What are canker sores and how do they develop. How can you manage canker sore symptoms at home. What medical treatments are available for severe cases of canker sores. How can diet and oral hygiene impact canker sore development and healing. What are the most effective over-the-counter remedies for canker sore pain relief.

Understanding Canker Sores: Causes and Symptoms

Canker sores, also known as mouth ulcers, are small, painful lesions that develop on the soft tissues inside the mouth. Despite their prevalence, the exact cause of canker sores remains unknown. These ulcers typically heal on their own within a few days to two weeks, depending on their severity.

There are three main types of canker sores:

• Minor canker sores: The most common type, affecting 85% of canker sore sufferers. They are small (less than 1 cm in diameter) and typically heal within 1-2 weeks without scarring.
• Major canker sores: Larger and deeper than minor canker sores, these can be extremely painful and may take up to 6 weeks to heal. They often leave scars.
• Herpetiform canker sores: These occur in clusters of 10-100 very small ulcers, but may merge into one large ulcer. They typically heal within 1-2 weeks.

While the exact cause is unknown, several factors may contribute to the development of canker sores:

• Stress or tissue injury
• Certain foods (e.g., acidic or spicy foods)
• Hormonal changes
• Nutritional deficiencies (e.g., vitamin B12, zinc, folate, or iron)
• Weakened immune system
• Genetic predisposition

Natural Remedies and Home Care for Canker Sores

For minor canker sores, treatment may not be necessary as they often heal on their own. However, there are several home remedies and lifestyle changes that can help alleviate symptoms and promote faster healing:

Dietary Modifications

Adjusting your diet can significantly impact the healing process of canker sores. Consider the following tips:

• Avoid hard, crunchy, or abrasive foods that may irritate the sore
• Steer clear of acidic, spicy, or salty foods that can cause discomfort
• Opt for soft, cool foods like yogurt, smoothies, and soups
• Stay hydrated by drinking plenty of water
• Consider supplementing with vitamins B12, zinc, folate, and iron if deficient

Oral Hygiene Practices

Maintaining good oral hygiene is crucial when dealing with canker sores. Follow these guidelines:

• Use a soft-bristled toothbrush to avoid further irritation
• Brush gently but thoroughly, paying extra attention to the affected area
• Rinse with warm salt water to promote healing and reduce inflammation
• Avoid mouthwashes containing alcohol, as they may exacerbate the pain
• Consider using toothpaste free of sodium lauryl sulfate (SLS), which may trigger canker sores in some individuals

Natural Remedies

Several natural remedies may help alleviate canker sore symptoms:

• Apply honey directly to the sore to promote healing and reduce pain
• Use aloe vera gel for its anti-inflammatory and soothing properties
• Try chamomile tea bags as a compress to reduce inflammation
• Dab milk of magnesia on the sore to neutralize acid and form a protective coating
• Rinse with a solution of baking soda and water to neutralize acid and reduce bacteria

Over-the-Counter Treatments for Canker Sores

When home remedies aren’t enough, over-the-counter (OTC) treatments can provide relief from canker sore symptoms. These products typically come in the form of gels, creams, pastes, or sprays and may contain the following active ingredients:

Local Anesthetics

Topical anesthetics like benzocaine and lidocaine can provide temporary pain relief by numbing the affected area. They are available in various forms, including gels, ointments, and oral rinses.

Anti-inflammatory Agents

Non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac can help reduce pain and inflammation when applied topically. These are often formulated as gels or creams specifically for oral use.

Antiseptic Mouthwashes

Mouthwashes containing chlorhexidine or triclosan can help prevent bacterial growth, reducing the risk of secondary infections and promoting faster healing. These should be used as directed, typically by swishing and spitting out the solution.

Protective Barriers

Some OTC products form a protective film over the canker sore, shielding it from further irritation and promoting healing. These may contain ingredients like hyaluronic acid or polyvinylpyrrolidone (PVP).

Natural Astringents

Tinctures or rinses containing natural astringents like myrrh or rhubarb root can help reduce pain and inflammation by constricting blood vessels in the affected area.

Medical Treatments for Severe or Recurrent Canker Sores

In cases where canker sores are severe, recurrent, or do not respond to OTC treatments, medical intervention may be necessary. A healthcare professional may recommend the following treatments:

Prescription Medications

• Topical corticosteroids: These potent anti-inflammatory drugs can be applied directly to the sore to reduce pain and promote healing.
• Systemic corticosteroids: In rare, severe cases, oral steroid tablets may be prescribed to manage widespread or persistent canker sores.
• Immunosuppressants: For patients with frequent outbreaks, medications that modulate the immune system, such as colchicine or thalidomide, may be considered.

