SICKLE CELL DISEASE: LEG ULCERS
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Yesterday I saw a 29 yo male with a history of sickle cell anemia and also a
history of generalized pustular psoriasis of Von Zumbusch which began in
childhood.  I had taken care of him about 10 years ago when he was getting
frequent sickling crises and experiencing poor control of his GPP with
methotrexate.  Since Tegison became available his hematologist has kept him
controlled with it, dosing it 10-25 mg a day prn.  Currently his main problem
is recurrent and recalcitrant lower leg ulcers.  He states that these have
been the main source of his disability and pain in the past decade.  They
have been multiple and nearly constant.  He has been treated with Procuren at
a Wound Care Center with only temporary success. He has been through a few
skin grafting attempts, only to have rapid ulcer recurrence and graft
breakdown.  His current ulcers are of mid-dermal depth, and the largest is
4x11 cm.  They have not been biopsied. Several types of synthetic dressings
(Duoderm, N-terface, Allevyn) have also been of little help.

My current plans are: 1. Biopsy  2. Try Iodosorb dressings
3. Try Trental.  Does anyone know if Trental works for this type of problem?
 If SS disease makes RBC's less deformable and Trental makes them more
deformable, it might.  Dr. Ely?????


Gene Sienkiewicz, M. D. 
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I have had very positive experience with Trental in sickle cell disease.
In the patient I treated, not only did the recalcitrant ulcers heal and
stay healed, the incidence and duration of crises improved markedly.
Based on that experience, our hematology department put all the sicklers
on Trental.

	Huntley AC: Sickle cell ulcers treated with pentoxifylline: a case
	report.  Wounds: 3(5):192-194. 1991.

Art Huntley MD
Dermatololgy UC Davis
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