Hypochlorous Acid: An Ideal Wound Care Agent With Powerful Microbicidal, Antibiofilm, and Wound Healing Potency

Serhan Sakarya, MD; Necati Gunay, MS; Meltem Karakulak, MS; Barcin Ozturk, MD; Bulent Ertugrul, MD Wounds. 2014;26(12):342-350.

Abstract and Introduction

Abstract

Introduction Chronic wounds and the infections associated with them are responsible for a considerable escalation in morbidity and the cost of health care. Infection and cellular activation and the relation between cells are 2 critical factors in wound healing.

Since chronic wounds offer ideal conditions for infection and biofilm production, good wound care strategies are critical for wound healing. Topical antiseptics in chronic wounds remain in widespread use today. These antiseptics are successful in microbial eradication, but their cytotoxcity is a controversial issue in wound healing.

Objective The aim of this study was to investigate the effect of stabilized hypochlorous acid solution (HOCl) on killing rate, biofilm formation, antimicrobial activity within biofilm against frequently isolated microorganisms and migration rate of wounded fibroblasts

and keratinocytes.

Materials and Methods. Minimal bactericidal concentration of stabilized HOCl solution for all standard microorganisms was 1/64 dilution and for clinical isolates it ranged from 1/32 to 1/64 dilutions.

Results All microorganisms were killed within 0 minutes and accurate killing time was 12 seconds. The effective dose for biofilm impairment for standard microorganisms and clinical isolates ranged from 1/32 to 1/16. Microbicidal effects within the biofilm and

antibiofilm concentration was the same for each microorganism.

Conclusion. The stabilized HOCl solution had dose-dependent favorable effects on fibroblast and keratinocyte migration

compared to povidone iodine and media alone. These features lead to a stabilized HOCl solution as an ideal wound care agent.

Introduction

Wound healing is a sequence of complex and well-orchestrated events. Although the precise mechanism of wound healing is not fully understood, 3 interrelated phases—inflammation, migration, and remodeling—require coordinated activity for successful wound healing, which is a progressive series of events facilitated by platelets, leukocytes, fibroblasts, and keratinocytes. Platelets facilitate homeostasis and the release of growth factors, then leukocytes participate in the inflammatory process. Fibroblasts and keratinocytes have a critical role in wound healing by enhancing reepithelization and the remodeling of the extracellular matrix (ECM).[1–3] Most chronic wounds are related to diabetes mellitus, venous stasis, peripheral vascular diseases, and pressure ulcerations. An open wound is a favorable niche for bacterial colonization and infection. Infection in chronic wounds starts with contamination, then colonization and critical colonization take place before an infection forms. Biofilm formation is now recognized as a serious problem in chronic wound infections.[4] Biofilm is a complex structure of microorganisms that generate a protective shell, allowing bacteria to collect and proliferate.[5] Most of the microorganisms that form biofilms can also be found growing in microbial infections. The same species of bacteria have significant differences in existence that range either free floating and living within the biofilm. The biofilm structure of microorganisms renders phagocytosis difficult,[6] increases resistance to antibiotics,[7] and adheres to unfavorable niches such as chronic wounds.[8] One of the remarkable features of the immune system against invading pathogens is its ability to generate an effective and rapid response by developing a group of highly reactive chemicals, such as reactive oxygen species (ROS). The mitochondrial membrane-bound enzyme nicotinamide adenine dinucleotide phosphate-oxidase (NADPH) is a primary enzyme responsible for ROS production.[9] During the activation of neutrophils, respiratory bursts generate hydrogen peroxide (H2O2) and the activated granule enzyme myeloperoxidase converts H2O2 to hypochlorous acid (HOCl) in the presence of Cl- and H+.[10] Hypochlorous acid leads to cell death by the oxidation of sulfhydryl enzymes and amino acids, ring chlorination of amino acids, loss of intracellular contents, decreased uptake of nutrients, inhibition of protein synthesis, decreased oxygen uptake, oxidation of respiratory components, decreased adenosine triphosphate production, breaks in DNA, and depressed DNA synthesis.[11–15] Hypochlorous acid is highly active against all bacterial, viral, and fungal human pathogens[16] and a small amount of HOCl can kill spore-forming and non-spore bacteria in a short time period.[17,18] Since most of the etiologic factors in chronic wound infections are forming biofilm,[19] and most of the topical antiseptics impair wound healing with their cytotoxic effect, therapeutic strategies against biofilm with high microbial eradication and good wound healing effects will decrease the morbidity and mortality rates of patients and reduce the economic burden. The aim of this study was to investigate the effect of stabilized HOCl solution on microbial and biofilm eradication, antimicrobial activity within biofilm against frequently isolated microorganisms, and migration rate of wounded fibroblasts and keratinocytes.

