|Also listed as: Williams-Beuren syndrome||Integrative Therapy Quick Links:|
- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
Dog and cat bites
- Overview: Pets, especially dogs and cats, are the most common cause of animal bites. Although dog bites are more common than cat bites, cat bites are more likely to cause infections because they have longer and sharper teeth that can potentially produce deeper wounds. Dog bites usually cause a crushing-type wound because of their rounded teeth and strong jaws.
- Individuals should not assume that their pet dogs or cats would never bite them. All animals are capable of biting humans. The animal may be the patient's pet, a friend or stranger's pet, or a stray animal.
- A dog or cat bite may or may not be provoked. Older animals are typically less tolerant of disturbances, such as tugging the animal's ears. In many cases, a dog or cat will warn a person if they feel threatened. For instance, dogs may growl while cats may hiss.
- Symptoms: A dog or cat bite may cause the skin to break with or without bleeding. Others may have a puncture-type wound, which means the animal's teeth pierced small holes into the skin. Dogs are more likely to cause major cuts, bruising, or crushing injuries that may break bones.
- Infections may develop if the wound is not properly cleaned. Symptoms of an infection may include fever, swelling, increased pain, and redness.
- Cats may also carry cat scratch disease. Although this infection does not affect cats, it can be transmitted to humans if they are bitten. Infected humans may experience enlarged lymph nodes, fever, headache, fatigue, abdominal pain, bone or joint pain, and decreased appetite.
- Cats or dogs can potentially transmit a disease called rabies if they are not vaccinated. Rabies is a rare, but potentially deadly disease. Animals that are rabid may be foaming at the mouth or behaving strangely. They may be less afraid of humans than normal. To be safe, individuals who are bitten by an animal that is not their own should seek immediate medical treatment because once symptoms of rabies develop, it is almost always fatal. Humans infected with rabies may develop a fever, general feelings of discomfort, insomnia, confusion, seeing or hearing things that are not there, difficulty swallowing, agitation, convulsions, and fear of water.
- Treatment: If the bite is not bleeding, the patient should wash the wound thoroughly with soap and warm water. To help prevent infection, the wound should be covered with an antibiotic ointment and a clean dressing, such as a band-aid.
- If the bite is bleeding, the patient should apply pressure onto the wound with a clean, dry cloth until the bleeding stops. Elevating the area that was bitten will also help slow the bleeding. Once bleeding slows or stops, the wound should be cleaned with soap and water and covered with a clean dressing. If bleeding does not stop or the wound is deep, patients should go to the emergency department of a nearby hospital because the patient may need stitches.
- If the bite site is extremely painful and causes significant swelling and pain, the patient should visit the emergency department of the nearest hospital. Once at the hospital, an X-ray may be taken to determine if any bones are broken. Patients who have broken bones may need to wear a cast or brace for several weeks.
- All bite wounds should be observed for 24 to 48 hours for signs of infection, such as swelling, increased pain, redness, and pus. If symptoms of infection develop, patients should go to the emergency department of a nearby hospital for treatment. Patients will receive drugs called antibiotics to fight off the infection. Cat scratch disease usually resolves on its own. However, antibiotics may be needed if the patient experiences a fever for several days or the lymph nodes stay painful and swollen for more than two or three months.
- If it is unknown if the animal has received a rabies vaccination, the patient should go to the nearest hospital to receive a rabies vaccine. The vaccination consists of three injections over the course of several weeks. The vaccination will prevent rabies from developing in the patient. However, treatment is almost never effective once symptoms of rabies have developed. Individuals should notify animal control authorities if a stray animal bit them. If the animal that bit the patient is caught and has rabies, it will be euthanized to prevent further injuries.
- Prevention: Most animals only attack when they are provoked or feel threatened. However, some may attack for no known reason.
- Animals who are new mothers are extremely protective of their young. Approach new mothers cautiously.
- Do not pet a stranger's dog or cat without asking the owner if the animal is friendly.
- When meeting a new dog or cat, individuals should crouch down to the animal's level and hold out a hand for the animal to smell.
- Do not pet a dog that is wearing a muzzle. This is a sign that the dog may be aggressive.
- Do not pet a dog if it growls or its fur is standing on end. These are warning signs that the dog feels threatened and may attack.
- Do not pet a cat if it hisses or if its fur is standing on end. These are warning signs that the cat feels threatened and may attack.
