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November 2005

Combination Therapy of Doxycycline and Topical Tacrolimus for Venous Ulcers

Arch Dermatol. 2005;141(11):1476-1477. doi:10.1001/archderm.141.11.1476

Venous ulcers are common and debilitating skin lesions that occur predominantly in the lower extremities of elderly patients. They are associated with trauma and varicose veins and are highly susceptible to contact allergies to topical antibiotics, including bacitracin. Pain and infections are major causes of morbidity in patients with venous ulcers. Multiple therapies have been attempted for venous ulceration with varying degrees of success.

Recently, it has been recognized that certain subsets of ulcers are highly angiogenic and that high levels of angiogenesis may prevent optimal reepithelialization.1-3 We found that patients with recessive dystrophic epidermolysis bullosa, a deficiency of collagen type VII in which ulceration is a prominent feature, have abnormally high levels of the proangiogenic factor basic fibroblast growth factor (bFGF).2 Doxycycline, a commonly used antibiotic for acne, is an effective inhibitor of matrix metalloproteinases. Given these findings, we successfully used combination therapy of doxycycline and tacrolimus for the treatment of long-standing venous ulceration in a patient who did not tolerate compression stockings. Given our success, larger studies of this therapy are justified.

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