What role do topical treatments play in the management of chronic leg ulcers, and which are most effective?

Topical treatments play a supportive but selective role in the management of chronic leg ulcers, primarily aiming to maintain an optimal wound environment and manage infection when clinically indicated. The use of topical antimicrobial dressings may be considered in cases where there is clinical evidence of local infection, such as spreading cellulitis, but routine use of topical antiseptics or antimicrobials is not recommended without signs of infection NICE CG179.

Dressings that promote a warm, moist wound healing environment are preferred to support healing in chronic leg ulcers, including pressure ulcers and diabetic foot ulcers, as they facilitate autolytic debridement and tissue repair NICE CG179,NICE NG19. Gauze dressings are generally discouraged due to inferior healing outcomes NICE CG179.

Systemic antibiotics should only be used when there is clinical evidence of systemic infection or spreading cellulitis, not solely based on positive wound cultures NICE CG179.

Recent literature on venous leg ulcers supports the use of advanced topical dressings that maintain moisture balance and may include antimicrobial properties when infection is present, highlighting that no single topical agent is universally superior but that treatment should be tailored to wound characteristics and patient factors Shaydakov et al. 2022. For leg ulcers related to sickle cell disease, topical treatments are adjunctive, focusing on wound care and infection control, with systemic management being crucial Minniti & Kato 2016Monfort & Senet 2020.

In summary, the most effective topical treatments for chronic leg ulcers are those that maintain a moist wound environment and support autolytic debridement, with selective use of topical antimicrobials when infection is clinically evident. The choice of dressing should consider pain, exudate level, and patient tolerance NICE CG179,NICE NG19 Shaydakov et al. 2022.