We present an outline of the cutaneous wound healing cascade, emphasizing the importance of the interaction between regenerated keratinocytes and fibroblasts via cAMP during the proliferative stage of wound healing. We suggest that this mechanism can be explained by the cycle theory. In addition, we speculate that vasculogenesis might contribute to the vascular development of granulation tissues, as well as to angiogenesis. In clinical practice, we stress that the choice of treatment should be adapted to the wound stage. Finally, it should be kept in mind that contact dermatitis due to disinfectants and ointments used in refractory ulcers is possible.
We tried to demonstrate Candida albicans by the cotton swab method from the tongues of DM patients less than 60 years old ; they had no lesions. Candida albicans was isolated from 29 out of 81 patients (35.8%), as well as 4 patients (4.7%) positive by the KOH method. The mean serum HbA1c level of patients with Candida albicans was significantly higher than that of patients without it (9.4% versus 8.1%). The number of colonies of Candida albicans was correlated with the HbA1c level of the patients. The complication rate of diabetic retinopathy of patients positive for Candida albicans was 63%，significantly higher than that of patients negative for Candida albicans.