Posts Tagged ‘ulcer’

Destination WOW? Be a Poster Presenter

Thursday, January 21st, 2016

Wild on Wounds conference attendee shares a wound-care mystery through her first-ever poster abstract, and has a message for fellow clinicians: “Don’t give up!”

Susie Lee, RN WCC, was the 2015 WOW Grand Prize recipient in the poster presentations.

Susie Lee, RN WCC, was the 2015 WOW Grand Prize recipient in the poster presentations.

Susie Lee, RN WCC, traveled from Honolulu, Hawaii last year to attend the Wild on Wounds National Conference (WOW) for the first time, and all because of a challenging wound care case. A nurse for 38 years (and specializing in wound care for the past 10 years), she submitted a poster abstract in order to share her experience with fellow clinicians and conference attendees.

At the time, Susie had never created a clinical poster before, let alone one of such magnitude. And on top of that, she had never been asked to present a case for such a large audience. But this opportunity was a perfect fit for WOW attendees, because they love learning and finding ways to better help and care for wound care patients.

Little did she know that her entry (and all the hard work that went with it) would not only be a smashing success, she would go on to receive the coveted Grand Prize, plus a complimentary conference registration for WOW 2016. The icing on the cake was that she enjoyed learning more about her passion – wound care – in a lively, fun and inspirational environment while attending the WOW conference.

The Case

So what was Lee’s poster topic? It all started with an old wound that refused to heal. Located around a patient’s colostomy site, the wound was a tricky one, accompanied by intermittent appliance leakage. But the kicker? The patient wasn’t feeling pain.

“It was so frustrating,” says Lee. “The wound would get better for months at a time, but then suddenly flare up again. After trying different methods of treatment, none of which seemed to work I researched symptoms and scoured the Internet, looking for related articles, photos and any clue that might help find a solution. A  dermatologist could not provide any diagnosis, so I finally consulted with another wound care nurse colleague.”

Again, since the patient wasn’t feeling any pain, it was more difficult to diagnose. But finally Lee experienced an aha moment. She learned that the patient had suffered from a stroke on her left side (where the colostomy was), which had caused extensive nerve damage. This suddenly explained the patient’s lack of pain.

The diagnosis? Peristomal pyoderma gangrenosum – a rare condition that causes large, painful ulcers to develop in the area surrounding an abdominal stoma. Working with a nurse practitioner, Lee decided to apply a high-dose of topical steroid cream. And guess what? It worked.

The WOW Experience

Although Lee’s case was difficult, the successful outcome – and the opportunity to share her story so that others might learn from it – inspired her to create the first poster presentation of her life. Being named the Grand Prize recipient was a surprise, for sure. But it was her message that meant even more. “The bottom line for me was to tell other clinicians that no matter how long it takes, don’t give up!” she says. “It’s such a great satisfaction to get a stubborn wound healed – for the patient, certainly, but also for you!”

Attending her first WOW conference was extra special because Lee’s daughter came with her to see the presentation. “It was kind of a role reversal,” she says. “My daughter came to see me participate in something. She was impressed with my poster, and it was nice for her to be proud of me, just like I’m always proud of her!”

As for her WOW trip, Lee says that she loved every minute. “I’ve been to other conferences, and they were really nice, but WOW is a whole other experience,” she says. “They had so many sessions and resources – on topics that I have to deal with every day. I met so many great people, and it was well worth the trip. WOW makes learning fun.”

A Little Background on Susie

Lee’s first class with the Wound Care Education Institute (WCEI) was in 2004, when she completed the Skin and Wound Management course presented by Nancy Morgan, WCEI Co-Founder.  Later, she sat for the Wound Care Certified Examination provided by National Alliance of Wound Care and Ostomy, and then became a WCC. “No doubt about it, my career path is a direct result of WCEI,” she says.

More about WOW

What have your experiences at WOW conferences been, and how many times have you attended? What were your favorite moments, sessions or experiences? Please leave your comments below. And if you’re interested in sharing the details of an unusual or particularly challenging case, get your 2016 Poster Submission Form here. We can’t wait to see you in Las Vegas!

To learn more about the case, “Atypical Presentation of Peristomal Pyoderma Gangrenosum,”  see Lee’s article in the Jan/Feb 2016 issue of Wound Care Advisor.

Dry Skin Alert: Foot Xerosis in Diabetic Patients

Thursday, January 14th, 2016

Diabetic wound management requires awareness, including knowing the signs and progression of xerosis – an abnormal dryness of skin.

