Compression Therapy with Zinc Oxide Dressings in Dermatology
Zinc oxide dressings have a long-standing tradition and continue to find their place in modern dermatology. Compression therapy is the cornerstone of conservative treatment for chronic venous insufficiency and lymphatic insufficiency and should not be overlooked even at the stage of venous leg ulcers.
Long Tradition with Innovations to the Present
The first gauze bandage soaked in a mixture of 15% zinc oxide in a glyco-gelatin-based paste for the treatment of leg ulcers was invented as an alternative to poorly tolerated compression bandages of its time in 1881 by German dermatologist Paul Gerson Unna, a pioneer of modern dermatopathology and dermotherapy. This mixture had drying, cooling, and antipruritic effects due to the constant mild pressure on the skin. After thorough testing of different forms of the bandage, the so-called Unna's boot was presented at a dermatological congress in London in 1896.
Zinc oxide dressings were thus introduced into practice at the end of the 19th century, when many similar zinc dressings appeared on the market. Over time, it became widely used for its ease of application, effectiveness, and low cost. Nowadays, there are similar products on the market composed of low-compression gauze (18–24 mmHg) impregnated with zinc oxide in a base containing substances such as Arabic gum, glycerol, castor oil, and deionized water. The result is a semi-solid form suitable for external use.
Basic Properties
Modern mass-produced zinc oxide dressings are available in a form ready for immediate use. The longitudinally and transversely woven elastic bandage, made of cotton, polyamide, and zinc paste with bi-directional elasticity, allows for wrapping under uniform pressure without the need for cutting at difficult anatomical transitions, with a uniformly distributed decrease in pressure from the ankle upwards along the leg. The result is a semi-rigid permanent bandage.
A rigid zinc oxide bandage increases the compression of the venous system above 60 mmHg (working pressure) during calf muscle contraction, thereby supporting venous drainage and aiding healing. The resting pressure is minimal and acts on the macrocirculation (increasing venous return by restoring valve function and reducing reflux) and on interstitial fluid, thus supporting the reabsorption of edema and the return of fluids localized in interstitial spaces into the vascular and lymphatic systems.
Practical Use
The zinc oxide compression bandage is suitable for wounds in various phases, considering the frequency of bandage changes. For a wound in the cleaning phase, a change is recommended once a week, in the granulation and epithelialization phase once every two weeks. When changing the bandage, clean the wound, possibly perform debridement, and cover with tulle gras and compression moistened with a suitable wound cleansing solution. Then apply the zinc oxide compression bandage.
Patient Education
Patients are often used to changing dressings multiple times a week, which is not necessary with zinc oxide bandages, and less frequent changes are sufficient. Because of this, patients initially tend to distrust this method, but they quickly get used to less frequent changes, especially after local findings improve. Patients should also be instructed that conditions requiring attention and consultation with a doctor include the occurrence of new pain or numbness in the toes or foot, a change in the color of the toes, or an unpleasant odor. An important part of the treatment when wearing a zinc oxide compression is movement. Patients should therefore be mobilized.
In the first few hours after application, before the bandage dries, patients should avoid long walks to prevent damage to the bandage. If possible, they should avoid getting the bandage wet, and during showers, cover the leg with a suitable cover, such as a combination of taped plastic bags. The leg with the zinc oxide bandage should not be subjected to compression garments (socks, knee-highs, stockings); ordinary socks and shoes are appropriate.
Conclusion
Zinc oxide dressings are a traditional compression tool that continues to find applications in dermatological practice. A rigid zinc oxide bandage provides support and resistance to contracted calf muscles, increasing effective venous system compression pressure above 60 mmHg, while resting pressure is minimal.
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Sources:
1. Tekiner H., Karamanou M. The Unna boot: a historical dressing for varicose ulcers. Acta Dermatovenerol Croat 2019; 27 (4): 273–274.
2. Paranhos T., Paiva C., Cardoso F., et al. Assessment of the use of Unna boot in the treatment of chronic venous leg ulcers in adults: systematic review protocol. BMJ Open 2019; 9 (12): e032091, doi: 10.1136/bmjopen-2019-032091.
3. Kalný J., Léčba žilního bércového vředu. Interní medicína 2013; 15 (3–4): 118–120.
4. Inovia Vein Specialty Centers. Unna boots for wounds and venous stasis ulcers. Inovia Vein, 2023. Available at: https://inoviavein.com/unna-boots-for-wounds-venous-stasis-ulcers/
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