The Use of Prontosan Solution and Prontosan Debridement Pad in Kyperkeratosis on the Foot
Beth Williams, High Risk Podiatrist, Manchester Local Care Organisation, shares her experience of using Prontosan Debridement Pad. This is adapted from an article originally presented at Wounds UK 7th – 9th November 2022
Patient:
83 year old male with Type 2 Diabetes, Hba1c 68mmols, Neuropathy, Hypertension, CKD 3, Carotid artery stenosis, Left Ventricular hypertrophy. With podiatry since November 2021. Multiple treatments have been initiated by the GP from December 2021 to August 2022 including Urea 10%, Hydromol, Daktocort, Salycilic cid and Terbinafine. Extensive Psosiasis suspected and discussed.
August 2022: Hands and feet symptomatic, palms of hands dry, itchy, flaky.
Dorsum of feet itchy, painful, fissures present, dry plaques. Plantar feet hyperkeratotic plaques – extensive thickness and unable to sharp debride – skin intact but painful.
Objective – Quality of Life:
The patient was psychologically distressed by a deteriorating skin condition. The plantar skin was responding poorly to sharp debridement and prescribed topical medications. It was felt appropriate to improve the dorsal skill condition to ease the distress felt by the patient. Sharp debridement would have been limited due to the fragile presentation, therefore Prontosan Debridement Pads were selected to gently debride the dorsal skin plaques. A further aim focused on reducing the risks of a diabetes foot infection, as it was felt removal of skin plaques that harbour bacteria would be beneficial.
Treatment and Results
A Debridement Pad was moistened with Prontosan Solution and applied to the dorsum to soften the dry plaques for 5 minutes. The dry plaques were gently lifted using a circular motion with the larger end of the pad, the interdigital areas were mechanically debrided with ease thanks to the thinness of the pad and by utilising the tapered end. The pictures below are the results after 1 session in clinic, one debridement pad per foot.
Patient Impact:
The patient had been engulfed in a cycle of skin deterioration for months, before this treatment it had been difficult to hold lifestyle conversations due to the level of pain and distress. He would decline treatment and became frustrated with clinicians. By visualising the positive progress of this treatment the patient was more positive, for the first time opening up about his smoking status. It allowed us to discuss the impact stress has on conditions like Psoriasis and allowed him to focus on something positive whilst waiting for Dermatology input. The patient experienced no pain throughout the treatment. We plan to repeat the mechanical debridement when he returns in 2 weeks.