Cauterization Procedures

For particularly stubborn or large canker sores, a healthcare provider may recommend cauterization to destroy the inflamed tissue and promote healing. This can be done using:

• Silver nitrate solution
• Laser therapy
• Debacterol® (a topical cauterizing agent)

Nutritional Supplements

If nutritional deficiencies are suspected to contribute to recurrent canker sores, a healthcare provider may recommend supplements such as:

• Vitamin B12
• Folate
• Iron
• Zinc

Prevention Strategies for Reducing Canker Sore Occurrences

While it’s not always possible to prevent canker sores entirely, certain strategies may help reduce their frequency and severity:

Stress Management

Since stress is a common trigger for canker sores, implementing stress-reduction techniques can be beneficial:

• Practice regular meditation or mindfulness exercises
• Engage in physical activity or yoga
• Ensure adequate sleep and rest
• Consider cognitive-behavioral therapy if stress is a significant issue

Dietary Adjustments

Identifying and avoiding trigger foods can help prevent canker sore outbreaks. Common culprits include:

• Acidic fruits and vegetables (e.g., citrus fruits, tomatoes)
• Spicy or salty foods
• Foods with sharp edges (e.g., chips, crackers)
• Chocolate and coffee (for some individuals)

Oral Hygiene Modifications

Adjusting your oral care routine may help prevent canker sores:

• Use a soft-bristled toothbrush to minimize tissue damage
• Consider switching to an SLS-free toothpaste
• Be gentle when brushing and flossing to avoid irritating the oral tissues
• Rinse with an alcohol-free mouthwash

Addressing Underlying Health Issues

Some health conditions may increase the likelihood of developing canker sores. Managing these conditions can help reduce outbreaks:

• Celiac disease
• Inflammatory bowel disease (IBD)
• Behçet’s disease
• HIV/AIDS

When to Seek Professional Medical Advice for Canker Sores

While most canker sores are benign and resolve on their own, certain situations warrant professional medical attention:

Persistent or Severe Symptoms

Consult a healthcare provider if:

• Canker sores persist for more than three weeks
• The pain is severe and interferes with eating, drinking, or speaking
• You experience frequent outbreaks (more than 3-4 times per year)
• The sores are unusually large (greater than 1 cm in diameter)

Accompanying Symptoms

Seek medical advice if canker sores are accompanied by:

• Fever
• Swollen lymph nodes
• Unexplained fatigue
• Skin rashes or lesions

Suspected Underlying Conditions

A healthcare provider should be consulted if you suspect canker sores may be related to:

• Nutritional deficiencies
• Autoimmune disorders
• Gastrointestinal diseases
• Medication side effects

Emerging Research and Future Treatments for Canker Sores

As our understanding of canker sores evolves, researchers are exploring new treatment modalities and prevention strategies:

Probiotics and Microbiome Research

Recent studies have begun investigating the role of the oral microbiome in canker sore development. Probiotics and targeted microbiome interventions may offer promising avenues for prevention and treatment in the future.

Gene Therapy

For individuals with a genetic predisposition to recurrent canker sores, gene therapy could potentially provide long-term relief by addressing the underlying genetic factors.

Novel Drug Delivery Systems

Researchers are developing innovative drug delivery systems to improve the efficacy of existing treatments. These may include:

• Nanoparticle-based formulations for enhanced drug penetration
• Mucoadhesive patches for prolonged drug release
• Smart hydrogels that respond to changes in the oral environment

Immunomodulatory Treatments

As the role of the immune system in canker sore development becomes clearer, new immunomodulatory treatments may be developed to target specific immune pathways involved in the formation of these lesions.

By understanding the various treatment options, prevention strategies, and ongoing research, individuals suffering from canker sores can make informed decisions about their care and work with healthcare providers to develop effective management plans. While these painful ulcers can be frustrating, a combination of self-care measures and appropriate medical interventions can significantly improve quality of life for those affected by recurrent canker sores.

Canker sores (mouth ulcers): What can you do if you have a canker sore? – InformedHealth.org

Created: August 15, 2019; Next update: 2022.

Canker sores (mouth ulcers) usually heal on their own within a few days. Gels, creams or mouthwashes can help to relieve the pain. In severe cases, steroid tablets may be considered.

It’s not known why canker sores develop. That’s why the treatment focuses on the symptoms instead of the cause. It aims to relieve the acute symptoms and support the healing process.

Is treatment always necessary?

If the symptoms are bearable, then treatment isn’t needed. This is most likely the case for the more common minor canker sores: 85 out of 100 people who have canker sores have this type, which is the mildest. Minor canker sores are only a few millimeters wide, are painful for three to five days, and go away completely after about two weeks.

What foods should you avoid or eat?

During the phase of acute inflammation, it’s helpful to avoid certain foods that can irritate the inflamed mucous membranes even more – such as crispy or hard foods like bread rolls or crispbread (such as Ryvita). Very acidic, spicy or salty foods can also be unpleasant, as can fizzy drinks or alcohol. But you should still make sure that you don’t eat too much of the same thing, or too little overall. Eating soups and soft foods can help to protect the mucous membranes. It’s also a good idea to let any food that you cook cool off enough or to eat cold meals.

