Efficacy of Cadexomer Iodine in management of inflammation and peripheral tissue healing related to Exuding wounds

In this scenario, understanding the basic mechanism of wound healing and repair remains the keystone to achieving treatment success. As more and more chronic, exudating wounds are being noted, it has now become mandatory to choose an optimum dressing for quick healing. The availability of a variety of ready-to-apply dressings have placed a challenge in front of clinicians.

Iodine based dressings have been used widely since long ago, though previous reports have pointed out the adverse effects of such dressings in the management of chronic wounds. (3,4) Further research in this field has further led to the use of newer dressings. Accumulating evidence now suggests that cadexomer iodine is emerging to be a highly effective dressing for chronic wounds. (5,6,7)

Recent researches have highlighted the higher efficacy of Cadexomer iodine compared to other topical wound dressings, due to its ability to penetrate and work against microbial biofilms (8), commonly associated with chronic wounds. Having wound healing features of rapid fluid absorption, constant release of free iodine, desloughing, and anti-inflammatory properties have made cadexomer iodine stand out among other available dressings. (3)

Taking a cue from this, in 2019, a team of researchers under Sahitya Uppada, from the Department of Pharmacy Practice, Hindu College of Pharmacy, undertook a study to evaluate the healing process of various types of exuding wounds, thus comparing the effectiveness of Cadexomer iodine ointment and normal saline dressing. (9)

The findings have been published in the Journal of Pharma Research.

The study design consisted of 100 patients, who were included based on study criteria and were divided into two cohorts. One cohort was given the treatment with topical cadexomer iodine ointment and another group was treated with normal saline solution. All the 100 patients were observed during the study period of 6 months from October 2018 to March 2019.

The inclusion criteria were patients with age between 21-60 years, with (b) Diabetic foot ulcers, (c) I to IV stages of pressure ulcers, (d) Venous ulcers, (e) Post cellulitis wounds, (f) Abscess wounds and (g) Post-trauma wounds.

Bates-Jensen's wound assessment tool was used for the comparison of the effectiveness of the test and control treatments on wound healing. Topical cadexomer iodine ointment and normal saline, both were used according to the protocol, every 2 days while changing the dressing.

After 10 weeks, the peripheral tissue healing was compared for the test and controls.

Data analysis put forth some interesting facts, based on the following parameters.

• Skin colour surrounding the wound: Change in the skin colour surrounding the wound was observed from week-0 to week-10. By the end of the study, 90% of the cadexomer iodine and 50% of saline group subjects showed normal or pink peri-wound area.
• Peripheral tissue oedema: By the end of the study, 100% of cadexomer iodine and 92% of the saline group subjects showed a reduction in peripheral tissue edema. Researchers noted that this reduction is faster in the case of the cadexomer iodine group which is significant by week 4.
• Peripheral tissue induration: 100% of cadexomer iodine subjects and 84% of saline dressing subjects showed a complete reduction in peripheral tissue induration. Significant reduction started by week 4 in the case of cadexomer iodine, but it is gradual and delayed in saline dressing when compared to the cadexomer iodine group.
• Granulation tissue: The rate of granulation in the cadexomer iodine group is more than 2 times that of the saline group, specifically,70% of cadexomer iodine and 26% of saline group subjects' wounds are of the partial thickness or superficial (skin intact).
• Epithelialization: 66% of cadexomer iodine and 20% of the saline group subject have had complete wound closure. So, epithelialization is three-fold times faster in the cadexomer iodine group in comparison with the saline group.
• Odour: Change in odour started significantly from week 2 itself in the case of the Cadexomer iodine group, while there is a gradual change in the case of saline dressing. By the end of the study, 96% of cadexomer iodine had not shown any odour, which is 78% in the case of saline dressing.
• Pain: 78% of subjects in the cadexomer iodine group showed absence of pain, while it is 48% in the case of saline dressing. Change in pain started significantly from week 4 in the case of cadexomer iodine, while it is delayed in the case of saline dressing.

The above findings highlight the superiority of Cadexomer Iodine to normal saline as a wound dressing.

Observing the results, the team concluded that "Wound healing with the use of topical cadexomer iodine was found to be dominant when compared to saline dressing in several parameters involved in wound healing which were assessed using Bates-Jensen wound assessment tool. Most of the patients using topical cadexomer iodine are shown to be having improved wound status by week 4 significantly, while patients using saline have shown gradually improving wound with a slower rate of healing."

The above article has been published by Medical Dialogues under the MD Brand Connect Initiative. For more details on Cadexomer Iodine, click here

References

1. Percival, S. L., McCarty, S. M., & Lipsky, B. (2015). Biofilms and Wounds: An Overview of the Evidence. Advances in wound care, 4(7), 373–381.

2. Dabiri, G., Damstetter, E., & Phillips, T. (2016). Choosing a Wound Dressing Based on Common Wound Characteristics. Advances in wound care, 5(1), 32–41.

3. Sood, A., Granick, M. S., & Tomaselli, N. L. (2014). Wound Dressings and Comparative Effectiveness Data. Advances in wound care, 3(8), 511–529.

4. Han, G., & Ceilley, R. (2017). Chronic Wound Healing: A Review of Current Management and Treatments. Advances in therapy, 34(3), 599–610.

5. Fitzgerald DJ, Renick PJ, Forrest EC, Tetens SP, Earnest DN, McMillan J, Kiedaisch BM, Shi L, Roche ED. Cadexomer iodine provides superior efficacy against bacterial wound biofilms in vitro and in vivo. Wound Repair Regen. 2017 Jan;25(1):13-24. doi: 10.1111/wrr.12497. Epub 2016 Dec 5. PMID: 27859922.

6. Roche ED, Woodmansey EJ, Yang Q, Gibson DJ, Zhang H, Schultz GS. Cadexomer iodine effectively reduces bacterial biofilm in porcine wounds ex vivo and in vivo. Int Wound J. 2019 Jun;16(3):674-683. doi: 10.1111/iwj.13080. Epub 2019 Mar 13. PMID: 30868761; PMCID: PMC6850490.

7. Brustolin EV, Skare TL, Nassif PA, Biondo-Simões Mde L, Prestes MA, Ozono LM, Ramos CE. Wound healing under the effect of iodine cadexomer in rats. Acta Cir Bras. 2012 Dec;27(12):874-9. doi: 10.1590/s0102-86502012001200008. PMID: 23207754.

8. M. Malone, K. Johani, S. O. Jensen, I. B. Gosbell, H. G. Dickson, S. McLennan, H. Hu, K. Vickery, Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers complicated by biofilm in vivo, Journal of Antimicrobial Chemotherapy, Volume 72, Issue 7, July 2017, Pages 2093–2101,

9. Sahitya Uppada, et al. TOPICAL CADEXOMER IODINE VERSUS SALINE DRESSING IN THE MANAGEMENT OF ACUTE AND CHRONIC EXUDING WOUNDS. J Pharm Res 2019;8(8):704-721. DOI:https://doi.org/10.5281/zenodo.3706446