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Thank you for entrusting in the compounding services at MD Custom Rx to help meet the unique medication needs of your patients. We are excited to share with you our monthly newsletter and look forward to continuing to be your medication problem solvers. Please don't ever hesitate to let us know how we can be of further assistance to you and your practice.
Sincerely,
John, Dan and Monica |
Wound healing is important not only for the local repair but also for its beneficial effect to systemic physiological processes. When wounds become chronic, individuals are susceptible to generalized inflammatory cascades that can affect many organs and even lead to death. Skin is the most commonly injured tissue, and its proper repair is important for reestablishment of its barrier function.
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Occlusive, Water-Soluble Gel for Wound Management
Polyethylene Glycol (PEG) based occlusive, water-soluble gels specifically formulated for wound management promote a moist environment allowing for optimal healing. These gels contain organic Meadowsweet Extract with phenolic glycosides and flavonoids that potentially provide germicidal, anti-inflammatory and healing properties along with the ability to deliver Active Pharmaceutical Ingredients (APIs) topically to sensitive wound sites. Benefits:
- Adherent
- Occlusive
- Water-washable allowing for easy cleaning and debridement
- Maintains a moist wound site
Ideal for:
- Wounds
- Diabetic skin ulcers, insufficiency (stasis) ulcers, stage I-IV pressure ulcers
- first and second degree Burns
- post-surgical incisions
- Cuts & Abrasions
- Dermatological Applications where a water-washable base would be of benefit
A moist wound environment allows the possibility of increased macrophage and fibroblast activity, re-epithelialization and the production of collagen, and decreased pain. Water washable bases are very important in wound care since wounds need to be cleaned/debrided on a regular basis. Ointments that are not water soluble can disrupt the healing process when the wound is cleaned. Studies in pigs have shown a shortened epithelialization time for occluded wounds versus wounds left open to air. Occlusive dressings increase re-epithelialization rates by 30% to 50% and collagen synthesis by 20% to 60% compared to wounds exposed to air.3 Occlusive preparations also provide a physical barrier against further trauma to the wound. NOTE: Polyethylene glycol (PEG) based vehicles should not be used where absorption of large quantities of polyethylene glycol is possible, such as on extensive burn areas and large surface areas, particularly in patients with moderate or severe renal impairment. |
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Topical Insulin Accelerates Re-epithelializationn
Insulin, when topically applied to wounds, accelerates re-epithelialization and stimulates maturation of the healing tissue, and has significant potential for the treatment of chronic wounds in which re-epithelialization is impaired. Because of its long history of safe use in humans for decades, insulin may prove to be a powerful therapy without major adverse effects.
Re-epithelialization is initiated during the early stages of healing; "it involves the proliferation, migration, and differentiation of keratinocytes from the wound margins. Appropriate re-epithelialization requires not only the development of a continuous epidermal layer but also full epidermal differentiation and the formation of junctions between the epidermis and dermis. Because the epidermis provides a barrier against infection and maintains homeostasis, improving re-epithelialization, particularly in impaired healing situations, has attracted a great deal of attention. One molecule with the potential to enhance these processes is insulin, a hormone known to maintain the growth and development of different cell types. It can affect the proliferation, migration, and ECM secretion by keratinocytes, endothelial cells, and fibroblasts... In addition to the studies in vivo, experiments with cultured cells have shown that insulin increases the rate of growth of fibroblasts, cells that are critically involved in the development of the granulation tissue... Local application of insulin to excision wounds stimulates keratinocyte migration and differentiation, and a regenerative process in the wound tissue. Therefore, insulin may prove to be useful in the treatment of chronic wounds, dental/gum healing problems, and burns. These are important findings because issues of impaired healing and of lack of tissue regeneration have implications for numerous health- and financially-related problems."
Topical application of insulin accelerates and improves the quality of healing. In a study, excision wounds in mice were locally treated with 0.03 U of insulin. This dose of insulin was chosen because it significantly stimulated healing without affecting blood glucose levels (unpublished data). Researchers found that insulin significantly decreased wound area by day 3 after injury. Insulin-induced keratinocyte migration is time- and dose-dependent, and insulin receptor-dependent and epidermal growth factor receptor (EGFR)-independent.
These results strongly suggest that insulin improves wound healing through an integrated effect not only on re-epithelialization but also on the underlying granulation tissue. Compared with other growth factors used to promote wound repair, insulin treatment is likely to be much less expensive and more readily available. When choosing a concentration of insulin for wound therapy, it is important to determine a dose that does alter blood glucose levels in vivo.
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Topical Phenytoin to Promote Wound Healing
A systematic review of fourteen randomized controlled trials provided moderate evidence to support the use of phenytoin for the treatment of leg ulcers, leprosy wounds, chronic wounds and diabetic foot ulcers.
A randomized control study in India evaluated the effect of topical phenytoin on healing in diabetic foot ulcers. One hundred patients with grade I/II diabetic foot ulcers were randomly divided into two equal groups with the study group treated with topical phenytoin dressings and the control group receiving normal saline wound dressings. Discharge and slough from wound reduced significantly by day 14 in phenytoin group and within 21 days in control group. Mean duration of hospital stay in phenytoin group was 20 days, whereas in control group, it was 26 days.
We compound topical preparations for wound healing. By prescription, based on each patient's specific needs, we can customize the preparation by adding active ingredients such as the following:
Insulin - Phenytoin - Sildenafil - Misoprostol - Mupirocin - Gentamicin - Pentoxifylline - Nifedipine - Lidocaine
We welcome your questions.
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