Minor Wound Care for Diabetic Patients

US Pharmacist. 2001;26(11) 

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Self-Care Products and Diabetic Wounds

Within the realm of nonprescription products and devices, several carry a specific warning against use on diabetic skin. The greatest concern is with salicylic acid, which acts to intentionally create a wound. Its ability to slowly erode epidermis is useful for minor problems such as warts, corns and calluses. However, all salicylic acid products carry a strict contraindication against use by diabetic patients. This warning should be extended to various corn and callus removal devices. These products present varying degrees of danger to diabetic patients. There are "pumice stones," a type of solid rock; some are attached to contoured handles. These rocks may even be labeled "beauty stones." The patient is encouraged to intentionally abrade the skin by rubbing it with the rock in a misguided attempt to remove rough skin. The fallacy is that skin (e.g., elbows and knees) roughens in response to trauma. Thus, abrasion with a rock is counterproductive at best, and could cause serious infection in the diabetic who uses it to reduce a corn or callus. Other products to be avoided resemble vegetable graters, and are either perforated metal plates attached to a handle, or are actual files. A final group is "corn planes" which appear to be hair removal razors, except the distal end has a curved razor blade in it. The patient is instructed to draw it across the skin, removing successive layers of epidermis, much as a dermatologist uses a dermatome to remove skin prior to transplantation. These graters, files and planes should be advised against, and the diabetic patient who contemplates their use must be cautioned most strongly to see a podiatrist or a physician instead.

If a diabetic patient has an existing infection that is not located on the foot (e.g., folliculitis, carbuncle, furuncle, infected cut or scratch), he or she may be tempted to use any of the nonprescription ointments that contain antibacterial or antibiotic ingredients. These products are never to be used to treat an existing infection in any patient, and must not be used by the diabetic. Diabetic skin infections require aggressive and immediate prescription therapy, coupled with tight control of blood glucose, since hyperglycemia inhibits granulocyte activity and lymphocyte function.[4]

If, however, the diabetic patient has an uninfected wound or minor burn, there is no specific contraindication against the use of antibiotic ointments to prevent infection. Presumably, their use might be helpful (and probably better than nothing at all). However, the patient should be urged to watch the wound closely and report to the physician at the first sign of any infection (e.g., redness, heat, inflammation, pain).


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