Healing time of cuts with various topical treatments

[bluebanded goby]

At various times when I've had cuts I've used various topical treatments on them. Usually Neosporin and/or hydrogen peroxide and/or 91% rubbing alcohol.

When I tell the doctors at my local clinic that I'm using Neosporin, they nod approvingly and go out of their way to tell me to continue to use it.

However, my anecdotal experience is that Neosporin seems to slow down healing of cuts, at least in my case. Although I'm sure it's delivering topical antibiotic to the cut, it seems as though it acts as a barrier cream and prevents a scab from forming more quickly.

By contrast, when I dab on 91% alcohol, it dries out the cut and it usually seems like after a day or two the cut crusts over and is on its way toward disappearing.

Is this a dumb thing to do for some reason?

 

[Laurence Stein DDS]

BBG,

Nobody seems to want to answer your question. So here's my 2 cents.

Time for healing of a wound is actually variable. It can depend upon the nature of the wound, the depth, the type of tissue injured, the injuring agent, etc.

On skin...ie, outside the body, the first thing you do is clean the site. Alcohol works because it degreases the area and physically removes local germs on the skin. It is NOT an anti-infective agent. You get "wiped" before an injection to reduce the bacteria embedded in the oily layer on your skin. This reduction in bacterial numbers is useful.

Hydrogen peroxide can be bacteriocidal to certain germs. It also dissolves blood residue and can clean by "foaming" the surface. The usual OCT concentration is 3% and at your beauty supply store you may find 5-6%. This percentage is getting pretty strong and in some people can cause chemical burns. In dentistry, we use up to 30% H2O2, called Superoxol. This WILL cause a chemical burn and in a pinch can be used as rocket oxidizer.

Neosporin and similar products are antibiotics. As such, they, in fact do kill a variety of germs for a time that exceeds the limited contact time of the other mentioned agents. As long as you have a treated dressing in contact with the wound, and change it regularly, the antibiotic is working on any susceptible organisms.

What you percieve as reduced healing time may be because, 1) Alcohol is a drying agent and the scab just seems dry and healing. 2) Peroxide, dissolves blood and some of the clot so you may see a dissappearance of the scab sooner but immature skin is underneath. 3) Neosporin, especially if used with an occlusive dressing keeps everything kind of greasy and wet. The scab never looks dry, like its getting ready to fall off.

Please use care with puncture wounds. None of these agents are going to penetrate well. You could well need a tetanus booster.

I prefer to clean wounds at home, at the office and on the boat with Hibiclens surgical soap--4% Chlorhexidine Gluconate, followed by Neosporin or other triple antibiotic. I prefer a non-occlusive dressing to allow air in. The Hibiclens has a property of substantivity--it is absorbed into the skin and continues to kill germs that contact the site for some time after washing. It can be used without water--although you would probably want to wash it off--but even salt water can do that or even better, drinking water. There is some alcohol in the Hibiclens.

If the wound is going to get wet, then you have to use a waterproof dressing--3M Nextcare waterproof bandages are great. They work if you can get the surrounding skin dry and free of oil or Neosporin at the time of application. Done properly, they rarely come off underwater. Later, though, when the wound will not be getting wet, remove this bandage and apply one that breathes.

A wound that can be closed "skin to skin" will heal faster than a scrape. Scrape type of wounds require the formation of a scab and then the replacement of the scab by skin. A cut on the otherhand, that can be closed together, forms little or no scab except at the surface and healing is directly between the sides that touch.

As a dentist, various recommendations have been made as to how to cover a wound and treat patients. While not FDA approved, superglue is recommended to close small cuts and scrapes--it creates a barrier and then that is covered with rubber gloves. There are now some medical superglues that do away with sutures in some cases--I use them in the mouth. Finally, there are products like NuSkin which forms a barrier over the injury. NuSkin and Neosporin don't work well--it's like putting butter in the frying pan and then frying the eggs--they don't stick because of the grease. I carry superglue in my dive medical kit, along with Hibiclens and Neosporin. BTW, the Hibiclens is available without Rx at better pharmacies or surgical supply stores.

