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New Therapy Using Omega-3-Acid Ethyl Esters for Decubitus Ulcers and Stasis Dermatitis: A Case Report

AUTHORS

Kazuki Nagai 1 , * , Katsuhiko Matsumaru 1 , Ikuko Hirai 2 , Yujiro Takae 2 , Kazuo Andoh 3

AUTHORS INFORMATION

1 Department of Internal Medicine, Nagai Clinic, Yokohama, Japan

2 Department of Dermatology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan

3 Department of Radiology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan

How to Cite: Nagai K, Matsumaru K, Hirai I, Takae Y, Andoh K. New Therapy Using Omega-3-Acid Ethyl Esters for Decubitus Ulcers and Stasis Dermatitis: A Case Report, Iran Red Crescent Med J. 2014 ; 16(12):e19500. doi: 10.5812/ircmj.19500.

ARTICLE INFORMATION

Iranian Red Crescent Medical Journal: 16 (12); e19500
Published Online: December 15, 2014
Article Type: Case Report
Received: April 15, 2014
Revised: September 25, 2014
Accepted: October 7, 2014
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Abstract

Introduction: In daily practice, it is common to experience difficulty in treating decubitus ulcers (pressure ulcers, also known as decubitus ulcers) and stasis dermatitis of the lower limbs. We hereby report that omega-3-acid ethyl esters were remarkably effective when administered to cases of refractory pressure ulcers and stasis dermatitis for the purpose of improving the blood flow and promoting blood circulation.

Case Presentation: Case 1: A 21-year-old Japanese female with lower-body paralysis. Pressure ulcers appeared on the heel and first toe of her left lower extremity. Although the patient had been treated with various ointments such as dimethyl isopropylazulene and 0.9% iodine-containing ointment, the course showed no improvement, so omega-3-acid ethyl esters was administered orally, completely healing the ulcer of the first toe in 10 weeks. Case 2: A 76-year-old Japanese male. The patient had been treated on an outpatient basis for 15 years due to hypertension, heart failure, type 2 diabetes mellitus, and hyperlipidemia. Two years prior to this presentation, stasis dermatitis occurred in the lower limbs and at the end of last year, erosive ulcers appeared on the front part of the lower-right thigh and shin. Although treatment with various topical ointment and dressings was performed, the course showed no improvement. Oral administration of omega-3-acid ethyl esters was initiated. At 12 weeks, his condition entered the white phase and healed almost completely.

Conclusions: This report is the first to document other treatment possibilities for pressure ulcer and/or stasis dermatitis in cases where the use of topical applied ointments and medications is difficult. This new therapy may therefore help physicians to treat pressure ulcers and stasis dermatitis.

Keywords

Omega-3 Fatty Acids Ethyl-Eicosapentaenoic Acid Docosahexaenoic Acid Ethyl Ester Pressure Ulcers

Copyright © 2014, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Introduction

In daily practice, it is common to experience difficulty in treating venous stasis dermatitis of the lower limbs and decubitus ulcers (pressure ulcers, also known as decubitus ulcers). For treatment, depending on the condition of the wound, conservative treatment with medicines for external use (1) and dressings (2, 3), as well as surgical procedures are mainly carried out, while decubitus ulcers are refractory depending on their severity.

Recently, Pronova BioPharma ASA (Norway) manufactured Lotriga® granular capsule 2 g (generic name: omega-3-acid ethyl esters 90) with fatty acid having a high level of omega-3 as the active ingredient and containing ethyl icosapentate (EPA-E) and docosahexaenoic acid ethyl (DHA-E) as major ingredients at high concentrations. It contains 930 mg EPA-E and 750 DHA-E per 2g. Pronova and Takeda Pharmaceutical Company Limited (“Takeda”) announced that Lotriga is now available for the treatment of hyperlipidemia. It is believed that this EPA-E and DHA-E has an effect of stimulate blood circulation, increase the breakdown of fibrin, a compound involved in clot and scar formation and improving blood flow (4, 5). And more, in peripheral arterial disease, EPA-E and DHA-E induced a marked improvement in endothelial function (6). They have a vasoprotective effect, providing improving elastic properties of the arteries by preventing fibrosis (7). With decubitus, peripheral vascular endothelial function decreases (8), and as a result of blood stagnation, the intercellular adhesion molecule-1 (ICAM-1) and the vascular cell adhesion molecule-1 (VCAM-1) are expressed (9). EPA-E and DHA-E attenuate the expression of inflammatory cytokines such as this VCAM-1 (10, 11). We herein report that omega-3-acid ethyl esters were remarkably effective when administered to two cases of refractory pressure ulcers and stasis dermatitis for the purpose of improving blood flow and promoting blood circulation.

3. Discussion

Regarding the treatment of pressure ulcers, not only an improvement of the underlying diseases, but also, depending on the condition of wound, conservative treatment with medicines for topical ointments use and dressings, as well as surgical procedures are mainly carried out, while decubitus ulcers are refractory depending on their severity. Moreover, chronic venous insufficiency is appropriately treated by the elevation of the lower limbs and compression stockings, and if stasis dermatitis occurs, then either corticosteroid cream or ointment is applied or it is used in a mixture with zinc oxide paste; however, this condition may still sometimes remain refractory.

