Researchers at the Johns Hopkins Evidence-Based Practice Center and the Johns Hopkins Wound Healing Center, both located in Baltimore, Maryland, conducted a systematic review of 66 research papers focused on the treatment of skin ulcers, such as those related to diabetes, and have concluded that most are so technically flawed that their results are unreliable. Further, even for those that pass muster, there is only weak evidence that some treatments work better than standard compression therapy or special stockings, according to a Johns Hopkins Medicine, Baltimore, press release.
The research review team noted that about $25 billion is spent annually in the United States to treat chronic skin wounds related mostly to poor blood circulation, the prevalence of which is rising along with rates of diabetes and obesity. The review was undertaken in an effort to inform physicians about the treatment options.
The research review team began by identifying 10,066 citations that were possibly related to wound care. They found that only 66 of these papers specifically addressed their questions about the effectiveness of treatments for chronic venous leg ulcers. For the study, the investigators analyzed clinical outcomes involving wound dressings, antibiotics, and venous surgery. Overall results found that dressings that used living human cells increased wound healing. Results suggested that cadexomer iodine and collagen may also increase healing, said Gerald Lazarus, MD, founder of the Johns Hopkins Wound Healing Center and professor of dermatology and medicine at Johns Hopkins Bayview Medical Center, Baltimore.
“That doesn’t mean that other types of dressings don’t work,” he said. “It just means that there is no evidence yet on which treatments work the best.” Support stockings, he added, must for now remain the standard of care for treating chronic venous ulcers.
Lazarus said the review also showed evidence is inconclusive about using systemic antibiotics unless there are demonstrated signs of infection. It is also inconclusive whether surgical treatments such as radiofrequency ablation, endovenous laser treatment, and sclerotherapy helped healing. However, surgical correction of underlying pathology did decrease ulcer recurrence.
“There is a critical need for well-designed research studies to compare the current minimally invasive surgical interventions to the gold standard of care, compression therapy,” he said.