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Hypertrophic scar is an important clinical problem with limited therapeutic options. Aside from their roles as 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, statins have also been demonstrated to decrease scarring by reducing connective tissue growth factor (CTGF) expression. However, poor penetrative ability limits their utility as topical treatments for hypertrophic scar. Here, we aim to develop novel statin formulations using liposomes to enhance dermal penetrative ability and to evaluate their efficacy against formation of hypertrophic scar utilizing our validated rabbit ear hypertrophic scar model. Liposomal simvastatin or pravastatin were compounded using a novel, flexible liposomal formulation and applied topically to rabbit ear hypertrophic scars daily from postoperation day (POD) 14 until POD 25. Scar color, including erythema and melanin, was measured using reflectance spectrophotometry on POD 28, and scar tissue was harvested for evaluation of scar elevation index as well as gene and protein expression. Human foreskin fibroblasts were also treated with statin formulations and CCN2 expression was determined by quantitative PCR. Both simvastatin and pravastatin were efficiently encapsulated in liposomes, forming nanometer-scale particles possessing highly negative charges. Topical treatment with liposomal simvastatin and pravastatin at 6.5% concentration significantly reduced scar elevation index and decreased type I/III collagen content and myofibroblast persistence in the wound. The erythema/vascularity of scars was reduced by liposomal statin treatment, with concomitant decrease of CD31 expression as measured histologically. Expression levels of transcripts encoding CTGF, collagen I, and collagen III collagen in scar tissue were also decreased by liposomal pravastatin treatment, as were myofibroblast persistence and the type I/III collagen ratio as assessed by immunofluorescence and picrosirus red staining, respectively. Treatment of human foreskin fibroblasts with simvastatin or with liposome-encapsulated pravastatin resulted in decreased expression of transcript encoding CTGF. Overall, our novel statin formulations encapsulated in liposomes were successfully delivered through topical application, significantly reducing hypertrophic scarring in a rabbit ear model.

To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After participating in this educational activity, the participant will:1. Identify the population most often affected by COVID toes.2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions.This review article focuses on the pathogenesis, clinical features, and diagnostic testing of the common pathologies that can manifest as chilblains-like lesions. These differentials include “COVID toes,” Raynaud phenomenon, acrocyanosis, critical limb ischemia, thromboangiitis obliterans, chilblains associated with lupus erythematosus, and idiopathic chilblains. The authors present a helpful mnemonic, ARCTIC, to assist clinicians in recognition and diagnosis.

GENERAL PURPOSE: Forthcoming. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: Forthcoming. ABSTRACT: This review article focuses on the pathogenesis, clinical features, and diagnostic testing of the common pathologies that can manifest as chilblains-like lesions. These differentials include COVID toes, Raynaud phenomenon, acrocyanosis, critical limb ischemia, thromboangiitis obliterans, chilblains associated with lupus erythematosus, and idiopathic chilblains. The authors present a helpful mnemonic, ARCTIC, to assist clinicians in recognition and diagnosis.

General purpose To provide an overview of osteomyelitis. Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes After completing this continuing education activity, you should be able to:1. Distinguish the pathogenesis of osteomyelitis in children and adults.2. Identify practical considerations for diagnosis and evidence-based treatment of osteomyelitis. Abstract This educational activity reviews the pathogenesis of osteomyelitis and discusses practical considerations for diagnosis, treatment, and functional rehabilitation of pediatric and adult patients with osteomyelitic wounds. Antibiotic, surgical, and adjunctive treatments will be addressed. Emphasis is placed on consulting with infectious disease specialists and using evidence-based guidelines for antibiotic prescribing.

Sickle cell disease is a genetic disorder of hemoglobin synthesis leading to a deformation of the red blood cell. This disorder is associated with painful, slow-to-heal leg ulcers. This article discusses the wound bed preparation paradigm as a guide to the treatment of sickle cell-associated leg ulcers.

Recently, 4 separate human controlled trials reported that honey appeared to protect from the effects of radiation-induced oral mucositis formation, a complication of radiation therapy that is responsible for pain and overall reduction in quality of life. In this systematic review and meta-analysis, the authors examined 3 of these controlled trials (n = 120) that met the inclusion and exclusion criteria to determine whether honey had protective effects against radiation-induced oral mucositis. The meta-analysis demonstrated an overall relative risk reduction of 80% in the honey treatment group compared with the control. Although favorable, the data must be approached with caution because of lack of description of the method of randomization and potential bias in all 3 of the individual studies included in the meta-analysis. The results are promising, and further studies are needed to strengthen the current evidence prior to a firm clinical recommendation being given.

This article was designed to help healthcare professionals assess their roles and responsibilities as authors of articles certified for CME credit and to develop appropriate objectives to reflect the desired outcomes of education through CME articles.

Purpose To provide the wound care practitioner with a review of the assessment, prevention, and management of pressure ulcers in pediatric patients with spinal cord injury. Target audience This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. Objectives After reading this article and taking this test, the reader should be able to

To provide wound care practitioners with information about the effects of smoking on wound healing.This continuing education activity is intended for physicians and nurses with an interest in wound care.After reading this article and taking this test, the reader should be able to: 1. Describe the physiologic relationship between smoking and wound healing. 2. Discuss the phenomenon of smoking addiction and both pharmacologic and behavioral approaches to smoking cessation.

Purpose To improve clinical practice and the quality of patient care by providing a learning opportunity that enhances the participant's understanding of how wound microbiology affects healing. Target audience This CME/CE activity is intended for physicians and nurses with an interest in interpreting the role of microorganisms in wound healing. Objectives At the conclusion of this course, participants should be able to: 1. Identify the microbiology of acute and chronic wounds, risk factors for infection, and advantages and disadvantages of wound culturing. 2. Identify methods of debridement and wounds for which they are appropriate. 3. Identify systemic antibiotic treatment options for acute and chronic wound infections.

Purpose To improve clinical practice and the quality of patient care by providing a learning opportunity that enhances the participant's understanding of the tools and techniques available for wound measurement. Target audience This CME/CE activity is intended for physicians and nurses with an interest in learning about tools and techniques available for wound measurement. Objectives After reading the article and taking the test, the participant will be able to: Identify advantages and disadvantages of various dimensional methods used to measure wounds. Identify advantages and disadvantages of visual and photographic assessment methods. Identify advantages and disadvantages of vascular and pressure assessment methods.

Purpose To provide physicians and nurses with an overview of the mechanisms, pathophysiology, assessment, and treatment of pain related to pressure ulcers. Target audience This continuing education activity is intended for physicians and nurses with an interest in learning about management of patients with pressure ulcer-related pain. Learning objectives After reading the article and taking the test, the participant will be able to: 1. Describe the mechanisms and pathophysiology of pain related to pressure ulcers. 2. Identify assessment parameters and treatment options for pain related to pressure ulcers.