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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?

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

Drosou A, Falabella A, Kirser RS. Antiseptics
On Wounds: An Area of Controversy. Wounds.

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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