title: Topical steroids for chronic wounds displaying abnormal inflammation.
abstract: BACKGROUND
  Chronic, non-healing wounds are often characterised by an excessive, and detrimental, inflammatory response. We review our experience of using a combined topical steroid, antibiotic and antifungal preparation in the treatment of chronic wounds displaying abnormal and excessive inflammation.
  
  
  METHODS
  A retrospective review was undertaken of all patients being treated with a topical preparation containing a steroid (clobetasone butyrate 0.05%), antibiotic and antifungal at a tertiary wound healing centre over a ten-year period. Patients were selected as the primary treating physician felt the wounds were displaying excessive inflammation. Healing rates were calculated for before and during this treatment period for each patient. Changes in symptom burden (pain, odour and exudate levels) following topical application were also calculated.
  
  
  RESULTS
  Overall, 34 ulcers were identified from 25 individual patients (mean age: 65 years, range: 37-97 years) and 331 clinic visits were analysed, spanning a total time of 14,670 days (7,721 days 'before treatment' time, 6,949 days 'during treatment' time). Following treatment, 24 ulcers demonstrated faster rates of healing, 3 ulcers showed no significant change in healing rates and 7 were healing more slowly (p=0.0006). Treatment generally reduced the burden of pain and exudate, without affecting odour.
  
  
  CONCLUSIONS
  In normal wound healing, inflammation represents a transient but essential phase of tissue repair. In selected cases, direct application of a steroid containing agent has been shown to improve healing rates, presumably by curtailing this phase. Further evaluation is required to establish the role of preparations containing topical steroids without antimicrobials in the management of chronic wounds.
authors.affiliation: Cardiff University School of Medicine, UK. davebosanquet@hotmail.com
authors.forename: D C
authors.initials: DC
authors.lastname: Bosanquet
authors.forename: A
authors.initials: A
authors.lastname: Rangaraj
authors.forename: A J
authors.initials: AJ
authors.lastname: Richards
authors.forename: A
authors.initials: A
authors.lastname: Riddell
authors.forename: V M
authors.initials: VM
authors.lastname: Saravolac
authors.forename: K G
authors.initials: KG
authors.lastname: Harding
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D002990:Clobetasol / Q000008:administration & dosage / Q000031:analogs & derivatives; D004338:Drug Combinations; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009761:Nystatin / Q000008:administration & dosage; D009824:Ointments; D010118:Oxytetracycline / Q000008:administration & dosage; D012189:Retrospective Studies; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D004338:Drug Combinations; D005938:Glucocorticoids; D009824:Ointments; D009761:Nystatin; C010893:clobetasone butyrate; D002990:Clobetasol; D010118:Oxytetracycline