| Per a prescription order,
a formulation can be compounded to contain the
proper combination of active ingredients, in the
most appropriate base, to treat a specific type
of wound. We customize medications to meet each
individual’s specific needs. For example,
the choice of cream, ointment, or gel can be clinically
significant. Each time a wound needs to be cleaned,
there is the potential for disruption of new tissue
growth. Gels, which are more water soluble than
creams or ointments, may be preferable for wound
use because a gel can be rinsed from the wound
by irrigation. Ointments may contain polyethylene
glycol (PEG), which can be absorbed from open
wounds and damaged skin. If the wound is quite
large and too much PEG is absorbed, it can lead
to renal toxicity. Another useful dosage
form is the “polyox bandage” - which
can be puffed onto a wound and will adhere even
if exudate is present. A polyox bandage
can be compounded to contain the active ingredient(s)
of your choice.
Decubitus Ulcers
Phenytoin has been used topically to speed the
healing of decubitus ulcers, pressure sores, venous
stasis and diabetic ulcers, traumatic wounds,
skin autograft donor sites, and burns. Ketoprofen
may be used to control inflammation and pain,
lidocaine provides topical anesthesia, and pentoxifylline
may improve microcirculation at the wound margins
and promote healing of the injured area. Misoprostol,
a prostaglandin analog, is often included in wound
care formulations to promote healing. Debridement
of necrotic eschar with 40% urea paste may also
speed healing. Medications which improve capillary
blood flow can be added to a compounded medication
to enhance circulation at the wound margins and
promote healing of the injured area.
Topical Phenytoin for Wound Healing
Phenytoin may promote wound healing by a number
of mechanisms, including stimulation of fibroblast
proliferation, facilitation of collagen deposition,
glucocorticoid antagonism, and antibacterial activity.
Rhodes et al compared the healing of stage II
decubitus ulcers with topically applied phenytoin
and two other standard topical treatment procedures
in 47 patients in a long-term care setting. Ulcers
were examined for the presence of healthy granulation
tissue, reduction in surface dimensions, and time
to healing. Topical phenytoin therapy resulted
in a shorter time to complete healing and formation
of granulation tissue when compared with DuoDerm
dressings or triple antibiotic ointment applications.
The mean time to healing in the phenytoin group
was 35.3 +/- 14.3 days compared with 51.8 +/-
19.6 and 53.8 +/- 8.5 days for the DuoDerm and
triple antibiotic ointment groups, respectively.
Healthy granulation tissue in the phenytoin group
appeared within 2 to 7 days in all subjects, compared
to 6 to 21 days in the standard treatment groups.
The phenytoin-treated group showed no detectable
serum phenytoin concentrations.
Anstead et al. described a patient with a massive
grade IV pressure ulcer that was unresponsive
to conventional treatment, yet responded rapidly
to treatment with topical phenytoin. Song and
Cheng reported phenytoin improved wound breaking
strength in normal and radiation-impaired wounds.
The results of their study indicated that topical
phenytoin accelerated normal and irradiation-impaired
wound healing by increasing the number of wound
macrophages and improving the macrophage function.
Pendse et al evaluated the effectiveness of topical
phenytoin in healing chronic skin ulcers in a
controlled trial of 75 inpatients. At the end
of the fourth week, 29 of 40 phenytoin-treated
ulcers had healed completely versus 10 of 35 controls.
They concluded: "topical phenytoin appears
to be an effective, inexpensive, and widely available
therapeutic agent in wound healing."
The effectiveness of topical phenytoin as a wound
healing agent was compared with that of OpSite
and a conventional topical antibiotic dressing
(Soframycin) in a controlled study of 60 patients
with partial-thickness skin autograft donor sites
on the lower extremities. Mean pain scores were
lower and mean time to complete healing (complete
epithelialization) was best in the phenytoin-treated
group (6.2 +/- 1.6 days). Topical phenytoin
compared very favorably with, and in some aspects
was superior to, occlusive dressings.
No study reported any significant adverse effects
secondary to topical phenytoin therapy.
Phenytoin references:
Ann Pharmacother 2001 Jun;35(6):675-81
Click here to access the PubMed abstract of this article.
Biochem Pharmacol 1999 May 15;57(10):1085-94
Click here to access the PubMed abstract of this article.
Ann Pharmacother 1996 Jul-Aug;30(7-8):768-75
Click here to access the PubMed abstract of this article.
Int J Dermatol 1993 Mar;32(3):214-7
Click here to access the PubMed abstract of this article.
Chung Hua I Hsueh Tsa Chih 1997 Jan;77(1):54-7
Click here to access the PubMed abstract of this article.
Burns 1993 Aug;19(4):306-10
Click here to access the PubMed abstract of this article.
Diabetes Care 1991 Oct;14(10):909-11
Benzoyl Peroxide for Treatment of
Decubitus Ulcers
Benzoyl peroxide is a powerful oxidizing agent
with broad spectrum germicidal activity and good
liposolubility. Therefore, it may represent a
good agent for prevention of wound infection in
areas with high density of sebaceous glands. Topical
treatment of pressure sore with 20% benzoyl peroxide
in O/W emulsion yielded very satisfactory results.
In another study, 10% benzoyl peroxide gel was
used prophylactically once a day for 7 days before
surgery. The researchers concluded that topical
benzoyl peroxide is an efficacious, harmless,
and inexpensive agent for prevention of wound
infections in seborrheic regions.
Med Cutan Ibero Lat Am 1988;16(5):427-9
[Benzoyl peroxide in the treatment of
decubitus ulcers].
Fernandez Vozmediano JM, Alonso Blasi
N, Almenara Barrios J, Alonso Trujillo F, Lafuente
L
Servicio de Dermatologia, Hospital Clinico Universitario
Moreno de Mora, Cadiz.
Click here to access the PubMed abstract of this article.
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