HYPERBARIC OXYGEN THERAPY AND SCLEROSING PANNICULITIS:
A Case Presentation
Hoggard ML,1 Shirachi DY1, 2 and Johnson KE1
1Chico Hyperbaric Center, Chico, CA 95926, USA and 2Department of Physiology and Pharmacology, T. J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211.
INTRODUCTION
A 60 year old female patient was diagnosed by a dermatologist (Dec 1998) to be suffering from a clinical condition known as sclerosing panniculitis, a condition which is relatively rare (1). The patient came to our Center in May 2002. She presented with a progressive hardening of her lower legs or induration. Physical examination showed a classic picture of this condition, erythema and hyperpigmentation of the lower legs probably hemosiderin-associated; edema accompanied with severe pain; and a constriction from near mid calves to the feet in what is described in the literature as “an inverted champagne bottle” appearance to the lower legs. The patient was treated symptomatically with multiple treatments including complete bedrest, compression dressings, Jobst stockings, antibiotics, diuretics and pain medications with very little success.
We now report on the effect of HBO treatment on sclerosing panniculitis.
METHODS
The patient was treated in a multiplace hyperbaric chamber at 2.36 ATA for 60 minutes twice daily for 20 treatments. All protocols were followed according to the Declaration of Helsinki and the patients signed an informed consent form detailing the treatment and patient rights.
RESULTS
At completion of 20 HBO treatments the patient reported that the pain and discomfort were significantly improved upon awakening and throughout the day, but the induration still remained. At approximately 60 days after completion of the HBO treatment the patient reported the pain was continuing to decrease and the induration was significantly improved. Approximately 6 months post-HBO treatment the patient reported that pain and induration were resolved. However, it did not reverse the cutaneous hyperpigmentation and did result in a residual amount of scarring. At 10 months post-HBO a follow-up medical review verified that the pain and induration were resolved, however the scarring remained.
DISCUSSION
The patient was an avid golfer but could not play the game because of the pain resulting from having to walk even if she used a golf cart to minimize the walking. After completion of HBO treatment as discussed above the pain and induration had completely resolved, allowing her to resume her previous active life style and dramatically improving her quality of life.
The mechanism by which HBO was effective is not understood. However, it did take some time before the symptoms started to diminish which might suggest that HBO could have stimulated angiogenesis (2) and improved the local circulatory system, resulting in improved oxygenation of the immediate tissue. In addition HBO could have increased wound healing (3) as evidenced by local cutaneous scarring of the lower legs.
CONCLUSIONS
The results of this case study suggest that HBO might be a potential treatment modality in this clinical condition, since there are no known treatments at this time. Further study of the effect of HBO treatment in this clinical condition is desirable, however this would not be practical because it is such a rare dermatological condition.
REFERENCES
- Jorizzo JL, White WL, Zanolli MD, Greer KE, Solomon AR, and Jetton RL. Sclerosing panniculitis: a clinicopathologic assessment. Arch Dermatol. 1991;127:554-58.
- Lin S, Shyu KG, Lee CC, Wang BW, Chang CC, Liu YC, Huang FY and Chang H. Hyperbaric oxygen selectively induces angiopoietin-2 in human umbilical vein endothelial cells. Biochem Biophys Res Comm. 2002;296:710-5.
- Broussard CL. Hyperoxygenation and wound healing. J Vasc Nurs. 2004;22:42-8.
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