Xiaolong A. Zhou1 | Michael B. Burns2 | Ziyou Ren1 | Elise Stagaman2 | Stefan J. Green3 | Lok Yiu Ashley Wu3 |
Lynna Yang1 | Stephanie Rangel1 | Lydia Rabbaa1 | Amy S. Paller1
1Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA | 2Department of Biology, Loyola University
Chicago, Chicago, Illinois, USA | 3Genomics and Microbiome Core Facility, Rush University Medical Center, Chicago, Illinois, USA
Correspondence: Amy S. Paller (该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)
Received: 6 February 2025 | Revised: 6 June 2025 | Accepted: 3 August 2025
Funding: This work was supported by Applied Pharma Research.
Keywords: acid-oxidising solution | epidermolysis bullosa | hypochlorous acid | microbiome | Staphylococcus aureus | wounds
ABSTRACT
Epidermolysis bullosa (EB) is a group of rare genetic skin disorders characterised by skin fragility and chronic, painful wounds that are highly susceptible to bacterial infection, particularly by Staphylococcus aureus (SA). This study evaluated the efficacy of an acid-oxidising solution containing hypochlorous acid (HOCl) in reducing SA colonisation, promoting wound healing, and restoring a healthier microbiome in EB wounds. In a 12-week open-label pilot study, 15EB patients applied the HOCl-based spray (APR-TD011) daily to chronic wounds for 8weeks, with full-length 16S rRNA sequencing of wound swabs performed before, during, and after treatment. At baseline, 87% of patients were culture-positive for SA, and sequencing revealed that SA had the highest relative abundance (34%), followed by Acinetobacter guillouiae and Pseudomonas poae. SA relative abundance decreased precipitously by Weeks 4 (to 11%) and 8 (primary endpoint; to 10%, p<0.01), and this effect persisted at 4weeks post-treatment (Week 12; to 9.7%), including for methicillin-resistant SA. Concurrently, bacterial diversity increased, and wound sizes diminished in correlation with reduced SA levels (r=0.64). Younger patients exhibited greater SA reduction trends. The treatment was well-tolerated, with minimal adverse effects and high patient satisfaction. This study underscores the role of microbial dysbiosis in EB wounds and highlights HOCl-based solutions as a promising therapy to mitigate pathogenic burden and enhance wound healing.
中华医学会内分泌学分会中国内分泌代谢病专科联盟
【提要】糖尿病足溃疡(diabetic foot ulcer,DFU)是糖尿病患者致残、致死的主因之一,致病因素复杂,严重危及生命,带来巨大的社会和经济负担。本共识专家组结合最新临床研究进展,总结我国糖尿病足溃疡的临床诊疗经验,从糖尿病足溃疡评估、整体治疗与创面修复治疗等方面形成共识,指导临床实践。
【关键词】糖尿病;糖尿病足溃疡;创面修复;创面敷料;共识
DO1:10.3760/cma.j.cn311282-20240625-00281
Expert consensus on wound treatment of diabetic foot ulcer( 2024)
Chinese Society of Edndocrinology , China Endocrinology and Metabolism Specialist Alliance
【Summary) Diabetic foot ulcer ( DFU) is one of the main causes of disability and death in diabeticpatients. This life-threatening condition arises from complex pathogenic factors , leading to substaintial societal andeconomic burdens. The expert group summarizes the latest research worldwide and the experience of clinical diagnosisand treatment of DFU in China. To guide clinical practice，the consensus forms from the aspects of evaluation,systemic treatment ,and DFU wound therapeutics.
【Key words】Diabetes mellitus;Diabetic foot ulcer; Wound healing; Wound dressing ; Consensus
DOI: 10.3760/ cma.j.cn311282-20240625-00281
原创： 十六点五 中山二院糖尿病足中心
男性，24岁，3年前外院诊断“下丘脑生殖细胞瘤”，进行γ刀治疗后，长期应用“氢化可的松”早晚各2片维持，半年前不慎损伤左小腿下部外侧皮肤，之后长期不愈合，收入院。
含银的敷料是目前治疗糖尿病足的主流敷料，有各种剂型，包括泡沫状、胶冻态、液态、粉末态、膏态等等，生产的厂家的非常多，其中的质量良莠不齐，很难鉴别。
进一步的清创就到了骨骼，对于骨髓炎最彻底的治疗方法就是去除被细菌侵袭的骨，正常的骨骼一般是浅黄色，如果发白或者变黑，往往就提示这段骨头可能活性比较差，另外，还有一种是面积比较大的骨暴露，一般的肉芽组织很难爬上去，因此，对于坏死的骨头及较大面积的骨暴露，一般需要清除。
皮下组织中的脂肪组织在足部分布广泛，而皮下脂肪中血管分布非常少，在相对或绝对缺血的糖尿病足中，脂肪组织边缘的是否出血不是其是否存活的可靠指标。
这是一个我们在《糖尿病足切开设计（1）》中提到过，这次从不同角度谈谈足趾的保全。
大趾是足部最重要的结构，如果被切除，对足部的功能会有比较大的影响，因此，应该尽可能的保存。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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