Gold Leaf Treatment of Ischemic Skin Ulcers
https://jamanetwork.com/journals/jama/article-abstract/659686
Abstract
On 13 patients, 22 ischemic skin ulcers which had resisted a variety of therapeutic agents were treated with ordinary gold leaf. Three coexisting lesions served as controls. After initial cleansing and debridement, the ulcers were wetted with 95% alcohol, covered with four to eight layers of gold leaf, and protective dressings were applied; this procedure was repeated every 48 hours. A venous-stasis lesion decreased in size 86% in one month, and a diabetic ulcer showed 44% improvement in 11 days. Twenty decubitus ulcers decreased an average of 62%, and three coexisting control ulcers increased in size an average of 96%. Deterrents to successful treatment include a hemoglobin value below 12 gm/100 cc, excessive friction, undermining of ulcer edges, ringing of the lesion with scar tissue, and copious purulent discharge. No adverse reactions to gold leaf were observed.
Content
May 23, 1966
Gold-Leaf Treatment of Ischemic Skin Ulcers
Marion Wolf; Paul C. Wheeler, MD; Lester E. Wolcott, MD
JAMA. 1966;196(8):693-696. doi:10.1001/jama.1966.03100210063016
Ischemic skin ulcers, resulting from inadequate blood supply, present significant treatment challenges due to their resistance to conventional therapies. An innovative approach involving the application of gold leaf has demonstrated promising results in enhancing the healing of these persistent ulcers.
Historical Context and Methodology
A pivotal study published in 1966 explored the efficacy of gold leaf in treating ischemic skin ulcers. In this study, 22 ulcers across 13 patients, unresponsive to various treatments, were subjected to gold leaf therapy. The treatment protocol involved initial cleansing and debridement of the ulcers, followed by moistening with 95% alcohol. Subsequently, four to eight layers of ordinary gold leaf were applied, and protective dressings were placed over the treated area. This procedure was repeated every 48 hours.
Clinical Outcomes
The results from this study were noteworthy:
- Venous Stasis Ulcer: One lesion exhibited an 86% reduction in size within a month.
- Diabetic Ulcer: Another showed a 44% improvement over 11 days.
- Decubitus Ulcers: Twenty such ulcers decreased in size by an average of 62%.
In contrast, three untreated control ulcers increased in size by an average of 96%, highlighting the potential effectiveness of gold leaf treatment.
Mechanisms of Action
While the exact mechanisms by which gold leaf promotes ulcer healing are not fully elucidated, several hypotheses exist:
- Antimicrobial Properties: Gold exhibits inherent antimicrobial activity, which may reduce infection risk in ulcerated areas.
- Anti-Inflammatory Effects: Gold compounds have been noted for their anti-inflammatory properties, potentially mitigating local inflammation and promoting healing.
- Electrical Conductivity: Gold’s conductive properties might influence local bioelectric fields, which play a role in tissue repair processes.
Considerations and Limitations
Despite the promising outcomes, certain factors were identified as deterrents to successful treatment:
- Low Hemoglobin Levels: Hemoglobin below 12 gm/100 cc was associated with poorer healing outcomes.
- Mechanical Factors: Excessive friction and undermining of ulcer edges impeded healing.
- Scar Tissue and Discharge: Surrounding scar tissue and copious purulent discharge were detrimental to the treatment’s success.
Importantly, no adverse reactions to gold leaf were observed, suggesting its safety in clinical application.
Contemporary Perspectives
Advancements in nanotechnology have led to the development of gold nanoparticle-based therapies for wound healing. Gold nanoparticles incorporated into hydrogels have shown potential in promoting wound healing due to their antimicrobial and anti-inflammatory properties.
Conclusion
The application of gold leaf presents a novel and promising approach to the treatment of ischemic skin ulcers, particularly those unresponsive to conventional therapies. While historical studies have demonstrated its potential efficacy and safety, further research is warranted to fully understand the underlying mechanisms and to optimize treatment protocols. Additionally, modern advancements in gold-based nanotechnology may offer new avenues for enhancing wound healing in ischemic conditions.