Unna boot efficacy in dermatologic diseases

To the Editor: The Paul Gerson Unna boot (UB) is a compressive semisolid gauze casting saturated with mixture of zinc oxide, gum acacia, glycerol, castor oil, and deionized water.1Paranhos T. Paiva C.S.B. Cardoso F.C.I. et al.Assessment use in treatment chronic venous leg ulcers adults: systematic review protocol.BMJ Open. 2019; 9: e032091Crossref PubMed Scopus (3) Google Scholar In setting stasis ulcers, UB compression results wound granulation reepithelization.2Milam E.C. Brinster N.K. Superficial granulomatous pyoderma improved after conservative management intralesional steroid injections.JAAD Case Rep. 2018; 4: 797-799Abstract Full Text PDF (2) Scholar,3Tekiner H. Karamanou M. boot: historical dressing for varicose ulcers.Acta Dermatovenerol Croat. 27: 273-274PubMed Evidence supporting efficacy other dermatologic conditions scant.3Tekiner Scholar,4West L. Ayoade K. Vandergriff Nijhawan R.I. Multiple reactive keratoacanthomas treated oxide wraps corticosteroids.JAAD 701-704Abstract (1) purpose this study to outcomes 19 UB. A retrospective chart all patients from October 2015 July 2020 was conducted approval institutional board at Medical University South Carolina. Electronic health record query criteria included natural-language searches “Unna,” “Unna Boot,” or “Unna's Current Procedural Terminology (CPT) codes multilayer wraps, International Statistical Classification Diseases Related Health Problems, 10th Revision known pathologies by UB.1Paranhos Scholar, 2Milam 3Tekiner 4West total 2055 charts were subsequently manually screened who received an disease. Treatment response classified as worsened disease, no change, partial improvement, complete resolution. One hundred thirty-six (37 men 99 women) identified (Table I). Five participants had 2 separate courses (number = 141). White Black subjects constituted 83% 14.7% patient population, respectively, mean age 68.5 years (range 28-92 years). bilateral aspect lower extremities (35.3%) most common site application II). UBs changed every 3 14 days, duration 3.55 months (1 day 52 weeks). Six percent alone, 94% concurrent therapies positive found 91.9% courses, 72.3% achieving improvement 17.7% resolution across entities Ten (7.4%) associated worsening Eleven adverse events occurred when used therapies. 2.9% directly attributed discomfort (2), pruritis (1), edema whereas contributing factor infection (3), discoloration unspecified.Table IDiagnoses, treatments, outcomesDiagnosisTreatmentsNo. diagnoses (% total)∗Percentages calculated according 141 individual present our cohort. Percentages may not add 100% owing rounding.Negative responseNo responsePartial responseComplete responseActinic keratosisUB + 5FU ± TAC calcipotriene16 (13.5)11122Bullous lymphedemaUB timolol petroleum jelly6 (4.3)1041Bullous pemphigoidUB TAC2 (1.4)0020Delusions parasitosisUB risperidone aripiprazole haloperidol tramadol3 (2.1)0030EczemaUB ILK clobetasol PO prednisone taper halobetasol tacrolimus emollients7 (5.0)1051Eruptive keratoacanthomaUB IL5FU calcipotriene acitretin EDC17 (12.1)2195Fat necrosisUB TAC1 (0.7)0001Lichen simplex chronicusUB halcinonide desoximetasone9 (6.4)1170LipodermatosclerosisUB pentoxifylline timolol12 (8.5)00102Elephantiasis nostra verrucosaUB jelly1 (0.7)0001Neuropathic itch excoriationsUB (0.7)0010Neurotic TAC5 (3.5)0050Prurigo nodularisUB gabapentin NAC jelly20 (14.2)30125PsoriasisUB (1.4)0020Radiation ulcerUB cyclosporine1 (0.7)0010Systemic sclerosis (0.7)0001Ulcer, unspecifiedUB gentamycin Dakin's (25%) sulfadiazine cephalexin peroxide doxycycline7 (5.0)0061Venous dermatitisUB furosemide acetic acid clobetasol14 (9.9)10121Venous Mepitel jelly emollients acid16 (11.3)10114EDC, Electrodessication curettage; ILK, Kenalog; IL5FU, 5-fluorouracil; NAC, N-acetylcysteine; PO, oral; TAC, triamcinolone; UB, boot; 5FU, 5-fluorouracil.∗ rounding. Open table new tab Table IITreatment locationUnna locationNo. 136 rounding.Bilateral arms18 (13.2)Bilateral legs48 (35.3)Bilateral arms legs8 (5.9)Right only23 (16.9)Left only30 (22.0)Right arm only3 (2.2)Left only1 (0.7)Bilateral feet2 (1.5)Left heel1 legs, right arm2 (1.5)∗ EDC, 5-fluorouracil. are inexpensive noninvasive strategy which compression, antioxidants, physical restraint, topical medication absorption enhance healing, well quality-of-life measures.1Paranhos 5Faria Loiola Salomé G.M. Ferreira L.M. therapy impact on wellbeing, hope spirituality ulcer patients: prospective clinical trial.J Wound Care. 2020; 29: 214-220Crossref Even though has been successfully dermatologists more than century, prior research regarding diseases treated, used, reported minimal remain underused. Our findings suggest clinicians should consider using wide variety feasible option. These highlight that effective tolerated spectrum pathologies, but also versatile locations they can be applied. Limitations include design lack validated measurement tool. Future studies compare relative effect adjunctive None disclosed. authors would like thank Alexa Demaio, BS assistance data collection.