If you think that certain foods or oral hygiene products are encouraging the development of canker sores, then try avoiding them. But there’s a lack of good research on whether a certain diet can delay the formation of new canker sores.

Oral hygiene: What you need to know

Even though moving your mouth can make the pain worse, you should brush your teeth just as well as you usually do when you don’t have a canker sore. A soft brush can help to prevent injuries to your gums that could increase the risk of new canker sores developing. There are various ways to clean the spaces between your teeth – for instance, with an interdental brush or dental floss. You can ask your dentist for advice to help you find the right option for you.

It’s also important to check the ingredients used in the oral hygiene products: Mouthwashes that contain alcohol may make the pain worse, for instance. Some people also react sensitively to toothpaste that has sodium lauryl sulfate in it.

What can help relieve the symptoms?

Various kinds of medications can be used to treat canker sores. They can be applied to the sores in the form of a gel, cream, paste or spray. Some are also available as a mouthwash or lozenges:

• Local anesthetics: Local anesthetics like lidocaine or benzocaine can dull the pain. They are typically applied to the sores as a gel or cream.

• Anti-inflammatory drugs: Some medicines contain the painkiller diclofenac, which is an NSAID. Diclofenac can relieve pain and reduce inflammation.

• Antiseptic drugs: Mouthwashes with germ-killing ingredients like chlorhexidine or triclosan are used to stop germs from growing in the wound and delaying the healing process or making the inflammation worse.

• Plant-based remedies (astringents): Tinctures made from myrrh or rhubarb root help some people. These plant-based remedies cause the blood vessels in the mucous membranes to become narrower, which is believed to relieve the pain.

What can you do if these things don’t help?

If treating canker sores with local anesthetics, painkillers or antiseptic medications doesn’t help, you can apply steroid creams. If those aren’t effective or if the sores are very severe, it’s a good idea to see a doctor or dentist. They can cauterize (destroy) the inflamed tissue – for instance, using a silver nitrate solution or laser treatment.

When are tablets needed?

About 15 out of 100 people who keep on getting canker sores have large inflammations or an especially large number of them. Some of them then have such severe pain that it becomes difficult to eat, drink or sleep – especially if the canker sores heal only gradually or constantly come back.

In these rare, severe cases, it may be a good idea to take tablets in addition to using a local treatment – for instance, steroid tablets. They have an effect both on the membranes lining the mouth and the rest of the body (systemic treatment). But side effects may be more common then.

Sources

• Altenburg A, El-Haj N, Micheli C, Puttkammer M, Abdel-Naser MB, Zouboulis CC. The treatment of chronic recurrent oral aphthous ulcers. Dtsch Arztebl Int 2014; 111(40): 665-673. [PMC free article: PMC4215084] [PubMed: 25346356]

• Brocklehurst P, Tickle M, Glenny AM, Lewis MA, Pemberton MN, Taylor J et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev 2012; (9): CD005411. [PubMed: 22972085]

• Han M, Fang H, Li QL, Cao Y, Xia R, Zhang ZH. Effectiveness of Laser Therapy in the Management of Recurrent Aphthous Stomatitis: A Systematic Review. Scientifica (Cairo) 2016 [Epub ahead of print].

• Interdisziplinärer Arbeitskreis Oralpathologie und Oralmedizin (AKOPOM), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK). Diagnostik und Therapieoptionen von Aphthen und aphthoiden Läsionen der Mund- und Rachenschleimhaut (S2k-Leitlinie). AWMF-Registernr.: 007-101. November 2016.

• Staines K, Greenwood M. Aphthous ulcers (recurrent). BMJ Clin Evid 2015: pii: 1303.

• Suter VG, Sjölund S, Bornstein MM. Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review. Lasers Med Sci 2017; 32(4): 953-963. [PubMed: 28345122]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Canker sores (mouth ulcers): What can you do if you have a canker sore? – InformedHealth.org

Created: August 15, 2019; Next update: 2022.

Canker sores (mouth ulcers) usually heal on their own within a few days. Gels, creams or mouthwashes can help to relieve the pain. In severe cases, steroid tablets may be considered.

It’s not known why canker sores develop. That’s why the treatment focuses on the symptoms instead of the cause. It aims to relieve the acute symptoms and support the healing process.

Is treatment always necessary?

If the symptoms are bearable, then treatment isn’t needed. This is most likely the case for the more common minor canker sores: 85 out of 100 people who have canker sores have this type, which is the mildest. Minor canker sores are only a few millimeters wide, are painful for three to five days, and go away completely after about two weeks.

What foods should you avoid or eat?

