Hypertensive leg ulcers (HLUs) are frequently seen in patients with long-standing hypertension and/or diabetes mellitus. HLUs are characterized by dermal and subdermal vessel arteriosclerosis and malfunction of the mechanisms that regulate local vasoconstriction at that level. Arterial occlusion of deeper vessels is generally absent. Currently, managing HLUs can be challenging due to the lack of an effective treatment that specifically modifies the natural history of the disorder.
In a recent issue of the Archives of Dermatology Dr. Senet and co-workers address this subject communicating their experience when treating HLUs with becaplermin, a human recombinant platelet-derived growth factor (rhPDGF-BB). It has been previously reported in literature that becaplermin has an important role in the complex process of wound healing, and it is currently approved as part of the treatment of chronic diabetic ulcers.
Topical Treatment of Hypertensive Leg Ulcers With Platelet-Derived Growth Factor-BB: A Randomized Controlled Trial.
Arch Dermatol. 2011 Apr 11. PMID: 21482863
This is a multi center, randomized, double-blind, controlled study which included 59 patients suffering from HLUs. Patients were randomized to receive either daily hydrogel dressing or daily becaplermin in hydrogel, during 8 weeks. Patients were followed-up until week 12. The authors consider the patients enrolled representative of the HLUs population.
The authors did not find significant differences between becaplermin and hydrogel in terms of complete wound closure at week 8 or 12, changes in the area of the ulcer at week 8, changed ulcer-related pain or quality of life. Therefore, Dr. Senet and collaborators conclude that becaplermin does not represent an improvement in the treatment of HLUs.
The short follow-up time could be a limitation of the study, but it is probably not significant due to the lack of initial effectiveness.
In conclusion, according to Dr. Senet and collaborators, topical becaplermin is not a therapeutic innovation in the field of HLUs. This finding is in accordance with previous studies which were unable to demonstrate a benefitial effect of topical growth factors for chronic wounds, with the exception of becaplermin and diabetic ulcers.
The authors underline the need to keep in mind this diagnosis when managing rapidly enlarging necrotic and very painful ulcers located on the dorsolateral aspect of the legs. Skin biopsies can be crucial to rule out other infrequent conditions. Currently, treatment is still symptomatic and limited to a good control of the risk factors involved, local wound care and surgical intervention with grafts when needed.