Management Non-healing Trophic Ulcer in a Leprosy Patient with Combination of Injection and Topical Platelet Rich Plasma

Abstract

Introduction: Trophic ulcer is one of the leprosy sequelae due to peripheral neuropathy. Trophic ulcers in leprosy patients can pose a significant stigma to the patients and remain challenging to clinicians due to the low response to treatment. Recent studies have reported the effectiveness of Platelet-rich plasma (PRP) in the management of chronic ulcers. This study reports a case of non-healing trophic ulcers in leprosy patients treated with a combination of injection and topical PRP. Case Presentation: A 61-year-old female patient referred to complaining of a non-healing wound in her right foot since two months ago. She was a leprosy patient with already finished medication since 19 years ago. She treated the wound with sodium chloride compress and gentamycin ointment without any improvement. The general status was in normal condition. Skin examination on the right plantar pedis showed a solitary ulcer sized 1 × 0.5 × 0.3 cm and linear ulcer sized 2.5 × 3 × 0.3 cm with callus in the surrounding. The sensoric test with Semmes-Weinstein Monofilaments (SWM) showed decreased sensory in magenta monofilament (300 g). The whole blood test, blood glucose, renal function, and kidney function showed no abnormality. Gram examination from the base of the ulcer showed no bacteria. We diagnosed a trophic ulcer and treated it with a combination of injection and topical PRP every week. The clinical result showed that the ulcer completely healed in four weeks of PRP treatment and no side effect appeared during treatment. Conclusions: A combination of injection and topical PRP showed to be promising in the management of non-healing trophic ulcers in leprosy patients. It is a simple, safe, and cost-effective in-office procedure and can improve the patient’s quality of life.