Mechanisms of delayed wound healing by commonly used antiseptics.
BACKGROUND
The cytotoxic effects of antiseptics on pivotal cell types of the healing process have been well documented. The purpose of our investigation was to explore the ability of subcytotoxic levels of antiseptics to interfere with fibroblast function.


METHODS
Cell proliferation assays were performed by culturing fibroblasts in the presence of commonly used antiseptics. Migration was evaluated using scratch assays in which monolayers were "wounded" and cellular movement was monitored by digital photography. Matrix metalloproteinase (MMP) release was analyzed by zymography.


RESULTS
H2O2 and povidone-iodine reduced both migration and proliferation of fibroblasts in a dose-dependent fashion. Treatment with silver-containing antiseptics and chlorhexidine exhibited reductions in proliferation at high concentrations, but enhanced growth at lower doses. Silver-containing compounds and chlorhexidine also proved to be the least detrimental to migration in these assays. metalloproteinase release from the cells was differently affected depending on the dosage and class of antiseptic applied.


CONCLUSIONS
When debridement of the wound bed is not sufficient to reduce bacterial loads, the application of broad-spectrum antiseptics maybe indicated. Our data would suggest that H2O2 and iodine are poor choices, potentially retarding the contribution of fibroblasts to the healing process. Silver sulfadiazine and chlorhexidine, at levels still proven to be bactericidal, had fewer detrimental effects on fibroblast activity in these assays. The silver-containing antiseptics may even increase the proliferative potential of these cells in culture.
Thomas
Gregory W
GW
Trauma Research Department, HealthONE Swedish Medical Center, Englewood, Colorado 80113, USA.
Rael
Leonard T
LT
Bar-Or
Raphael
R
Shimonkevitz
Richard
R
Mains
Charles W
CW
Slone
Denetta Sue
DS
Craun
Michael L
ML
Bar-Or
David
D
D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002465:Cell Movement / Q000187:drug effects; D049109:Cell Proliferation / Q000187:drug effects; D002710:Chlorhexidine / Q000494:pharmacology; D005347:Fibroblasts / Q000187:drug effects; D006801:Humans; D006861:Hydrogen Peroxide / Q000494:pharmacology; D020781:Matrix Metalloproteinase 1 / Q000378:metabolism; D011206:Povidone-Iodine / Q000494:pharmacology; D012837:Silver Sulfadiazine / Q000494:pharmacology; D014945:Wound Healing / Q000187:drug effects*
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D006861:Hydrogen Peroxide; D020781:Matrix Metalloproteinase 1; D002710:Chlorhexidine; D012837:Silver Sulfadiazine