Related Items: Bedsores, Decubitus Ulcer, Leg Ulcer, Pressure
Ulcer, Venous Ulcer
Skin Ulcers Information
Skin ulcers are open sores that are often accompanied by the sloughing-off of inflamed
tissue.
Skin ulcers can be caused by a variety of events, such as trauma, exposure to heat or cold,
problems with blood circulation, or irritation from exposure to corrosive material. Pressure
ulcers, also known as decubitus ulcers or bedsores, are skin ulcers that develop on areas of
the body where the blood supply has been reduced because of prolonged pressure; these may
occur in people confined to bed or a chair, or in those who must wear a hard brace or plaster
cast. Skin ulcers may become infected, with serious health consequences. Other health
conditions that can cause skin ulcers include mouth ulcers (canker sores), chronic venous insufficiency, diabetes,
infection, and peripheral vascular
disease.
What are the symptoms of skin ulcers?
People with a skin ulcer may have an area of reddened skin. In advanced cases, people may
have areas where the skin is open and oozing fluid.
Medical treatments for skin ulcers
Over the counter topical antibiotics, such as neosporin (Myciguent®), bacitracin
(Baciguent®), and combinations of the two with polymyxin B (Neosporin®,
Polysporin®), are used to treat skin infections.
Prescription strength topical antibiotics,
such as metronidazole (MetroGel®) and mupirocin (Bactroban®), might be necessary
to treat infection.
Healthcare providers recommend shifting position at least every two hours to avoid
sustained pressure on the same area of the body. Some people might benefit from special
mattresses or supports. For skin ulcers in general, wound dressings need to be changed
frequently. Severe cases might require surgery to remove diseased tissue and to repair the
wound.
Dietary changes that may be helpful for skin ulcers
Dietary deficiencies may hinder the body’s ability to heal pressure ulcers. A
controlled study of 28 malnourished nursing home patients with skin ulcers found that ulcer
healing was significantly enhanced by a high-protein diet (24% protein) compared with a lower
protein (14%) diet.1 A controlled study of critically ill older patients found that
increasing calorie and protein intake with dietary supplements for 15 days reduced the risk of
developing a skin ulcer.2
Nutritional supplements that may be helpful for skin ulcers
Antioxidants such as vitamin C, vitamin E, and glutathione are depleted in healing skin
tissue.3 One animal study found that vitamin E (alpha-tocopherol) applied to the
skin shortened the healing time of skin ulcers.4 Another animal study reported that
administration of oral vitamin E before skin lesions were introduced into the skin prevented
some of the tissue damage associated with the development of pressure ulcers.5 A
controlled human trial found that 400 IU of vitamin E daily improved the results of skin graft
surgery for chronic venous ulcers.6 No further research has investigated the
potential benefit of vitamin E for skin ulcers.
Animal research has suggested that vitamin C may help prevent skin ulcers,7 and
in a preliminary study,8 elderly patients with pressure ulcers had lower blood
levels of vitamin C than did ulcer-free patients. Supplementation with vitamin C (3 grams per
day) increased the speed of healing of leg ulcers in patients with a blood disorder called thalassemia, according to a double-blind
study.9 And while a double-blind trial of surgical patients with pressure ulcers
found that supplementation with 500 mg of vitamin C twice a day accelerated ulcer
healing,10 a similar double-blind trial found no difference in the effectiveness of
either 20 mg per day or 1,000 mg per day of vitamin C.11
An older preliminary report suggested that large amounts of folic acid given both orally and by injection could
promote healing of chronic skin ulcers due to poor circulation.12 No controlled
research has further investigated this claim.
