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12/05/2016 David Secord, DPM
Betadine® and Silvadine® on an Open Wound Long-Term
I’m always curious about the recommendation of using either Povidone Iodine (Betadine®) or silver sulfadiazine (Silvadine®) on an open wound, long-term, to promote healing. As you can see from the chart enclosed (from “The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations”, Betadine® is toxic to fibroblasts and keratinocytes. The other article(s) cited questions the usage of Silvadene® (as opposed to nanocrystalline silver) on wounds. From: Wound Cleansers and Toxicity. ADV SKIN WOUND CARE 2005;18:373-78: “Skin cleansers in the present study were most toxic to fibroblasts, showing toxicity indexes between 10,000 and 100,000 (Dove Moisturizing Body Wash, Hibiclens, Hollister Skin Cleanser, Dial Antibacterial Soap, and Ivory Liqui-Gel). This was not surprising because fibroblasts (connective tissue cells) are not exposed to chemical insults in their normal environment. A similar argument may be applied to other cellular internal tissue components (eg, endothelial cells); circulating cells (eg, red blood cells), which are afforded additional protection within the circulatory system, should be even more vulnerable.
In contrast, keratinocyte monolayers, representing the in vivo basal layer of the epidermis that epithelializes the wound surface after injury, are more sensitive to wound cleansers such as hydrogen peroxide, modified Dakin's solution (0.025%), and povidone (10%). The different responses of these cell types to wound cleansers are due, in part, to varying abilities to respond to inflammatory events. Direct exposure to inflammatory events may increase hydrogen peroxide production, which fibroblasts are better equipped to handle; keratinocytes are able to handle other inflammatory mechanisms. This hypothesis of progressive cellular vulnerability or susceptibility to skin/ wound cleansers could be used as a predictive guide.” Comments?
http://www.sciencedaily.com/releases/2008/10/08 1007192447.htm
Silver Sulfadiazine cream
Rani SA, Hoon R, Najafi R, et al. The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations. In: ADV SKIN WOUND CARE 2014;27:65Y9
http://www.medscape.com/viewarticle/456300_1
Drosou A, Falabella A, Kirser RS. Antiseptics On Wounds: An Area of Controversy. Wounds. 2003;15(5)
See also: Lipsky, BA, Hoey, C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis 2009; 49(10):1541-9
David Secord, DPM, Corpus Christi, TX
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