Hypochlorous Acid for Wound Healing in Diabetic Rats: Effect on MMP-9 and Histology

Dita Mutiara Irawan ¹, Ronny Lesmana^2–4 , Edhyana Sahiratmadja ⁴

¹Graduate School of Master Program in Anti Aging and Aesthetic Medicine, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, 45363, Indonesia; ²Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, 45363, Indonesia; ³ Division of Biological Activity, Central Laboratory, Universitas Padjadjaran, Sumedang, 45363, Indonesia; ⁴ Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Sumedang, 45363, Indonesia

Correspondence: Dita Mutiara Irawan, Email 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Background: People who suffered type 2 diabetes have impaired healing of wounds due to the large number of circulating inflammatory cells resulting from high blood sugar levels. The wound healing process involves various complex processes including the degradation of extracellular matrix, a process characterized by an increase in matrix metalloproteinase-9 (MMP-9). Conventional management of diabetic wounds usually involves systemic blood sugar control and topical antimicrobial treatment, including hydrogen peroxide and povidone-iodine, which are known to be cytotoxic to the cells involved in the wound healing cascade. Finding a safe, non-toxic, and effecting wound cleansing still poses a challenge, and hypochlorous acid (HOCl) could act as a potential candidate.

Purpose: Unveiling an HOCl ion as an agent for diabetic wound management and MMP-9 as a marker for delayed diabetic wound

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram is used to find and select related, eligible literatures for the review. The authors used several databases such as Pro Quest, Scopus, Springer link an Science Direct. In addition, and to expand the data, the database on Google Scholar was also opened. Then, the compiled data are analyzed to form results and discussions to the research question.

Results: Five eligible articles passed the inclusion criteria and reviewed for data synthesis. From 5 pieces of literature, it was found that the use of HOCl ions can be a good choice of topical agent in the management of diabetic wounds and decrease the activity of MMP-9, which act as a marker for delayed healing of diabetic wounds.

Conclusion: Topical agent, in this case HOCl ion, shows good results and can be used as an option in the management of diabetic wounds and MMP-9 can be used as a predictive marker in the management of diabetic wounds.

Keywords: diabetic wound, HOCl ion, hypochlorite acid, MMP-9, wound healing

Topical Hypochlorous Acid (HOCl) as a Potential Treatment of Pruritus

Robert Y. Pelgrift & Adam J. Friedman

芍绮迎来首席诗人：从此，草木有诗，护肤有词

一个护肤品牌，为什么要请一位诗人？

这是我们被问得最多的问题，也是今天最想回答的问题。

芍绮的答案：东方女性的美，一半在草木，一半在诗书

芍绮相信，中国女子的美，从来不只在皮相。

晨起对镜，一盏草木精华，是善待自己；夜深人静，一行小诗入怀，是安顿自己。前者养身，后者养心——千百年来，中国女人爱惜自己的方式，从来都是这两件事。

所以，芍绮不仅要做好草木护肤这一半，也想认真陪伴另一半。

今天，我们荣幸地宣布：简书诗词伯乐、九洲诗词主编纳兰蕙若女士，正式出任芍绮首席诗人。

纳兰蕙若以芍药为约

她是谁：一位把诗过成日子的人

纳兰蕙若女士，简书诗词伯乐，九洲诗词主编，在简书笔耕多年，写下四十七万字，收获十六万赞、过万诗友追随。

她长期主持九洲诗词接龙大赛、文字家园诗歌文化节，是诗友心中「蕙心一片寻禅道，若梦浮生只赋诗」的引路人。她出题，千百人唱和；她点评，新人由此被看见；她发奖金的那个晚上，整个诗友圈像过年。

