74].