Case Series/Study

(CS-031) Curing Necrotic Angiodermatitis with an Intact Fish Skin Graft in a Patient Living with Diabetes: A Case Report

Co-Author(s):

tatiana benard, MSS; Marie Bouly, Mss – centre hospitalier Sud francilien; Anne Christine Jugnet, MSS – centre hospitalier Sud francilien; Corinne Lequint, Nurse; Ragna Björg, Project manager - Medical Affairs – +354 419-8000, Kerecis; Hilmar Kjartansson, MD PhD – Kerecis; Baldur Tumi Baldursson, MD PhD – Kerecis; Alfred Penfornis, Pr – centre hospitalier Sud francilien

Introduction: Curing a necrotic angiodermatitis is a challenge for medicine, the treatment is often heavy and requires repeated hospitalization, we describe a case of a man who presents a necrotic angiodermatitis with a refusal to be hospitalized, the alternative was to use an Intact Fish Skin Graft. Methods: <span lang="EN-US" style="font-size: 12.0pt; font-family: 'Comic Sans MS'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; color: black; background: white; mso-ansi-language: EN-US; mso-fareast-language: FR; font-style: normal;">Our 76-year-old male patient had been living with type 2 diabetes since the age of 34 years. His diabetes was associated with arterial hypertension and dyslipidemia His diabetes was further complicated by the following: (i) sensitive neuropathy diagnosed by an abnormal response to the monofilament test; (ii) severe proliferative retinopathy managed by a complete retinal pan-photocoagulation; (iii) ischemic heart disease with a triple coronary bypass in 2012; and (iv) end-stage renal failure treated since 2018 with hemodialysis. The patient consulted our diabetology department in France in April 2021 after the appearance of an ulcer on his right leg accompanied by significant pain but with out trauma or diffuse infection of the soft tissues. He showed no hyperthermia. The patient had been treated by his family physician with clavulanic acid 125 mg + amoxicillin 1 g per day for 7 days for a suspected skin infection. However, the patient described intense permanent pain. The ulcer was initially reddish before turning necrotic and finally developing into a necrotic lesion surrounded by erythematous purpura that gradually spread. Based on the evolution of the lesion, its clinical appearance, and the patient’s profile, necrotic angiodermatitis was diagnosed. Analgesic therapy was prescribed with oxycodone hydrochloride 5 mg four times a day. For family reasons and so as not to change his dialysis center, the patient refused hospitalization in the dermatology department and was instead managed by the diabetology out patient service. As alternative at-home treatment, the patient was offered an intact fish skin<span lang="EN-US" style="font-size: 12.0pt; font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: black; background: white; mso-ansi-language: EN-US; mso-fareast-language: FR; font-style: normal;"> <span lang="EN-US" style="font-size: 12.0pt; font-family: 'Comic Sans MS'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; color: black; background: white; mso-ansi-language: EN-US; mso-fareast-language: FR; font-style: normal;">graft produced by Kerecisis® Results: Between April and June 2021, the patient received a total of 10 fish skin grafts. He was received in consultation in outpatient clinic every 3 weeks. The appearance of the wound gradually improved with the complete cessation of analgesic therapy in the 5th week of treatment and the complete epithelization of the lesion after the application of the 10th fish skin graft Discussion: we describe the cure of necrotic angiodermatitis by the application of a fish skin graft. The use of this therapy seems to open a new avenue for the out-of-hospital management of necrotic angiodermatitis. Trademarked Items: Intact Fish Skin Graft by Kerecis® References: 1-Körber, A., Klode, J., Al-Benna, S., Wax, C., Schadendorf, D., Steinstraesser, L., Dissemond, J. Etiology of chronic leg ulcers in 619 patients in Germany analyzed by an expert survey. J Dtsch Dermaatol Ges. 2011, 9, 116–121.
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