During the phase of acute inflammation, it’s helpful to avoid certain foods that can irritate the inflamed mucous membranes even more – such as crispy or hard foods like bread rolls or crispbread (such as Ryvita). Very acidic, spicy or salty foods can also be unpleasant, as can fizzy drinks or alcohol. But you should still make sure that you don’t eat too much of the same thing, or too little overall. Eating soups and soft foods can help to protect the mucous membranes. It’s also a good idea to let any food that you cook cool off enough or to eat cold meals.

If you think that certain foods or oral hygiene products are encouraging the development of canker sores, then try avoiding them. But there’s a lack of good research on whether a certain diet can delay the formation of new canker sores.

Oral hygiene: What you need to know

Even though moving your mouth can make the pain worse, you should brush your teeth just as well as you usually do when you don’t have a canker sore. A soft brush can help to prevent injuries to your gums that could increase the risk of new canker sores developing. There are various ways to clean the spaces between your teeth – for instance, with an interdental brush or dental floss. You can ask your dentist for advice to help you find the right option for you.

It’s also important to check the ingredients used in the oral hygiene products: Mouthwashes that contain alcohol may make the pain worse, for instance. Some people also react sensitively to toothpaste that has sodium lauryl sulfate in it.

What can help relieve the symptoms?

Various kinds of medications can be used to treat canker sores. They can be applied to the sores in the form of a gel, cream, paste or spray. Some are also available as a mouthwash or lozenges:

• Local anesthetics: Local anesthetics like lidocaine or benzocaine can dull the pain. They are typically applied to the sores as a gel or cream.

• Anti-inflammatory drugs: Some medicines contain the painkiller diclofenac, which is an NSAID. Diclofenac can relieve pain and reduce inflammation.

• Antiseptic drugs: Mouthwashes with germ-killing ingredients like chlorhexidine or triclosan are used to stop germs from growing in the wound and delaying the healing process or making the inflammation worse.

• Plant-based remedies (astringents): Tinctures made from myrrh or rhubarb root help some people. These plant-based remedies cause the blood vessels in the mucous membranes to become narrower, which is believed to relieve the pain.

What can you do if these things don’t help?

If treating canker sores with local anesthetics, painkillers or antiseptic medications doesn’t help, you can apply steroid creams. If those aren’t effective or if the sores are very severe, it’s a good idea to see a doctor or dentist. They can cauterize (destroy) the inflamed tissue – for instance, using a silver nitrate solution or laser treatment.

When are tablets needed?

About 15 out of 100 people who keep on getting canker sores have large inflammations or an especially large number of them. Some of them then have such severe pain that it becomes difficult to eat, drink or sleep – especially if the canker sores heal only gradually or constantly come back.

In these rare, severe cases, it may be a good idea to take tablets in addition to using a local treatment – for instance, steroid tablets. They have an effect both on the membranes lining the mouth and the rest of the body (systemic treatment). But side effects may be more common then.

Sources

• Altenburg A, El-Haj N, Micheli C, Puttkammer M, Abdel-Naser MB, Zouboulis CC. The treatment of chronic recurrent oral aphthous ulcers. Dtsch Arztebl Int 2014; 111(40): 665-673. [PMC free article: PMC4215084] [PubMed: 25346356]

• Brocklehurst P, Tickle M, Glenny AM, Lewis MA, Pemberton MN, Taylor J et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev 2012; (9): CD005411. [PubMed: 22972085]

• Han M, Fang H, Li QL, Cao Y, Xia R, Zhang ZH. Effectiveness of Laser Therapy in the Management of Recurrent Aphthous Stomatitis: A Systematic Review. Scientifica (Cairo) 2016 [Epub ahead of print].

• Interdisziplinärer Arbeitskreis Oralpathologie und Oralmedizin (AKOPOM), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK). Diagnostik und Therapieoptionen von Aphthen und aphthoiden Läsionen der Mund- und Rachenschleimhaut (S2k-Leitlinie). AWMF-Registernr.: 007-101. November 2016.

• Staines K, Greenwood M. Aphthous ulcers (recurrent). BMJ Clin Evid 2015: pii: 1303.

• Suter VG, Sjölund S, Bornstein MM. Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review. Lasers Med Sci 2017; 32(4): 953-963. [PubMed: 28345122]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Use of antiseptics for wound care – PROS and CONS

Antiseptics are substances that destroy or slow down the growth and development of microorganisms within or on living tissue. Unlike antibiotics, which act selectively on a selected target, antiseptics affect multiple targets and have a broader spectrum of action, which includes: bacteria, fungi, viruses, protozoa, and even prions. There are several categories of antiseptics: alcohols (ethanol), anilides (triclocarban), biguanides (chlorhexidine), bisphenols (triclosan), chlorine-containing substances, iodine-containing substances, silver compounds, peroxides and quaternary ammonium compounds. The most commonly used compounds in clinical practice are povidone-iodine, chlorhexidine, alcohol, hydrogen peroxide, boric acid, silver nitrate, silver sulfadiazine (argosulfan), and sodium hypochlorite.

