Comparison of Zinc Barrier Cream and Elastomeric Skin Protectant in Venous Leg Ulcer Periwound Skin

Background: Venous leg ulcers (VLUs) have a history of prolonged wound healing and high rates of recurrence.^1,2 Venous insufficiency, an underlying cause of VLUs, can lead to fragile periwound skin prone to breakdown and medical adhesive-related skin injury.¹ VLU periwound skin was examined in 5 patients following use of zinc barrier cream or elastomeric skin protectant* with topical wound dressings and multilayer compression wrap.^†

Methods: Endovenous ablation was performed, followed by application of zinc barrier cream or an elastomeric skin protectant to periwound skin prior to application of topical wound dressings and multilayer compression wraps. Dressings were changed every 7 days. Wound healing and periwound skin condition were monitored.

Results: Five patients presented for care with medial ankle VLUs. Average patient age was 72.6 years old. Common patient comorbidities included hypertension, obesity, venous insufficiency, and varicose veins. After 3 weeks, the skin protectant was switched to elastomeric skin protectant due to periwound skin injury during the removal of the zinc barrier cream. All patients showed periwound skin improvement after elastomeric skin protectant use was initiated. Unwanted product buildup was noted with the zinc barrier cream during application, compared to the elastomeric skin protectant. The removal of the zinc barrier cream at dressing changes often led to periwound skin epidermal stripping. Epidermal stripping was not observed with the elastomeric skin protectant, as it wears off and does not require removal.

Conclusions: In our experience, use of zinc barrier creams for VLU periwound skin can be difficult due to unwanted product buildup during application and/or epidermal stripping upon removal. When the elastomeric skin protectant was used, product buildup and epidermal stripping were not observed. In these 5 patients, use of an elastomeric skin protectant under wound dressings and multilayer compression wraps resulted in improved periwound skin compared to zinc barrier cream use.

*3M™ Cavilon™ Advanced Skin Protectant, †3M™ Coban™ Two-Layer Compression System, (3M, St. Paul, MN)

References

1. Dini V, Janowska A, Oranges T, De Pascalis A, Iannone M, Romanelli M. Surrounding skin management of venous leg ulcers: a systematic review. J Tissue Viability. 2020;29(3):169-175.
2. McDaniel HB, Marston WA, Farber MA, Mendes RR, Owens LV, Young ML, Daniel PF, Keagy BA. Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography. J Vasc Surg. 2002;35(4):723-728.