Hydroxychloroquine (HCQ) is NOT used in the treatment of diabetic foot ulcers
Hydroxychloroquine has no established role in diabetic foot ulcer management and is not mentioned in any current evidence-based guidelines or treatment algorithms for this condition. The comprehensive American Diabetes Association Standards of Care (2025,2022,2021) and International Working Group on the Diabetic Foot guidelines make no reference to HCQ as a therapeutic option for diabetic foot ulcers 1, 2.
Standard Treatment Approach for Diabetic Foot Ulcers
The evidence-based management of diabetic foot ulcers follows five fundamental principles 1:
- Offloading of plantar ulcerations - using total contact casting, removable cast walkers, or specialized footwear 1
- Debridement of necrotic, nonviable tissue - sharp debridement with scalpel is preferred 2
- Revascularization of ischemic wounds when necessary - vascular assessment and intervention for peripheral arterial disease 1
- Management of infection - most diabetic foot infections are polymicrobial with aerobic gram-positive cocci (staphylococci and streptococci) as the most common organisms 1, 2
- Use of physiologic, topical dressings - maintaining a moist wound environment with sterile, inert protective dressings 1
Antibiotic Therapy (Not HCQ)
Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy 1, 2. When infection is present:
- Empiric antibiotic therapy should be narrowly targeted at gram-positive cocci in patients with acute infections 1, 2
- Broader-spectrum regimens are required for patients at risk for antibiotic-resistant organisms or with chronic, previously treated, or severe infections 1, 2
- These patients should be referred to specialized care centers 1, 2
Advanced Therapies for Non-Healing Ulcers
If a wound fails to show 50% or more reduction after 4 weeks of appropriate wound management, advanced wound therapy should be considered 1. Evidence-supported options include:
- Negative-pressure wound therapy 1, 2
- Placental membranes and bioengineered skin substitutes 1, 2
- Acellular matrices 1, 2
- Autologous fibrin and leukocyte platelet patches 1, 2
- Topical oxygen therapy 1, 2
- Sucrose-octasulfate impregnated dressing for non-infected, neuro-ischemic diabetic foot ulcers 2
Common Pitfall
A critical pitfall is attempting to use medications outside their indicated scope. HCQ is an antimalarial and immunomodulatory agent used for conditions like rheumatoid arthritis and systemic lupus erythematosus, but it has no mechanism of action relevant to wound healing, infection control, or the pathophysiology of diabetic foot ulcers 1, 2. The absence of HCQ from all major diabetic foot guidelines reflects the complete lack of evidence for its use in this condition 2.