Zinc and its Role in Wound Care

As seen in the Consultant Connection October 2013 Issue
Lauren Cooley, Ohio Northern University, PharmD Candidate 2014

Historically the use of zinc for wound care has shown inconclusive results. However, new studies have increasing shown that zinc is an effective therapeutic option for treating wounds. Zinc is an essential trace element that serves many functions. Some functions of zinc include autodebridement and keratinocyte migration, both of which are essential for wound repair. Furthermore, the antioxidant effects of zinc warrant the element resistant to cell death and bacterial toxins. There are two formulations of zinc that can be used for wound management, zinc oxide and zinc sulfate. 
Zinc oxide is commercially available as a topical agent, and is commonly compounded in a 10-20% formulation. Lansdown et al. looked at various studies using different formulations of topical zinc oxide on wound healing. The study concluded that the many different formulations of topical zinc oxide were effective in speeding up the time it took a wound to heal. However, all of the studies had a different duration of treatment; therefore, making a recommendation for the duration of treatment difficult. Since the side effect profile of zinc oxide is mild, it would be safe to use zinc oxide many times a day for the time is takes the wound to heal.  
Zinc sulfate is available as 66 mg, 110 mg, and 220 mg tablets or 220 mg capsules. A study conducted by Pories et al. showed therapeutic effects of oral zinc sulfate 220 mg three times a day for the time it took the wound to heal. In this study, the participants who took zinc healed 34.3 days earlier than the control group. The results of this study are consistent with other studies using 220 mg of zinc sulfate three times a day. Therefore, using 220 mg of zinc sulfate three times a day for the time it takes the wound to heal could be a safe option in wound management.
Zinc as a compound is relatively safe in all patient populations. The most common side effects of zinc sulfate are dizziness, headache, abdominal cramps, diarrhea, nausea, and vomiting. To lessen the chance of experiencing these side effects, zinc can be taken with a glass of milk or shortly after a meal. The most common side effect of zinc oxide is skin irritation and sensitivity. Zinc does possess a few drug interactions; therefore perform a drug utilization review before dispensing this medication.
In conclusion, studies are continually showing the effectiveness of zinc for wound management, however more research needs to be conducted before zinc can be added to wound healing guidelines. The safety profile of zinc is relatively mild; therefore it can be used for the treatment of wounds in the forms of topical zinc oxide multiple times a day or oral zinc sulfate three times a day. 

Zinc sulfate. Hudson (OH): Lexi-Comp, Inc. [cited 2013 August 22]. Available from: http://0-online.lexi.com.polar.onu.edu/lco/action/doc/retrieve/docid/patch_f/7895#f_dosages
Zinc oxide. Hudson (OH): Lexi-Comp, Inc. [cited 2013 August 22]. Available from: http://0-online.lexi.com.polar.onu.edu/lco/action/doc/retrieve/docid/patch_f/7894
Pories WJ, Henzel JH, Rob CG, Strain WH. Acceleration of Healing With Zinc Sulfate. Annals of Surgery. March 1967. Vol. 165; 3:432-436.
Lansdown AB, Mirastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: Theoretical, experimental, and clinical aspects. Wound Rep Reg (2007) 15:2–16.
Walravens PA. Zinc Metabolism and Its Implications in Clinical Medicine (Clinical Nutrition Symposium). West J Med 130:133-142, Feb 1979

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