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The Effect of Short-Contact Topical Tretinoin Therapy for Foot Ulcers in Patients With Diabetes
Wynnis L. Tom, MD; David H. Peng, MD, MPH; Atabak Allaei, BS; Daniel Hsu, DPM; Tissa R. Hata, MD
Setting Outpatient clinic at a Veterans Affairs medical center.
Patients Twenty-four volunteers with diabetic foot ulcers but without evidence of peripheral arterial disease or infection.
Interventions Patients were randomized to 4 weeks of daily treatment with either topical 0.05% tretinoin solution (Retin-A) or placebo saline solution. Photographs and assessment of wound size and appearance were assessed every 2 weeks for a total of 16 weeks.
Main Outcome Measures The proportion of ulcers that healed in each group and the degree of change in ulcer size.
Results Twenty-two patients, with a total of 24 foot ulcers, completed the study. At the end of 16 weeks, 2 (18%) of 11 ulcers in the control group and 6 (46%) of 13 ulcers in the tretinoin treatment group healed completely. Topical tretinoin therapy significantly decreased ulcer area and depth compared with placebo treatment over the 16 weeks of the study (P<.01 for surface area; P = .02 for depth). Adverse effects mainly consisted of mild pain at the ulcer site.
Conclusions Short-contact application of topical tretinoin improved the healing of foot ulcers in patients with diabetes. The tretinoin therapy was generally well tolerated, without serious local or systemic adverse effects.
aaaaaggggggghhhhhhhhh!!!!!!
Why do so many do this:
Quote:
or placebo saline solution
Why are they so scared to compare new wound dressings to "standard" treatments and not "saline solutions"??? Who actually uses saline solutions for wound management???
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
The use of Saline moistened Gauze as the control is the fault of the American Diabetes Association who in 1996 published (not available in electronic form)
American Diabetes Association: Foot care in patients with diabetes mellitus (Position Statement). Diabetes Care 19 (Suppl. 1): S23–S24, 1996
that established saline gauze as the primary treatment of dibetic foot wounds due to in part not clear winner fron other dressing types at the time and cost.
This has been corrected in a more recent publication
Factors guiding dressing selection include wound type, presence of exudate, surrounding skin conditions, likelihood of re injury, and cost. Characteristics of available dressings include those designed to achieve absorption, hydration, conform ability, and other special needs. Dressings do not replace debridement or off-loading. Since it has been shown that costs for nursing care and patient transportation are major financial factors in outpatient wound care, dressings that can be applied at home and by the patient or family may yield substantial savings.
__________________ Stephen Tucker Eastern Health
Podiatry Manager
Retin-A Heals Foot Ulcers in Patients With Diabetes
Retin-A Heals Foot Ulcers in Patients With Diabetes
Press release via Reuters:
Quote:
By Graciela Flores
NEW YORK (Reuters Health) Nov 23 - Topical tretinoin (Retin-A) improves the healing of foot ulcers in patients with diabetes, researchers report in this month's issue of the Archives of Dermatology.
Previous studies suggesting that tretinoin was helpful in enhancing wound healing in patients with diabetes were small, and some results had been conflicting. "We wanted to know if tretinoin really helps or not," Dr. Tissa R. Hata of the Department of Medicine, University of California, San Diego, told Reuters Health.
The researchers conducted a double-blind, placebo controlled trial on 24 volunteers with diabetic foot ulcers who lacked evidence of peripheral arterial disease or infection. The patients were randomized to 4 weeks of daily treatment with topical 0.05% tretinoin solution or placebo saline solution. Wound size was assessed every 2 weeks.
The 22 patients who completed the study had a total of 24 foot ulcers. Two of the 11 ulcers in the control group (18%) and 6 of the 13 ulcers in the treated group (46%) healed completely at the end of 16 weeks. There were no significant adverse events, although some patients experienced mild pain at the ulcer site.
"We are very pleased with the results. We were a bit concerned because Tretinoin is very irritating and we thought that the patients would become so irritated that we wouldn't be able to continue the study, but actually, that didn't seem to be a problem in most cases," Dr. Hata said. "The patients seemed to get used to it."
"We are hoping that diabetic foot clinics will adopt some of this, and use it as a sort of adjunctive therapy when some of the other therapies that they are using don't work," she concluded.
I work in a high risk foot clinic: who thinks we should use this therapy based on the evidence of a sample trial on 24 ulcers?
Our clinic has treated at least 25 patients with ulcers this week and most of them have PAD and many have infections as per the usual presentations of diabetic foot ulcers.
Noone does daily dressings unless they are inpatients and I agree with Craig that we don't use saline as a dressing option.
"We are hoping that diabetic foot clinics will adopt some of this, and use it as a sort of adjunctive therapy when some of the other therapies that they are using don't work," she concluded."
What sort of dreamworld are these people living in? If they didn't have PVD, etc we would heal them all in 4 weeks if controlling for pressure relief!
There is more evidence for using honey on wounds than this.
Topical Tretinoin for Foot Ulcers
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