You might also be interested to know that I carry super absorbent feminine napkins in my kit as well! They are clean but not sterile. If you are really bleeding though, they will soak up gobs of blood and allow pressure to be applied. They bind with the blood and help stop the bleeding. They don't fit under a bandaid though. Their bulk can also help splint a finger or toe as well.

If you are sensitive or allergic to any of these products then don't use them. A puncture wound, a wound that is red, warm to the touch and with "deep" soreness should be seen by a physician. Redness or red-blue to purplish discoloration extending away from the wound is also a reason to see the doc.

Puncture wounds from animal bites or envenomations should not be closed with suture or superglue and should not be covered with a waterproof dressing--get to the doc.

Finally, you have some sort of answer--hope it was what you were looking for.

Now, I have to go clean fish!

Regards,

Larry Stein

Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)

 

[John Reinertson]

Dr Stein's comments are excellent, as usual.

The only thing I would add is that a certain percentage of people have or develop an allergy to Neomycin, which is one of the antibiotics in neosporin.
The allergic reaction can create quite a mess and delay healing.

Some docs recommend plain bacitracin ointment, or Polysporin
(which is the same as Neosporin but without the neomycin)
as better alternatives. If people using Neosporin note an unusual amount of itching in the wound or worsening redness, the allergy may be at work.

As Dr Stein, mentioned, careful cleaning at the outset is a big part of good wound care, followed by bandaging that reduces the risk of bacteria getting back into the wound and absorbs the drainage from the wound.

"Sterile" surgical wounds do well under occlusive dressings (plastic covers) for the first two days, but most accidental wounds aren't of that type and need some absorptive bandage.

Dive safe,

John

 

[BillP]

Howdy bluebanded goby:

Didn't mean to ignore you. I'd like to echo what you've all already said.

The people who make Neosporin will be happy to tell you that scientific studies show that it promotes re-epithelialization (growing back of the outer covering layer) of the skin. Wounds treated with Neosporin re-epithelialize as much as 25% faster than untreated wounds. But my anecdotal experience is similar to yours and Dr. Reinertson's. I find Neosporin to be a goopey mess- a "dry" wound is a more convenient wound IMHO and it heals just fine. I also have seen several patients that were referred to me for non-healing wounds to be excised because after a year of not healing "it must be cancer". Once I get the patient to stop using the Neosporin that they have been religously applying several times a day but are allergic to, then the wound heals in short order. I only use Neosporin on infection prone wounds like significant burns or wounds with dead tissue that can't be completely debrided.

Hydrogen peroxide on the other hand can be tissue toxic and when used in large amounts will slow wound healing. It does do a good job of cleaning wounds and doesn't hurt like alcohol so I will have patients use it in small amounts on selected wounds. If a wound is deep enough that you have to "get in there" to clean it out with a Q-tip I'll have patients use peroxide to lubricate the Q-tip and clean the wound. Otherwise, I don't use it at all.

Alcohol cleans, but it hurts like the dickens on an open wound. I use it to clean non-sterile tools and intact skin, but not wounds.

The best cleanser for all but the most complicated wounds IMHO is ordinary soap and water. It's cheap, readily accessible, neat, and quite effective. I use it exclusively on my own wounds and my children's wounds. I recommend it to he vast majority of my patients.

You didn't ask about it but as for dressings, I would like to stand up and applaud Dr. Stein for recommending feminine napkins as dressings. For almost all wounds, the purpose of the dressing is to keep your clothes clean, not to keep the wound clean. As Dr. Reinertson already implied, even a sterile surgical wound made in the operating room doesn't stay sterile very long even with the best of care. Dressings applied to wounds by patients generally don't need to be sterile, they just need to be clean. And they only need to be big enough to catch what drainage comes out. Like soap and water, feminine napkins are cheap, readily available, neat, and quite effective. They also come in a variety of sizes so you can put a "maxipad" on that big draining wound or a panty liner or a smaller or cleaner wound. They also can come in handy for their intended function sometimes on trips. I keep them in my office to dress wounds and use them anywhere I might otherwise use large amounts of expensive gauze. They do stick to wounds so a non-stick "Telfa" pad next to the wound is sometimes nice.

Just my 2¢,

Bill

The above information is intended for discussion purposes only and is not meant as specific medical advice for any individual.