Ointments with trophic ulcers

Means for topical treatment - ointments with trophic ulcers that arise on the site of tissue necrosis - help to clean the affected areas from dead cells, stop the inflammatory processes that result from infection, provide tissue nutrition and stimulate their recovery.

[1], [2], [3], [4], [5], [6]

Indications for use of ointments for trophic ulcers

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

Also, doctors prescribe ointments for trophic ulcers, which can be formed in patients suffering from rheumatoid polyarthritis, systemic lupus erythematosus, systemic scleroderma having necrotic stage of Raynaud's syndrome or congenital granulomatous vasculitis.

Trophic ulcers are caused by skin lesions associated with a variety of pathologies of an infectious, metabolic and systemic nature, and require the use of effective means for local treatment.

Pharmacodynamics

Pharmacodynamics of Levomecol ointments is provided by its active ingredients - bacteriostatic antibiotic chloramphenicol (levomycetin) and leukopoiesis stimulant methyluracil. Chloramphenicol enters bacteria cells, where it binds to the subunits of their ribosomes, disrupting the synthesis of proteins in the cells of microorganisms. A methyluracil activates metabolic processes in inflammation-damaged tissues and stimulates their recovery.

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

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

The effect of ointment on trophic ulcers Streptonitol-Darnitsa and Mafenide acetate is based on the ability of the active substances of these drugs - streptocid and 4- (aminomethyl) benzenesulfonamide - to disrupt the 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 with external application of an ointment with this substance promotes cell regeneration at the site of tissue damage due to the normalization of metabolism nucleic acids and the acceleration of protein synthesis.

Ointments with silver for trophic ulcers (Sulfargin) also belong to bactericidal and wound healing agents - due to the active substance sulfatiazol silver, which acts on the microbes by blocking their enzyme dihydropteroate synthetase and the subsequent termination of the production of nitrogen-containing bases necessary for the synthesis of proteins. In addition, the bactericidal action of the ointment is enhanced by silver ions, which disastrously act on negatively charged bacterial cells.

Pharmacodynamics ointment Solkoseril is based on the fact that the extract of calf blood extracted from the protein stimulates tissue metabolism, which contributes to better nutrition and regeneration of damaged tissues and accelerates healing.

Active substances of the Dioxoxol Ointment are the antimicrobial derivative of the di-N-oxide of quinoxaline Dioxidine (it penetrates the cell membranes of microbes and irreversibly breaks the structure of their cells), as well as the already mentioned methyluracil and trimecaine.

In the ointment Oflokain-Darnitsa there is an antibiotic of the group of fluoroquinolones ofloxacin and a local anesthetic of lidocaine hydrochloride. The antibiotic breaks the stability of bacterial DNA (which stops their reproduction and leads to death), and lidocaine prevents the passage of nerve fibers through pain signals (due to a decrease in the permeability of neuronal membranes for Na +).

Antiinflammatory and analgesic ointment with trophic ulcers Mephenate as active components contains: anti-inflammatory and analgesic non-steroid substance - mefenamine sodium salt and antiseptic vinylin (polyvinylbutyl ether or Shostakovskiy balsam). Due to their joint action, inflammatory mediators are blocked (at the level of cyclooxygenase), synthesis of endogenous interferons is increased, phagocytosis of dead cells is accelerated and the process of healing of trophic ulcers is accelerated.

Pharmacokinetics

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

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

After applying to the trophic ulcers of Argosulfan ointment, an insignificant part of the sulfatiazole of silver gets into the blood, which is metabolized in the liver and excreted by the kidneys.

Partially absorbed and the constituents of the ointment Dioxoxol, but quickly excreted through the kidneys without changes.

No more than 3% of Oflokain-Darnitsa's antibacterial ofloxacin enters the systemic circulation, circulating for about 5-6 hours and is excreted by the kidneys and intestines almost unchanged.

Names of ointments for trophic ulcers

Ointments from trophic ulcers on the legs (most often in the region of the shins), arising from varicose veins and thrombophlebitis, as well as ointments with trophic ulcers in diabetes (in particular, with diabetic feet - local ulceration with proximal motor neuropathy and pathological changes in the blood vessels of the lower limbs), include preparations of various pharmacological groups.

