Objective: The aim was to describe the effects of the use of citric acid in the healing process of chronic leprosy wounds. Approach: This is a case series, carried out with 5 people with chronic leprosy wounds, under continuous care in an outpatient center wound care in the center-south region of Brazil. The intervention protocol consisted of topical application of 3% citric acid (ointment), on the wound bed, in a thin layer of approximately 2 mm, on alternate days, and followed up for a total period of 8 weeks and secondary coverage rayon and gauze. The cases were analyzed regarding wound dimensions, histology and clinical observation. Results: It was observed in all cases better aspect of the wound bed, presence of granulation tissue and decrease of the inflammatory process with predominance of lymphocytes, reduction of bacterial colonies, increase and verticalization of type I collagen fibers, reduction of type III collagen and increased areas of epithelialization. Innovation: There was also a reduction in the level of pain and exudation after the treatment protocol. Conclusions: Therefore, the use of citric acid in leprosy neuropathic wounds is promising and may be a treatment option, considering its cost, clinical management and possible effect on the chronic inflammatory process.
VérasLSTValeRGSMelloDB, et al. Degree of disability, pain levels, muscle strength, and electromyographic function in patients with hansen’s disease with common peroneal nerve damage. Rev Soc Bras Med Trop. 2012;45(3):375-379.
5.
LockwoodDNSaundersonPR. Nerve damage in leprosy: A continuing challenge to scientists, clinicians and service providers. Int Health. 2012;4(2):77-85.
6.
MaluRGNagobaBSJajuCR, et al. Topical use of citric acid for wound bed preparation. Int Wound J. 2016;13(5):709-712.
7.
NagobaBSWadherBJRaoA, et al. Treatment of lepromatous ulcers using citric acid as a sole antimicrobial agent. Int Wound J. 2012;9(5):553-556.
8.
PuriVVenkateshwaranNKhareN. Trophic ulcers-practical management guidelines. Indian J Plast Surg2012;45(2):340-351.
9.
CamposACLBorges-BrancoAGrothAK. Wound healing. ABCD Arq Bras Cir Dig. 2007;20(1):51-58.
10.
VolkSWWangYMauldinEA, et al. Diminished type III collagen promotes myofibroblast differentiation and increases scar deposition in cutaneous wound healing. Cells Tissues Organs. 2011;194(1):25-37.
11.
LimaICWuSVSilvaLM, et al. Quantification of collagen types I and III in skin lesions of leprosy patients. Rev Pan-Amaz Saude. 2020;11(11):e202000259.
12.
TangSCYangJH. Dual effects of alpha-hydroxy acids on the skin. Molecules. 2018;23(4):863.
13.
CohenPRAndersonCA. Topical selenium sulfide for the treatment of hyperkeratosis. Dermatol Ther. 2018;8(4):639-646.
14.
Davison-KotlerEMarshallWSGarcía-GaretaE. Sources of collagen for biomaterials in skin wound healing. Bioengineering. 2019;6(3):56.
15.
RangarajAHardingKLeaperD. Role of collagen in wound management. Wounds. 2011;7(7):54-63.
16.
GouldLJ. Topical collagen-based biomaterials for chronic wounds: Rationale and clinical application. Adv Wound Care. 2016;5(1):19-31.
17.
BlairMJJonesJDWoessnerAE, et al. Skin structure-function relationships and the wound healing response to intrinsic aging. Adv Wound Care. 2020;9(3):127-143.
18.
StrangHKaulAParikhU, et al. Role of cytokines and chemokines in wound healing. In BagchiDDasARoyS, eds. Wound healing, tissue repair, and regeneration in diabetes. Elsevier;2020; 197-235.
19.
DamodarasamyMJohnsonRSBentovI, et al. Hyaluronan enhances wound repair and increases collagen III in aged dermal wounds. Wound Repair Regen. 2014;22(4):521-526.
20.
ZhaoRLiangHClarkeE, et al. Inflammation in chronic wounds. Int J Mol Sci. 2016;17(12):2085.
21.
RaziyevaKKimYZharkinbekovZ, et al. Immunology of acute and chronic wound healing. Biomolecules. 2021;11(5):700.
22.
HanGCeilleyR. Chronic wound healing: A review of current management and treatments. Adv Ther. 2017;34(3):599-610.
23.
LaroucheJSheoranSMaruyamaKMartinoMM. Immune regulation of skin wound healing: Mechanisms and novel therapeutic targets. Adv Wound Care. 2018;7(7):209-231.
24.
DominguesEARCavalcantiMCSLCostaPCP, et al. Pain prevalence, socio-demographic and clinical features in patients with chronic ulcers. J Tissue Viability. 2016;25(3):180-184.
25.
HardingKCarvilleKChadwickP, et al. Wound exudate, effective assessment and management. In: Wounds International. Consensus document. Wounds UK; 2019;34.
26.
SouzaCDFMedronhoRASantosFGB, et al. Spatial modeling of leprosy in the state of Bahia, Brazil, (2001–2015) and social determinants of health. Ciênc Saúde Coletiva. 2020;25(8):2915-2926.
