Benefit and harm of iodine in wound care: a systematic review

doi:10.1016/j.jhin.2010.04.026

Journal of Hospital Infection

Volume 76, Issue 3, November 2010, Pages 191-199

https://doi.org/10.1016/j.jhin.2010.04.026 Get rights and content

Summary

Nowadays many products are available to combat infections and thus to promote wound healing. Iodine is one of these products, but reports are conflicting as to the effectiveness and adverse effects of iodine in the treatment of wounds. A systematic review was performed of 27 randomised clinical trials, reporting on chronic, acute, burn wounds, pressure sores, and skin grafts. Main outcome parameters were wound healing, bacterial count, and adverse effects. Iodine did not lead to a reduction or prolongation of wound-healing time compared with other (antiseptic) wound dressings or agents. In individual trials, iodine was significantly superior to other antiseptic agents (such as silver sulfadiazine cream) and non-antiseptic dressings, but seemed inferior to a local antibiotic (Rifamycin SV MMX^®) and, when combined with alcohol, to crude honey in reducing bacterial count and/or wound size. Adverse effects, including thyroid function derailment, did not occur more frequently with iodine. Based on the available evidence from clinical trials, iodine is an effective antiseptic agent that shows neither the purported harmful effects nor a delay of the wound-healing process, particularly in chronic and burn wounds. The antiseptic effect of iodine is not inferior to that of other (antiseptic) agents and does not impair wound healing. Hence, iodine deserves to retain its place among the modern antiseptic agents.

Introduction

Wound healing can be negatively influenced by many factors. One major contributor of impaired healing is wound infection, due to a plethora of pathogens. It is therefore not surprising, considering the increasing prevalence of multi-resistant micro-organisms in hospitals, that many (modern) antiseptic products such as silver, honey and (local) antibiotics are available to prevent and combat wound infection.

Iodine is probably the best known antiseptic and has been used for more than a century.¹ However, the use of iodine to treat or prevent wound infection is under discussion. Iodine (as well as antiseptics in general) in wound treatment is believed to cause allergic reactions, to be less effective due to poor penetration, or to negatively influence tissue regeneration due to a toxic effect on the host cells.2, 3, 4 These reports, however, were published more than 25 years ago.

On the other hand, other reports suggest that these fears may be unjustified as they are based on sometimes inappropriately performed studies with animals, or in a laboratory setting with standardised wound conditions, and are therefore not applicable to humans.5, 6

In this systematic review of randomised clinical trials (RCTs) we investigated the possible beneficial and harmful clinical effects of iodine in the treatment of all kinds of (contaminated) wounds.

Section snippets

Literature search

The search for potentially relevant RCTs was performed in Cinahl, Embase, and Medline, from inception of the databases to August 2008, and the Cochrane Controlled Trials Register up to Issue 3, 2008. The searches were performed without restrictions on language, publication date, or publication status. In addition, references in relevant articles were searched for other potentially relevant publications.

Inclusion criteria

Eligible RCTs needed to report on a local wound care product containing iodine in patients

Results

The search yielded 266 potentially relevant studies. Of these, 29 publications met our inclusion criteria. Trial flow and reasons for exclusion are shown in Figure 1.

Of the 29 studies included, Reimer et al. and Vogt et al. used the same patient set as did Hauser et al. and Vogt et al.7, 8, 9, 10 Thus, this review comprised 29 publications on 27 RCTs. Relevant data were extracted from all publications. Trial sizes ranged from 27 to 1089 patients, totalling 4495. More than half (52%) of the

Discussion

Iodine has been used as an antiseptic for more than a century. Despite its reputation, this systematic review yielded only 27 randomised trials conducted since 1976 on the effectiveness of various iodine-containing products to treat or prevent infection in wound care. To date, however, iodine is one of the best-documented antiseptic agents. The majority of trials showed no substantial differences in beneficial or adverse reactions between iodine and other methods of local care for various

Acknowledgements

We thank Prof. Dr A. Voss, clinical microbiologist, Dr K. Munte, dermatologist, Dr A.F.P. Vloemans, surgeon and M.J. Lubbers, surgeon-intensivist, for reviewing the manuscript. Furthermore we are grateful to Mrs H. Vriends, one of our university clinical librarians, for assistance with the development of the search strategy.

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ReviewBenefit and harm of iodine in wound care: a systematic review

Summary

Introduction

Section snippets

Literature search

Inclusion criteria

Results

Discussion

Acknowledgements

Burns

Ann Chir Main Memb Super

Burns

Burns

Lancet

Lancet

The history of iodine in medicine. Part 1: from discovery to essentiality

Orig Internist

Topical antimicrobial toxicity

Arch Surg

Local tissue effects of wound disinfectants

Acta Chir Scand

Bactericidal activity and toxicity of iodine-containing solutions in wounds

Arch Surg

What is the evidence for tissue regeneration impairment when using a formulation of PVP-I antiseptic on open wounds?

Dermatology

An appraisal of povidone-iodine and wound healing

Postgrad Med J

An innovative topical drug formulation for wound healing and infection treatment: in vitro and in vivo investigations of a povidone-iodine liposome hydrogel

Dermatology

Polyvinyl pyrrolidone-iodine liposome hydrogel improves epithelialization by combining moisture and antisepsis. A new concept in wound therapy

Wound Repair Regen

Efficacy of treatment with Repithel and Jelonet in comparison to treatment with Jelonet alone – a randomized clinical trial in patients receiving meshed skin grafts

Zentralbl Chir

Use of an aqueous triple iodine solution in the treatment of chronic leg ulcers and gangrene

Angiology

An evaluation of dextranomer as a cleansing agent in the treatment of the post-phlebitic stasis ulcer

S Afr Med J

In-patient treatment of chronic varicose venous ulcers. A randomized trial of cadexomer iodine versus standard dressings

J Int Med Res

Cavity foot ulcers in diabetic patients: a comparative study of cadexomer iodine ointment and standard treatment. An economic analysis alongside a clinical trial

Acta Dermat Venereol

Quality control in chronic wound management: the role of local povidone-iodine (Betadine) therapy

Dermatology

Review
Benefit and harm of iodine in wound care: a systematic review