The effect of short-contact topical tretinoin therapy for foot ulcers in patients with diabetes.

Author(s): Tom WL, Peng DH, Allaei A, Hsu D, Hata TR

Affiliation(s): Division of Dermatology, Department of Medicine, University of California, San Diego, USA.

Publication date & source: 2005-11, Arch Dermatol., 141(11):1373-7.

Publication type: Randomized Controlled Trial

OBJECTIVE: To determine the efficacy and safety of short-contact administration of topical tretinoin on foot ulcers in patients with diabetes. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Outpatient clinic at a Veterans Affairs medical center. PATIENTS: Twenty-four volunteers with diabetic foot ulcers but without evidence of peripheral arterial disease or infection. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: The proportion of ulcers that healed in each group and the degree of change in ulcer size. RESULTS: 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. CONCLUSIONS: 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.