Oral zinc for arterial and venous leg ulcers.
BACKGROUND
Leg ulcers affect up to one percent of people at some time in their life. Leg ulceration is chronic in nature with ulcers being present for months and in some cases years without healing, and with a high risk of recurrence. Management approaches include dressings and the treatment of underlying medical problems such as malnutrition, lack of minerals and vitamins, poor blood supply or infection.


OBJECTIVE
To assess the effectiveness of oral zinc in healing arterial or venous leg ulcers.


METHODS
For this sixth update we searched The Cochrane Wounds Group Specialised Register (searched 17 May 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5); Ovid MEDLINE (2010 to May Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations May 16, 2012); Ovid EMBASE (2010 to 2012 Week 19); and EBSCO CINAHL (2010 to May 2 2012). In the original version of the review a company manufacturing zinc sulphate tablets was asked for references to relevant trials.


METHODS
Randomised controlled trials comparing oral zinc sulphate with placebo or no treatment in people with arterial or venous leg ulcers were eligible for inclusion. There were no restrictions on date or language of publication. The main outcome measure used was complete healing of the ulcers. Trials were eligible for inclusion if they measured ulcer healing objectively by documenting time to complete healing, proportion of ulcers healed during the study, or healing rates of ulcers.


METHODS
All data extraction and assessment of trial quality were done by both authors independently.


RESULTS
Six small trials (183 participants) were eligible for inclusion. Four trials considered people with venous ulcers, one trial arterial ulcers and one people with mixed ulcers. In four trials, serum zinc was measured at baseline or during the trial. Pooling the four trials that compared oral zinc sulphate with placebo in people with venous ulcers showed no statistically significant difference between the two group (RR 1.22, 95%CI 0.88 to 1.68). Overall, there was no evidence of a beneficial effect of treatment with zinc sulphate on the number of ulcers healed.


CONCLUSIONS
Oral zinc sulphate does not appear to aid healing of arterial and venous leg ulcers, however all included studies were small and of mediocre quality.
Department of Public Health, Liverpool, UK. ewan.wilkinson@liverpoolpct.nhs.uk.
Ewan A J
EA
Wilkinson
D000284:Administration, Oral; D001252:Astringents / Q000008:administration & dosage*; D006801:Humans; D007871:Leg Ulcer / Q000097:blood / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D015032:Zinc / Q000097:blood; D019287:Zinc Sulfate / Q000008:administration & dosage*
D001252:Astringents; D019287:Zinc Sulfate; D015032:Zinc