The Effectiveness of Hypochlorous Acid Solution on Healing of Infected Diabetic Foot Ulcers

Islam.I.Ragab¹ Ahmed Kamal ²

1. Lecturer, Adult Medical Surgical Nursing Department, Faculty of Nursing, South Valley University, Qena, Egypt

2. Assistant Professor, Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut Egypt

Abstract:

Introduction: Wound cleansing remains a corner stone in the management of diabetic foot ulcer. Hydrogen Peroxide (H2O2) and Povidone Iodine are topical antimicrobial agents but known to be toxic to cells involved in the wound healing cascade. The biggest challenge for the physicians and nurses is searching for a safe, non-cytotoxic and effective wound cleansing as Hypochlorous acid (HOCL). This study aimed to compare the efficacy of HOCL versus H2O2 followed by Povidine Iodine as a wound care agent in treating infected diabetic foot ulcers. Patients and methods: Design: used a randomized clinical trial design to compare the efficacy of HOCL versus H2O2 followed by Povidine Iodine as a wound care agent in treating infected diabetic foot ulcers.

Setting: This study was carried out in outpatient plastic and vascular surgery clinic at Assiut university Hospital.

Subjects: A random selection was performed on 60 patients with infected diabetic foot ulcers divided equally to control and study group. Methods: HOCL was used for the study group, as irrigate the wound with HOCL in a concentration; sterile Nacl 0.9% to HOCL 50.5% at ratio 8:2 and leave for 5 minutes, before covered the wound with sterile dressing. While H2O2 followed by Povidine Iodine used for the control group and the results were compared. Bacterial cultures were obtained before start washing, after five days thin each five days to the end of the study for the two groups.

Results: HOCL was able to be effective against Candida, Proteus, Klebsella, Psudomonas, and Methicillin resistant staphylococcus aureus (MARSA) compare to H2O2 and Povidine iodine. There is a statistically significant difference between using HOCL and H2O2 and Povidine iodine as a washing therapy in reducing bacterial count, wound pain, odor, discharge and improve wound healing in diabetic foot ulcer.

Conclusion: Hypochlorous acid is a potent antimicrobial cleanser against a wide range of microorganisms. Hypochlorous Acid is safe, low cost, painless, easy to perform, and improve wound healing or rapidly prepared diabetic foot ulcer for skin flap or graft. Recommendation: The study recommended use of HOCL as a virtuous diabetic wound care cleanser. Further research is needed on a larger scale to validate the effectiveness of Hypochlorous acid as a wound care agent in septic diabetic foot ulcers.

Keywords: Hypochlorous Acid, Hydrogen Peroxide, Infected diabetic foot ulcer, Povidine Iodine.

Sodium Hypochlorite 0.005% Versus Placebo in the Treatment of Mild to Moderate Acne: A Double-Blind Randomized Controlled Trial

Azadeh Dorostkar¹ , Mehdi Ghahartars¹ , Mohammadreza Namazi¹ , Nafiseh Todarbary² , Maryam Hadibarhaghtalab¹ , Maryam Rezaee¹

¹ Dermatology Department, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

² Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

Key words: topical, sodium hypochlorite, acne vulgaris, treatment

Citation: Dorostkar A, Ghahartars M, Namazi M, Todarbary N, Hadibarhaghtalab M, Rezaee M. Sodium hypochlorite 0.005% versus placebo in the treatment of mild to moderate acne: a double-blind randomized controlled trial. Dermatol Pract Concept. 2021;11(3):e2021046. DOI: https://doi.org/10.5826/dpc.1103a46

Accepted: December 9, 2020; Published: May 20, 2021

Copyright: ©2021 Dorostkar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Competing interests: The authors have no conflicts of interest to declare.

Funding: None

Corresponding author: Maryam Hadibarhaghtalab, Department of Dermatology, Faghihi Hospital, Zand Street, Shiraz, Iran.

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ABSTRACT

Background: Acne vulgaris is a common inflammatory disease of the pilosebaceous follicle that affects many teenagers and young people. There is an obvious need for topical treatments with good tolerability and efficacy for the management of acne lesions.

Objective: This study determined the therapeutic efficacy of topical sodium hypochlorite solution (0.005%) in the treatment of mild to moderate acne lesions.

