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Clinical Question:
Does brief daily application of tretinoin improve healing in diabetic foot
ulcer?
Bottom Line:
Short-contact application of topical tretinoin improved the healing of foot
ulcers in patients with diabetes. The tretinoin therapy was generally well
tolerated, without serious local or systemic adverse effects.
Reference:
Tom WL, Peng DH, Allaei A, Hsu D, Hata TR. The effect of short-contact
topical tretinoin therapy for foot ulcers in patients with diabetes. Arch
Dermatol 2005; 141:1373-377.
Study Design:
Randomized controlled trial (double-blinded)
Synopsis:
To determine the efficacy and safety of short-contact administration of
topical tretinoin on foot ulcers in patients with diabetes. Randomized,
double-blind, placebo-controlled trial was done. Outpatient clinic at a
Veterans Affairs medical center. Twenty-four volunteers with diabetic foot
ulcers but without evidence of peripheral arterial disease or infection.
Patients were randomized to 4 weeks of daily treatment with either topical
0.05% tretinoin solution (Retin-A) or placebo saline solution. Photographs
and assessment of wound size and appearance were assessed every 2 weeks for
a total of 16 weeks. The proportion of ulcers that healed in each group and
the degree of change in ulcer size. Twenty-two patients, with a total of 24
foot ulcers, completed the study. At the end of 16 weeks, 2 (18%) of 11
ulcers in the control group and 6 (46%) of 13 ulcers in the tretinoin
treatment group healed completely. Topical tretinoin therapy significantly
decreased ulcer area and depth compared with placebo treatment over the 16
weeks of the study (P < .01 for surface area; P = .02 for depth). Adverse
effects mainly consisted of mild pain at the ulcer site. |