Ointments for trophic ulcers

Local treatments – ointments for trophic ulcers that occur at the site of tissue necrosis – help cleanse the affected areas of dead cells, stop inflammatory processes that develop as a result of infection, provide tissue nutrition and stimulate their restoration.

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Indications for the use of ointments for trophic ulcers

Indications for the use of ointments for trophic ulcers are purulent-necrotic inflammation of tissues in varicose veins and thrombophlebitis of the veins of the lower extremities; ischemic trophic ulcers; diabetic neurotrophic ulcers on the legs; ulcers caused by arteriovenous fistulas or lymphedema of various etiologies; trophic ulcers that occur with traumatic tissue damage (mechanical, thermal, chemical, radiation).

Doctors also prescribe ointments for trophic ulcers, which can form in patients suffering from rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, having a necrotic stage of Raynaud's syndrome or congenital granulomatous vasculitis.

Trophic ulcers are formed when the skin is damaged due to a number of infectious, metabolic and systemic pathologies, and require the use of effective means for local treatment.

Pharmacodynamics

The pharmacodynamics of Levomekol ointment is provided by its active ingredients - the bacteriostatic antibiotic chloramphenicol (levomycetin) and the leukopoiesis stimulant methyluracil. Chloramphenicol enters the bacterial cells, where it binds to the subunits of their ribosomes, disrupting the synthesis of proteins in the cells of microorganisms. And methyluracil activates metabolic processes in tissues damaged by inflammation and stimulates their restoration.

Levosin ointment consists of chloramphenicol, sulfadimethoxine, methyluracil and local anesthetic trimecaine hydrochloride. Therefore, the ointment not only kills germs when trophic ulcers are infected and relieves inflammation, but also reduces the feeling of pain. Many patients believe that this is, if not the best ointment for trophic ulcers, then at least one of the most effective.

Erythromycin ointment contains the bacteriostatic macrolide antibiotic erythromycin, which helps reduce the intensity of inflammation by preventing the proliferation of bacteria by blocking the production of proteins by their ribosomes.

The action of the ointment for trophic ulcers Streptonitol-Darnitsa and Mafenide acetate is based on the ability of the active substances of these drugs - streptocide and 4-(aminomethyl) benzenesulfonamide - to disrupt the process of biotransformation of dihydrofolic and folic acids, which are growth factors for microbial cells.

Methyluracil ointment contains methyluracil (2,4-dioxo-6-methyl-1,2,3,4-tetrahydropyrimidine), which stimulates the formation of leukocytes, and when applied externally, ointments with this substance promote cell regeneration at the site of tissue damage by normalizing the metabolism of nucleic acids and accelerating protein synthesis.

Silver ointments for trophic ulcers (Sulfargin) also belong to bactericidal and wound-healing agents - thanks to the active substance silver sulfathiazole, which affects microbes by blocking their enzyme dihydropteroate synthetase and the subsequent cessation of the production of nitrogen-containing bases necessary for protein synthesis. In addition, the bactericidal effect of the ointment is enhanced by silver ions, which have a destructive effect on negatively charged bacterial cells.

The pharmacodynamics of Solcoseryl ointment is based on the fact that the protein-purified extract of calf blood included in the preparation stimulates tissue metabolism, which promotes better nutrition and regeneration of damaged tissues and accelerates healing.

The active ingredients of Dioxycol ointment are the antimicrobial derivative of quinoxaline di-N-oxide dioxidine (it penetrates the cell membranes of microbes and irreversibly disrupts the structure of their cells), as well as the above-mentioned methyluracil and trimecaine.

The Oflokain-Darnitsa ointment contains the fluoroquinolone antibiotic ofloxacin and the local anesthetic lidocaine hydrochloride. The antibiotic disrupts the stability of bacterial DNA (which stops their reproduction and leads to death), and lidocaine prevents pain signals from passing through nerve fibers (by reducing the permeability of neuronal membranes for Na+).

Anti-inflammatory and analgesic ointment for trophic ulcers Mefenat contains as active components: anti-inflammatory and analgesic non-steroidal substance - mefenamine sodium salt and antiseptic vinylin (polyvinyl butyl ether or Shostakovsky's balm). Due to their combined action, inflammation mediators are blocked (at the cyclooxygenase level), the synthesis of endogenous interferons increases, phagocytosis of dead cells and the healing process of trophic ulcers are accelerated.

Pharmacokinetics

Referring to the local use of the ointment for trophic ulcers and minimal systemic absorption of its components, most manufacturers do not provide pharmacokinetics in the official instructions for drugs in this group.

Mefenate ointment applied to damaged skin and tissue (as well as to the scab covering the wound) is partially absorbed and is detected in the blood plasma three hours after application. In the body, the sodium salt of mefenamine is transformed into an inactive metabolite and excreted in the urine.

After applying Argosulfan ointment to trophic ulcers, a small amount of silver sulfathiazole enters the blood, is metabolized in the liver and excreted by the kidneys.

The components of Dioxicol ointment are partially absorbed, but are quickly excreted through the kidneys unchanged.

No more than 3% of the antibiotic ofloxacin included in the Oflokain-Darnitsa ointment enters the systemic bloodstream, where it circulates for about 5-6 hours and is excreted by the kidneys and intestines almost unchanged.

Names of ointments for trophic ulcers

Ointments for trophic ulcers on the legs (most often in the shin area), arising as a result of varicose veins and thrombophlebitis, as well as ointments for trophic ulcers in diabetes (in particular, in diabetic feet - local ulcers in proximal motor neuropathy and pathological changes in the blood vessels of the lower extremities), include drugs of various pharmacological groups.