- Teach children not to provoke or tease animals. For instance, individuals should not tug on an animal's ears or tail. They should not hit or jump on the animal. Some animals may not like to be held. Do not try to take away an animal's food when they are eating. Young children should be closely supervised when spending time with animals.
- Individuals should make sure their pets are up-to-date with their rabies shots.
- Snakebites can be potentially deadly, even if the snake is not poisonous. Patients can die from an infection or allergic reaction caused by a non-venomous snakebite. Poisonous snakebites are medical emergencies that are potentially fatal if not treated immediately. Children have an increased risk of dying from poisonous snakebites because they are smaller than adults.
- It is estimated that nearly 8,000 Americans are bitten by poisonous snakes each year. Non-venomous snakes bite even more people. However, if treated quickly and properly, most patients who are bitten by venomous or non-venomous snakes can expect to fully recover.
- Most snake bites occur outdoors, especially during the summer months. People may be exposed to snakes when they are camping, hiking, picnicking, or gardening. Snakes are often found in tall grass, under rocks, and under tree stumps because these habitats offer protection from predators. In some areas of the country with high snake populations, such as Arizona, snakes may even enter the home. Even a non-venomous pet snake may bite its owner.
- Snakes bite when they feel threatened or surprised. However, most snakes will move away from humans, and they will only bite as a last resort.
- Identifying poisonous snakes: There are many poisonous snakes. Some of the most common include rattlesnakes, cottonmouths, copperheads, and coral snakes.
- Rattlesnakes make a distinctive rattling sound with their tails when they feel threatened. This is a warning sign that the snake may try to bite if the person does not back away. Rattlesnakes have a triangular-shaped head, and they are often found near barns, garbage, livestock, plywood, and in areas that have high mice populations.
- Cottonmouths are difficult to identify because they range in color from coppery brown to black to greenish, and they can be solid-colored, blotchy-patterned, or have bands of colors. These snakes have a white stripe along the side of their triangular-shaped head. Young cottonmouths have bright, sulfur-yellow tails. These snakes are most likely to be found near water.
- Copperheads look similar to cottonmouths, except they have much brighter colors that range from coppery brown to bright orange, silver-pink, and peach. These snakes are often found in wooded or hilly areas, and they are often attracted to shady areas, such as tall grass or under rocks.
- Coral snakes are distinctly colored. They are black, yellow, and red, with a solid black band on the face, and a bright yellow head. These snakes are often found in the southern and eastern parts of the United States. People do not usually encounter coral snakes because they spend much of their lives underground, and they are most active at night. Although coral snakes rarely bite humans, individuals should still stay far away from them.
- Symptoms: Symptoms of a poisonous snakebite vary depending on the specific snake. In general, symptoms may include bleeding, bloody discharge from the wound, fang marks in the skin, swelling at the site of the bite, severe localized pain, diarrhea, burning, convulsions, fainting, dizziness, weakness, blurred vision, excessive sweating, fever, increased thirst, loss of muscle coordination, nausea, vomiting, numbness and tingling, increased heartbeat, and dead skin or blistering near the bite site.
- Symptoms of a non-poisonous bite may include bleeding, fang marks, pain, swelling at the bite site, and tenderness. Patients who develop these symptoms should seek immediate medical attention.
- Some individuals may develop allergic reactions after being bitten by a non-venomous snake. Symptoms may include difficulty breathing, chest pain, hives, nausea, vomiting, throat tightness, dizziness, and loss of consciousness. Patients who develop these symptoms should seek immediate medical attention.
- If a non-venomous snakebite is not properly treated, an infection may develop. Signs of an infection include swelling, increased pain, redness, and fever.
- Treatment: Patients should call for emergency assistance immediately after being bitten by a snake, even if it is suspected that the snake is non-poisonous. While waiting for help, the patient should wash the bite site with soap and water and rest the area that was bitten. Any constrictive items on the affected area, such as rings or bracelets, should be removed because the affected area may swell.
- Do not use a tourniquet or apply ice.
- If a victim is unable to reach medical care within 30 minutes, the American Red Cross recommends that the patient apply a bandage to the wound and wrap a bandage two to four inches above the bite, to help slow the venom. The bandage should be loose enough to slip a finger under it. A suction device, such as a snakebite kit, which is available at most hiking stores, can be placed over the bite to help draw venom out of the wound without making cuts. Do not try to remove the venom without a snake kit.
