From the Guidelines
A recalcitrant lesion refers to a skin condition or growth that is stubborn, resistant to treatment, and difficult to resolve despite standard therapeutic approaches. These lesions persist over time and do not respond adequately to conventional treatments that would typically be effective for similar conditions. Recalcitrant lesions can include persistent warts, certain ulcers, psoriatic plaques, or other dermatological conditions that fail to improve with first-line therapies. According to the British Association of Dermatologists' guidelines for the care of patients with actinic keratosis 2017 1, treatment failure is defined as the failure to achieve clearance of an individual lesion, and the reason for failure needs assessment.
Key Characteristics of Recalcitrant Lesions
- Persist over time despite standard treatment
- Do not respond adequately to conventional treatments
- May require alternative or more aggressive treatment strategies
- Can include various dermatological conditions such as warts, ulcers, or psoriatic plaques
Factors Contributing to Recalcitrance
- Location of the lesion
- Depth of the lesion
- Blood supply to the lesion
- Immune factors in the surrounding tissue
- Characteristics of the causative organism (in infectious lesions)
Management of Recalcitrant Lesions
- Consider alternative or more aggressive treatment strategies
- May require combination therapies, increased medication dosages, surgical intervention, or newer therapeutic modalities
- Patients typically require referral to specialists, more frequent monitoring, and patience throughout the extended treatment process
- According to the guidelines, failure of an individual lesion to respond to physical therapy indicates a need for further evaluation, which could include formal excision 1.
In the context of actinic keratosis, the British Association of Dermatologists' guidelines 2017 1 emphasize the importance of assessing the reason for treatment failure and considering alternative treatment options. Similarly, the guidelines for the management of bullous pemphigoid define treatment failure as the development of new nontransient lesions or continued extension of old lesions despite certain strengths of corticosteroids with or without higher doses of adjuvants 1. However, the most recent and highest quality study on this topic is the British Association of Dermatologists' guidelines for the care of patients with actinic keratosis 2017 1, which provides a comprehensive approach to managing recalcitrant lesions.
From the Research
Definition of Recalcitrant Lesion
- A recalcitrant lesion refers to a wound or lesion that is resistant to standard forms of treatment and fails to heal after a prolonged period, typically 6-12 months 2.
- Recalcitrant lesions can be found in various forms, including lower limb ulcers 2, chronic wounds 3, nongenital cutaneous warts 4, and oral lesions 5.
Characteristics of Recalcitrant Lesions
- Recalcitrant lesions are often characterized by delayed healing, inflammation, and infection 3.
- They can be caused by various factors, including impaired arterial circulation, inflammatory disorders, chronic venous insufficiency, diabetes mellitus, and malnutrition 6.
- Recalcitrant lesions can be challenging to treat, and standard treatments may not be effective, leading to frustration for both patients and physicians 2, 4.
Treatment Options for Recalcitrant Lesions
- Treatment options for recalcitrant lesions vary depending on the underlying cause and type of lesion, but may include immunosuppressive agents 2, immunotherapy 4, cytotoxic agents 4, and wound dressings 3.
- In some cases, novel treatments such as PRGF infiltrations may be effective in managing recalcitrant lesions 5.
- A comprehensive approach to treatment, including correction of underlying conditions and use of appropriate therapies, is essential for achieving wound closure and resolving recalcitrant lesions 6.