她的签名是：「花半开最美，情留白最浓。」——这也是芍绮想和你一起过日子的方式。

花半开最美，情留白最浓。

她带来了什么：芍绮诗友会，即日成立

签约之日，纳兰蕙若女士带给芍绮的第一份心意，就是发起芍绮诗友会——一个属于所有爱诗之人的家园：

月度接龙大赛：每月一期，先生亲题首句，诗友依韵唱和；

节气诗历：二十四节气，写诗、读诗、把诗印在芍绮的海报上；

年度诗歌盛典：一年一届「芍绮杯」七夕颁奖盛典，佳作结集成《芍绮诗友会年鉴》，署名传世。

无论你是能写格律的老手，还是只爱读诗的新朋友，这里都有你的位置。

开场盛事：首届「芍绮杯」诗词大赛

诗友会开张大吉，纳兰蕙若女士亲题《鹧鸪天·芍药》一阕开擂：

五月庭前著绮纱，沉香亭北旧人家。

不随桃李争春早，独抱温柔向晚斜。

风细细，露些些，一簪红雪压鬓鸦。

从今约取东君笔，写尽人间静好花。

纳兰蕙若主持“芍绮杯”诗词大赛

赛事速览：

主赛道「芍绮杯」接龙大赛：依纳兰蕙若女士题句接龙，夺芍绮大奖——奖金 3,000 元 + 四季产品礼盒（春夏秋冬每季一套，共四套，合计价值约2,000元）+ 先生亲题赠诗；

参与赛道「草木有约」同题诗：写东方草木与女子之美，自由命题，佳作将登上芍绮节气海报；

投稿方式：简书「芍绮诗友会」专题投稿，或发送至赛事邮箱该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。，每人每赛道限投 2 首；

截稿时间：2026年11月1日开擂起四周；颁奖将以线上诗会形式举行，由先生主持、亲手发奖。

纳兰蕙若女士已在简书写下《我以芍药为约——致天下诗友》，亲述她与芍药、与诗、与芍绮的缘分，欢迎移步共读。

写在最后

草木有本心，诗词有知己。

从今天起，芍绮的每一瓶草木精华里，都住着一句诗；每一位爱诗的你，都是芍绮最想珍惜的人。

我以芍药为约，君赴否？

                                                           芍绮　敬上

Hypochlorous Acid: Clinical Insights and Experience in Dermatology, Surgery, Dentistry, Ophthalmology, Rhinology, and Other Specialties

Vanda Haralovi´c ¹ , Mislav Mokos ¹ , Sanja Špoljar ¹ , Lorena Dolaˇcki ² , Mirna Šitum ^1,2 and Liborija Lugovi´c-Mihi´c ^1,2,*

¹Department of Dermatovenereology, University Hospital Center Sestre Milosrdnice, Vinogradska cesta 29, 10000 Zagreb, Croatia; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (V.H.)

²School of Dental Medicine, University of Zagreb, Gunduli´ceva 5, 10000 Zagreb, Croatia

*Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。; Tel.:+385-(01)-3787-111

Abstract

Background: Hypochlorous acid (HOCl) is an integral component of the human innate immune system. It possesses antimicrobial properties and is available in solution, dermal spray, and scar gel forms. Objectives/Methods: This review presents data from studies on the clinical use of HOCl in various specialties, including der-matology, surgery, dentistry, ophthalmology, and rhinology. Results: Due to its antiinflammatory/antimicrobial/immunomodulatory and healing properties, HOCl is advantageous in treating various skin disorders: ulcus cruris (and wound care), diabetic ulcers, atopic dermatitis, seborrheic dermatitis, pruritus, acne vulgaris, etc. Also, the application of a HOCl spray/gel after surgical procedures may prevent infection, reduce inflammation, and accelerate healing. HOCl is also effective and safe for the prevention and treatment of hypertrophic and keloid scars. Growing evidence shows a broader role for HOCl in limiting cancer cell survival and slowing tumor growth. It is also important in treating various viral infections like SARS-CoV-2 (coronavirus), influenza, and herpes, thereby helping to prevent the spread of aerosols. In addition, since HOCl is an endogenous compound naturally present in mammals with a high safety profile, it may be an effective bacterial disinfectant in dental waterlines. In ophthalmology, adjuvant treatment with HOCl ophthalmic spray can reduce the duration of antibiotic/corticosteroid use, even in severe blepharitis. To fully harness the protective/therapeutic properties of HOCl, future advancements will rely on the development of new chemical compounds and sophisticated pharmaceutical formulations.Conclusions: The majority of clinical studies have confirmed that HOC1 is useful in therapy, although the results are not entirely consistent. Further research is essential to optimize HOCl dosing and to develop controlled-release systems aimed at maximizing its anti-inflammatory and photoprotective effects while minimizing tissue irritation and damage.

