Mar 5, 2020
Hyperbaric oxygen therapy (HOT) is an effective second-line
treatment option anytime there is a chronic complicated wound or
tissue with vascular compromise. Dr. Josephine Nguyen, president of
the Association of Military Dermatologists, talks with Dr. Emily
Wong and Dr. Jonathan Jeter about
how dermatologists can use HOT. “The most common scenario ...
would be a situation where you have a compromised flap or graft
after a surgery,” says Dr. Jeter “[The site is] not getting enough
blood flow that’s threatening it to necrose ... hyperbaric oxygen
therapy can come in [and] can increase the oxygen delivery to those
sites,” says Dr. Jeter. They discuss the mechanism of action for
HOT, tips for treatment, and potential complications.
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We also bring you the latest in dermatology news and
research:
1. What medical conferences are being canceled by
coronavirus?
Despite COVID-19, most U.S. medical conferences are moving forward
as planned.
2. Nemolizumab tames itching in prurigo nodularis patients
in phase 2 study
Adults with moderate to severe prurigo nodularis who were treated
with the investigational drug nemolizumab showed significant
improvement in itching, compared with patients who received
placebo.
3. Esophageal stricture signals urgent treatment in kids
with butterfly skin
A quarter of urgent contacts in 20 children with generalized severe
recessive dystrophic epidermolysis bullosa were tied to esophageal
narrowing.
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Things you will learn in this episode:
- Hyperbaric oxygen therapy is best known for treating
decompression sickness (e.g., "the bends" in scuba divers or
aircrew members) and carbon monoxide poisoning. “[HOT] occurs in a
specialized chamber that gradually becomes pressurized in order to
increase the ambient pressure,” Dr. Wong explains. “Then the
pressure can return to atmospheric pressure in a controlled, slow
manner.”
- In addition to persistent wounds and compromised grafts and
flaps, other dermatologic applications for HOT include
radiation-induced ulceration, vasculitis/vasculopathy, and
autoimmune reactions.
- Patients may inquire about HOT for anti-inflammatory conditions
such as psoriasis, but there currently is no evidence to support
its effectiveness. Only published dermatologic indications for HOT
are recommended until more research is conducted.
- According to the Undersea &
Hyperbaric Medical Society, there currently are nearly 200
accredited HOT locations in the United States. Hyperbaric oxygen
therapy is most likely to be available within large medical centers
and is less common in rural areas.
- In cases in which tissue is threatened, it is important to
refer patients for HOT sooner rather than later. “The longer it
goes since the initial injury or loss of blood flow, the less
likely [HOT is] going to be effective,” notes Dr. Jeter.
- Dermatologists typically need to refer patients to large
academic medical centers with wound care centers to receive
HOT.
- Potential complications of HOT include fire, middle ear
barotrauma, and reversible myopathy. More severe but rare
complications include central nervous system symptoms, seizures,
and pulmonary toxicity.
- The only absolute contraindication for HOT is an untreated
pneumothorax.
- Treatment sessions can last anywhere from a few minutes up to
several hours. “The longer [the sessions] get, the more likely you
are to have complications, but generally around an hour to an hour
and a half is a pretty reasonable time period,” Dr. Jeter
recommends.
- In a hyperbaric oxygen chamber, the patient sits or lays down
and breathes in pressurized 100% oxygen through a mask or a
tight-fitting hood, and the affected skin stays covered with a
bandage or the patient’s clothing. “Ultimately, it is the increased
level of systemic oxygen that promotes wound healing and graft or
flap survival. The systemic oxygen improves the fibroblast
function, blood flow, vascularity, and mitigates the
ischemia-reperfusion injury,” explains Dr. Wong.
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Hosts: Nick Andrews; Josephine
Nguyen, MD
Guests:
Emily B. Wong, MD; Jonathan
P. Jeter, MD (San Antonio Uniformed Services Health Education
Consortium, Joint Base San Antonio–Lackland, Tex.)
Show notes by: Alicia Sonners, Melissa Sears,
Elizabeth Mechcatie
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