Methods: This placebo-controlled randomized controlled trial compared 0.005% sodium hypochlorite to placebo administered topically on each side of the patients’ faces 3 times a day for 1 month. The numbers of papules and pustules were recorded at baseline, 1, 2 and 4 weeks after initiation.

Results: The total number of papules and pustules decreased after topical application of sodium hypochlorite 0.005% for 1 month.

Conclusions: Topical sodium hypochlorite solution (0.005%) can be effective in the treatment of mild to moderate acne, and its clinical efficacy was evaluated between the male and female groups and between the hormonal and non-hormonal ones.

Trial registration: Our study was registered in the Iranian Registry of Clinical Trials (IRCT) with the code number IRCT20200701047976N1.

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Past, Present, and Future of Sodium Hypochlorite in Dermatology: A Scoping Review

Christy H. Chang¹  · Maura Devine²  · Deborah Woo²  · Theresa Hopkins²  · Tiago Torres^3,4 · Raj Chovatiya^2,5

Abstract

Background For over a century, dilute sodium hypochlorite (NaOCl), historically recognized as the antiseptic component of bleach, has been well established in wound care, primarily owing to its broad antimicrobial activity and ability to penetrate soft tissue and necrotic debris. NaOCl has been increasingly utilized and studied in clinical dermatology owing to its broad ranging antimicrobial, skin healing, and more recently described anti-inflammatory properties.

Objectives This scoping review (Open Science Network; osf.io/6hyru) synthesizes current evidence of NaOCl’s applications in skin care, highlighting mechanistic insights, clinical trends, and knowledge gaps.

Methods A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov was conducted from inception through November 2024. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results From 6959 deduplicated records, 222 studies published between 1915 and 2024 were identified for final inclusion. Four key clinical themes for NaOCl use emerged upon analysis of these publications: antimicrobial properties (n = 57), wound care (n = 64), eczematous skin disease (n = 78), and noneczematous inflammatory skin conditions (n = 23). NaOCl exhibits broad-spectrum activity against various organisms, notably Staphylococcus aureus and Pseudomonas aeruginosa, contributing to its effectiveness in treating chronically infected burns, ulcers, and other wounds. Limited studies also suggest NaOCl’s potential role in modulating critical processes that support wound repair. In addition, the anti-inflammatory effects of NaOCl have supported its utility in treating eczematous and noneczematous skin disorders.

Conclusions Current literature provides broad and extensive evidence supporting NaOCl’s role in wound-healing, antimicrobial, and anti-inflammatory activity. However, considerable heterogeneity exists in recommended concentrations, preparation methods, and usage instructions across studies. There is a need for more randomized controlled trials and standardized protocols to better define the efficacy, safety, and optimal use of NaOCl in dermatologic practice.

基于红外热成像的皮肤温度监测对糖尿病足患者 下肢动脉病变的诊断价值研究

王利娇,何小兰

(温州医科大学附属第一医院创面修复中心,浙江温州 325035)

[摘要] 目的 探讨基于红外热成像的皮肤温度监测对糖尿病足患者下肢动脉病变(LEAD)的诊断价值。方法 选取2023年3月至2024年12月该院收治的160例糖尿病足患者为研究对象,根据彩色多普勒超声诊断结果分为 LEAD组(n=120)和未病变组(n=40)。Spearman分析红外热成像的糖尿病足溃疡(DFU)创面相对温差与下肢动脉血管内径及血流量之间的相关性,逐步logistic回归分析 LEAD的影响因素并按照是否感染进行亚组分析,受试者工作特征(ROC)曲线分析用于评估 DFU 创面相对温差对 LEAD 及下肢动脉硬化斑块、管腔狭窄和腔闭塞的诊断效能。结果 两组不同 DFU 创面温度、健康侧同部位皮肤温度、DFU 创面相对温差、踝肱指数(ABI)、C反应蛋白(CRP)、尿酸和股动脉、腘动脉、足背动脉血流峰值流速(PSV)、搏动指数(PI)水平及下肢动脉硬化斑块、下肢动脉管腔狭窄比例比较,差异有统计学意义(P<0.05)。Spearman分析结果显示,DFU 创面相对温差与股动脉、腘动脉和足背动脉的 PSV 呈负相关,与 PI呈正相关(P<0.05)。单因素logistic回归分析显示,DFU 创面相对温差、ABI、尿酸,以及股动脉、腘动脉和足背动脉的 PSV 及 PI是LEAD的影响因素(P <0.05)。多 因 素logistic回 归 分 析 结 果 显 示,DFU 创 面 相 对 温 差、尿 酸 是 糖 尿 病 足LEAD的影响因素(P<0.05)。亚组分析结果表明,DFU 创面相对温差是糖尿病足 LEAD 的影响因素(P<0.05),糖尿病足感染对于 DFU 创面相对温差与糖尿病足 LEAD的关系无响(P>0.05)。DFU 创面相对温差在预测 LEAD时的曲线下面积(AUC)为0.923,cut-off值为5.4 ℃;预测下肢动脉硬化斑块、管腔狭窄及管腔闭塞时的 AUC分别为0.720、0.657和0.554,cut-off值分别为5.6、6.3、4.6℃。结论红外热成像的 DFU创面相对温差可有效诊断 LEAD。

