Adjunct Solutions for Chronic Wounds


In the United States alone, chronic wounds affect 6.5 million people. Chronic wounds are a painful, expensive, and hard-to-treat issue. The problem is that somewhere around (or above) 90% of chronic wounds contain bacteria living within biofilms. In fact, according to the book “Biofilms in Human Diseases: Treatment and Control,” Skin diseases, including atopic dermatitis, various forms of chronic ulcers, necrotizing fasciitis, cellulitis, and erysipelas are usually caused by polymicrobial pathogens living in biofilms. Unfortunately, many doctors are simply unaware of what can be done, and fewer are willing to experiment.

Biofilms are essentially an aggregate of microorganisms that have produced a protective shield that allows them to adhere to their chosen surface. In this case, that surface is the skin. Traditional wound treatments (like antibiotics) are not as effective when biofilms form. In fact, sometimes antibiotics make things worse. An example of this might be that antibiotic ointments like mupirocin can actually stimulate biofilm formation. And if left unchecked, biofilm-related wounds can get worse – a LOT worse.

Fighting biofilms can be challenging, and without serious and constant treatment, such wounds can get out of hand rapidly. Skin infections, in particular, can be severe and sometimes life-threatening due to potentially dangerous bacteria such as staphylococcus, streptococcal, and others. So it behooves anyone with a chronic wound to ensure that it is treated aggressively and persistently. However, unfortunately, the recurrence of the wound is common. This is often because the biofilm and bacteria were not completely eradicated during treatment. This becomes a potentially dangerous situation for obvious reasons, especially if your doctor has chosen only antibiotics as their weapon of choice.

The truth is that there are several mainstream treatment options for chronic wounds. Unfortunately, none of them are exactly ideal. Options include debridement, compression stockings, compression bandages, antibiotics, hyperbaric oxygen therapy, ultrasound, electromagnetic therapy, and photodynamic therapy, to name a few. While these can and often do help, they are also expensive and sometimes ineffective options.

That is sort of scary when you think about it because that bacteria associated with chronic wounds can spread and cause damage in other parts of the body as it does. Furthermore, if a wound is left to fester too long, the possibility of amputation or death becomes quite real. Still, regardless of which option is chosen, such treatments’ time and cost must be considered.

Is There Another Way?

Has there been a better solution or two staring us in the face the entire time? I believe that there has been. But if that’s true, why hasn’t the general public or even the medical community been made aware of it?

I cannot answer that question, but I want you to consider the following: do your research and confer with your medical professional before taking action on this information. I will say it now, and I will say it again, skin infections are nothing to play around with.


Recently, my research helped me stumble upon something called Polyhexanide (also Polyhexamethylene biguanide – PHMB). PHMB is an antiseptic and disinfectant that was originally developed as a presurgery antimicrobial scrub. Today, it’s used in various products ranging from wound care dressings to contact lens cleaning solutions.

To be quite frank, I was shocked to discover just how effective this stuff really is. More importantly, I was shocked to discover that it lacks reports of severe adverse reactions, bacterial resistance, or dangerous interactions. In fact, some studies suggest that it is “an excellent choice as a topical antiseptic to prevent and treat bacterial infections.

PHMB has another trick up its sleeve, though. As it turns out, PHMB has been successfully used for bacterial decolonization and prevention of biofilm formation in wound management – including MRSA. However, it is often used as a rinsing solution instead of a primary treatment. I can only imagine that this is due to its somewhat thin viscosity. Another issue might be its short shelf-life.

Regardless, I conferred with several medical doctors, and all but one of them was seemingly unaware of this product. The one that was aware of it knew about it because of his time working in a burn unit, but he had not considered providing it to his patients despite being aware of its effectiveness. The point is that I’m sure that if these doctors were unaware, then many more are probably unaware as well. This might explain the default to potentially dangerous antibiotics or intrusive treatments.

N-acetylcysteine (NAC)

While researching issues related to root canals, I stumbled upon a study regarding dental biofilms. This study demonstrated that N-acetylcysteine (NAC) showed greater efficacy in biofilm cell removal and killing than the other root canal medicaments. Furthermore, NAC disrupted the mature multispecies endodontic biofilms completely. This got me thinking, and further research revealed numerous studies suggesting the same in various settings – including the skin.

I absolutely love NAC. In fact, I have written about NAC before on several occasions. NAC can do many great things for the body. I’m not the only one, though. Check out this great article in Pharmacy Times.

One of the things that I love about NAC is that it is a precursor to Glutathione, which is critical in helping your immune system fight off infections and prevent cancer. That’s when it started to “click.” I found myself down a few rabbit holes and discovered that it’s great when used topically. I had not previously considered that.

Several studies suggest that topical NAC was effective in conditions ranging from acne vulgaris to atopic dermatitis. Further research revealed that it could also be used for conditions such as Type I lamellar ichthyosis, bullous morphea, systemic sclerosis, toxic epidermal necrolysis, and pseudoporphyria. Ultimately, and why I have included it here was that studies have repeatedly demonstrated that NAC substantially benefits wound healing. But again, this is something that the medical doctors that I have conferred with knew little to nothing about.

And let me clarify something about that. It’s not that doctors are unaware of WHAT NAC is. Doctors use NAC quite a bit. For example, NAC is also used to treat acetaminophen overdose and to loosen thick mucus in patients with conditions like cystic fibrosis or chronic obstructive pulmonary disease. I’m just saying that (at least with the doctors I have discussed this with), it has not occurred to them to use it topically as I have suggested. Additional clarity here might be that I was not discussing this with dermatologists. They might be aware.

