Successful Peripheral Stem Cell Autologous Engraftment in Skin of a Patient with Severe Dermal Atrophy and Senile Purpura. First Venezuelan Report.
Authors: Herrera-Cepeda Jorge I. , Devis-Hazim Roger R. , Urdaneta-Herrera Maira L. , Marquez-Herrera Glenda R. 
Published: October 2019

Abstract
Background: Severe skin manifestations, lacerations, ecchymoses and other extravasations have always been a medical problem in patients usually older than 65 y/o and sometimes are associated to depressive conditions. It is a common degenerative status as expression of aging and known as Senile Purpura (SP). Pathophysiological bases of this disorder have been associated with skin atrophy, loss of adipose tissue, elastin and collagen with decreased support of vascularity and blood extravasations. Despite early clinical recognition by Bateman in 1817, any topic nor systemic treatment has been successful.
Material and Methods: Patient A.P. 67 y/o, MD, in good clinical conditions, consulted for multiples ecchymoses and several abrasions areas after minimal traumas on extensor surface of skin of both forearms and dorsum of hands. His blood counts revealed Hgb 12.9 g/dL, Hct 40.5%, WBC 8.2x103/ μ L Platelets 166x103/ μ L and normal differential count. Coagulation Profile was also normal (Mielke bleeding time 2 min.) normal clot retraction, PT 12”(Cont. 12.5”), PTT 29”(Cont. 30”) TT 10”(Cont. 9”). Blood chemistry and hepatic enzimes were normal. Diagnosis was made of SP and taking into account the severity of skin lesions and depressive status with anxiety and distress, we propose an autologous stem cell engraftment (ASCE) based on known good previous experiences on other tissues engrafted, especially in heart, pancreas, muscle and others. Requirement of patient consent was positive and procedure was undertaken, administering treatment with lenograstin (rHuG-CSF) SC 5 ug/Kg/day/5 doses, utilizing a cell-separator (Hemonetics) and 7.2% of stem cell CD34+/CD45+ was obtained on the cellular suspension identified in a B-D Flow Cytometer for the mentioned markers, corresponding to 5 x106/mL CD34+ cells. Multiple subdermic injections were performed on the extensor areas of forearms and hands, spacing at 0.5 to 1 cm using insulin syringes type 31 G x 8mm needles, with a previous aseptic preparation of the area to be treated.
Results: The whole skin treated with ASCE in the mentioned areas, was initially very thin due to the degenerative process of aging. Besides, it was becoming progressively less wrinkled and therefore more elastic and resistant, without ecchymoses on the first week, and in two weeks the skin appeared almost normal. Subsequently, in a period of one month the patient’s skin did not show substantial differences with the skin of a normal person of a comparable age.
Discussion: SP is an entity practically almost with no adequate treatment so far and for that reason this therapeutic approach is a new, valid, easy and effective alternative to treat patients, particularly those cases with severe clinical features and depressive behavior changes. No references were found in venezuelan, latin-american and international reviewed medical literature. In Venezuela this represents the first report on ASCE for dermal atrophy and SP with an obvious cure.
Conclusions: Stem cells obtained by apheresis and appropriately injected in multiple subdermic sites of hands and forearms is a curative procedure and confer a normal appearance to the skin treated from two to four weeks. There is no available information on this subject, reason for which this report is probably the first in SP.