[关键词] 红外热成像;糖尿病足;下肢动脉病变;创面相对温差;诊断价值[中图法分类号] R587.2[文献标识码] A[文章编号] 1671-8348(2025)05-1085-07

Diagnostic value of infrared thermography-based skin temperature monitoringfor lower extremity arterial disease in patients with diabetic foot

WANG Lijiao,HE Xiaolan

(Wound Repair Center ,the First Affiliated Hospital of Wenzhou Medical University, Wenzhou,Zhejiang 325035,China)

[Abstract]

Objective To investigates the diagnostic value of infrared thermography-based skin temper-ature monitoring for lower extremity arterial disease (LEAD) in patients with diabetic foot. Methods A totalof 160 patients with diabetic foot admitted to the hospital from March 2023 to December 2024 were selected asthe research subjects and divided into the LEAD group (n=120) and the non-lesion group (n=40) based onthe diagnostic results of color Doppler ultrasound. Spearman analysis was used to evaluate the correlation be-tween the relative temperature of diabetic foot ulcer (DFU) wounds measured by infrared thermography andthe diameter and blood flow of lower limb arteries, Stepwise logistic regression analysis was performed to i-dentify the influencing factors of LEAD and subgroup analysis was conducted based on the presence or absenceof infection. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic efficacyof DFU wound relative temperature for LEAD and lower limb arterial atherosclerotic plaques,lumen stenosis.and lumen occlusion. Results There were statistically significant differences between the two groups in DFUwound temperature,skin temperature at the same site on the healthy side. DFU wound relative temperature.ankle brachial index (ABD,C-reactive protein (CRP), uric acid, and the peak velocity (PSV) and pulsatility index (PI) levels of the femoral artery. popliteal artery,and dorsalis pedis artery,as well as the proportions oflower limb arterial atherosclerotic plaques and lumen stenosis (P<0. 05). Spearman analysis showed that therelative temperature of DFU wounds was negatively correlated with PSV of the femoral artery.popliteal arter-y,and dorsalis pedis artery,and positively correlated with PI (P<0. 05). Univariate logistic regression analysis indicated that ABI.DFU wound relative temperature, uric acid,and the PSV and PI of the femoral artery.popliteal artery.and dorsalis pedis artery were influencing factors for LEAD (P<0. 05). Multivariate logisticregression analysis revealed that DFU wound relative temperature and uric acid were influencing factors forLEAD in diabetic foot (P <0. 05). Subgroup analysis showed that DFU wound relative temperature was an in-fluencing factor for LEAD in diabetic foot (P <0. 05),and there was no interaction between diabetic foot infection and the relationship between DFU wound relative temperature and LEAD in diabetic foot (P>0. 05).The area under the curve (AUC) for predicting LEAD using DFU wound relative temperature was 0.923,withthe cut-off temperature being 5.4 °C. The AUCs for predicting lower limb arterial atherosclerotic plaques. lumenstenosis,and lumen occlusion were 0. 720,0. 657 ,and 0. 554, respectively, with the cut-off temperatures being5. 6.6. 3,and 4. 6 °C.respectively.

Conclusion DFU wound surface relative temperature of infrared thermography can effectively diagnose LEAD in diabetic foot.

