Topical Mupirocin Vs Traditional Dressing for Persistent Skin Ulcers: A Randomized Controlled Trial

Jayalal JA^1*, S Edwin Kins Raj², G John Nickson², E Suresh Manikandan², Venkatesh K³, Chithra³

¹Professor and Head of Department of General Surgery, Kanyakumari Govt. Medical College, India
²Assistant Professor, Department of General Surgery, Kanyakumari Govt. Medical College, India
³Post Graduate of General Surgery, Kanyakumari Govt. Medical College, India

*Correspondence author: Jayalal JA, Professor and Head of Department of General Surgery, Kanyakumari Govt. Medical College, India; Email: [email protected]

Citation: Jayalal JA, et al. Topical Mupirocin Vs Traditional Dressing for Persistent Skin Ulcers: A Randomized Controlled Trial. J Surg Res Prac. 2025;6(1):1-6.

Copyright^© 2025 by Jayalal JA, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Wagner grading system for skin ulcers.

Inclusion Criteria:

Patients of both genders aged between 45 and 85 years with non-healing chronic ulcers of Grade 1 and 2, such as diabetic ulcers, traumatic ulcers, pressure sores, amputation stump ulcers and post-surgical wound gaping of at least six weeks duration, were included.

Exclusion Criteria:

• Ulcers with bone-exposed raw areas
• Malignant ulcers
• Reduced vascularity
• Patients with connective tissue and immune system disorders
• Patients on immunosuppressive drugs, steroids, chemotherapy and radiotherapy

We recruited participants from the hospital’s outpatient clinic and randomly assigned them to either the mupirocin or traditional dressing groups. The mupirocin group cleaned the ulcers, applied mupirocin ointment to the ulcer bed once a day and covered the wound with a sterile dressing. The traditional dressing group cleaned the ulcers and then covered them with sterile dressings.

We analyzed the data using appropriate statistical tests, such as t-tests or chi-square tests. The level of significance was set at p < 0.05.

Results

Total number of patients included in the study are 60, with male and female of 30.

Table 2: Distribution of gender and age between groups.

Based on the Wagner grading the ulcers were graded and number of patients in each grades are shown here in Table 3.

Table 3: Ulcer (Wagner) grading.

Diabetes mellitus, venous or arterial insufficiency, trauma, cancer, smoking and superadded infections are some of the risk factors for developing chronic skin ulcers. The following Table 4,5 shows the associated comorbidities and types of ulcer.

Table 4: Co-morbidities.

Table 5: Presents the distribution of ulcer types across.

The mean wound surface area decreases over time for both treatment methods, indicating that the wounds are healing. However, we can also see that the mean wound surface area for wounds treated with mupirocin is consistently lower than that for wounds treated with traditional dressing. Patients who received mupirocin had a shorter mean hospital stay of 32.10 days than those who received traditional treatment, whose mean hospital stay was 45.57 days (Table 6).

The sequential change in ulcer features is seen in Table 5. Between baseline and the end of the research, the ulcer size in both arms considerably shrank (P < 0.001). Fisher’s exact test for the ulcer’s categorical characteristics and the Mann-Whitney U-test for ulcer size and wound infection score provide the P values used to compare the two groups. SD stands for Standard Deviation is represented by SD and interquartile range by IQR.

The mupirocin therapy group dramatically decreased the median ulcer area after 6 weeks.

of treatment, even though the groups were comparable at baseline and at the end of week 3. By the end of six weeks, 41.30% of participants in the mupirocin group had fully healed their ulcers, compared to 18.18% in the mupirocin-only group (P = 0.022).

Table 6: Variations in ulcer features over time between research groups.

Discussion
An ageing population and a higher prevalence of risk factors such as smoking, obesity and diabetes, which can cause atherosclerotic occlusion, are increasing the incidence of ulcers. These factors not only contribute to the development of ulcers but also complicate their healing process, leading to more severe health complications. Addressing these underlying risk factors through public health initiatives and education is crucial to mitigate the rising incidence of ulcer cases.

The widely accepted treatment for ulcers involves removing necrotic and fibrous tissue to promote granulation tissue formation, proper epithelialization and lower the risk of infection [10]. Skin ulcers are a common reason patients visit emergency departments, especially in hospitals serving socioeconomically disadvantaged populations. While the incidence of skin ulcers is not necessarily higher among disadvantaged groups, these patients tend to have worse prognoses and require more frequent emergency care. Various factors influence wound healing, including angiogenesis, immune response activation and the availability of growth factors, such as EGF, bFGF and transforming growth factors, in the local environment [11].

Researchers discovered that applying granulocyte-macrophage colony-stimulating factors locally helps cells do things like attract inflammatory cells, help epithelial cells migrate and boost keratinocyte proliferation to help heal chronic venous leg ulcers [12]. These findings underscore the importance of targeted therapies in enhancing the healing process for chronic wounds. By understanding the mechanisms at play, clinicians can develop more effective treatment strategies that not only address the symptoms but also promote optimal healing environments.

The findings of Ahmed and Anusharani’s, study are consistent with the use of mupirocin more frequently to treat male patients than female patients. They found more male patients than female patients in the mupirocin group [13]. In the present study, mupirocin was more effective in reducing wound surface area than traditional dressing. This finding is consistent with previous studies that have reported the efficacy of mupirocin in treating skin infections and promoting wound healing [14,15]. Mupirocin is a commonly used antibiotic ointment for treating bacterial infections. Its mechanism of action involves inhibiting bacterial protein synthesis, making it particularly effective against a range of gram-positive bacteria. Consequently, the use of mupirocin not only aids in infection control but also enhances the overall healing process, demonstrating its value in clinical practice [16].

Limitations
Limitations of the study include the exclusion of very severe ulcers and the lack of microbiological investigations before antimicrobial treatment. Additionally, the small sample size may limit the generalizability of the findings to a broader population. Future studies should consider including a more diverse range of ulcer severity and incorporate microbiological assessments to provide a comprehensive understanding of mupirocin’s effectiveness.

Conclusion
The study supports mupirocin as a topical treatment for chronic skin ulcers compared to the traditional dressing method. More research is needed to compare mupirocin with other topical treatments and wound healing strategies and to identify any differential effects on ulcers located in different areas of the body.

Conflict of Interest

No conflict of interest from co-authors nor from any organization.

Availability of Data and Materials

Data is custodied by the author and can be released on trust.

Availability of Data and Materials

Data is custodied by the author and can be released on trust.

Funding

No funding from any institution or organization.

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