Wound Biopsies of Atypical Wound Presentations Lead to the Diagnosis of Rare Disease States: A Case Series Editorial Summary The prevalence of atypical wounds has not been studied extensively, but it has been estimated that 20% of all chronic wounds are due to unusual causes. As our population ages, clinicians are caring for patients with increased numbers of comorbidities and pathological processes that can contribute to the development of hard-to-heal wounds. Therefore, clinicians should have a high index of suspicion for atypical wound etiologies and skin condition in wounds that fail to heal with standard of care. This article details the clinical and histological appearance of 3 atypical wound recently encountered by the author: Granular Parakeratosis, Bullous Disseminated Herpes Zoster, and Pancreatic Panniculitis. Identifying atypical wounds can be a difficult undertaking. If a chronic wound persists despite appropriate wound care treatments, then typical wound etiologies should be ruled out. Atypical wounds are rare, and their pathophysiology is not well understood. The diagnosis and management of these ulcer types is a real challenge to physicians. Skin biopsy plays a pivotal role in making the diagnosis and should be performed in all cases of refractory wounds.
Introduction
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he prevalence of atypical wounds has been estimated that 20% of all chronic wounds are due to unusual 1,2 causes. As our population ages clinicians are caring for patients with increased numbers of comorbidities and pathological processes that can contribute to the development of hard-toheal wounds. The negative impact of chronic wounds is well recognized in the literature. It is not uncommon for wound patients to suffer daily with pain, malodor, exudate management and reduced physical mobility. Patients dealing with chronic wounds often relate feelings of isolation and depression. Therefore, ability to identify and treat chronic wounds caused by uncommon etiologies is an important skill. Unfortunately, it can take years of clinical experience to master. To this argument, it is imperative that all wound care clinicians are knowledgeable about uncommon wound etiologies. Wound care providers are encouraged to be proactive when faced with hard-to-heal wounds of the lower extremity.
Dr Windy Cole College of Podiatric Medicine, Kent State University Kent OH, United States
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This case series details the clinical and histological appearance of 3 atypical wounds: Porphyria Cutanea Tarda, Bullous Disseminated Herpes Zoster and Pancreatic Panniculitis. A detailed history and physical exam including medical, travel, recreational and occupational histories were obtained to assure an accurate diagnosis was made. In addition, a complete physical exam and wound assessment including wound measurement, location, staging, tissue character and color, odor, exudate quality and amount, peri-wound tissue appearance, and pain were noted for each patient. In each case,
Wound Masterclass - Vol 1 - December 2022
Case 1: Porphyria Cutanea Tarda An 88-year-old female presented with multiple partial thickness wounds on the extremities. No history of trauma or other inciting event. PMH consists of Diverticulosis, CKD stage II, polyneuropathy, NIDDM, DJD, asthma, breast cancer, HTN and heart failure. Wound appearance is as follows: partial thickness tissue loss with irregular borders. Wound base is mixed of fibrotic and pink granulation tissue with scant serosanguinous exudate. The periwound skin appearance is friable with normal temperature. (Figure 1). Figure 1: Clinical appearance of Porphyria Cutanea Tarda wounds
Previous therapy included cleansing the wound using an antibacterial wound cleanser, protecting the periwound skin with barrier prep and applying an antimicrobial moisture managing dressing changed twice weekly.
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