The use and purpose of antiseptics varies depending on their properties. Some antiseptics are used mainly for preoperative skin treatment, some are used to disinfect instruments and surfaces in the operating room, and some antiseptics are used to treat hands. The use of antiseptics for skin treatment is well studied and widely used. However, the use of antiseptics for the treatment of open wounds is still an arena for discussion among specialists.

Two documents have been issued by US health authorities describing the use of antiseptics for wound care. Povidone-iodine has been approved for short-term use in superficial and acute wounds. The document notes that povidone-iodine neither accelerates nor inhibits wound healing. On the other hand, US health authorities express a very negative attitude towards the treatment of pressure ulcers with antiseptics and recommend that pressure ulcers be treated only with saline.

Arguments for antiseptics for wound care. The main argument for the use of antiseptics for the treatment of open wounds is the prevention and elimination of infection, and as a result, the acceleration of healing processes. It has been proven that infection not only slows down wound healing, but can cause deterioration and lead to significant tissue destruction. Pathogenic microorganisms hinder healing processes through several mechanisms: they constantly release inflammatory mediators, metabolic products and toxins into the wound, maintain a high level of neutrophils, which in turn produce cytolytic enzymes and free radicals. All this causes damage to healthy cells and slows down the wound healing process.

Moreover, bacteria rob living cells of oxygen and nutrients necessary for wound healing. Wound infection can also lead to tissue hypoxia, impair the granulation process, reduce the number of collagen-producing fibroblasts, and inhibit epithelialization.

The second argument in favor of using antiseptics for treating open wounds is that antiseptics, unlike antibiotics, do not develop bacterial resistance. Despite the fact that the facts of resistance of microorganisms to antiseptics have been recorded, the level of resistance is much lower than in the case of antibiotics.

Antiseptics are also significantly less likely to cause allergies than antibiotics.

Arguments against the use of antiseptics on open wounds. The main concern among specialists is the safety of the use of antiseptics. The most powerful argument against the use of antiseptics is their cytotoxicity against the cells that are responsible for wound healing processes: fibroblasts, keratinocytes and leukocytes. However, such cytotoxicity depends on the concentration of the applied antiseptic.

The second argument against the use of antiseptics on open wounds is that the effectiveness of antiseptics when used in practice is much lower than the effectiveness that can be observed in test tube studies. Components of the wound environment such as wound exudate, tissue fluid and blood reduce the effectiveness of antibiotics.

Compounds Iodine

Since its discovery by the French chemist Bernard Courtois in 1811, iodine and its compounds have been actively used to fight infection and treat wounds. However, the iodine molecule can be very toxic to living tissues. Therefore, a large role was assigned to the creation of iodine compounds with less toxicity. Povidone-iodine (PVP-I) is formed from an iodine molecule and polyvinylpyrrolidone. Povidone-iodine is available in several forms: solution, ointment, cream. Numerous studies have been conducted to determine the safety and efficacy of iodine compounds in wound healing processes.

The effect of iodine compounds on the bacterial contamination of the wound. Povidone – iodine . Several animal studies have been conducted investigating the effect of povidone-iodine in reducing wound bacterial contamination. These studies have not proven the effectiveness of povidone-iodine. In studies conducted on guinea pigs, a decrease in the number of microorganisms in the wound was noted immediately after treatment. However, this effect is very short-lived, and after a while the level of bacterial contamination of the wound returned to its previous level.

Human studies have shown that povidone-iodine is effective in most clinical situations. In one study, povidone-iodine ointment was applied to burn wounds in 50 patients, which helped control the level of infection in the wound.

In a recent study, povidone-iodine was used in combination with hydrocolloid dressings to treat clinically uninfected trophic leg ulcers, which resulted in a decrease in the number of bacteria in the wound, a decrease in the manifestations of neutrophilic vasculitis and phagocytic infiltration, and accelerated the healing process of ulcers compared with independent dressings. using hydrocolloid coatings.

Effect of iodine compounds on the wound healing process. Povidone – iodine . The results of animal studies described in the literature are very inconsistent. There are many reasons for this interpretation of the results. Here are some of them: the studies use various parameters to assess wound healing, the frequency of evaluation of results, the concentration of povidone-iodine, the origin of wounds (burn wounds, ulcers, etc.). Also, the type of animal plays an important role in the evaluation results.

Some studies show that povidone-iodine does not delay healing, while other studies show delayed healing.

