Clinical Question: Does brief daily application of tretinoin (Retin-A) improve healing in diabetic foot ulcers?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Findings from uncontrolled studies have suggested that brief application of topical tretinoin may improve healing in patients with chronic skin ulcers. In this small study, 24 patients with diabetic foot ulcers, but without evidence of peripheral vascular disease or infection, were identified at a Veterans Affairs medical center. Groups were reasonably well balanced at the start of the study: the control group had a mean age of 61 years, mean duration of ulcer of 12 months, and mean ulcer size of 1.1 cm; corresponding values for the intervention group were 58 years, six months, and 0.9 cm.

The intervention group had 0.05 percent topical tretinoin applied for 10 minutes per day, followed by a saline rinse, for a total of four weeks. All wounds had cadexomer iodine gel (Iodosorb) applied between treatments with tretinoin or placebo ointment. After 16 weeks, wounds in the intervention group were 55 percent smaller than at baseline; those in the control group were 3 percent larger (absolute values in terms of square centimeters are not reported). More ulcers were completely healed in the intervention group than in the control group (six per 13 versus two per 11; P = .03). Mild to moderate pain was more common in the tretinoin group (three versus one), but this was not statistically significant in this small study.

Bottom Line: This small study provides some support for a daily 10-minute application of 0.05 percent topical tretinoin to diabetic ulcers. (Level of Evidence: 1b–)