From the Guidelines
For treating ulcers, I recommend using over-the-counter creams or ointments that promote a moist healing environment, such as hydrocolloid patches or creams containing antibiotics like Neosporin, Polysporin, or Bacitracin, as they can help prevent infection and promote healing. When considering treatment options, it's essential to prioritize the patient's quality of life, morbidity, and mortality. The most recent and highest quality study, 1, provides guidelines on interventions to enhance healing of foot ulcers in people with diabetes, which can be applied to treating ulcers in general. Some key points to consider when treating ulcers include:
- Cleaning the affected area with mild soap and water before applying any medication
- Applying a thin layer of cream or ointment 2-3 times daily and covering with a bandage if needed
- Using hydrocolloid patches to create a moist healing environment for small wounds
- Considering creams containing benzocaine or lidocaine for pain relief
- Avoiding the use of topical antiseptic or antimicrobial dressings, as well as honey, collagen, or alginate dressings, as they are not recommended by the guidelines 1 If ulcers do not improve within 7-10 days, are severely painful, show signs of infection, or occur frequently, it is crucial to consult a healthcare provider, as prescription treatments may be necessary. Additionally, the guidelines suggest considering the use of sucrose-octasulfate impregnated dressing as an adjunctive treatment for non-infected, neuro-ischaemic ulcers that have had insufficient change in ulcer area with standard care 1. It's also important to note that the management of leg ulcers may require a multidisciplinary approach, including the use of immunosuppressives, antibiotics, debridement, or occlusive measures, and should be planned with a dermatologist and vascular surgeon experienced with such lesions 1. Overall, the treatment of ulcers should be tailored to the individual patient's needs, taking into account their quality of life, morbidity, and mortality, and guided by the most recent and highest quality evidence available.
From the Research
Available OTC Creams for Treating Ulcers (Sores)
- Docosanol cream is available over-the-counter for the treatment of recurrent herpes labialis (cold sores) 2
- Penciclovir cream is also available for the treatment of cold sores, and has been shown to be effective in reducing lesion number, area, and virus titer compared to its vehicle control 3
- Acyclovir cream is another option for the treatment of herpes labialis, although its efficacy may be less than that of penciclovir cream 3
Efficacy of Docosanol Cream
- Docosanol cream has been shown to be safe and effective in the treatment of recurrent herpes simplex labialis, with a median time to healing of 4.1 days compared to 4.8 days for placebo 4
- Docosanol cream has also been shown to reduce the time to cessation of pain and other symptoms, as well as the time to complete healing of classic lesions 4
- However, the efficacy of docosanol cream may be limited, with some studies showing no significant difference between docosanol and placebo in reducing healing time 5, 3
Comparison of OTC Creams
- Penciclovir cream has been shown to be more effective than acyclovir cream and docosanol cream in reducing lesion number, area, and virus titer 3
- Acyclovir cream may be less effective than penciclovir cream, but more effective than docosanol cream 3
- Docosanol cream may be less effective than other available treatments, but is still a safe and effective option for the treatment of recurrent herpes labialis 2, 4