Zinc plays an important role in tissue
growth processes important for skin ulcer healing. One study reported that patients with
pressure ulcers had lower blood levels of zinc and iron than did patients without pressure
ulcers,13 and preliminary reports suggested zinc supplements could help some types
of skin ulcer.14 Supplementation with 150 mg of zinc per day improved healing in a
preliminary study of elderly patients suffering from chronic leg ulcers.15
Double-blind trials using 135 to 150 mg of zinc daily have shown improvement16 only
in patients with low blood zinc levels,17 and no improvement in leg ulcer
healing.18 19 A double-blind trial of 150 mg zinc per day in people with
skin ulcers due to sickle cell anemia found that the healing rate was almost three times
faster in the zinc group than in the placebo group after six months.20 Lastly, a
preliminary study of patients with skin ulcers due to leprosy found that 50 mg of zinc per day
in addition to anti-leprosy medication resulted in complete healing in most patients within 6
to 12 weeks.21 Long-term zinc supplementation at these levels should be accompanied
by supplements of copper and perhaps calcium, iron, and magnesium. Large amounts of zinc (over
50 mg per day) should only be taken under the supervision of a doctor.
Topically applied zinc using zinc-containing bandages has improved healing of leg ulcers in
double-blind studies of both zinc-deficient22 and elderly individuals.23
Most controlled comparison studies have reported that these bandages are no more effective
than other bandages used in the conventional treatment of skin ulcers
Herbs that may be helpful for skin ulcers
Gotu kola (Centella asiatica)
extracts are sometimes used topically to help speed wound healing. Test tube studies have
found that extracts of gotu kola high in the active triterpene constituents asiaticosides,
madecassoides, asiatic acids, and madecassic acids increase collagen synthesis.36
37 An animal study found that topical application of asiaticoside isolated from
gotu kola, used in a 0.2% solution, improved healing in nonulcer skin wounds.38 An
overview of three small human clinical trials suggests that topical use of an ointment or
powder containing a gotu kola extract high in the active triterpene compounds may speed wound
healing in people with slow-healing skin ulcers.39 These studies used either a
topical ointment with a 1% extract concentration or a powder with a 2% extract concentration.
People in these studies were typically treated with intramuscular injections of either
isolated asiaticosides or the mixed triterpenes three times per week while using the topical
ointment or powder.
Aloe vera has been used
historically to improve wound healing and contains several constituents that may be important
for this effect. A group of three patients who had chronic skin ulcerations for 5, 7, and 15
years, respectively, had a rapid reduction in ulcer size after the application of aloe gel on
gauze bandages to the ulcers, according to a preliminary report.40 A controlled
study found most patients with pressure ulcers had complete healing after applying an aloe
hydrogel dressing to the ulcers every day for ten weeks.41 However, this result was
not significantly better than that achieved with a moist saline gauze dressing. The amorphous
hydrogel dressing used in the above study and derived from the aloe plant (Carrasyn Gel Wound
Dressing, Carrington Laboratories, Irving, TX) is approved by the U.S. Food and Drug
Administration for the management of mild to moderate skin ulcers.
Are there any side effects or interactions with Skin Ulcers?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful for skin ulcers
A double-blind trial found systemic hyperbaric
oxygen (HBO) treatments, in which the patient is placed in a chamber with highly
concentrated oxygen, five days per week for six weeks significantly improved healing of
nondiabetic chronic leg ulcers.42 This trial confirms the results from several
preliminary studies of systemic HBO therapy.43 44 While topical
application of HBO (the affected body part is encased in a balloon-like chamber and exposed to
concentrated oxygen) for skin ulcers has been reported effective in preliminary
trials,45 controlled trials have produced conflicting results.46
47 In controlled studies of diabetic patients with skin ulcers or gangrene, systemic HBO
has been shown to prevent amputation of affected limbs.48 49
Electrical stimulation applied to the skin is thought to have several biological effects
that might accelerate skin ulcer healing.50 A variety of techniques have been
investigated, and controlled or double-blind trials have shown positive results for the use of
low-voltage galvanic current, high-voltage pulsed current, transcutaneous electrical nerve
stimulation (TENS), and pulsed high-frequency electromagnetic therapy.51
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The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in
vitro), clinical experience, or traditional usage as cited in each article.
The results reported may not necessarily occur in all individuals. For many of
the conditions discussed, treatment with prescription or over the counter
medication is also available. Consult your doctor, practitioner, and/or
pharmacist for any health problem and before using any supplements or before
making any changes in prescribed medications.
References:
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