Nicole Natarelli, BA 1 , Yvonne Nong, MS 2,3,4 , Jessica Maloh, ND 2,3 , Raja Sivamani, MD, MS, AP 2,3,5,6 a
1 Morsani College of Medicine, University of South Florida, Tampa, Florida, 2 Pacific Skin Institute, Sacramento, CA, 3 Zen Dermatology, Sacramento,
CA, 4 Michigan State University College of Human Medicine, Flint, Michigan, 5 Department of Dermatology, University of California-Davis, Sacramento,
CA , 6 College of Medicine, California Northstate University, Elk Grove, CA
Keywords: hypochlorous acid, integrative dermatology, wound healing, scar management, infection, atopic dermatitis, pruritus
Relevance
Hypochlorous acid (HClO) is a weak acid and powerful oxidant traditionally used as an active ingredient in various sanitizers and disinfectants. HClO is produced endogenously from activated leukocytes, and it was first exogenously synthesized in 1834, later to be used medicinally as a wound disinfectant during World War I and II.
Objective
In this review, we aim to review the literature assessing the efficacy and safety of dermatologic uses of topical hypochlorous acid.
Methods
A PubMed search for articles with the following keywords was performed: “hypochlorous acid” AND “dermatology” OR “dermis” OR “dermal.” Forty-one reports were included in the efficacy and safety analysis.
Results
Hypochlorous acid exhibits antimicrobial properties and has been demonstrated to promote re-epithelialization in wound healing with low cytotoxicity to keratinocytes and fibroblasts. Recent work has highlighted its anti-inflammatory properties via modulation of the NF-kβ signaling pathway and downregulation of inflammatory cytokines; reports have discussed its application for the management of various inflammatory skin conditions including atopic dermatitis and psoriasis.
Conclusion
Dermatologic application of hypochlorous acid includes infection prevention, wound care and scar management, inflammatory modulation, treatment in atopic dermatitis and pruritus. Emerging research has discussed potential applications in acne vulgaris, seborrheic dermatitis, and tumor suppression.
Le´o-Paul Tricou,1–3 Marie-Lynn Al-Hawat,1 Katia Cherifi,1 Gabriela Manrique,1 Benjamin R. Freedman,4,* and Simon Matoori1,*
1Faculte´ de Pharmacie, Universite´ de Montre´al, Montre´al, Canada.
2ISPB Faculte´ de Pharmacie, Universite´ Claude Bernard Lyon 1, Lyon, France.
3Chemical Engineering Department, Polytechnique Montreal, Montre´al, Canada.
4Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Massachusetts, USA.
Significance: Chronic diabetic wounds on the lower extremities (diabetic foot ulcers, DFU) are one of the most prevalent and life-threatening complications of diabetes, responsible for significant loss of quality of life and cost to the health care system. Available pharmacologic treatments fail to achieve com plete healing in many patients. Recent studies and investigational treatments have highlighted the potential of modulating wound pH in DFU.
Recent Advances: Data from in vitro, preclinical, and clinical studies highlight the role of pH in the pathophysiology of DFU, and topical administration of pH-lowering agents have shown promise as a therapeutic strategy for diabetic wounds. In this critical review, we describe the role of pH in DFU patho-physiology and present selected low-molecular-weight and hydrogel-based pH-modulating systems for wound healing and infection control in diabetic.
Critical Issues: The molecular mechanisms leading to pH alterations in diabetic wounds are complex and may differ between in vitro models, animal models of diabetes, and the human pathophysiology. Wound pH-lowering bandages for DFU therapy must be tested in established animal models of diabetic wound healing and patients with diabetes to establish a comprehensive benefit-risk profile.
Future Directions: As our understanding of the role of pH in the pathophysiology of diabetic wounds is deepening, new treatments for this therapeutic target are being developed and will be tested in preclinical and clinical studies. These therapeutic systems will establish a target product profile for pH-lowering treatments such as an optimal pH profile for each wound healing stage. Thus, controlling wound bed pH could become a powerful tool to accelerate chronic diabetic wound healing.
Keywords: pH management, diabetic wound healing, diabetes, pH-lowering strategies, pH modulation, acidic wound dressings
原创： 十六点五 中山二院糖尿病足中心
糖尿病足的预防是各种指南中最重要的部分，无论是国内还是国外的，在各版的IWGDF指南都是重要内容，而且说明得特别详细及有比较多得循证医学的证据支持。但比较几个版本的IWGDF指南及国内外其他指南，这部分是肯定存在的，从中可以看出“糖尿病足的预防”已经深入人心。
糖尿病足实质上就是一种糖尿病人足部出现难以愈合的皮肤慢性溃疡，如何使糖尿病人足部皮肤慢性溃疡愈合是糖尿病足治疗的中心，因此，围绕足部皮肤慢性溃疡愈合是糖尿病足治疗的中心环节。
IWGDF（The International Working Group on the Diabetic Foot）是一个以欧美从事糖尿病足工作的专家为主的，有其他大洲有关专家共同组成的，目前国际上有关糖尿病足的预防、诊断、治疗、研究、管理等方面最专业的国际组织之一（基本上没有之一）。
脓腔切开，3型安尔碘纱布填塞一天之后，重新打开伤口，进行第二次清创，这次清创也是非常重要的。一般需要完成三个任务：探查创面、鉴别坏死及感染的组织、仔细清除各种需要清除的组织。
（3）要把足部被细菌侵袭的各个空隙最好都能打开，尤其是足部比较重要的“空隙”，也是为了引流充分。
糖尿病足的创面清创术是最有效的局部抗菌治疗。毛主席很早之前就教导我们：扫把不到灰尘照例不会自己跑掉，糖尿病足清创术就是治疗糖尿病足局部创面上的“灰尘”（细菌）最有效的“扫把”。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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