Hydrogen peroxide

A 3% hydrogen peroxide solution is often used as an antiseptic for wounds. A 3% hydrogen peroxide solution shows a broad spectrum of activity in in vitro tests. In general, hydrogen peroxide is effective against gram-positive bacteria. Surprisingly, with such an active use of hydrogen peroxide as an antiseptic for wound treatment, there has been very little research testing the effectiveness and effect of hydrogen peroxide on wound healing processes.

Animal and human studies have shown that hydrogen peroxide has no significant effect on wound healing. At the same time, hydrogen peroxide has a minimal antibacterial effect. All researchers unanimously noted that hydrogen peroxide causes a burn of young cells, and therefore it is strictly not recommended for the treatment of wounds in the granulation and epithelialization stages.

Chlorhexidine

Chlorhexidine has been used for many years in the manufacture of disinfectant and antiseptic solutions.

Chlorhexidine antiseptic solutions are used in various branches of medicine: in urology, gynecology, dentistry, as well as for the treatment of wounds.

The efficacy and safety of chlorhexidine has been tested in numerous studies.

Treatment of wounds with chlorhexidine leads to a significant reduction in the microbial load on the wound.

Chlorhexidine is fairly safe and has virtually no effect on the healing process.

Silver Compounds

Silver compounds have been widely used for many years as an antiseptic in wound care, most commonly in burn wounds. Silver sulfadiazine and silver nitrate are the most popular.

Animal studies have shown that both of these silver compounds do not accelerate the epithelialization process.

In studies involving patients with trophic ulcers of the lower leg, silver sulfadiazine showed good results: a significant reduction in microbial contamination and a reduction in the size of the ulcer compared with the placebo group. Silver products were well tolerated. Unlike antibiotics, microorganisms do not develop resistance to silver.

Treatment of trophic ulcers: ointments, solutions, preparations

Due to prolonged circulatory disorders and, as a result, soft tissue nutrition deficiency, long-term non-healing wounds – trophic ulcers can form. As a rule, they occur on the lower extremities.

One of the factors in the formation of circulatory disorders is the slowdown in the processes of renewal of skin tissues (regeneration). Therefore, poorly healing trophic ulcers often occur in older people. But they can appear in young and middle-aged people under certain conditions.

Main symptoms

Initially, signs of malnutrition (trophism) of soft tissues develop. A person at this stage, as a rule, has a burning sensation, soreness in the lower extremities. The skin becomes thinner, a cyanotic or brownish-bluish tint appears, lamellar peeling and a characteristic luster appear.

Then a small painful ulcerative defect (formation on the skin at the site of injury) is formed, increasing in size over time. The edges of the ulcer are thickened. Inside the defect, a gray coating may occur. A trophic ulcer may also bleed.

Causes and types of trophic ulcers

Causes of trophic ulcers can be (lymphostasis)

In 15% of cases, the patient may have several causes simultaneously, provoking formation of a trophic ulcer ² . A common combination of such causes is venous disease, arterial disease and diabetic angiopathy ² .

Types of trophic ulcers

Trophic ulcers of the lower extremities are most often formed against the background of chronic circulatory disorders, the cause of which may be varicose veins of the lower extremities or impaired lymph outflow. Such trophic ulcers are called ulcers in chronic venous insufficiency .

Arterial ulcers are formed due to a significant narrowing of the lumen of the arteries, which causes circulatory deficiency. The most common cause of a decrease in the diameter of the vessel is atherosclerosis and diabetes mellitus.

Neurotrophic ulcers – a long-term result of a fracture of the spine and nerve injury (usually sciatic and tibial), with a neuropathic form of diabetic foot syndrome, tertiary syphilis (spinal dryness), multiple sclerosis, etc.

Martorella ulcer 900 10 (hypertensive ulcer) develops against the background of poorly controlled arterial hypertension (including when the patient ignores hypertension and does not receive the necessary treatment).

Pyogenic ulcer may result from infection of wounds, skin defects after previous erysipelas (known as “erysipelas”), an existing abscess (abscess), and acute purulent inflammation of tissues (cellulitis). However, as a rule, chronic immunodeficiency of the body is a predisposing factor.

Trophic ulcers in osteomyelitis – an infectious and inflammatory process that affects the bones.

About trophic ulcers, their treatment and treatment, see a short video with surgeon Fedor Yanovich Kraskovsky

Diagnosis

Usually the diagnosis of a trophic ulcer does not cause difficulties and is based on the clinical picture: the presence of a long-term non-healing painful defect of the skin and surrounding tissues. But to determine the tactics of treatment, it is necessary to establish the cause of the formation of an ulcer.

For this, the doctor may prescribe tests aimed at determining circulatory disorders of the extremities:

• Ultrasound duplex scanning ² .
• Radiocontrast angiography is a method for detecting vascular diseases in which a contrast agent is injected into them. On a special device, an angiograph, the passage of contrast through the vessels is traced.
• X-ray examination of bones in two projections, magnetic resonance angiography, computed tomography are used in the diagnosis of trophic ulcers in osteomyelitis ² .
• Ankle-brachial systolic pressure index determination. This parameter shows the degree of blood circulation in the limbs.

