Losses of Substances in Dermatology: Etiological Panoramic View and Therapeutic and Evolutive Modalities

Abstract

Background: The loss of substances (LS) is a common reason for consultation and hospitalization in dermatology. Etiologies are many and varied and the care is often long. Objective: To study the etiological, therapeutic and evolutive characteristics of the losses of substances within the dermatology department of the military training hospital Mohammed V of Rabat. Materials and Methods: We present a prospective study, conducted over a period of 8 months (September 2017-April 2018) Results: 35 cases were included, including 24 men and 11 women, the ages of patients ranged between 16 and 80 years with an average of 49.88 years. The LS observed were 31.5% ulcers, 20% plantar pains, 14.5% pressure ulcers, severe erysipelas and necrotizing fasciitis 11.5%, 8.5% pyodermas gangrenosum, 6% cutaneous necrosis, 5% vasculitis and burns. 3%. The lesion size ranged from one centimeter to more than 30 centimeters with an average of 4.28 centimeters. The location of the LS was: 34% feet, 34% legs, 15% sacrotrochanteric, 6% upper limbs, 5% trunk, 3% thigh and 3% scalp. The underlying sites were: diabetes 29%, vascular 26%, neurological 23%, obesity 6%, hematological diseases and chemotherapy 6%, systemic diseases 6%. The risk factors for poor healing were: 77% infection, 46% anemia, and 34% hypo-proteinemia / hypo albuminemia. The treatments used were: 100% local and adapted dressings, 100% local and / or general antibiotherapy, 66% debridement / trimming, 49% hyperbaric oxygen therapy, 23% Bioptron light therapy, 15% systemic corticosteroids, 9% PRP, 6% skin grafting and anticoagulants 3%. 20 patients healed between three weeks and six months with an average of two months, three patients died and the others are in progress. Conclusions: The LS in dermatology has a high frequency, a high cost, a high risk of complications and deaths, hence the interest of prevention and a multidisciplinary collaboration of quality.