Accumulation of Silver and Delayed Re-epithelialization in Normal Human Skin: An ex-vivo Study of Different Silver Dressings
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Abstract: Silver is commonly used in wound dressings and topical formulations to assist in the management of wounds that are infected or at risk of becoming infected. They provide potent broad-spectrum antimicrobial activity, but should not cause sustained staining of the skin, dermal or systemic accumulation of silver, or discomfort to the patient. However, clinicians and healthcare personnel have been concerned about topical staining of the skin and complaints of additional pain from patients treated with certain silver dressings. Some delay in re-epithelialization has also been noticed and reported. The reasons for this are not clear, and the authors believed further study regarding the possible effects of silver accumulation and silver dressings’ effect on re-epithelialization was required. The authors studied possible silver accumulation and re-epithelialization in normal human dermal skin. The results showed that most of the dressings or treatments discolored the wound surface and that there was a dermal accumulation of what were assumed to be silver particles. Varying grades of accumulation were found in deep dermal tissue, particularly around blood vessels, depending on the dressing used. The results also indicated that all of the tested products delayed re-epithelialization in this model.
Address correspondence to:
Camilla Fredriksson, Med, Lic
Department of Experimental Plastic Surgery, Faculty of Health Science
Linköping University
Sandbäcksgatan 7
S-581 83
Linköping, Sweden
Phone: 46 13-22 73 37
E-mail: camilla.fredriksson@liu.se
Silver has been used for its antimicrobial properties for a long time; even ancient Greeks applied silver chips or granules to wounds of injured soldiers to prevent infection. Ingestible silver in different soluble preparations has also been used, with the intention to cure many diseases. Silver nitrate and silver sulphadiazine have been used extensively in the care of burns for many years, with few questions asked. However, in 1977, Bridges and Lowbury1 raised a question about possible microbial resistance to silver, something that has been brought to the fore today when drug resistance is discussed.
With the extended use of different silver dressings, additional side effects such as staining of the skin, reduced wound healing, and increased wound pain of patients treated repeatedly with silver dressings have been reported and described.2,3 These phenomena have rightfully caught the attention of researchers. For example, Trop4 presented a case in which raised liver enzymes and argyria-like symptoms were noted when a patient with 30% total body surface area (TBSA) burns was treated with Acticoat™ (Smith & Nephew, Fort Lauderdale, Fla). Poon and Burd5 described silver to be highly cytotoxic to keratinocytes and suggestions were made that consideration of the cytotoxic effects of silver and silver-based products should be taken into account when deciding on what dressings to use, particularly when using cultured keratinocytes in situ. This is playing an increasing role in contemporary care of wounds and burns. Vlachou et al6 performed studies on systemic silver absorption in patients using Acticoat and showed that only small quantities of silver were absorbed systemically, which led to their recommendations for using Acticoat in the treatment of burns.
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