Characteristics of Chronic Wounds Related to Itching During Healing
Itching of wounds during healing is associated with larger wound size, more extensive tissue swelling, and the presence of granulation and necrotic tissue at the base. This was shown by an observational descriptive American study with 200 patients.
Family History
Father died at the age of 73 from a heart attack, mother at the age of 69 from the consequences of lung cancer. She was also long-term treated for high blood pressure. Brother (68 years old) is also being treated for "high blood pressure and high cholesterol", younger sister (52 years old) is healthy.
Personal History
The patient was a longtime pipe smoker (since age 20), quit smoking 6 years ago. Recently retired and engages in sports (plays golf 1–2 times a week). Reports consuming "a lot" of alcohol. Does not pay attention to the composition of food in terms of fats or sugars ("I eat what I want"). Usually adds extra salt to food. Gained 6 kg in the last year.
Denies non-compliance with recommended medication use. Never felt chest pain, did not notice blood in the sputum. Slightly short of breath when walking upstairs. Did not observe blood in the stool. Reports increased urge to urinate at night over the past 6 months, otherwise no dysuric issues. Occasionally treats pain in the left knee joint himself with acetylsalicylic acid (Aspirin).
Medicated Drugs
Combination of amiloride + chlorthalidone (Amicloton) 1 tbl. every other day. Takes ibuprofen (Brufen) for pain, uses drops for a stuffy nose (does not remember the name of the product).
Objective Physical Findings
BP 150/98 mmHg (sitting), 155/110 mmHg (standing); heart rate 56/min, regular.
Body weight 89 kg, height 180 cm, BMI = 27.5 kg/m2.
Laboratory and Auxiliary Examinations
Total cholesterol 7.5 mmol/l, HDL-c 0.75 mmol/l, LDL-c 4.69 mmol/l, triglycerides 4.52 mmol/l, HbA1c 7.0 mg/dl, uric acid 600 µmol/l.
A fixed combination of sartan and CCB was chosen for the patient due to the presence of hyperuricemia, which could be further aggravated by a thiazide/thiazide-like diuretic. The selected drug was a fixed combination of telmisartan (40 mg) and amlodipine (5 mg) Tezefort with a dosage of 1 tbl. daily. Simultaneously, the patient was started on antihyperuricemic treatment with allopurinol and antidiabetic treatment with metformin.
Follow-Up After 1 Month
Patient reports adhering to recommended diet and exercise regimen.
BP 140/95 mmHg (sitting), 145/100 mmHg (standing).
Body weight 85 kg, height 180 cm, BMI = 27.0 kg/m2.
Total cholesterol 6.48 mmol/l, HDL-c 0.91 mmol/l, LDL-c 3.49 mmol/l, triglycerides 4.29 mmol/l, HbA1c 6.5 mg/dl, uric acid 450 µmol/l.
Dosage of telmisartan was increased to 80 mg while maintaining the same dose of amlodipine. At the next follow-up after another month, BP was 130/80 mmHg (sitting), 135/85 mmHg (standing).
MUDr. Jiří Slíva, Ph.D.
Institute of Pharmacology, 3rd Faculty of Medicine, Charles University in Prague
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