Bosanquet DC, Rangaraj A, Richards AJ, Riddell A, Saravolac VM, Harding KG, et al.
Annals of the Royal College of Surgeons of England. Date of publication 2013 May 1;volume 95(4):291-6.
1. Ann R Coll Surg Engl. 2013 May;95(4):291-6. doi:
10.1308/003588413X13629960045634.
Topical steroids for chronic wounds displaying abnormal inflammation.
Bosanquet DC(1), Rangaraj A, Richards AJ, Riddell A, Saravolac VM, Harding KG.
Author information:
(1)Cardiff University School of Medicine, UK. davebosanquet@hotmail.com
Comment in
Ann R Coll Surg Engl. 2013 Sep;95(6):448.
Ann R Coll Surg Engl. 2013 Sep;95(6):448-9.
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.
DOI: 10.1308/003588413X13629960045634
PMCID: PMC4132506
PMID: 23676816 [Indexed for MEDLINE]
