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Second-Degree Burns and Aloe Vera: A Meta-analysis and Systematic Review

Sharma, Sonali; Alfonso, Allyson R; Gordon, Alex J; Kwong, Jennifer; Lin, Lawrence J; Chiu, Ernest S
OBJECTIVE:Aloe vera is a cost-effective, accessible wound care adjunct with a minimal risk profile. Despite its centuries-long history being used to treat varying wound types, published reports remain inconclusive on its efficacy. In this article, the authors report the results of a systematic review assessing the efficacy of topical aloe vera products in wound care applications, as well as a meta-analysis of its utility in burn healing where data are most robust. DATA SOURCES/METHODS:In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched PubMed, EMBASE, and Cochrane CENTRAL for randomized controlled trials assessing the use of aloe vera in healing various wound types. STUDY SELECTION/METHODS:The database search identified 91 articles. After duplicates were removed, 74 articles were screened, and of those, 47 were assessed for eligibility. Ultimately, 28 articles were included in the qualitative synthesis, and 4 studies assessing second-degree burns were included in the meta-analysis. DATA EXTRACTION/METHODS:The following data points were collected from each study: number of participants/wounds, treatment type, adjunctive therapy (if any), and primary outcomes. DATA SYNTHESIS/RESULTS:Risk-of-bias analysis was conducted on included articles, and results were compiled. A meta-analysis was undertaken for studies focusing on the treatment of burns. Cumulatively, these studies had a total of 133 patients with 163 wounds being assessed. Analysis revealed a statistically significant mean difference in time to healing of 4.44 days in favor of aloe vera treatment (P = .004). CONCLUSIONS:Topical aloe vera usage for second-degree burn wound healing demonstrated significantly faster time to healing compared with other treatments.
PMID: 36264753
ISSN: 1538-8654
CID: 5352492

Capturing essentials in wound photography past, present, and future: A proposed algorithm for standardization

Onuh, Ogechukwu C; Brydges, Hilliard T; Nasr, Hani; Savage, Elizabeth; Gorenstein, Scott; Chiu, Ernest
PMID: 36040729
ISSN: 1538-8670
CID: 5332082

Radiation therapy modalities for keloid management: A critical review

Liu, Elisa K; Cohen, Richard F; Chiu, Ernest S
OBJECTIVE:To provide a critical overview of current radiation modalities for keloid management. BACKGROUND:Despite multimodal therapies, keloids that can develop following injury are poorly controlled. A number of studies have suggested that post-excisional radiation therapy can reduce rates of keloid recurrence. However, existing reports span multiple radiation modalities, including brachytherapy, electron beam radiation, and photon radiation. In this review, we describe the advantages and disadvantages of commonly used radiation techniques and highlight their efficacy in keloid management. RESULTS:Electron beam radiation and high-dose rate brachytherapy are the two most commonly used modalities for adjuvant radiotherapeutic management of keloids and can provide effective keloid control but may be suited for different kinds of keloid growth patterns. Increasing biologically equivalent dose (BED) likely improves rates of control, though the clinical significance of this finding remains to be elucidated. Though radiation treatments are associated with acute and chronic side effects, the risk of developing a secondary malignancy is minimal. CONCLUSIONS:While radiation therapy is a promising modality for treating keloids, more studies of a prospective, randomized nature are needed to standardize its utility.
PMID: 35817711
ISSN: 1878-0539
CID: 5279822

Terbinafine induced pancreatitis in a healthy young adult male [Letter]

Brydges, Hilliard T; Onuh, Ogechukwu C; Nasr, Hani Y; Gonda, Tamas A; Chiu, Ernest S; Caplan, Avrom S
PMID: 35620915
ISSN: 1529-8019
CID: 5248072

Basal cell carcinoma after breast radiation: An uncommon disease with varying clinical presentations.

