Venous Ulcers: Microcirculatory Improvement and Faster Healing with Local Use of Pycnogenol®

Abstract

Chronic venous insufficiency (CVI) causes a well-defined microangiopathy described as venous hypertensive microangiopathy (VHM) leading to venous ulcerations. VHM is mainly observed in the distal part of the leg, in the perimalleolar region. In VHM edema is the consequence of increased capillary pressure and reduced local clearance, and this affects local perfusion. The healing of venous ulcers is usually very slow. Many treatments are available, but there is still no standard. Oral Pycnogenol^® is effective in venous disease and particularly in controlling edema. The aim of this study was the evaluation of the local effects of Pycnogenol on ulcers healing associated with venous hypertension. The study lasted 6 weeks including 18 patients (16 completed the study) with venous ulcerations. The oral treatment with Pycnogenol was compared with a combination treatment including oral and local treatment. In subjects treated with the combination treatment (oral and local), venous ulcers healed better (there was a faster reduction in ulcerated area) in comparison with oral treatment only. According to this pilot study Pycnogenol appears to have an important role in local treatment of venous ulcers improving healing and signs/symptoms.

Get full access to this article

View all access options for this article.

References

Belcaro G , Nicolaides AN , Stansby G (eds): The Venous Clinic. London: Imperial College Press, 1999.

De Sanctis MT , Cesarone MR , Incandela L , et al : Methods of evaluation and quantification of microangiopathy in high perfusion microangiopathy (chronic venous insufficiency and diabetic microangiopathy). J Cardiovasc Pharmacol Ther 7(suppl I):S3-S5, 2002.

Belcaro G , Nicolaides AN (eds): Noninvasive Investigations in Vascular Disease. London: Imperial College press, 2001.

Almond NE : A laser Doppler blood flowmeter used to detect thermal entrainment in normal persons and patients with Raynaud’s phenomenon. In: Practical Aspects of Skin Blood Flow Measurement, ed. by Spence VA , Sheldon CD . London: Biological Engineering Society, 1985, pp 14-28.

Anning ST : The cause and treatment of leg ulcers. Lancet ii:789-791, 1952.

Anning ST : Leg ulcers. Their Causes and Treatment. London: J & A Churchill Ltd, 1954.

Anning ST : The historical aspect. In: The pathology and Surgery of the Veins of the Lower Limb, ed. by Dodd H , Cockett FB . Edinburgh: Churchill-Livingstone, 1976, pp 29-37.

Belcaro G : The role of transcutaneous PCO2 measurements in association with laser Doppler flowmetry in venous hypertension. Phlebology 3:189-193, 1988.

Belcaro G , Grigg M , Rulo A , et al : Blood flow in the perimalleolar skin in relation to posture in patients with venous hypertension. Ann Vasc Surg 1:5-8, 1989a.

10.

Belcaro G , Christopoulos D , Nicolaides AN : Skin flow and swelling in postphlebitic limbs. Vasa 18:136-138, 1989b.

11.

Belcaro G , Nicolaides AN , Volteas N , et al : Skin flow, the venoarteriolar response and capillary filtration in diabetics. A three-year follow-up study. Angiology 43:490-494, 1992a.

12.

Belcaro G , Bollinger A , Hoffman U , et al (eds): Laser Doppler Flowmetry. London: Med-Orion, 1994.

13.

Fagrell B : Local microcirculation in chronic venous incompetence and leg ulcers. Vasc Surg 13:217-219, 1979.

14.

Fagrell B : Microcirculatory disturbances—the final cause for venous leg ulcers? Vasa 11:101-103, 1982.

15.

Franzeck U , Bollinger A , Huch R , et al : Transcutaneous oxygen tension and capillary morphologic characteristics and density in patients with chronic venous incompetence. Circulation 70:806-809, 1984.

16.

Hendriksen O : Local reflex in microcirculation in human subcutaneous tissue. Acta Physiol Scand 97:446-449, 1976.

17.

Rayman G , Hassan A , Tooke JE : Blood flow in the skin of the foot related to posture in patients with diabetes mellitus. Br Med J 292:87-91, 1986.

18.

Thulesius O : Capillary filtration under normal and pathological conditions. Angiologia 10:198-201, 1973.

19.

Bollinger A , Jager K , Geser A , et al : Transcapillary and interstitial diffusion of Na-Fluorescein in chronic venous insufficiency with white atrophy. Int J Microcirc I:5-8, 1982b.

20.

Belcaro G , Nicolaides AN , Veller M : Venous Disorders. A Manual of Diagnosis and Treatment. Cambridge: Saunders, 1995.

21.

Belcaro G: Laser Doppler in venous hypertension. PhD thesis, University of London. UCL, 1996.

22.

Bollinger A , Leu AJ , Hoffman U , et al : Microvascular changes in venous disease: An update. Angiology 48:27-32, 1997.

23.

Nicolaides AN , Abenhaim L , Akeson H , et al : Investigation of chronic venous insufficiency. A consensus statement. Circulation 102:e126-e163, 2000.

24.

Rohdewald P : A review of the French maritime pine bark extract (Pycnogenol), a herbal medication with a diverse clinical pharmacology. Int J Clin Pharmacol Ther 40:158-168, 2002.

25.

Petrassi C , Mastromarino A , Spartera C : Pycnogenol® in chronic venous insufficiency. Phytomedicine 7:383-388, 2000.

26.

Schmidtke I , Schoop W : Le pycnogénol: Thérapeutique médicamenteuse de l’dème statique. J Suisse de médecine globale 3:114-115, 1995.

27.

Putter M , Grotemeyer KHM , Wurthwein G , et al : Inhibition of smoking-induced platelet aggregation by aspirin and Pycnogenol. Thromb Res 95:155-161, 1999.

28.

Wang S , Tan D , Zhao Y , et al : The effect of Pycnogenol® on the microcirculation, platelet function and ischemic myocardium in patients with coronary artery diseases. Eur Bull Drug Res 7:19-25, 1999.

29.

Blasó G , Gábor M , Schönlau F , et al : Pycnogenol® accelerates wound healing and reduces scar formation. Phytother Res 18:579-581, 2004.

30.

Packer L , Cho K-J , Yun C-H , et al : Effects of bioflavonoids extracted from the bark of Pinus maritima on proinflammatory cytokine interleukin-1 production lipopolysaccharide-stimulated RAW 264,7. Toxicol Appl Pharmacol 168:64-71, 2000.

31.

Högger P , Schäfer A , Chovanová Z , et al : Inhibition of COX-1 and COX-2 activity by plasma of human volunteers after ingestion of French maritime pine bark extract (Pycnogenol). Biomedicine and Pharmacotherapy, in print.

32.

Saliou C , Rimbach G , Moni H , et al : Solar ultraviolet-induced erythema in human skin and nuclear factor-kappa-B-dependent gene expression in keratinocytes are modulated by a French maritime pine bark extract. Free Rad Biol Med 30:154-160, 2001.