A Review of Iodophors, with the Focus on Their Role in Biofilms Control

Biofilms are omnipresent in virtually all nonhealing ulcers and some consider their presence to be among the primary reasons for chronicity. Therefore, prevention and treatment of biofilms is essential in changing the balance in wound healing. Debridement is crucial but should be combined with adjunct treatments to prevent biofilm recurrence and “kill” biofilm remnants. Many systemic or topical antimicrobial agents have been shown to be minimally or not efficacious since they may not reach or penetrate the matrix that supports a biofilm.

Iodine has antimicrobial properties on several levels, leading to denaturation as well and deactivation of multiple cellular compounds, and is effective against an extensive series of different types of microorganisms. Iodophors, in contrast to iodine tinctures which are efficacious for just a short period, slowly release iodine and, therefore, are effective over a prolonged period, which is necessary for sustained killing of the biofilm. In an explant porcine skin study, an iodophor (a disinfectant combining iodine with a surfactant) was shown to be superior to a series of other antimicrobial agents.

In a case series of different types of wounds, all on the lower leg, an iodophor was used as part of a multipronged approach, which also included surgical debridement. Some of the wounds were more than one year old and some were unsuccessfully treated previously with skin grafts and/or an artificial dermis. All showed a very good and rapid healing result once treatment was changed to the debridement/iodophor regimen. Clinical cases will be presented.