Poland, Sarah G.; Guth, Amber A.; Feinberg, Joshua Adam; Ebina, Wataru; Chiu, Ernest; Levine, Jamie; Gonzalez, Leonel Maldonado; Muggia, Franco
Current breast cancer care involves a multidisciplinary clinical approach for diagnosis and treatment including input from radiology, surgery, pathology, radiation, and medical oncology. Radiation is an integral part of the treatment for locoregionally confined breast cancer, and has well-recognized long-term risks of secondary malignancies, such as angiosarcomas. Basal cell carcinoma (BCC), a common skin malignancy, is not typically considered a radiation-induced carcinoma following breast cancer treatment. Our recent experience with 4 patients with vastly different presentations of BCC in previous radiation fields prompts the current report in order to alert clinicians to this entity.
ISSN: 2666-6219
CID: 5315662

Hidradenitis suppurativa is associated with iron deficiency anemia, anemia of chronic disease, and sickle cell anemia-A single-center retrospective cohort study

Parameswaran, Anupama; Garshick, Michael S; Revankar, Rishab; Lu, Catherine Pei-Ju; Chiu, Ernest S; Sicco, Kristen I Lo
PMID: 35028363
ISSN: 2352-6475
CID: 5116322

Novel evidence of androgen receptor immunoreactivity in skin tunnels of hidradenitis suppurativa: assessment of sex and individual variability [Letter]

Yu, W; Barrett, J; Liu, P; Parameswaran, A; Chiu, E S; Lu, C P
PMID: 34047363
ISSN: 1365-2133
CID: 5003622

Development of a Method for Clinical Evaluation of Artificial Intelligence-Based Digital Wound Assessment Tools

Howell, Raelina S; Liu, Helen H; Khan, Aziz A; Woods, Jon S; Lin, Lawrence J; Saxena, Mayur; Saxena, Harshit; Castellano, Michael; Petrone, Patrizio; Slone, Eric; Chiu, Ernest S; Gillette, Brian M; Gorenstein, Scott A
Importance/UNASSIGNED:Accurate assessment of wound area and percentage of granulation tissue (PGT) are important for optimizing wound care and healing outcomes. Artificial intelligence (AI)-based wound assessment tools have the potential to improve the accuracy and consistency of wound area and PGT measurement, while improving efficiency of wound care workflows. Objective/UNASSIGNED:To develop a quantitative and qualitative method to evaluate AI-based wound assessment tools compared with expert human assessments. Design, Setting, and Participants/UNASSIGNED:This diagnostic study was performed across 2 independent wound centers using deidentified wound photographs collected for routine care (site 1, 110 photographs taken between May 1 and 31, 2018; site 2, 89 photographs taken between January 1 and December 31, 2019). Digital wound photographs of patients were selected chronologically from the electronic medical records from the general population of patients visiting the wound centers. For inclusion in the study, the complete wound edge and a ruler were required to be visible; circumferential ulcers were specifically excluded. Four wound specialists (2 per site) and an AI-based wound assessment service independently traced wound area and granulation tissue. Main Outcomes and Measures/UNASSIGNED:The quantitative performance of AI tracings was evaluated by statistically comparing error measure distributions between test AI traces and reference human traces (AI vs human) with error distributions between independent traces by 2 humans (human vs human). Quantitative outcomes included statistically significant differences in error measures of false-negative area (FNA), false-positive area (FPA), and absolute relative error (ARE) between AI vs human and human vs human comparisons of wound area and granulation tissue tracings. Six masked attending physician reviewers (3 per site) viewed randomized area tracings for AI and human annotators and qualitatively assessed them. Qualitative outcomes included statistically significant difference in the absolute difference between AI-based PGT measurements and mean reviewer visual PGT estimates compared with PGT estimate variability measures (ie, range, standard deviation) across reviewers. Results/UNASSIGNED:A total of 199 photographs were selected for the study across both sites; mean (SD) patient age was 64 (18) years (range, 17-95 years) and 127 (63.8%) were women. The comparisons of AI vs human with human vs human for FPA and ARE were not statistically significant. AI vs human FNA was slightly elevated compared with human vs human FNA (median [IQR], 7.7% [2.7%-21.2%] vs 5.7% [1.6%-14.9%]; P < .001), indicating that AI traces tended to slightly underestimate the human reference wound boundaries compared with human test traces. Two of 6 reviewers had a statistically higher frequency in agreement that human tracings met the standard area definition, but overall agreement was moderate (352 yes responses of 583 total responses [60.4%] for AI and 793 yes responses of 1166 total responses [68.0%] for human tracings). AI PGT measurements fell in the typical range of variation in interreviewer visual PGT estimates; however, visual PGT estimates varied considerably (mean range, 34.8%; mean SD, 19.6%). Conclusions and Relevance/UNASSIGNED:This study provides a framework for evaluating AI-based digital wound assessment tools that can be extended to automated measurements of other wound features or adapted to evaluate other AI-based digital image diagnostic tools. As AI-based wound assessment tools become more common across wound care settings, it will be important to rigorously validate their performance in helping clinicians obtain accurate wound assessments to guide clinical care.
PMID: 34009348
ISSN: 2574-3805
CID: 4877232

