What is the best topical cream for promoting healing of venous leg ulcers?

From the Guidelines

For leg ulcers, the most effective treatment is to maintain a moist environment that promotes tissue regeneration while protecting the wound, and this can be achieved with dressings that control exudate, are comfortable, and cost-effective, as recommended by the IWGDF 2023 update 1. The best cream to put on ulcers on the legs for healing is not explicitly stated in the guidelines, but it is recommended to avoid using topical antiseptic or antimicrobial dressings for wound healing of diabetes-related foot ulcers 1. Some key points to consider when treating leg ulcers include:

• Cleaning the ulcer gently with saline solution before applying any cream or dressing
• Using dressings that control exudate, are comfortable, and cost-effective
• Avoiding hydrogen peroxide or alcohol as these can damage healing tissue
• Considering the use of sucrose-octasulfate impregnated dressing as an adjunctive treatment for non-infected, neuro-ischaemic diabetic foot ulcers that are difficult to heal 1
• Seeking medical attention promptly if the ulcer shows signs of infection, such as increased redness, warmth, swelling, or discharge. It's also important to note that the specific type of leg ulcer (venous, arterial, or diabetic) may require additional specialized treatment, so professional evaluation is important for proper diagnosis and management. The use of sharp debridement is recommended to remove slough, necrotic tissue, and surrounding callus of a diabetic foot ulcer, taking relative contraindications such as pain or severe ischemia into account 1. Overall, the goal of treatment is to create an environment that promotes healing, prevents infection, and minimizes the risk of complications, and this can be achieved by following the recommendations outlined in the IWGDF guidelines 1.

From the FDA Drug Label

Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. The best cream to put on ulcers on the legs for healing is urea cream. It is useful for debridement and promotion of normal healing of surface lesions.

• Urea cream can be used to treat conditions where healing is retarded by local infection, necrotic tissue, or debris. 2

From the Research

Types of Creams and Dressings for Ulcer Healing

• Hyaluronic acid (HA) cream has been shown to be effective in promoting faster healing of chronic wounds, including venous leg ulcers 3
• Foam dressings are commonly used for venous leg ulcers, but the current evidence base does not suggest that they are more effective than other wound dressing treatments 4
• Silver dressings may increase the probability of venous leg ulcer healing compared to nonadherent dressings, but the evidence is of moderate certainty 5
• Medical honey has been shown to be effective in wound healing via wound bed preparation, promoting comfort, reducing pain, and protecting from infection 6
• Hydrocolloid dressings have not been shown to be more effective than simple low-adherent dressings used beneath compression in terms of ulcer healing 7

Key Findings

• The proportion of subjects with complete ulcer healing was substantially higher in the HA cream group (31.3%) than in the neutral cream group (14.8%) 3
• There was no significant difference in healing outcomes between hydrocellular foam dressings and polyurethane foam dressings 4
• The evidence for the network as a whole was of low certainty, and the uncertainty was perpetuated when the results were considered by ranking the treatments in terms of the probability that they were the most effective for ulcer healing 5
• Promotion of healing occurred in all instances with a reduction in the incidence of infection, reduction in pain, and the provision of comfort with medical honey 6
• The type of dressing applied beneath compression has not been shown to affect ulcer healing, and decisions regarding which dressing to apply should be based on local costs of dressings and practitioner or patient preferences 7

Comparison of Different Treatments

• HA cream vs neutral cream: HA cream was more effective in promoting complete ulcer healing 3
• Foam dressings vs other wound dressing treatments: no significant difference in healing outcomes 4
• Silver dressings vs nonadherent dressings: silver dressings may increase the probability of venous leg ulcer healing 5
• Medical honey vs other treatments: medical honey was effective in promoting wound healing and reducing pain and infection 6
• Hydrocolloid dressings vs simple low-adherent dressings: no significant difference in healing rates 7