Keywords: topical treatment; antimicrobial therapy; anti-inflammatory drugs; immunomodulator; healing; ulcer; atopic dermatitis; surgical procedures; postoperative care; disinfectant

An Acid-Oxidising Solution Containing Hypochlorous Acid Reduces Staphylococcus aureus and Improves Bacterial Diversity in Epidermolysis Bullosa Wounds

Xiaolong A. Zhou¹ | Michael B. Burns² | Ziyou Ren¹ | Elise Stagaman² | Stefan J. Green³ | Lok Yiu Ashley Wu³ | Lynna Yang¹ | Stephanie Rangel¹ | Lydia Rabbaa1 | Amy S. Paller¹

¹Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA | ²Department of Biology, Loyola University Chicago, Chicago, Illinois, USA | ³Genomics and Microbiome Core Facility, Rush University Medical Center, Chicago, Illinois, USA

Correspondence: Amy S. Paller (该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)

Received: 6 February 2025 | Revised: 6 June 2025 | Accepted: 3 August 2025

Funding: This work was supported by Applied Pharma Research.

Keywords: acid-oxidising solution | epidermolysis bullosa | hypochlorous acid | microbiome | Staphylococcus aureus | wounds

ABSTRACT

Epidermolysis bullosa (EB) is a group of rare genetic skin disorders characterised by skin fragility and chronic, painful wounds that are highly susceptible to bacterial infection, particularly by Staphylococcus aureus (SA). This study evaluated the efficacy of an acid-oxidising solution containing hypochlorous acid (HOCl) in reducing SA colonisation, promoting wound healing, and restoring a healthier microbiome in EB wounds. In a 12-week open-label pilot study, 15EB patients applied the HOCl-based spray (APR-TD011) daily to chronic wounds for 8weeks, with full-length 16S rRNA sequencing of wound swabs performed before, during, and after treatment. At baseline, 87% of patients were culture-positive for SA, and sequencing revealed that SA had the highest relative abundance (34%), followed by Acinetobacter guillouiae and Pseudomonas poae. SA relative abundance decreased precipitously by Weeks 4 (to 11%) and 8 (primary endpoint; to 10%, p<0.01), and this effect persisted at 4weeks post-treatment (Week 12; to 9.7%), including for methicillin-resistant SA. Concurrently, bacterial diversity increased, and wound sizes dimin ished in correlation with reduced SA levels (r=0.64). Younger patients exhibited greater SA reduction trends. The treatment was well-tolerated, with minimal adverse effects and high patient satisfaction. This study underscores the role of microbial dysbiosis in EB wounds and highlights HOCl-based solutions as a promising therapy to mitigate pathogenic burden and enhance wound.

Topical hypochlorite ameliorates NF-κB–mediated skin diseases in mice

Thomas H. Leung,^1,2 Lillian F. Zhang,¹ Jing Wang,¹ Shoucheng Ning,³ Susan J. Knox,³ and Seung K. Kim^1,4,5

¹Department of Developmental Biology, ²Department of Dermatology, ³Department of Radiation Oncology, ⁴Howard Hughes Medical Institute, and ⁵Department of Medicine, Oncology Division, Stanford University School of Medicine, Stanford, California, USA.

Nuclear factor-κB (NF-κB) regulates cellular responses to inflammation and aging, and alterations in NF-κB signaling underlie the pathogenesis of multiple human diseases. Effective clinical therapeutics targeting this pathway remain unavailable. In primary human keratinocytes, we found that hypochlorite (HOCl) reversibly inhibited the expression of CCL2 and SOD2, two NF-κB–dependent genes. In cultured cells, HOCl inhibited the activity of inhibitor of NF-κB kinase (IKK), a key regulator of NF-κB activation, by oxidizing cysteine residues Cys114 and Cys115. In NF-κB reporter mice, topical HOCl reduced LPS-induced NF-κB signaling in skin. We further evaluated topical HOCl use in two mouse models of NF-κB–driven epidermal disease. For mice with acute radiation dermatitis, topical HOCl inhibited the expression of NF-κB–dependent genes, decreased disease severity, and prevented skin ulceration. In aged mice, topical HOCl attenuated age-dependent production of p16INK4a and expression of the DNA repair gene Rad50. Additionally, skin of aged HOCl-treated mice acquired enhanced epidermal thickness and proliferation, comparable to skin in juvenile animals. These data suggest that topical HOCl reduces NF-κB–mediated epidermal pathology in radiation dermatitis and skin aging through IKK modulation and motivate the exploration of HOCl use for clinical aims.