Recently, a high level of omega-3 fatty acids, containing EPA-E and DHA-E as major ingredients, have been developed and become available for prescription. It contains 930 mg EPA-E and 750 mg DHA-E per 2 g. Usually, for adults; 2 g of Omega-3-acid ethyl esters is orally administered immediately after meals once a day. It is believed that this DHA has an effect of softening the cell membrane of the vessel wall and promoting blood circulation, and it was administered orally to two cases resistant to treatment with ointment under adequate consensus. In Case 1, it is believed that the patient’s condition improved by the use of 0.9% iodine-containing ointment because 0.9% iodine-containing ointment was used for the purpose of protecting the ulcer surface; however, the application of that ointment was discontinued at 4 weeks. Moreover, in Case 2, although 0.9% iodine-containing ointment had been applied before oral administering omega-3-acid ethyl esters 90, the course showed no improvement, and it is believed that healing could not be expected after treatment with 0.9% iodine-containing ointment alone. Therefore, it is believed that omega-3-acid ethyl esters improved the treatment effect on the lesions in both cases.

With pressure ulcers, which are local blood flow disturbances, and stasis dermatitis, which is a chronic blood flow disturbance, various inflammatory cytokines have appeared. These omega-3-acid ethyl esters suppress inflammatory cytokines (12, 13) and leucocyte chemotactic factors (14), thus suggesting that wound healing could have been promoted as a result. Although this treatment is not yet fully established, it may be effective not only as a treatment for refractory decubitus ulcers.

This report is the first to document other treatment possibilities for pressure ulcers and/or stasis dermatitis in cases where the topical ointments and medications are difficult. This new therapy may therefore help physicians to effectively treat pressure ulcers and stasis dermatitis.

Acknowledgements

Footnote

References

  • 1. Piljac A, Stipcevic T, Piljac-Zegarac J, Piljac G. Successful treatment of chronic decubitus ulcer with 0.1% dirhamnolipid ointment. J Cutan Med Surg. 2008; 12(3) : 142 -6 [PubMed]
  • 2. Mauckner P. [The treatment of heel pressure ulcer with V.A.C. therapy using the new V.A.C. GranuFoam "Heel-Dressing"]. Zentralbl Chir. 2004; 129 Suppl 1 -7 [DOI][PubMed]
  • 3. Bou Torra JE, Soldevilla Agreda JJ, Martinez Cuervo F, Rueda Lopez J. [Collagen powder dressing in the treatment of pressure ulcer. Multicenter comparative study assessing effectiveness and cost]. Rev Enferm. 2002; 25(9) : 50 -7 [PubMed]
  • 4. Morris MC, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993; 88(2) : 523 -33 [PubMed]
  • 5. Mori TA, Bao DQ, Burke V, Puddey IB, Beilin LJ. Docosahexaenoic acid but not eicosapentaenoic acid lowers ambulatory blood pressure and heart rate in humans. Hypertension. 1999; 34(2) : 253 -60 [PubMed]
  • 6. Schiano V, Laurenzano E, Brevetti G, De Maio JI, Lanero S, Scopacasa F, et al. Omega-3 polyunsaturated fatty acid in peripheral arterial disease: effect on lipid pattern, disease severity, inflammation profile, and endothelial function. Clin Nutr. 2008; 27(2) : 241 -7 [DOI][PubMed]
  • 7. Koziolova NA, Shilova Ia E, Nikonova Iu N, Agafonov AV, Polianskaia EA. [State of the structure and functions of the arterial wall in patients with chronic heart failure against the background of permanent atrial fibrillation and assessment of vasoprotective effect of omega-3 polyunsaturated fatty acids]. Kardiologiia. 2013; 53(3) : 15 -24 [PubMed]
  • 8. Jiang L, Dai Y, Cui F, Pan Y, Zhang H, Xiao J, et al. Expression of cytokines, growth factors and apoptosis-related signal molecules in chronic pressure ulcer wounds healing. Spinal Cord. 2014; 52(2) : 145 -51 [DOI][PubMed]
  • 9. Matic M, Duran V, Ivkov-Simic M, Poljacki M, Gajinov Z, Begenisic M. [Microcirculatory changes in chronic venous insufficiency]. Med Pregl. 2000; 53(11-12) : 579 -83 [PubMed]
  • 10. Yates CM, Calder PC, Ed Rainger G. Pharmacology and therapeutics of omega-3 polyunsaturated fatty acids in chronic inflammatory disease. Pharmacol Ther. 2014; 141(3) : 272 -82 [DOI][PubMed]
  • 11. Wang TM, Chen CJ, Lee TS, Chao HY, Wu WH, Hsieh SC, et al. Docosahexaenoic acid attenuates VCAM-1 expression and NF-kappaB activation in TNF-alpha-treated human aortic endothelial cells. J Nutr Biochem. 2011; 22(2) : 187 -94 [DOI][PubMed]
  • 12. Seljeflot I, Arnesen H, Brude IR, Nenseter MS, Drevon CA, Hjermann I. Effects of omega-3 fatty acids and/or antioxidants on endothelial cell markers. Eur J Clin Invest. 1998; 28(8) : 629 -35 [PubMed]
  • 13. De Caterina R, Cybulsky MI, Clinton SK, Gimbrone MJ, Libby P. The omega-3 fatty acid docosahexaenoate reduces cytokine-induced expression of proatherogenic and proinflammatory proteins in human endothelial cells. Arterioscler Thromb. 1994; 14(11) : 1829 -36 [PubMed]
  • 14. Tull SP, Yates CM, Maskrey BH, O'Donnell VB, Madden J, Grimble RF, et al. Omega-3 Fatty acids and inflammation: novel interactions reveal a new step in neutrophil recruitment. PLoS Biol. 2009; 7(8)[DOI][PubMed]
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