My Conclusions

Keep in mind that there is plenty of research out there on both NAC and PHMB that you should consider. I’m just giving you an overview here. Specifically, I’ve taken a few weeks’ worth of research and slammed it all into an article that only takes a few minutes to read. You should always do your research and draw your own conclusions. And if you have a question, please confer with your doctor or medical professional.

With that being said, I will tell you that my key takeaways are that both NAC and PHMB are safe when used on the skin, they have a strong and researched history of effectiveness in inhibiting new biofilms and destroying established ones, and they both have few (if any) reports of adverse effects when used correctly. Used separately or together, these could potentially be a couple of strong weapons to add to your wound management and treatment arsenal.

Remember, I am not your medical doctor, so I am not in a position to prescribe or treat you. However, the science is clear. There are solid alternatives to some of the mainstream chronic wound treatments. Finally, these two treatment options are relatively inexpensive and readily available, and both are available without a prescription.


My first recommendation is to follow your doctor’s advice. Please don’t make decisions based on what you read on some random guy’s website. You probably don’t know me, and I could potentially be wrong.

Remember: skin infections are nothing to play around with.

My second recommendation would be to address any underlying health concerns. Getting your overall health squared away will help you in this fight tremendously. If you need some help with this, I’ve written an article that covers the basics, and you can review it here. Either way, just try to ensure that any deficiencies are addressed and that you’re eating a well-balanced diet with at least 150 minutes of moderate exercise each week (more if possible).

With that out of the way, I will share a few products that I have recently put in my wound-care arsenal (based on my research) via the following links:

How To Do It

If I were struggling with a chronic wound that my doctor was seemingly unable to treat or cure, I would place Protosan on the wound and cover it with a polyhexanide-laced dressing, then rub the Zetpil into the surrounding tissue. I might also try Zetpil on the wound, though it might burn. Remember that dressings should be changed as often as needed to prevent wound drainage from soaking the gauze. This is usually one to four times a day. This treatment would continue until at least a week after the wound was seemingly healed.

Logic dictates that this plan would aid in disrupting biofilms while maintaining a clean and moist environment for healing. All this while getting a glutathione boost (which will also help fight the infection) AND without creating dangerous antibiotic-resistant superbugs. The additional time would be to ensure that the biofilms are eradicated and that the body has taken over its natural defenses. This could be aided by ESWT, which I will explain below.

NOTE: You might also be able to boost the power of NAC with liquid ibuprofen. You can learn more about that by reviewing the following journal entry in the American Journal of Epidemiology and Infectious Disease. CLICK HERE – Summary: aside from a reduction in pain, they conclude that regarding wounds, “NSAIDs and NAC combination showed increased activity and a higher effect than the effect of each alone.

NOTE #2: If you are looking for, even more, you could also consider adding Epicatechin to your supplement stack. Epicatechin is often used as a sports supplement, but it has also been found to acutely increase microcirculation in human skin and may also improve wound healing. Here is a product example. This will be a great addition if you explore the following option.

One More Option to Consider

There is another tool I would like to share with you. I’m separating this from the others because it is usually expensive. However, I need to include it because it appears to be a reliable adjunct to other treatments. After all, it can aid in the wound-healing process significantly. This is true regardless of whether you are dealing with biofilms or not.

Extracorporeal shock wave therapy (ESWT) is a tool that is often used in sports medicine. People suffering from shoulder injuries, chronic Achilles tendonitis, plantar fasciitis, elbow tendinopathies, and chronic stages of myofascial syndrome have found significant relief by using it. In recent years, it has even found favor in treating conditions such as erectile dysfunction, and they are finding new uses for it all the time.

Essentially, ESWT is a noninvasive treatment that involves the delivery of shock waves to injured soft tissue to promote healing. Research has demonstrated that one of the several healing mechanisms is due to increased blood flow. However, recent research has also demonstrated that it can reduce bacterial counts, making it a strong candidate for chronic wound treatment.

For example, experiments have demonstrated that when shock waves are applied to catheters colonized with bacteria that were not susceptible to the antibiotic ciprofloxacin, they are suddenly sensitive to the treatment. In fact, the bacteria became 100 to >1000-fold more sensitive after being exposed to the shockwaves. Several randomized controlled trials have found similar results and showed that ESWT (as an adjunct to wound treatment) significantly accelerated the healing process of chronic wounds. Furthermore, several other studies have shown that shockwave treatment specifically, combined with other therapies (like antimicrobials), is significantly effective in clearing multispecies biofilms.

Best of all, ESWT is being characterized as a noninvasive, mostly painless, and safe treatment. This makes it a perfect candidate for this article, especially since it does not require a prescription to get and because it puts the power (literally) in your hands. However, understand that studies are ongoing, and they are still learning about what this can and cannot do.

As mentioned before, the upfront cost can be a little steep. I have found ESWT machines ranging from several hundred to just over $2500. Professional machines are substantially higher and usually start at about $7500. However, considering that it can be used for multiple injuries and pains, it may be a wise investment for some. Again, I will leave some research to study and consider below.

Good luck!

If you enjoyed this article or are looking for even more ideas to try, be sure to check out my article titled “Consider Adding Far Infrared for Chronic Wounds.”

Research to Consider – A Few of the Many

This article was written from a Health Science perspective. Dr. Robertson is a health researcher and educator, not a physician. The information provided here is not medical advice, a professional diagnosis, opinion, treatment, or service to you or any other individual. The information provided is for educational and anecdotal purposes only and is not a substitute for medical or professional care. You should not use the information in place of a visit, call consultation, or the advice of your physician or other healthcare providers. Dr. Robertson is not liable or responsible for any advice, course of treatment, diagnosis, or additional information, services, or product you obtain or utilize. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN.