categories of topical application for hypergranulation treatment

Please read the main article on  hypergranulation treatment before going on to this segment.

As  discussed earlier, the key to winning the battle with overgranulation is not so much what you can put on it to make what is there in the  here and now, disappear–as it is to find what the likely cause, or causes are.

COMMON TRIGGERS:

  • continued minor trauma or friction from mobility
  • fungal or bacterial infection –often minor

These, in combination, or singly, will cause inflammation, or encourage granulation growth,  and perpetuate the  overgranulation formation.

In another page I talked about taping the g-tube to eliminate friction, and guard against unintentional trauma.

On this page, I will list the categories of topical agents used to treat overgranulation, as well as those that will help create  and maintain a healthy stoma.

 

STYPTIC  or ASTRINGENT applications, which chemically slough off the granulation tissue.

  • Silver nitrate sticks
  • Granulotion
  • Alum

Keep in mind that by removing hypergranulation tissue chemically, whether it is with a harsh caustic such as silver nitrate, with an astringent,  or  exposing it regularly to debriding agents  such as peroxide,   these types of substances  break down the fibroblasts that are the first stage of wound healing. The body keeps replacing them, but if we keep removing them, this  tells the body to try harder, and  the overgranulation cycle continues on indefinitely.

APPLYING PRESSURE  to flatten tissue can be an effective way to reduce overgranulation. Products used for this include the following:

Haelan Tape contains a moderately potent steroid and is used for a variety of inflammatory conditions in dermatology. It has been found to be useful in treating overgranulation, particularly around stoma sites. It is by prescription only.

Mepilex self adhesive foam dressing, is another choice.  It does not contain steroids, but is antimicrobial. A prescription is not needed for this.

Occlusive dressings have mixed results in published trials.  Keeping an area moist can  enhance the effect of growth factors, obviously not the goal here. (reference is below)

Occlusion should be limited to the early stages of wound healing and once granulation is established, a less occlusive dressing could be selected (occlusion can cause an over-stimulation of granulation tissue) (Stephen-Haynes  and  Hampton, 2010).

I, personally,  have never explored this method, due to my very reactive allergy to adhesives.

 

ANTI INFLAMMATORY STEROIDAL  TOPICALS

These are not selective as to the cause of inflammation, they will reduce or eliminate inflammation . Topical steroids are also  antiproliferative  So, while being used, an anti inflammatory will seem like they are “the answer”.

The problem is, that they mainly only treat the symptoms.  They reduce inflammation from friction, they reduce inflammation from infection,  and have an antiproliferative effect  during use.  But they don’t stop friction or infection. They don’t fix the problem.

Nevertheless, this classification of treatment is a painless way to get the inflammation causing  the process of overgranulation  under control.

  • Use of a mildly potent or potent topical steroid for less than three months is unlikely to result in adverse effects. This is according to my dermatologist, as well as what I’ve read during research.  But this advice is in reference to skin on the abdomen,  The risk of adverse affects is greater when applied to thin skin (eyelids, face, neck, skin fold areas).
  •  If the steroid is placed under an occlusive bandage, there is more  risk of systemic absorption.

Depending on the severity of overgranulation, a mild hydrocortisone could be helpful, but, in most cases, a mid strength, such as triamcinolone is called for.

OTHER ANTI INFLAMMATORY TOPICALS

Products containing zinc can have a calming effect.  Many diaper ointments are made up of mostly zinc.  Topicals with zinc have the ability to protect the skin, so not only are zinc products mildly anti inflammatory, but they serve as  barrier creams too.

ANTIMICROBIAL AGENTS

Tea tree oil is known for its properties as an antibacterial, antimicrobial, antiseptic, antiviral,  and fungicide.  It must be greatly diluted before applying to overgranulation tissue.

OTHER TOPICALS

An all natural spray called Miracle Mist Plus, although wonderful for other uses, is, in my opinion, not a good choice for treating granulation, or maintaining the stoma.  First, one of the main ingredients is caster oil, which has debridement properties, and secondly, it has an alkaline ph, and what is ideal for the stoma is the opposite, i.e. a slightly acidic environment.