Oral zinc supplements for treating leg ulcers

Wilkinson EAJ, Hawke CC

Published Online:

December 8, 2010

Leg ulcers (open sores) usually heal with good wound care and dressings. However they may take a long time to heal (weeks or months) despite good wound care and can cause distress to patients as well as being very costly for the health service. Failure to heal may be due to poor nutrition which reduces the ability of the body to repair itself. Minerals such as zinc are necessary for good healing and so it has been thought that taking zinc sulphate tablets might aid healing of ulcers. We found six trials that used zinc to treat leg ulcers but all were too small to pick up on any benefit, if such a benefit exists. In addition the quality of these trials was mediocre. On the basis of the evidence we have so far it appears that taking zinc tablets does not improve leg ulcer healing, however more good quality trials are needed.

Abstract (click to read)

Background:

Leg ulcers affect up to one percent of people at some time in their life. Leg ulceration is chronic in nature with ulcers being present for months and in some cases years without healing, and with a high risk of recurrence. Management approaches include dressings and the treatment of underlying medical problems such as malnutrition, lack of minerals and vitamins, poor blood supply or infection.

Objectives:

To assess the effectiveness of oral zinc in healing arterial or venous leg ulcers.

Search strategy:

For this fifth update we searched the Wounds Group Specialised Register (31 August 2010), The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library 2010 Issue 3, Ovid MEDLINE (1950 to August Week 3 2010), Ovid EMBASE (1980 to 2010 Week 34) and EBSCO CINAHL (1982 to 27 August 2010). In the original version of the review a company manufacturing zinc sulphate tablets was asked for references to relevant trials.

Selection criteria:

Randomised controlled trials comparing oral zinc sulphate with placebo or no treatment in people with arterial or venous leg ulcers were eligible for inclusion. There were no restrictions on date or language of publication. The main outcome measure used was complete healing of the ulcers. Trials were eligible for inclusion if they measured ulcer healing objectively by documenting time to complete healing, proportion of ulcers healed during the study, or healing rates of ulcers.

Data collection and analysis:

All data extraction and assessment of trial quality were done by both authors independently.

Main results:

Six small trials (183 participants) were eligible for inclusion. Four trials considered people with venous ulcers, one trial arterial ulcers and one people with mixed ulcers. In four trials, serum zinc was measured at baseline or during the trial. Pooling the four trials that compared oral zinc sulphate with placebo in people with venous ulcers showed no statistically significant difference between the two group (RR 1.22, 95%CI 0.88 to 1.68). Overall, there was no evidence of a beneficial effect of treatment with zinc sulphate on the number of ulcers healed.

Authors' conclusions:

Oral zinc sulphate does not appear to aid healing of arterial and venous leg ulcers, however all included studies were small and of mediocre quality.

This record should be cited as:

Wilkinson EAJ, Hawke CC. Oral zinc for arterial and venous leg ulcers. Cochrane Database of Systematic Reviews 1998, Issue 4. Art. No.: CD001273. DOI: 10.1002/14651858.CD001273

Assessed as up to date:

November 8, 2010

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Primary Review Group:

Wounds Group

Health topics:

Heart & circulation > Ulcers: venous > Systemic drug therapy

Wounds > Ulcers: venous > Systemic drug therapy

Complementary & alternative medicine > Heart & circulation > Ulcers: arterial & mixed

Complementary & alternative medicine > Heart & circulation > Ulcers: venous

Complementary & alternative medicine > Wounds > Ulcers: venous