Pearls of Wisdom: Venous Insufficiency Ulcer

Marcus is a 62-year-old man with a venous insufficiency ulcer that has failed to respond to elevation, compression, pentoxifylline, and aspirin.

What else might help?

A. Simvastatin
B. Ramipril
C. Doxycycline
D. Carbamazepine

What is the correct answer?
(Answer and discussion on next page)

Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. These “Pearls of Wisdom” often highlight studies that may not have gotten traction within the clinical community and/or may have been overlooked since their time of publishing, but warrant a second look.

Answer: Simvastatin

Venous insufficiency is a vexing problem. Patients are disturbed because of occasional discomfort, as well as the cosmetic appearance of the condition. So what can be done for a patient whose venous insufficiency has failed to respond to elevation, compression, pentoxifylline, and aspirin?

The Research

An article published in the British Journal of Dermatology suggested that simvastatin may be a useful tool in the treatment of venous ulcers. The randomized, double-blind, placebo-controlled trial included 66 patients with venous insufficiency ulcers treated for up to 10 weeks with simvastatin, 40 mg/d, or placebo. All patients were also advised to make use of compression and elevation, as well as other standard ulcer therapy during the study.

The Results

Overall, 90% of patients in the simvastatin group experienced wound healing, compared with only 34% of those in the placebo group. Time to healing was faster in the simvastatin group than in the placebo group.

Venous Ulcers and Simvastatin: Outcomes

Furthermore, in patients with ulcers measuring 5 cm or less, 100% in the simvastatin group experienced wound healing, while only 50% in the placebo group did. And 67% of patients with ulcers measuring greater than 5 cm in the simvastatin group experienced wound healing compared with 0% in the placebo group.

What’s the “Take-Home”?

The next step for many of these patients would have been surgical treatments, so I think we can celebrate the fact that we have an agent here that we are very familiar with and that is inexpensive that may make a major difference in healing. Whether statins other than simvastatin might work equally well is unknown, but since the dose and expense of simvastatin are accessible to essentially all of our patients, until further data confirm the efficacy of other agents, it’s probably best to stick with simvastatin.

Reference:
Evangelista MTP, Casintahan MFA, Villafuerte LL. Simvastatin as a novel therapeutic agent for venous ulcers: a randomized, double-blind, placebo-controlled trial. Br J Dermatol. 2014;170(5):1151-1157.