Cytotoxicity of silver dressings—time to rethink and react

Abstract

We read with great interest the article by Zou et al. on cytotoxicity of silver dressings on diabetic fibroblasts. In this study they have reported that all silver dressings tested were found to reduce the viability of the diabetic fibroblasts and collagen synthesis, and also found to change the cell morphology significantly, decrease cell proliferation and collagen synthesis of diabetic fibroblasts. Thus, silver dressings have significant toxic effects on morphology, proliferation and collagen synthesis of diabetic fibroblasts 1. Although several studies support the value of topical antimicrobial agents, a number of experimental studies both in vitro and in animal wounds suggest that many commonly used antiseptic agents including silver-based dressings have been shown to be toxic to the cells involved in wound healing process. Silver toxicity has long been a matter of debate and many studies have reported the same 2-11. Although silver has a broad spectrum of antibacterial, antifungal and antiviral activity 2 and is commonly used to treat chronic wounds that are at risk of infection, silver-based preparations have been reported to be toxic to cells involved in healing process. Silver sulphadiazine has been reported to be toxic to fibroblasts in culture 2 and also it delays re-epithelialisation 3. Silver nitrate has been reported to slow down the process of epithelialisation 4. Many other studies have found that the silver component in dressing materials is toxic to skin cells 5-7 and as well as toxic to the process of re-epithelialisation 5, 8-11. Although it is known that silver dressings are cytotoxic and retard healing, silver preparations are commonly used because of their powerful and broad antimicrobial activity. It is high time to rethink and react regarding the use of silver-containing preparations, whose toxicity has been proved beyond doubt against the cells involved in healing process. It is necessary to take appropriate steps regarding the use of silver in light of availability of more potential and safe options. Basavraj S Nagoba, PhD1, Namdev M Suryawanshi, MD1, Sohan P Selkar, MPhT2 1Department of Microbiology MIMSR Medical College Latur, India 2Department of Physiotherapy MIP College of Physiotherapy Latur, India dr_bsnagoba@yahoo.com; bsnagoba@gmail.com