D E R M A T O L O G I C A L

The Rewards
of Treating
Decubitus Ulcers
Compounding for patients with decubitus

Doug Chadwick, RPh, CF

Myers Drug, 22 S. Chadbourne, San Angelo, TX 76903

ulcers can be a fulfilling experience.

My pharmacy services two different hospice groups in our city.
Compounding helps us meet the many unique needs of these
hospices. At one hospice interdisciplinary group meeting we
discussed a patient (Patient One) who was stable and had sufficient
pain control but was suffering from multiple decubitus ulcers.
Though we had little experience with decubitus, I knew that there
was a cream formula designed to treat these ulcers.

during treatment. I would do this by taking weekly pictures

of the ulcers.

Compounding was a new idea for this hospice. To ease their

concerns about this process, I offered to provide the compound to
the patient at no charge until we saw improvement. I also
explained that I wanted to document the patients improvement

Using compounded decubitus ulcer cream in treating these patients produced results beyond our greatest expectations. Developing compounds and seeing the difference they make in my
patients is one of the most fulfilling parts of my pharmacy career.

The compound contains ketoprofen 2%, lidocaine 2%, aloe vera

0.2%, phenytoin 2% and misoprostol 0.0024% in an emollient cream
base. The cream has a 14-day expiration date and must be refrigerated. Treatment involved applying a thick film to the wound twice
daily. A 4- x 4-inch gauze pad was taped in place over the wound.

Patient One
The first patient was a 48-year-old
woman suffering from end-stage multiple sclerosis. Bedridden and in a
semifetal position, she had a poor nutritional status. She suffered from stage
4 decubitus ulcers on her left foot and
left buttock.
Neither pharmacy school nor retail
pharmacy prepared me for the handson experience I gained in treating this
patient. I planned to develop a personal
relationship with her so the photography would not make her uncomfortable. I did this by visiting with her
and getting to know her. A simple
touch on her arm or shoulder let her
know I cared about her. She loved ice
cream, so I brought some occasionally when I visited. These small acts of
care helped me to develop a good relationship with her and aided the treatment process.

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Patient One: Foot: Left anterior foot: 3 x 2 cm, Left heel: 6 x 3 x 1 1/4 cm

6/4/97 - Treatment started. Notice the condition of the entire

foot.

6/11/97 - Visible improvement

was seen after seven days. The
condition of the foot was already improving.

7/1/97 - The heel wound now

measured 4 x 1 cm.

7/15/97 - Bleeding was a good

sign of healthy tissue.

8/6/97 -The left anterior foot had

healed to a scab.

10/15/97 - Healing was complete.

International Journal of Pharmaceutical Compounding

Vol.2 No.4 July/August 1998

D E R M A T O L O G I C A L

Patient One: Left buttock: 6 14 x 6 x 2 cm

6/4/97 - In spite of a large area

of necrosis, treatment was
started.

6/11/97 - The rim of the wound

had shown significant improvement. There was no change in
necrosis. The physician decided to mechanically debride
the necrotic tissue.

7/15/97 - Treatment was started

once again.

12/11/97 - Treatment continued.

The ulcer was now 5 x 2.5 x 0.25
cm.

8/12/97 - The ulcer was upgraded

to stage 3.

Patient Two
Patient Two: Left shin: 11 x 6 1/2 cm

7/1/97 - Notice how necrosis

affected the left leg in comparison to the other. The ulcer was
mechanically debrided to
remove the necrosis.

7/15/97 - Treatment began.

7/23/97 - Granulation was already

evident. The challenge was to
achieve granulation on exposed
bone.

10/16/97 - Granulation on bone

was occurring.

12/11/97 - Treatment continued.

Granulation on bone was almost
complete.

The second patient was a 67-year-old

bedridden diabetic suffering from a
large stage 4 ulcer to the left shin. The
nursing home referred this patient to
us after the dramatic improvement
seen in the first patient.
When treatment started, this patient
was an amputee candidate. Due to the
excellent results of the treatment, plans
are to surgically close the wound and
finish it with a skin graft.

International Journal of Pharmaceutical Compounding

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Vol.2 No.4 July/August 1998