Key words: infrared thermography;diabetic foot; lower extremity arterial disease; wound surface relative temperature; diagnostic value

1型糖尿病多重环境因素的研究进展*

王 爽¹,王涵学¹,孟晓彤¹,朱晓双¹,王亚蕊^1,2,陈 蕴^1,2△ (1.新疆医科大学护理学院,乌鲁木齐 830000;2.新疆区域人群疾病与健康照护研究中心,乌鲁木齐 830000)

[摘要] 近年来,1型糖尿病发病率呈上升趋势,其发病原因极为复杂,发生机制尚未完全阐明。已有研究证实1型糖尿病的发生和演变是典型的多基因、多因素、多阶段和多途径的过程,是遗传和环境因素共同作用所致。目前认为环境因素与感染因素、饮食因素、早期暴露事件、肠道菌群、免疫因素、其他因素及遗传因素的交互作用有关。该文对近年来1型糖尿病多重环境因素的相关研究进行综述。

[关键词] 1型糖尿病;环境因素;多重;自身免疫;综述

[中图法分类号] R587.1

[文献标识码] A

[文章编号] 1671-8348(2025)05-1255-05

Advancesonmultipleenvironmentalfactorsaffectingtype1diabetes *

WANGShuang ¹,WANG Hanxue ¹,MENGXiaotong ¹,ZHU Xiaoshuang ¹,WANGYarui ^1,2,CHEN Yun ^1,2△ (1.NursingSchool,XinjiangMedicalUniversity,Urumqi,Xinjiang830000,China; 2.HealthCareResearchCenterforXinjiangRegionalPopulation,Urumqi,Xinjiang830000,China)

[Abstract]

In recent years, the incidence rate of type 1 diabetes is on the rise. The causes of the diseaseare extremely complex, and the pathogenesis has not yet been fully clarified. Different types of studies haveconfirmed that the occurrence and evolution of type 1 diabetes is a typical process of polygene, multifactor.multi-stage and multi-channel,which is considered to be caused by the combined effect of genetic and environmental factors, At present.it is believed that environmental factors are related to the interaction of infectionactors, diet factors,early exposure events,intestinal flora,immune factors,other factors and genetic factors.This article reviews the research on environmental factors of type 1 diabetes in recent years.

[Key words] type 1 diabetes;environmental factors; multiple;autoimmunity; review

Bactericidal and anti-inflammatory activity of defined hypochlorite solution

Christopher David Chapman ^1,2☯*, Myles Hyla Edward Dakin ² , Richard Aspinall^1☯

¹ Centre for Intelligent Healthcare, Coventry University, United Kingdom, ² Hypo-stream Limited, Cambridge, United Kingdom

☯ These authors contributed equally to this work.

Abstract

Background

Hypochlorite is an antiseptic that has been used for over a century for industrial sterilisation and antisepsis. More recently, the topical application of hypochlorite to severe burn patients increased their rate of survival post infection with Gram-negative bacteria, of which antisepsis cannot be solely responsible.

Methodology

Broth microdilution experiments were performed to confirm anti-microbial activity. Cytokine exposure was performed by dialytic exposure of serum spiked with either interleukin-6 or interleukin-10, accounting for contextually appropriate organic load. Cytokine degradation was measured by immunoassay and by functional bioassay utilising HEK-Blue cells. Hypochlorite mediated cytotoxicity against dermal cells was assessed via direct exposure, followed by a 1-hour attenuation period. Resazurin was utilised to assay the impact of hypochlorite on cell viability.

Results

We have shown that this formulation of hypochlorite in isotonic saline has multiple mechanisms. The first is that 7 mmol/L hypochlorite is capable of eliminating both Gram-negative and Gram-positive bacteria, and that the same concentration differentially degrades the function of IL-6 and IL-10. IL-6 was seen to be 3 times more susceptible to loss of function than IL-10 after only 5 minutes of exposure (P<0.005). The asymmetrical effect on these cytokines was observed between 7 and 1.75 mmol/L, and across the entire time scale examined. This hypochlorite formulation has the capability to sterilize a wound, and by altering the cytokine profile reduce inflammation and scarring, and improve wound healing.

Conclusions

These findings, taken with the burn survival study, suggest that the increased survival rate after application of hypochlorite could be due to the combined effect of elimination of infective pathogens, and the differential degradation of interleukin-6 and interleukin-10 at the site of injury