- Poisonous snakebites are usually treated with a drug called an antivenin. This drug is an antidote to the snake's venom. There are many types of antivenin, each corresponding to a different kind of snakebite. This is because each snake's venom is made up of different chemicals. In some cases, the snakebite will kill the tissue near the bite mark. In such cases, the dead tissue may need to be surgically removed.
- If an infection develops, the patient will receive drugs called antibiotics. These drugs kill the bacteria that cause the infection.
- If a patient develops an allergic reaction to the snakebite, epinephrine is given. This medicine helps open the breathing tubes, making it easier for the patient to breathe. The drug also constricts the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may also be admitted to the hospital to have their blood pressure monitored and possibly to receive breathing support. Other emergency interventions may also involve placing a tube through the nose or mouth and into the airway (a procedure called endotracheal intubation) or emergency surgery to place a tube directly into the trachea (called tracheostomy or cricothyrotomy).
- Prevention: Most snake bites occur when an individual is outdoors. Individuals who are hiking, camping, or biking in areas where there may be snakes should carry a cell phone and travel in groups. If a snake bites one person, someone else can go for help.
- Individuals who spend a lot of time in the woods, such as frequent hikers or campers, should consider purchasing snakebite kits, which are available at most hiking supply stores.
- Know where snakes live and what they look like.
- Leave snakes alone. Many people are bitten because they try to kill or capture a snake or get too close.
- Avoid areas where snakes may be hiding, such as under rocks and logs. Avoid walking through tall grass, unless wearing thick boots.
- Do not stray from hiking paths or trails.
- Individuals should always look where they are stepping or reaching when outside.
- Patients with a history of anaphylaxis should carry an auto-injectable epinephrine, called an EpiPen®. If symptoms of anaphylaxis develop, the patient injects the medication in the thigh. Once an EpiPen® is used, patients should immediately seek follow-up care at a nearby hospital.
Wild animal bites
- Overview: Wild animals, such as raccoons, bats, squirrels, foxes, and other rodents may also bite humans. Wild animal bites are generally more dangerous than domestic animal bites because wild animals may carry diseases, including rabies.
- Rabies is deadly if not treated immediately. Once symptoms develop, the condition is almost always fatal.
- Animals that have rabies may foam at the mouth, behave strangely, or act confused. They may be also be less afraid of humans than normal. For instance, if a raccoon is active during the day, this is a sign that it may have rabies because raccoons are normally nocturnal.
- According to the U.S. Centers for Disease Control and Prevention (CDC), about 7,000 cases of rabies in animals are reported each year in the United States. Raccoons are the most common carrier of rabies. However, bats caused 75% of rabies cases in humans.
- Wild animals may also carry disease-causing organisms in their saliva. As a result, humans that are bitten have a risk of developing infections.
- Symptoms: Some animals may cause the skin to break with or without bleeding. Others may cause puncture-type wounds, which mean the animal's teeth pierced small holes into the skin. Others may develop major cuts, bruising, or crushing injuries that may break bones.
- Individuals who become infected with rabies may experience symptoms, such as fever, general feeling of discomfort insomnia, confusion, seeing or hearing things that are not there, difficulty swallowing, agitation, convulsions, and fear of water.
- Symptoms of an infection include increased swelling and pain, fever, and redness.
- Treatment: Patients who are bitten by wild animals should seek immediate medical treatment at the emergency department of a nearby hospital.
- While waiting for help, patients should apply pressure to the wound with a clean cloth. This will help reduce bleeding. If the wound is not severely bleeding, individuals can gently wash the wound with warm water and mild soap. Then, apply antibiotic ointment and a clean dressing to the wound.
- Healthcare providers recommend that all patients who are bitten by wild animals receive a rabies vaccine as a precautionary measure.
- If the wound is deep, stitches may be required.
- If there is extensive bruising and pain, an X-ray may be taken to determine if the patient has any broken bones. Patients with broken bones will need to wear a brace or cast for several weeks until the bones heal.
- Patients should call animal control authorities if they were bitten by an animal. If the animal is caught and tests positive for rabies, it will be euthanized. This minimizes the animal's suffering because rabies is deadly, and it also prevents the animal from harming anyone else.
- Prevention: Do not approach any wild animal, even if it appears friendly.