Xerosis in Diabetic Patients

Patients with diabetes are prone to dry skin, particularly when blood glucose levels are running high. And as a clinician, one of the most common types of skin conditions you will see in your diabetic patients is xerosis, which is an abnormal dryness of the skin. This is just one reason why clinicians should routinely inspect the feet of diabetic patients.

According to research, 82.1% of patients with diabetes had skin with dryness, cracks or fissures, which serves as a predictor of foot lesions. In addition, an unpublished survey of 105 consecutive patients with diabetes revealed that 75% had clinical manifestations of dry skin. This serves as further evidence that xerosis in diabetic patients is a threat to foot ulcers, and the more we know about the condition, the better we can treat and heal our patients.

The Signs

The most common characteristics of xerosis include excessively dry, rough, uneven and cracked skin. Other signs include:

  • Possible raised or uplifted skin edges (scaling), desquamation (flaking), chapping, and pruritus.
  • Excessive dryness and scaling on the heels and feet.
  • Possible fissures (linear cracks in the skin) with hyperkeratotic tissue.

Progression and Patterns

The progression of xerosis follows a defined pattern that begins when the skin becomes dry and rough, with pronounced skin lines. As the condition progresses, you’ll see the development of superficial scaling, with fissuring and erythema. In severe cases, a crisscrossing pattern with superficial scaling is present. The skin becomes less elastic and loses both its flexibility and its ability to withstand trauma, which may result in skin breakdown and subsequent infection.

Causes

A number of conditions contribute to the onset of xerosis in diabetic patients, including the loss of natural moisturizing factors and moisture from the stratum cor­neum and intercellular matrix of the skin. Additionally:

  • Sebaceous and sweat glands normally maintain skin lubrication and control the oil and moisture in the foot, but they become atrophied when autonomic neuropathy occurs.
  • Corneocytes (cells that make up the top layer of epidermis) are aligned parallel to each other in normal skin; xerosis causes structural changes to these cells and disrupts the surface, resulting in a rough epidermal surface.
  • The dryness is due to the redistribution of blood flow in the soles of the feet by persistent and inappropriate dilatation of arteriovenous shunts. This activity diverts blood away from the skin surface. When this occurs in combination with alterations in the elasticity of the skin (due to nonenzymatic glycosylation of structural proteins and glycoproteins), the skin splits, creating portals for bacteria to enter.

Treatment

Once you see initial signs of xerosis in your patients, what should you do? Start by applying an agent to the feet every day in order to maintain skin moisture, such as an emollient lotion or cream. Use moisturizers that contain urea or lactic acid.

  1. Urea works by enhancing the water-binding capacity of the stratum corneum. Long-term treatment with urea has been demonstrated to decrease transepidermal water loss. Urea also is a potent skin humidifier and descaling agent, particularly in 10% concentration.
  2. Lactic acid (in the form of an alpha hydroxy acid) can accelerate softening of the skin, dissolving or peeling the outer layer of the skin to help maintain its capability to hold moisture. Lactic acid in concentrations of 2.5% to 12% is the most common alpha hydroxy acid used for moderate to severe xerosis.
  3. Examples of products with urea or lactic acid include Atrac-Tain Cream, Eucerin 10% Urea Lotion, Lac-Hydrin 12%, and AmLactin Foot Cream Therapy.

Additionally, it’s important to avoid:

  • Products that contain alcohol – because they evaporate, and their drying action compounds the original problem.
  • Petroleum-based products, because they seal the skin surface and prevent what little lubrication is made from evaporating. These products don’t penetrate the surface of the skin and don’t replace skin moisture.

Patient education

As always, part of our job is to continuously educate patients and their family members or caretakers. When it comes to your patients suffering from xerosis, make sure they know to:

  • minimize bathing to no more than once a day (or even every other day)
  • use cool or lukewarm water
  • pat – don’t rub – to dry the skin
  • avoid harsh soaps
  • avoid lotions with dyes or perfumes
  • ensure skin moisturizers are applied appropriately and at the right frequency

What do you think?

Knowing the signs of xerosis and how to treat it is crucial for diabetic patients. Have you had experience with this condition, and are there any specific techniques, treatments or products you find most effective? And what are the biggest challenges you face when it comes to this particular type of wound management? We would love to hear about and learn from your experiences! Please share your stories below.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.