Ulcers caused by bullous morphea treated with tissue-engineered skin.
Bullous morphea is an uncommon form of localized scleroderma. The exact pathogenesis is unknown and treatment of the accompanying ulcers is problematic. We report a patient with bullous morphea with long-standing ulcers whom we successfully treated with the tissue-engineered skin Apligraf (Organogenesis Inc., Canton, MA). The patient experienced rapid improvement in granulation tissue and the ulcers healed 4 months after a single application. The rationale for the use of Apligraf is based on experience with patients with venous ulcers who have surrounding peri-ulcer fibrosis. This condition, termed lipodermatosclerosis, has been reported as a poor prognostic factor for healing, yet many ulcers associated with lipodermatosclerosis may respond to treatment with tissue-engineered skin. Taken in concert, these results suggest a role for tissue- engineered skin in the treatment of chronic wounds with surrounding fibrosis.
Martin
Lucy K
LK
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, and Veterans Administration Medical Center, Miami, FL 33125, USA.
Kirsner
Robert S
RS
D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007866:Leg; D008875:Middle Aged; D012594:Scleroderma, Localized / Q000150:complications / Q000601:surgery*; D012883:Skin Ulcer / Q000209:etiology / Q000601:surgery*; D017768:Skin, Artificial; D023822:Tissue Engineering
C117898:Apligraf; D003094:Collagen