565 Epidermal remodeling and immunogenicity within sinus tracts in hidradenitis suppurativa at the single-cell resolution [Meeting Abstract]

Lin, M; Marohn, M; Yu, W; Mendoza, C; Remark, J; Khodadadi-Jamayran, A; Chiu, E; Lu, C P
Hidradenitis suppurativa (HS) is a severe chronic inflammatory skin disease affecting human apocrine sweat gland-bearing skin regions. The overall prevalence of HS ranges from 0.05-4.1% with higher occurrence among females and African Americans, and strong associations with smoking and obesity. One unique feature of HS is the development of highly immunogenic keratinized sinus tracts that grow deeply in the dermis which further complicate HS pathogenesis and treatment. Using single cell transcriptomic analyses, we finely dissected different epidermal cell types in the HS lesional skin and revealed significant dysregulation of skin barrier function in the sinus tracts. We demonstrated that sinus tract keratinocytes exhibit dual cell fates of surface epidermis and skin appendages, and derived from progenitors in infundibulum of the apocrine-pilosebaceous unit. By analyzing ligand-receptor expressions between different skin appendages and immune cells, we highlighted Th17 and TNF responses at early and late stages during HS progression, respectively. Our work provides unprecedented understanding of pathological epidermal remodeling in human inflammatory diseases and important implications for therapeutics.
ISSN: 1523-1747
CID: 4857682

030 Defining adaptive and innate immune cell profiles in Hidradenitis Suppurativa at the single cell resolution [Meeting Abstract]

Yu, W; Marohn, M; Lin, M; Barrett, J; Chiu, E; Lu, C P
Hidradenitis suppurativa (HS) is a severe chronic inflammatory skin disease lacking effective therapeutic options due to little understanding of the complex immune response within the lesional skin. Using single-cell transcriptomic analyses, we examined the signature changes in each immune cell types during HS progression, as well as in silico ligand-receptor predictions between different immune cell types to construct the interaction network that contribute to HS pathogenesis. Our results revealed a predominant Th17 response, as well as a distinct regulatory T cells existing in the lesional skin. We found that M1-polarized macrophages likely facilitate chemotaxis and IL1B responses in perilesional skin, while regulate lymphocyte activation and tissue remodeling in the lesional skin. In addition, we identified a significant increase of CCR7 expressing dendritic cells, as well as activated stromal fibroblasts expressing CCR7-ligand CCL19, which together support the organization of tertiary lymphoid organ (TLO)-like aggregates that contribute to persistent local inflammation. Importantly, we demonstrated a dense infiltration of plasma cells near sinus tracts, and that clonal expansion of the plasma cells frequently exists in HS patients. Together, our work provides a comprehensive understanding of immune responses and cytokine networks defining disease chronicity in HS, as well as significant implications for future therapeutics.
ISSN: 1523-1747
CID: 4857672