A Systematic Review of the Efficacy of Topical Skin Application of Dimethyl Sulfoxide on Wound Healing and as an Anti-Inflammato
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Pressure ulcers, also commonly referred to as bedsores, pressure sores, decubitus ulcers, or simply decubitus, can develop when sustained load, friction, or shear is applied to localized areas of the body, leading to degeneration of the skin and underlying soft tissues. As in other countries, pressure ulcers form a major problem in Dutch institutions for healthcare services. There are various theories that explain the etiology of pressure ulcers, with most experts adhering to the theory that pressure ulcers result from chronic occlusion of capillary blood flow, leading to alternating periods of ischemia and reperfusion. This process is associated with repetitive formation of reactive oxygen species (ROS) and concomitant tissue necrosis. Recently, pilot studies have revealed that rubbing the intact skin with a dimethyl sulfoxide (DMSO)-containing cream during the first stage of pressure ulcers according to the four grade system of the European Pressure Ulcer Advisory Panel (EPUAP) leads to a decrease in pressure ulcer occurrence among high-risk patients.[3,4]
DMSO [(CH3)2 S-O] is a water-white to straw-yellow-colored organic liquid. It is an oily substance with a smell of sulfur and a slightly bitter taste. In topical application, this simple, highly polar chemical compound has been found to alleviate ischemic damage in several experimental animal models.[5,6] In addition to an analgesic effect, the most important property of DMSO is the enhancement of percutaneous penetration. When used in combination with other substances, DMSO facilitates diffusion through the stratum corneum of the skin, triggers the formation of deposits in the deeper layers of the subcutaneous tissue, and promotes transport into the local blood vessels. Hence, dermatologists use it as a vehicle for other medications.
In pressure ulcer tissue, like any tissue in which inflammation occurs, repetitive ischemia-reperfusion episodes lead to the local formation of ROS. The main representatives of these radicals are the superoxide anion (O?2-), hydrogen peroxide (H2O2), and the hydroxyl radical (OH-). Since DMSO is known to be a hydroxyl-inactivating compound, it can be assumed that its beneficial effects on pressure ulcers are based upon this activity.
The purpose of this review was to evaluate the literature on the efficacy of DMSO in various concentrations on wound healing and as an anti-inflammatory drug administered by topical application to the skin.
A MEDLINE literature research was carried out covering the last 36 years (starting in 1966). At first, the search focused on studies involving DMSO by one specific disorder, e.g., pressure ulcers. However, this did not yield enough articles, so the domain was expanded. The following keywords were used: dimethyl sulfoxide, clinical dermatology, pharmacology and toxicology, bio-penetrator, the skin, hydroxyl radicals, ROS, scavengers, treatment of ulcers, and inflammation. In addition, the references of all articles retrieved were further examined. The same search was done in PUBMED and EMBASE-Excerpta Medica. A last extensive search strategy was used in the Cochrane Library by means of the Cochrane Controlled Trial Register and the Cochrane Database of Clinical Reviews. Finally, the Cochrane Skin Group and the Cochrane Wounds Group were explored. Abstracts were not selected. One unpublished study was selected because of its relevance to the topic of the present review. Studies were only included if DMSO was applied locally on the diseased skin in conditions involving wound healing and/or inflammation or on healthy skin in order to determine its sensitivity to various DMSO concentrations. Research using experimental animals was excluded.
Table 1 lists the criteria used, which were weighed by three independent reviewers with different backgrounds (dermatology, pharmacy, and physiotherapy and movement sciences).
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