What is the role of antiseptics/antibiotics in the wound healing process?

June 21, 2005 10:00 PM

What is the role of antiseptics/antibiotics in the wound healing process? On a cut, for example, it seems that constant reapplication of neosporin makes a cut take longer to heal. What's going on here? Is it just preventing a scab from forming due to the moisturizing quality of such creams? Does that actually impede healing? For cuts in the mouth, it seems like frequent use of an alcohol-based antiseptic mouthwash would kill most living cells in the area, preventing quick healing. Is this the case? I'm aware that these substances prevent infection, but do they have any other effects, good or bad in the healing process?
posted by sirion to health & fitness (10 comments total)

As far as Neosporin, I do know that my nurse-practitioner said it promotes redness and you should use plain bacitracin ointment instead. Haven't had that confirmed outside of her.

I would say that one application of whatever substance is fine, and keep it clean afterwards.

As far as inside the mouth, I had my wisdom teeth removed in April. They were infected, so for about 2 weeks before the surgery, I had to rinse with a prescription mouthwash before every brushing (which was upped to after every time I ate), and half-peroxide half-water afterwards. Starting one week after the surgery, I had a syringe with a curved plasic nose which I had to use to squirt full-strength peroxide into the holes 4-6 times daily for 6 weeks. Not pleasant-tasting, but it didn't seem to impede the healing.
posted by IndigoRain at 10:16 PM on June 21, 2005

I've had good results with neosporin, but maybe I'm a freak. (neosporin uses one of the *many* actinomycete-derived antibiotics; bacteria are always finding new ways of killing off other bacteria - *many* of our antibiotics were originally bacterial in origin)

Wound healing is something your cells/body normally does. Bacterial/viral infiltration into a wound (they'll grow because a wound = easy-to-access nutrients) means secondary damage (both from the bug and from your body responding to it - for example, inflammatory responses to pathogens exacerbates scar formation as well as delays 'normal' healing). Making the wound aseptic helps your cells do their thing after injury without having to worry about anything else.

Something like gurgling with alcohol... aside from intoxication impacting negatively on the immune system, it can also exacerbate inflammatory responses. Salt water (some bacteria will explode in a hypertonic environment) might help, but it depends on the bacteria so it's not always a good thing to do.

If you're really worried, just make sure that you're hydrated (drink lots of water, but not too much - if you're a worry wort, drink tons of "sport" drinks) and get enough sleep. If a wound isn't obviously infected, keeping to a good diet and getting enough sleep is the best that you can do to speed up wound recovery.
posted by PurplePorpoise at 10:50 PM on June 21, 2005

If a wound is clean, it'll heal fastest under an undisturbed scab. But if it gets infected it won't heal as quickly or as well, and as you said, first aid ointments seal the wound from oxygen, retarding scab formation, and contain antibiotics, preventing infection. So while they may not heal every wound faster, they can help prevent infection and scar formation.

(The best topical antibiotic is actually sterilized honey - there's a reason you don't have to refrigerate it!)

(I am not a doctor, I just get cut a lot.)
posted by nicwolff at 10:54 PM on June 21, 2005

As a cyclist who deals with cuts and road-rash abrasions all the time, I always cover my wounds with dressings. Sure it'll heal faster if you let a scab form, but that results in much more scarring.
posted by randomstriker at 11:02 PM on June 21, 2005

With all due respect, I disagree with nicwolff completely. In my own decades of unoffical experiments, I have found that neosporin or generic triple antibiotic cream speeds the healing process dramatically. I would estimate, in my own trials, at least 1/3 faster than with just cleaning the wound and allowing a scab to form. In another thread someone who purported to be a nurse said that neosporin does nothing more than keep the wound moist, which accelerates healing, but I would differ. At any rate, allowing the scab to form is not the fastest way to heal. The key is keeping the wound moist and covered.
posted by wsg at 12:05 AM on June 22, 2005

No respect is due! Remember, not a doctor. A perfectly clean wound might scab and heal quickly, but in the real world I guess every wound is contaminated with bacteria and benefits from being kept open so that antibiotics can reach the infection. And in fact, I always put Neosporin or Medihoney on cuts I want to heal fast. (Or QuikClot for the big ones...)
posted by nicwolff at 12:38 AM on June 22, 2005

I find the moisture from neosporin helps. Without it, the edges dry and don't heal together as quickly.
posted by Goofyy at 2:32 AM on June 22, 2005

Whatever happened to good old hydrogen peroxide? Isn't it bad to use antibiotics willy-nilly when there is something with no risk of superbug creation out there?

Anyway, I find that neosporin or similar + bandage makes my cuts take forever to heal and makes them all goopy.
posted by dame at 8:46 AM on June 22, 2005

I like to quote the old surgeon's maxim, "Never put anything in a wound that you wouldn't put in your eye." That's my guiding principle. I generally flush a wound with water or saline until the debris is gone and the blood is running clear, then I attempt to approximate the wound edges (if any) so that it can heal by primary intent.

The bandage serves the purpose of holding the wound together and preventing further mechanical disruption. It also may keep moisture in and oxygen out, but I've never been sure if these are important.

I do not use antibiotics where an infection is not known to be present. Bear in mind that your body's immune system puts even the most potent antibiotics to shame with its efficacy; penicillins, for instance, retard neutrophil leukotaxis, and there are other negative effects from antibiotics that suggest their use should be confined to active infections.

I do put A&D ointment on a large scrape, as a moisture barrier and to retard the formation of a crusting scab (which crust will lead to a longer wound-healing process.) Crusted scabs are nature's bandages but they are adhesive to the wound; this is actually good in filthy environments, where stripping the scab off takes necrotic tissue and debris with it, but not so good in a more modern hygienic environment. We use wet-to-dry dressings in hospitals for a similar purpose: healing large wounds by secondary intent requires periodic stripping of the necrotic tissue and exposure of fresh granulation tissue. As the gauze dries out, it adheres; then it is stripped away, leaving pink tissue behind it.

Antiseptics such as alcohol, peroxide, quaternary ammonium and iodine should never be used in a wound. They destroy the cells of your body that would otherwise be attempting to disinfect and repair the wound.

This is my opinion gained from years of study and practice, and it is geared towards the practical, not the theoretical. It is based in part on conversations with plastic surgeons and elderly wound care nurses who have forgotten more about wound healing than I'll ever know. I also learned much by caring for bedbound patients' bedsores; these are some of the most difficult wounds you'll ever find.
posted by ikkyu2 at 3:55 PM on June 22, 2005

Liquid Bandage and its like have been a godsend to me. I have skin like tissue paper and have open wounds almost daily. Generally, one dose of the liquid bandage and I never get any redness or infection at all.
posted by phewbertie at 2:32 AM on June 23, 2005