It is important to exclude the presence of concomitant diseases (which may be asymptomatic): diabetes mellitus, malignant arterial hypertension, immunodeficiency states. You may need to consult a dermatologist, rheumatologist to clarify the diagnosis.

Treatment of trophic ulcers

The main task in the treatment of trophic ulcers is to eliminate the cause: to normalize blood circulation, including surgical methods, to select drugs to lower blood pressure, to correct blood sugar levels.

Selection of external therapy depends on the stage of the wound process and the formation of ulcers ² .

Phase I of the wound process

In the treatment of trophic ulcers in the first phase of the wound process, when there are areas of dead tissue, signs of acute inflammation, excessive discharge (weeping), the main tasks are:

• dead tissue and pus
• reduce inflammation

Therefore, surgical debridement may be performed at this stage to remove dead tissue (necrosis). In any case, it is necessary to wash and treat the wound with disinfectants, for example, a solution of povidone-iodine .

At this stage, the wound surface is also treated with external decontaminating creams and ointments. For example, ointment Betadine ^® is applied directly to the site of the ulcer. Then the damaged area is covered with a clean, sterile dressing to prevent infection from outside.

Povidone iodine

Characteristics and properties of povidone iodine. What is povidone-iodine used for? Instructions for use of the solution, ointment, suppositories Betadine ^® with povidone-iodine.

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Phase II of the wound process

When the signs of inflammation decrease and the body has opportunities for healing, a new (granulation) tissue begins to sprout from the bottom of the trophic ulcer, which is distinguished by a pink color. Surgical plastic surgery of the ulcer is performed at this stage.

Phase III-IV of the wound process

If the entire volume of the ulcerative defect is filled with granulation tissue (which restores the site of the tissue defect), the wound will begin to “tighten” and restore the surface layer. To minimize cicatricial changes, preparations that improve the appearance of scar tissue (based on silicone, hyaluronidase, plant extracts) are recommended. It must be remembered that they can only be used on healed skin.

Correctly selected external therapy accelerates the healing process ² . For example, when treating a trophic ulcer that has developed against the background of diabetes mellitus, it is contraindicated to use aggressive antiseptics (hydrogen peroxide solution, potassium permanganate, etc.) ² , so as not to further injure viable tissues. Infection of the ulcer defect in patients with diabetes in 25-50% of cases, unfortunately, ends with amputation of the limb ² . Therefore, it is important to carefully consider the choice of local disinfectant.

Preparations for disinfection and treatment of trophic ulcers

Trophic ulcers can be washed with physiological saline (0.9% sodium chloride) for mechanical removal of purulent dead plaque and bacteria ² . However, this solution does not prevent infection.

Antiseptics suitable for treating ulcers:

• Povidone-iodine solution
• Chlorhexidine (chlorhexidine bigluconate)
• Hydrogen peroxide solution
• Potassium permanganate solution (potassium permanganate)
• Benzyl dimethyl myristoylamino propylammonium solution
• Octenidine dihydrochloride solution
• Eosin solution
• Polyhexanide

Treatment of trophic ulcers with povidone-iodine solution (Betadine®)

Povidone-iodine – an antiseptic drug that does not contain alcohol, while having a wide spectrum of action. Detrimental to most dangerous microorganisms: bacteria, unicellular microorganisms, herpes virus, pathogens of fungal infection ¹⁵ . When applied topically, povidone-iodine does not cause burning. For the treatment of trophic ulcers, a solution of Betadine ^® is used undiluted for lubrication and as a compress.

For use in drainage systems, the product must be diluted 10-100 times. Given that the solution is dark brown, this facilitates quality control of the treatment of the entire area of ​​the wound surface. The tool has a high safety profile ¹² . May be used in children older than 1 month.

Also, there were no cases of formation of resistance of harmful microorganisms to iodine preparations, that is, pathogens do not become addicted to treatment with agents based on povidone-iodine ¹⁵

In addition to solution Betadine ^{® ointment with povidone-iodine ( Betadine ® ). Ointment Betadine ® is carefully distributed over the area of ​​the ulcer (do not rub) 2-3 times a day and dressing is performed in a timely manner. Povidone-iodine disinfects, and macrogol, which is part of the ointment, helps to “pull” pus from the wound 14 .}

In the treatment of infected wounds under napkins impregnated with a solution or ointment Betadine ^® , during the first 5-7 days, edema and the amount of purulent discharge were noticeably reduced, pain was reduced ¹¹ .

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Chlorhexidine

An aqueous solution of chlorhexidine bigluconate belongs to the group of disinfectants and antiseptics. Detrimental to gram-positive and gram-negative bacteria, is active against fungal infection when exposed for 10 minutes ⁴ . Indicated for the treatment of purulent wounds, infected burns ⁴ .