Rapid, high level inactivation of infectious HPV16 and HPV18 using hypochlorous acid (HOCl)

Craig Meyers¹, Janice Milici¹, Lori Robins², Luis Contreras², Jeffrey Williams³, Richard Robison4 ¹Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA; ²Physical Science Division, School of STEM, University of Washington Bothell, Bothell, Washington 98011, USA; ³Briotech Inc., Woodinville, Washington 98072, USA; 4Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah 84602, USA

Effect of Transcutaneous Application of Carbon Dioxide on Wound Healing, Wound Recurrence Rate and Diabetic Polyneuropathy in Patients with Neuropathic, Ischemic and Neuroischemic Diabetes-Related Foot Ulcers

Tomislav Bulum ^1,2,* , Tamara Poljiˇcanin ³ , Anica Badanjak ⁴ , Jelena Držiˇc ⁴ and Željko Metelko ⁴

1 Clinical Hospital Merkur, University Clinic for Diabetes, Endocrinology, and Metabolic Diseases Vuk Vrhovac, Dugi dol 4a, 10000 Zagreb, Croatia

2 School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia

3 Zagreb County Health Center, Ljudevita Gaja 37, 10430 Samobor, Croatia

4 Polyclinic for Physical Medicine and Rehabilitation with Physical Therapy, Vascular Surgery, Neurology, Endocrinology, and Diabetology, Kalinovica 3, 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。

Abstract: (1) Background: Diabetes-related foot ulcers (DFUs) are a severe complication of diabetes mellitus (DM), with a five-year mortality rate of around 40%. Our study aimed to explore the effects of transcutaneous application of carbon dioxide (CO2 therapy) on DFU healing and recurrence rate, as well as diabetic polyneuropathy. (2) Methods: Adults with at least one chronic DFU were invited to undergo 20 50-min-long CO2 therapies within 4 weeks. After the completion of the last CO2 therapy, the effect of the therapies on wound healing and diabetic polyneuropathy was assessed, and 1 year later, we evaluated the incidence rate of DFU recurrence. (3) Results: Thirty-five subjects with DM and forty DFUs (ischemic: 15, neuropathic: 8, neuroischemic: 17) participated in our trial. After 4 weeks, 67.5% of all DFUs healed, whereas the reduction of the surface area of the unhealed wounds (74.0% ± 22.3%) was statistically significant. The restoration of protective sensations was also statistically significant. All unhealed wounds received standard care and healed within 2 additional weeks. The recurrence rate after 1 year was 17.5%. None of the patients required antibiotic treatment, hospitalization, or amputation. (4) Conclusion: CO2 therapy is a promising therapeutic intervention for treating DFUs and improving diabetic polyneuropathy.

Keywords: diabetic foot; diabetes-related foot ulcer; CO2 therapy; transcutaneous CO2 application; wound healing; distal symmetrical polyneuropathy; loss of protective sensation

Hypochlorous Acid: An Ideal Wound Care Agent With Powerful Microbicidal, Antibiofilm, and Wound Healing Potency

Serhan Sakarya, MD¹ ; Necati Gunay, MS² ; Meltem Karakulak, MS³ ; Barcin Ozturk, MD¹ ; Bulent Ertugrul, MD¹

Abstract: Introduction. Chronic wounds and the infections associated with them are responsible for a considerable escalation in morbidity and the cost of health care. Infection and cellular activation and the relation between cells are 2 critical factors in wound healing. Since chronic wounds offer ideal conditions for infection and biofilm production, good wound care strategies are critical for wound healing. Topical antiseptics in chronic wounds remain in widespread use today. These antiseptics are successful in microbial eradication, but their cytotoxcity is a controversial issue in wound healing. Objective. The aim of this study was to investigate the effect of stabilized hypochlorous acid solution (HOCl) on killing rate, biofilm formation, antimicrobial activity within biofilm against frequently isolated microorganisms and migration rate of wounded fibroblasts and keratinocytes. Materials and Methods. Minimal bactericidal concentration of stabilized HOCl solution for all standard microorganisms was 1/64 dilution and for clinical isolates it ranged from 1/32 to 1/64 dilutions Results. All microorganisms were killed within 0 minutes and accurate killing time was 12 seconds. The effective dose for biofilm impairment for standard microorganisms and clinical isolates ranged from 1/32 to 1/16. Microbicidal effects within the biofilm and antibiofilm concentration was the same for each microorganism. Conclusion. The stabilized HOCl solution had dose-dependent favorable effects on fibroblast and keratinocyte migration compared to povidone iodine and media alone. These features lead to a stabilized HOCl solution as an ideal wound care agent.