The names of ointments for trophic ulcers, which are most often used in clinical practice:

• wound healing ointments Levomecol and Levosin - based on the antibiotic chloramphenicol (levomycetin);
• erythromycin ointment;
• antimicrobial ointments with sulfonamides Streptonitol-Darnitsa, Mafenide acetate (Ambamid, Sulfamilon);
• methyluracil ointment (Metiluracil, Stisamet);
• ointments with silver Sulfargin (Argosulfan, Dermazin);
• Salceryl oil healing trophic ulcers;
• anesthetic ointments for trophic ulcers Dioksikol (Dioxydin), Oflokain-Darnitsa, Mefenat.

Containing zinc oxide Zinc ointment due to neutralization of sulfhydryl groups of bacteria enzymes and denaturation of their proteins dries wet eruptions with dermatitis or eczema, and with trophic ulcers it is used to treat tissues that surround the ulcer - to prevent or stop the maceration of the skin by the exudate released from the ulcer.

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

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

If you are interested in a miracle ointment from trophic ulcers on your legs, then this does not appear in the arsenal of external medications, since this ointment belongs to alternative agents and is prepared at home using beeswax.

Dosing and Administration

The way of application of all ointments with trophic ulcers is external. Levomecol and Levosin ointments should be applied to sterile wipes that are applied to the wound; The course of treatment depends on the degree of release of ulceration from pus. Levosin can also be applied directly to the affected area (up to 2-3 times during the day).

Erythromycin ointment, methyluracil ointment, ointments Streptonitol, Mafenide, Solcoseryl, Argosulfan, Mefenate are applied to the affected areas 2-3 times a day with the application of 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, ointments with silver for trophic ulcers - no more than two months.

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

[14], [15], [16], [17], [18], [19]

Contraindications for use

These ointments with trophic ulcers have such contraindications for use:

• Levomekol and Levosin - hypersensitivity to chloramphenicol;
• Streptonitol-Darnitsa - sensitivity to streptocid and nitazole, as well as a significant secretion of purulent exudate;
• Mafenide acetate - an allergy to sulfonamides and preparations containing them;
• ointments with silver for trophic ulcers - hypersensitivity, congenital deficiency of the cytosolic enzyme G6PD;
• ointment Solcoseryl - individual hypersensitivity to the drug, excessive granulation in the wound that appeared on the site of ulceration;
• ointment Dioksikol - intolerance of quinoxaline derivatives, serious pathologies of the adrenal glands;
• Oflokain-Darnitsa, Mefenat - sensitivity to the components of preparations.

It should be noted that in almost all cases, the use of ointments for trophic ulcers during pregnancy is contraindicated because of 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, during pregnancy and lactation, you can use Solcoseryl ointment, and Mefenate is used exclusively for strict medical indications.

[7], [8], [9], [10], [11], [12], [13]

Side effects of ointments with trophic ulcers

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

Irritation of the skin near the wound (with redness, itching and burning) can cause erythromycin ointment, methyluracil ointment, Levosin ointment, ointments with silver for trophic ulcers (Argosulfan, etc.). Often develops dermatitis after applying ointments Dioksikol and Oflokain.

Soreness in the place of application often accompanies the use of the drug Mafenide acetate.

Interactions with other drugs

The ointments mentioned in this review from trophic ulcers (on the feet, including those with diabetes) exhibit the following drug interactions.

Erythromycin ointment acts more strongly when combined with sulfonamides, as well as antibiotics of tetracycline groups.

Streptonitol-Darnitsa should not be used concomitantly with oral administration of cardiotonic glycosides of digitalis and drugs that stimulate the α-adrenergic receptors of blood vessels.

Methyluracil ointment is compatible with any antiseptics and antibiotics.

You can not simultaneously or alternately apply on the same area of ointments with silver and any other ointments.

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

Simultaneous use of Mephenate ointment with preparations of salicylic acid, as well as analgin, amidopyrine or butadione strengthens their action, including pain medication.

Storage conditions and shelf life

Conditions for storage of Levomekol, Levosin, Streptonitol-Darnitsa, Mafenide acetate, Solcoseryl, erythromycin and methyluracil ointment - at room temperature (not exceeding + 25 ° C);

Ointments with silver for trophic ulcers should be stored in a dark place at a temperature of + 5-10 ° C; ointments Dioksikol, Oflokain-Darnitsa and Mefenat - at a temperature not higher than + 15 ° С.

The shelf life of Levomekol, Levosin, Solcoseryl, Dioksikol, as well as erythromycin and methyluracil ointments is indicated on the packaging of each preparation. The shelf life of the ointments Streptonitol-Darnitsa, Argosulfan, Oflokain-Darnitsa and Mefenat is 24 months; ointments Mafenide acetate - 3 years.