However, according to recent studies, a number of bacteria become resistant to chlorhexidine bigluconate, that is, harmful microorganisms begin to resist the action of this antiseptic ¹³ . This reduces the likelihood of successful treatment with this drug.

Hydrogen peroxide

Contact of 3% aqueous hydrogen peroxide solution with the wound surface releases active oxygen, so the product is active against infections caused by putrefactive and anaerobic (which do not need oxygen) bacteria ⁵ .

However, the microbial reduction is temporary, i.e. there is no sterilization effect. The tool can not be used under dressings that prevent the penetration of infections, foreign bodies and air (occlusive dressings). The use of hydrogen peroxide does not guarantee against contracting a wound infection ⁵ .

Potassium permanganate (“potassium permanganate”)

A solution of potassium permanganate 2-5% has an antiseptic effect. When interacting with the wound surface, active oxygen is released, which is detrimental to anaerobic microorganisms ⁶ . But this mechanism has a downside – it can damage healthy tissues, as well as interfere with the formation of new ones.

In surgery, it is sometimes used to reverse ulcers, infected wounds, burn surfaces. It may be difficult to purchase potassium permanganate powder for solution preparation, since it is included in the list of drugs subject to special control. Moreover, an undissolved crystal of “potassium permanganate” can cause a burn.

Benzyldimethyl-myristoylamino-propylammonium solution

Detrimental to many bacteria, fungi, unicellular microorganisms, has an antiviral effect. Approved for the treatment and treatment of purulent wounds, burns ⁷ . When used externally, it is not absorbed into the bloodstream. Approved for use in adults and children. To prevent infection of the wound with a solution, you can irrigate the surface or drain, but the consumption of the drug can reach up to 1 liter per day. Given the cost of the drug, treatment can be costly.

Octenidine dihydrochloride solution

Polyhexanide based solution acts on bacteria and fungi, indicated for the treatment of infected wounds, burn surfaces ⁸ .

Can only be used diluted (0.2% and 0.1%). The required amount of the drug (according to the instructions) is added to 1 liter of lactate-free Ringer’s solution or to physiological saline.

Contraindicated for use in persons under 18 years of age.

Eosin solution

Eosin solution is used as an antiseptic and disinfectant drying agent. The wound surface is treated with a swab dipped in a solution of eosin. May cause allergic reactions ¹⁰ .

Local antiseptics are used in I (inflammation phase) and II phase of regeneration, as well as after surgical treatment.

Prevention of the formation of trophic ulcers

Since trophic ulcers are difficult to treat, and surgical methods do not always bring the expected results, the main task is the prevention of their formation, as well as the responsible actions of the patient with early signs of ulcers.

It is important to promptly identify provoking concomitant diseases, prevent vascular, neurological and other complications, seek medical help even at the early stages of the formation of ulcerative defects. If an ulcer occurs, conscientiously follow the doctor’s recommendations, keep the ulcer clean, and carry out timely antiseptic treatment. And it is also important to choose a drug with the best properties for this.

FAQ

How often should a trophic ulcer be treated?

The treatment of the ulcer is carried out according to the recommendations of the attending physician or according to the instructions of the antiseptic. Usually 2-3 times a day.

Is a trophic ulcer contagious?

This is not a contagious disease, but the result of severe somatic problems, such as diabetes, chronic lower limb vein disease, atherosclerosis obliterans, and others. However, an ulcerative defect is at risk of infection, then a soft tissue ulcer can become a chronic focus of infection.

Who treats trophic ulcers?

Trophic ulcers are treated by a surgeon, a phlebologist. To clarify the cause of the ulcer and select the treatment of the underlying disease, a consultation with a general practitioner, neurologist, traumatologist, oncologist, rheumatologist, dermatologist is required.

What are the general recommendations for people with trophic ulcers?

• Compliance with the regime of work and rest, limiting the load on the area of ​​the body with a trophic ulcer.
• External use of disinfectants and anti-inflammatory agents.
• Systemic antibiotics (tablets) if needed.
• Physiotherapy treatment.
• Timely medical examination to identify provocative comorbidities.

Moshkova Elena Mikhailovna

Dermatovenereologist, head of the KDO for the provision of paid services, St.0003

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References

1. Shakhrai S. V., Semenchuk I. D. Trophic ulcers of the lower extremities // Minsk BSMU 2009.
2. Saveliev V.S. Kirienko A.I. National Guide to Surgery // GEOTAR-Media 2008. Moscow.
3. Stoyko Yu. M., Kirienko A. I., Zatevakhin I. I. et al. Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases// Phlebology 2018;12(3): 146-240.
4. Instructions for medical use Chlorhexidine, radar.
5. Instructions for medical use hydrogen peroxide, radar.