Key words: hypochlorous acid, biofilm, wound healing, fibroblast, keratinocyte

Sodium Hypochlorite 0.005% Versus Placebo in the Treatment of Mild to Moderate Acne: A Double-Blind Randomized Controlled Trial

Azadeh Dorostkar¹ , Mehdi Ghahartars¹ , Mohammadreza Namazi¹ , Nafiseh Todarbary² , Maryam Hadibarhaghtalab¹ , Maryam Rezaee¹

1 Dermatology Department, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

Key words: topical, sodium hypochlorite, acne vulgaris, treatment

Citation: Dorostkar A, Ghahartars M, Namazi M, Todarbary N, Hadibarhaghtalab M, Rezaee M. Sodium hypochlorite 0.005%

versus placebo in the treatment of mild to moderate acne: a double-blind randomized controlled trial. Dermatol Pract Concept.

2021;11(3):e2021046. DOI: https://doi.org/10.5826/dpc.1103a46

Accepted: December 9, 2020; Published: May 20, 2021

Copyright: ©2021 Dorostkar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License

BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors

and source are credited.

Competing interests: The authors have no conflicts of interest to declare.

Funding: None

Corresponding author: Maryam Hadibarhaghtalab, Department of Dermatology, Faghihi Hospital, Zand Street, Shiraz, Iran.

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。

ABSTRACT  

Background: Acne vulgaris is a common inflammatory disease of the pilosebaceous follicle that affects many teenagers and young people. There is an obvious need for topical treatments with good tolerability and efficacy for the management of acne lesions.

Objective: This study determined the therapeutic efficacy of topical sodium hypochlorite solution (0.005%) in the treatment of mild to moderate acne lesions.

Methods: This placebo-controlled randomized controlled trial compared 0.005% sodium hypochlorite to placebo administered topically on each side of the patients’ faces 3 times a day for 1 month. The numbers of papules and pustules were recorded at baseline, 1, 2 and 4 weeks after initiation.

Results: The total number of papules and pustules decreased after topical application of sodium hypochlorite 0.005% for 1 month.

Conclusions: Topical sodium hypochlorite solution (0.005%) can be effective in the treatment of mild to moderate acne, and its clinical efficacy was evaluated between the male and female groups and between the hormonal and non-hormonal ones.

Trial registration: Our study was registered in the Iranian Registry of Clinical Trials (IRCT) with the code number IRCT20200701047976N1.

Micropore drainage to prevent hematoma in axillary bromhidrosis A comparative study

Jiao-Jiao Yang, MBBS^a , Jie-Ling Bai, MBBS^a , Shuai Qiang, PhD^b, Yong Ma, MBBS^c, *

Abstract

Axillary bromhidrosis is characterized by malodor stemming from hyperplastic and hypertrophic apocrine sweat glands. Although surgical excision remains the most definitive treatment, postoperative complications—particularly hematoma—can compromise outcomes and patient satisfaction. This study evaluated the effectiveness of a micropore drainage technique in reducing hematoma and improving overall results. This retrospective comparative study analyzed data from medical records of 73 patients diagnosed with axillary bromhidrosis who underwent surgical treatment at the 3201 Hospital in Hanzhong, China, from January 2020 to January 2024. Patients had initially been randomized into either the experimental group (group A, n = 38), which received micropore drainage combined with subdermal undermining via a miniature incision, or the control group (group B, n = 35), treated by subdermal undermining alone. Inclusion and exclusion criteria were strictly followed during retrospective selection. Outcomes, evaluated by blinded assessors, included malodor elimination, Dermatology Life Quality Index (DLQI) scores, hair growth reduction, scar formation, postoperative complications, and patient satisfaction. Both groups achieved significant improvements in malodor control and DLQI scores. Notably, the hematoma rate was 0% in Group A compared to 11.43% in Group B (P = .02). Group A also demonstrated higher patient satisfaction (81.58% vs 51.43%, P = .01). There were no significant differences between the groups in operative time, scar formation, DLQI improvement, or hair growth reduction. Incorporating micropore drainage into surgical management of axillary bromhidrosis effectively reduces postoperative hematoma and enhances patient satisfaction without increasing operative complexity or compromising apocrine gland removal. This technique shows promise as a safer, more reliable option for axillary bromhidrosis treatment, warranting further validation through larger multicenter studies and longer-term follow-up.

Abbreviations: AB = axillary bromhidrosis, DLQI = Dermatology Life Quality Index.

Keywords: apocrine glands, axillary bromhidrosis, Dermatology Life Quality Index, hematoma, micropore drainage, seroma, surgical treatment