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Topical dosage forms such as gels and sprays
are used in conjunction with various dressings to treat wounds.
Almost any active ingredient can be formulated into a gel or
a spray. These delivery vehicles are often preferred
over creams, because creams may be more difficult to remove
from the wound cavity and may affect the granulation process. Medications
can also be prepared as powders that can be dispensed in a
bellows bottle and puffed onto the affected area.
Aloe Vera has been utilized for many years to
treat wounds and burns. Aloe improves blood flow to the
wound and may work as a free radical scavenger. Topical
aloe vera has also been shown to have a synergistic effect
with other medications used for wound healing.
Antibiotics can be included in wound preparations
to prevent or treat infections, and can be selected based on
sensitivities of bacteria from wound cultures. Metronidazole
is effective topically against anaerobic bacteria that cause
foul and distressing wound odors. Elimination of these
embarrassing odors can greatly improve patient’s quality
of life. Exudate and associated cellulitis have also
been observed to decrease significantly with topical metronidazole
therapy.
Benzoyl Peroxide is a powerful oxidizing agent
with broad spectrum germicidal activity and good liposolubility
that may be useful for treatment of decubitis ulcers and prevention
of wound infection in areas with high density of sebaceous
glands.
Calcium Channel Blockers, in properly compounded
topical preparations, have been shown to hasten wound healing
and improve blood flow to diabetic ulcers. The advantages
and successful use of topical nifedipine and diltiazem for
healing both acute and chronic anal fissures have been reported
often in the medical literature. Topical nifedipine has
also been used to improve healing of foot wounds. Topical
therapy with calcium channel blockers is preferred over oral
administration due to the lesser incidence of side effects
such as hypotension, flushing, and headaches.
Estrogen, when applied topically, as been found
to reduce wound size, increase the rate of wound healing, and
stimulate collagen production in both male and female patients.
Glyceryl Trinitrate (GTN, nitroglycerin) has
been used successfully to speed healing after hemorrhoidectomy
and to treat chronic anal fissures.
Hyaluronic Acid has been applied topically to
improve the healing rate in chronic venous leg ulcerations. A
topical formulation combining hyaluronic acid and silver sulfadiazine
for the treatment of superficial and deep second degree burns
significantly reduced the healing time and accelerated the
reduction of local edema occurring shortly after injury, and
was shown to have favorable antibacterial and local analgesic
effects.
Pentoxifylline reduces blood viscosity and thus
can improve circulation to the wound. When used topically,
pentoxifylline may improve the rate of wound healing by improving
the ability of calcium channel blockers to reach the wound
tissue.
Phenytoin may be used topically to promote wound
healing by a number of mechanisms, including stimulation of
fibroblast proliferation, facilitation of collagen deposition,
glucocorticoid antagonism, and antibacterial activity. Topical
phenytoin has been used to heal pressure sores, venous stasis
and diabetic ulcers, traumatic wounds, skin autograft donor
sites, and burns.
Sucralfate, commonly used as a protectant, can
be formulated for topical use to treat second and third degree
burns, and has been shown to improve healing time. Topical
sucralfate has also been used successfully to treat bleeding
and diarrhea caused by radiation-induced proctitis. |