- Do not feed wild animals.
- Make sure garbage and trash is covered with lids. Many animals, including raccoons, will eat human garbage. If trash is properly sealed, it less likely to attract wild animals.
- When camping, make sure all food and garbage is tightly sealed and far away from the sleeping area.
- Notify the local animal control authorities if a wild animal is acting strangely, aggressively, or foaming at the mouth. These may be signs that the animal has rabies. Untrained individuals should not attempt to catch the animals themselves.
- Overview: Jellyfish are saucer-shaped marine animals that have a jelly-like body. The underside of a jellyfish consists of long tentacles that hang down in strands. Jellyfish use these tentacles to kill their prey. Tentacles have stingers that inject poisonous venom to small prey that come into contact with them.
- Jellyfish can sting humans with their tentacles. In most cases, a jellyfish sting simply causes temporary pain and transient rash in humans. However, the pain may be severe if the individual is stung multiple times or is stung by many different jellyfish.
- The severity and duration of symptoms also depends on the type of jellyfish. Some jellyfish, including the Portuguese man-o-war, can cause severe skin reactions that last for weeks. The tentacles of these enormous animals can reach up to 100 feet in length. Others, including the box jellyfish, are so toxic that they have killed humans.
- Although rare, some individuals can develop a potentially fatal allergic reaction, called anaphylaxis, to a jellyfish's venom.
- Symptoms: In general, jellyfish stings cause painful skin eruptions, which appear as a raised and itchy red rash. The rash usually only develops on the area of the skin that came into contact with the jellyfish tentacles. The rash can last for days to weeks. Severe stings, such as those caused by the Portuguese man-o-war, can cause deep wounds and the skin may peel off. Even detached tentacles of the Portuguese man-o-war are capable of causing stings for up to two weeks.
- Signs of an allergic reaction to jellyfish venom include difficulty breathing, chest pain, hives, dizziness, low blood pressure, and shock. Individuals who develop any of these symptoms should seek immediate medical treatment at the nearest hospital.
- Stings from the box jellyfish of Australia have been known to cause sudden death.
- Treatment: Jellyfish stings usually do not require any treatment. Rinse the affected area with salt water. Do not rinse with fresh water because it may worsen symptoms.
- Remove any tentacles in the skin with protective gloves or tweezers.
- Applying ice or a cool compress may help relieve pain, redness, and swelling. Applying vinegar to the affected area may help relieve pain. However, vinegar should not be applied to the skin if the patient has been stung by a Portuguese man-o-war. Vinegar may actually worsen the pain of these stings. Over-the-counter pain medications, such as ibuprofen (Motrin®, Advil®), may help reduce symptoms. It is unclear if other products, such as meat tenderizers, baking soda, or papaya, can help treat stings. It has been suggested that some meat tenderizers may help because they contain an enzyme, called papain, which may reduce the pain.
- A common myth is that urinating on a jellyfish sting will help relieve the pain of a jellyfish sting. However, this is not true.
- Patients who develop toxic reactions to jellyfish stings, including shedding of the skin or deep skin wounds, should seek immediate medical treatment. These patients are treated with drugs called antivenin. They counteract the actions of the jellyfish venom and reduce symptoms.
- If an individual develops anaphylaxis, epinephrine is injected into the patient. Epinephrine helps open the breathing tubes, making it easier for the patient to breathe. It also constricts the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may also be admitted to the hospital to have their blood pressure monitored and possibly to receive breathing support. Other emergency interventions may also include endotracheal intubation (placing a tube through the nose or mouth and into the airway) or emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy).
- Prevention: Get out of the water if a jellyfish is spotted. Jellyfish usually live in groups.
- Do not swim when there are jellyfish warnings at the beach.
- Do not touch jellyfish, even if they are washed up on the beach and appear to be dead. Even dead jellyfish are capable of stinging humans.
- Individuals should swim cautiously in warm ocean water because most jellyfish prefer warm water.
- Wearing a wet suit or Lycra® dive or swim suit may help prevent jellyfish stings.
- Individuals who have a history of anaphylaxis reaction to jellyfish should carry auto-injectable epinephrine, called an EpiPen®. If symptoms of anaphylaxis develop, the patient injects the medication into the thigh. Once an EpiPen® is used, patients should immediately seek follow-up care at a nearby hospital.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.