A comparative study of efficacy of silver stream versus povidone iodine in healing the diabetic ulcers


  • Ashwani Kumar Department of DNB Surgery, SBLS Civil Hospital, Jalandhar, Punjab, India
  • Satinderjit S. Bajaj Department of Surgery, SBLS Civil Hospital, Jalandhar, Punjab, India
  • Jagminder K. Bajaj Department of Pharmacology, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India




Diabetic ulcer, Povidone-iodine, Silver stream


Background: Diabetic ulcers affect morbidity, mortality and QOL of patients. Wound debridement and dressing using antiseptics are part of standard treatment. Silver stream solution containing silver ions, menthol, glycerol and surfactant has shown promising results in chronic DFU. But no clinical trials have been conducted yet. The aim of the study was to compare effectiveness of silver stream solution with traditionally used povidone iodine in healing diabetic ulcers.

Methods: 100 diabetic ulcer patients randomly divided into 2 groups A and B of 50 each, received ulcer dressing with silver stream solution or povidone iodine respectively every 48 hourly. Ulcer size and healing was evaluated at 2 weeks intervals for 8 weeks or till ulcer healed.

Results: Patients of both groups were comparable in their age/sex distribution, duration, control of diabetes and pre-treatment mean ulcer size. At end of 8 weeks, percentage reduction in mean ulcer size was much more in group A (89.51%) than in group B (33%). All patients treated with silver stream responded, though response was partial in (10%). Patients having poor glycemic control. In contrast only 46% showed complete response to povidone iodine, 42% had partial response and 12% did not responded.

Conclusions: Response rate with silver stream dressing is significantly higher and reduction in mean ulcer size at end of 8 weeks treatment is significantly more than with povidone iodine.



Edwards R, Harding KG. Bacteria and wound healing. Curr Opin Infect Dis. 2004;17(2):91-6.

Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. Am Fam Physician. 1998;57(6):1325-32.

König B, Reimer K, Fleischer W, König W. Effects of Betaisodona on parameters of host defense. Dermatology. 1997;195(2):42-8.

Dumville JC, Lipsky BA, Hoey C, Cruciani M, Fiscon M, Xia J. Topical antimicrobial agents for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2017;6(6):CD011038.

Eming SA, Smola-Hess S, Kurschat P, Hirche D, Krieg T, Smola H. A novel property of povidon-iodine: inhibition of excessive protease levels in chronic non-healing wounds. J Invest Dermatol. 2006;126(12):2731-3.

Clement JL, Jarrett PS. Antibacterial silver. Met Based Drugs. 1994;1(5-6):467-82.

Lok CN, Ho CM, Chen R, He QY, Yu WY, Sun H, et al. Proteomic analysis of the mode of antibacterial action of silver nanoparticles. J Proteome Res. 2006;5(4):916-24.

Matsumura Y, Yoshikata K, Kunisaki S, Tsuchido T. Mode of bactericidal action of silver zeolite and its comparison with that of silver nitrate. Appl Environ Microbiol. 2003;69(7):4278-81.

Silver steam Medical. Case series study: effect of silver ion solution on chronic ulcers, 2022. Available at: http://enzysurge.com/originaly%201434556380DFCon%20%20SAN%20Posters. Accessed on 21 March 2022.

O'Brien JF, Grace PA, Perry IJ, Burke PE. Prevalence and aetiology of leg ulcers in Ireland. Ir J Med Sci. 2000;169(2):110-2.

Callam MJ, Harper DR, Dale JJ, Ruckley CV. Chronic ulcer of the leg: clinical history. Br Med J (Clin Res Ed). 1987;294(6584):1389-91.

Cornwall JV, Doré CJ, Lewis JD. Leg ulcers: epidemiology and aetiology. Br J Surg. 1986;73(9):693-6.

Rao H, Pai A, Hussein I, Arun A, Ram HS, Pai A, Pai SR, et al. A comparative study between collagen dressings and conventional dressings in wound healing. Int J Collaborat Res Internal Med Public Health. 2012;1:2-12.

Dinh T, Veves A. The influence of gender as a risk factor in diabetic foot ulceration. Wounds. 2008;20(5):127-31.

Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, et al. Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study. Int J Endocrinol. 2018;2018:7631659.

Gwak HC, Han SH, Lee J, Park S, Sung KS, Kim HJ, et al. Efficacy of a povidone-iodine foam dressing (Betafoam) on diabetic foot ulcer. Int Wound J. 2020;17(1):91-9.

Sharma R, Gupta N, Kumar V, Pal S, Sharma R, Kaundal V, Sharma V. Silver colloid dressings score over conventional dressings in diabetic foot ulcer: a randomized clinical trials. Int Surg J. 2017;4:2627-31.

Gupta V, Kakkar G, Gill AS, Gill CS, Gupta M. Comparative Study of Nanocrystalline Silver Ion Dressings with Normal Saline Dressings in Diabetic Foot Ulcers. J Clin Diagn Res. 2018;12(6):1-4.






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