Names of ointments for trophic ulcers that are most often used in clinical practice:

• wound healing ointments Levomekol and Levosin - based on the antibiotic chloramphenicol (chloramphenicol);
• erythromycin ointment;
• antimicrobial ointments with sulfonamides Streptonitol-Darnitsa, Mafenide acetate (Ambamid, Sulfamilon);
• methyluracil ointment (Methyluracil, Stizamet);
• ointments with silver Sulfargin (Argosulfan, Dermazin);
• Solcoseryl ointment for healing trophic ulcers;
• pain-relieving ointments for trophic ulcers Dioxycol (Dioxidine), Oflokain-Darnitsa, Mefenate.

Zinc oxide-containing Zinc ointment dries out weeping rashes in dermatitis or eczema by neutralizing the sulfhydryl groups of bacterial enzymes and denaturing their proteins, and in the case of trophic ulcers it is used to treat the tissues surrounding the ulcer – to prevent or stop maceration of the skin by exudate secreted from the ulcer.

Antiseptic ichthyol ointment helps relieve inflammation, pain and activate blood circulation in damaged tissues. See more - Ichthyol ointment

Vishnevsky's antibacterial ointment for trophic ulcers is now used less and less, primarily because of its fatty base, which helps to "seal" the damaged area. Although this ointment not only draws pus from wounds and ulcers on the skin, but also stimulates microcirculation in the damaged area. Read more - Vishnevsky Liniment (Vishnevsky Ointment)

If you are interested in a miracle ointment for trophic ulcers on the legs, then this is not listed in the arsenal of external medicinal products, since this ointment is a folk remedy and is prepared at home using beeswax.

Method of administration and dosage

The method of application of all ointments for trophic ulcers is external. Levomekol and Levosin ointments are supposed to be applied to sterile napkins, which are placed on the wound; the course of treatment depends on the degree of release of ulcers from pus. Levosin can also be applied directly to the affected area (up to 2-3 times a day).

Erythromycin ointment, methyluracil ointment, Streptonithol, Mafenide, Solcoseryl, Argosulfan, Mefenate ointments are applied to the affected areas 2-3 times a day with sterile dressings over the ointments. Oflokain-Darnitsa is used once a day.

Streptonitol should be used for a maximum of three weeks, Mafenide – one month, silver ointments for trophic ulcers – no more than two months.

Most manufacturers indicate in the instructions that an overdose of ointments for trophic ulcers is unlikely, or that there have been no recorded cases of exceeding the doses of these drugs.

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Contraindications for use

The indicated ointments for trophic ulcers have the following contraindications for use:

• Levomekol and Levosin - hypersensitivity to chloramphenicol;
• Streptonitol-Darnitsa - sensitivity to streptocide and nitazole, as well as significant release of purulent exudate;
• Mafenide acetate - allergy to sulfonamides and drugs containing them;
• silver ointments for trophic ulcers - hypersensitivity, congenital deficiency of the cytosolic enzyme G6PD;
• Solcoseryl ointment - individual hypersensitivity to the drug, excessive granulation in the wound that has arisen at the site of ulceration;
• Dioxycol ointment – intolerance to quinoxaline derivatives, serious adrenal pathologies;
• Oflokain-Darnitsa, Mefenate – sensitivity to drug components.

It should be noted that in almost all cases, the use of ointments for trophic ulcers during pregnancy is contraindicated due to the lack of evidence of their safety or data on the use of drugs in the treatment of pregnant women.

According to the official instructions, Solcoseryl ointment can be used during pregnancy and breastfeeding, and Mefenat is used only for strict medical indications.

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Side effects of ointments for trophic ulcers

The most common side effects of ointments for trophic ulcers are expressed in skin allergic reactions at the site of application (Levomekol, Streptonitol-Darnitsa, Solcoseryl).

Skin irritation around the wound (with redness, itching and burning) can be caused by erythromycin ointment, methyluracil ointment, Levosin ointment, silver ointments for trophic ulcers (Argosulfan, etc.). Dermatitis often develops after using Dioxycol and Oflokain ointments.

Pain at the site of application often accompanies the use of Mafenide acetate.

Interactions with other drugs

The ointments for trophic ulcers (on the legs, including in diabetes) listed in this review exhibit the following drug interactions.

Erythromycin ointment is more effective when combined with sulfonamides and tetracycline group antibiotics.

Streptonitol-Darnitsa should not be used simultaneously with oral administration of cardiotonic digitalis glycosides and drugs that stimulate vascular α-adrenergic receptors.

Methyluracil ointment is compatible with any antiseptics and antibiotics.

It is not possible to apply silver ointments and any other ointments to the same area at the same time or alternately.

Interactions with other drugs of the ointment Oflokain-Darnitsa, containing lidocaine, consist of a high probability of systemic effects with the combined use of antiarrhythmic drugs.

The simultaneous use of Mefenate ointment with salicylic acid preparations, as well as analgin, amidopyrine or butadione enhances their effect, including pain relief.

Storage conditions and shelf life

Storage conditions for Levomekol, Levosin, Streptonitol-Darnitsa, Mafenide acetate, Solcoseryl, erythromycin and methyluracil ointments - at room temperature (not exceeding +25°C);

Silver ointments for trophic ulcers should be stored in a place protected from light at a temperature of +5-10°C; Dioxycol, Oflokain-Darnitsa and Mefenat ointments – at a temperature not exceeding +15°C.

The expiration date of Levomekol, Levosin, Solcoseryl, Dioxycol, as well as erythromycin and methyluracil ointments is indicated on the packaging of each drug. The expiration date of Streptonitol-Darnitsa, Argosulfan, Oflokain-Darnitsa and Mefenat ointments is 24 months; Mafenide acetate ointment is 3 years.