Topical steroids for chronic wounds displaying abnormal inflammation

Abstract

INTRODUCTION Chronic, non-healing wounds are often characterised by an excessive, and detrimental, inflammatory response. We review our experience of using a combined topical steroid, antibiotic and antifungal preparation in the treatment of chronic wounds displaying abnormal and excessive inflammation. METHODS A retrospective review was undertaken of all patients being treated with a topical preparation containing a steroid (clobetasone butyrate 0.05%), antibiotic and antifungal at a tertiary wound healing centre over a ten-year period. Patients were selected as the primary treating physician felt the wounds were displaying excessive inflammation. Healing rates were calculated for before and during this treatment period for each patient. Changes in symptom burden (pain, odour and exudate levels) following topical application were also calculated. RESULTS Overall, 34 ulcers were identified from 25 individual patients (mean age: 65 years, range: 37-97 years) and 331 clinic visits were analysed, spanning a total time of 14,670 days (7,721 days 'before treatment' time, 6,949 days 'during treatment' time). Following treatment, 24 ulcers demonstrated faster rates of healing, 3 ulcers showed no significant change in healing rates and 7 were healing more slowly (p=0.0006). Treatment generally reduced the burden of pain and exudate, without affecting odour. CONCLUSIONS In normal wound healing, inflammation represents a transient but essential phase of tissue repair. In selected cases, direct application of a steroid containing agent has been shown to improve healing rates, presumably by curtailing this phase. Further evaluation is required to establish the role of preparations containing topical steroids without antimicrobials in the management of chronic wounds.

The Role of IL-6 in Skin Fibrosis and Cutaneous Wound Healing

“…Targeting inflammation with corticosteroids is not a robust treatment method for chronic wounds and may only benefit a portion of patients, where others may show worsening pathology [142]. There is disagreement over the effectiveness of corticosteroids in patients that show improving wounds, compounded by a lack of controlled trials [143]. There is generally a lack of clinical research into therapies targeting IL-6 inhibition in chronic wounds; given that IL-6 is known to be important for wound closure [1], this is understandable.…”

Effects of platelet-rich fibrin on skin pedicle graft healing

“…The exudates scores were estimated as non (1), light (2), moderate (3), and heavy (4). while swelling scores classified into non 0, mild 1, and obvious 3 (Nikkhah et al 2013). The measurement of hydroxyproline allowed for the analysis of collagen and cross-links.…”