Clinicians still turning to alternative treatments that can be dangerous

Be leery of scary resurgence’

Honey and Dilantin (phenytoin) seem to have little in common, but both, at one time or another, have been used as topical wound treatments. In fact, some clinicians still use them for wound care, although proof of their effectiveness and safety is sketchy. 

In her travels as a lecturer, Cecilia R. Rund, RN, CETN, a clinical nurse consultant with Smith & Nephew’s Wound Care Division in Baltimore, regularly hears accounts about the use of unconventional topical wound treatments, although the substances being applied are of questionable effectiveness and may even be harmful. 

"Many times after a lecture, a nurse will take me aside and say that the doctor they work with is ordering honey or topical Dilantin. I hear it just about everywhere I go," Rund says. "The number of reports isn’t overwhelming, but there are people using these substances. There’s a scary resurgence in the use of unproven topicals, sort of what’s happening with aromatherapy and herbal therapy. Everywhere I go, someone wants to put honey or betadine and sugar into a wound."

Usefulness is mainly anecdotal

Using honey or Dilantin is not a wild idea by any means, Rund says. A small body of research has demonstrated that some components of unprocessed raw honey provide an antibiotic effect and perhaps can reestablish a bacterial balance within the wound that facilitates healing. Honey also appears to keep wounds moist. In a few small studies, Dilantin reportedly improved wound healing and promoted the formation of healthy granulation tissue. 

Other somewhat dubious topicals that have been used in wound treatment include insulin, animal and vegetable oils, gentian violet, and even antacid. (See story at right for details on the potential of alternative topical treatments.) 

Rund hypothesizes that two factors have driven the return to unconventional topical treatments. One is the desire of some physicians to skirt the constraints of reimbursement to increase their income. Many physicians, Rund says, are not interested in putting money into expensive topical dressings that are not approved by the U.S. Food and Drug Administration. "If they can find an alternative method that patients can do in their home and get satisfactory results, it seems to make them happy," she says. 

Frustration or confusion is the second factor. Many physicians don’t know how to proceed clinically with difficult wounds. Seeking sources of information to help guide their decisions is not only time-consuming, it also may result in losing a patient to another health care provider, such as a wound care specialist. Instead, doctors look to alternative methods, Rund says. She adds that some physicians may read an article in a reputable medical journal about alternative topicals, such as sugar, and undertake the practice themselves.

A little knowledge could be harmful

"This type of practice is risky," Rund says. "It’s one thing if someone felt he or she had knowledge about how honey, for instance, affects a wound, and if there had been adequate studies showing that it causes positive results and is safe. Then a practitioner might be justified in using it cautiously on well-screened patients. But just to randomly pull a piece of material from a medical journal and rely on it for treatment decisions as a guide is poor practice." 

Rund also notes that dermatologists and other physicians who treat chronic wounds are ordering bag balm for use on patients. 

"In West Virginia, I traveled through three different areas where doctors were routinely ordering it for skin care," she says. "It may be OK to use on intact skin, but using it on wounds concerns me." 

Anecdotal reports about the potency of several topical treatments for wound care abound, but only limited formal controlled research has been conducted, Rund adds. Trials that have been completed have been restricted to animals, have been small, or have not included reliable controls. 

"It’s all risky because we have very little outcome data. I’d like to see somebody establish a center to study these materials and get some data for practitioners," she says.