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I have a patient in her early 60's who has Polymyalgia and has been taking steroids for 5 years. She is now on a very low dose of steroid and has developed a VP to her PMA which she would like me to treat.

Her skin is in good condition, no vascular problems and is otherwise a very healthy individual.

I would like to try Silver Nitrate/Salicylic Acid treatments but I am cautious, I have seen examples on here where people with RA taking steroids have had VP treatments - any comments would be gratefully received.

 

Dear Kate,
I had an experience with a 70yo client with Vasculitis (an autoimmune condition) which similarly is treated with steroids & was on a low dose. He presented with a small leg ulcer though vascular perfusion fine, no other co morbities & otherwise healthy client. I started dressing the ulcer though it didn't respond in a normal manner. It wasn't until his specialist bumped up the steroids for a short burst that we saw dramatic improvement & there is nearly full resolution.
I have treated many leg ulcers however never witnessed the nature & presentation of this kind. Increasingly we are seeing more & more clients on Steriods for treatment of many & varied conditions.
So back to your VP client, I would proceed as per normal however if you are not getting any improvements, maybe consider contacting her GP/spec. & query if a short spell of elevated steroids would be appropriate?
My other observations are that VP's often present when immunity is low &/ client is run down. A boost of steroids will improve this however there are many unwanted side effects & it's a delicate balance.
Is the VP painful?
Another treatment option is Formalin.
Hope this helps

 

tootsiegirl

I think you might be making some very contentious leaps of faith regarding the use of steroid in vasculitis derived leg ulceration, and the treatment of verruca pedis.

One is an autoimmune condition where the use of corticosteroids is part of the usual treatment, hence improvement in the sequelae (leg ulceration) once the aetiology is addressed. The other is a human papilloma virus, which, if anything will take advantage and prosper in the immunosuppressed state which steroids deliver.

I would argue that the last thing this patient needs in more corticosteroids. It will be hard enough to treat just with the dosing that's in place currently.

And formalin? I'm not sure I have ever seen that recommended in any evidence based guidelines!

LL