Santyl ointment is a prescription medication for severe burns and chronic skin ulcers. It helps clean these wounds by removing dead skin tissue, which facilitates the healing process. The active ingredient is an enzyme called collagenase, which is applied directly to the skin to support the growth of new, healthy tissue.
Mechanism of Action
The primary function of Santyl ointment is enzymatic debridement, the process of removing dead (necrotic) tissue from a wound. This dead tissue can impede healing and provide a breeding ground for bacteria. The ointment’s active ingredient is collagenase, an enzyme derived from the bacterium Clostridium histolyticum.
This enzyme, collagenase, is highly specific in its action. It targets and breaks down denatured collagen, the structural protein that anchors necrotic tissue to the wound bed. The collagenase cleaves the non-living collagen strands, detaching the dead tissue from the healthy base of the wound. This process leaves healthy tissue largely unaffected, allowing for a selective removal of debris.
By digesting the collagen fibers that hold necrotic tissue in place, the ointment helps liquefy and soften the debris, making it easier to remove. This action cleans the wound surface and also permeates deeper into pockets of dead tissue within the wound bed. This breakdown prepares the wound for closure and the growth of new, healthy granulation tissue.
Proper Application
Proper application of Santyl ointment is necessary for its effectiveness. The process begins with preparing the wound, which involves gentle cleansing with a sterile normal saline solution. This removes loose debris and any residue from the previous dressing. The wound must be clean before each new application to allow the ointment to make direct contact with the necrotic tissue.
Once the wound is prepared, the ointment should be applied directly onto the dead tissue. A layer approximately the thickness of a nickel is recommended to ensure adequate coverage of the entire wound bed. The ointment should be confined to the wound area as much as possible to avoid irritating the surrounding healthy skin. For wounds covered by a thick, dry eschar, a healthcare provider might first score the surface with a scalpel to allow the ointment to better penetrate the necrotic tissue.
After application, the wound must be covered with a sterile dressing. This dressing helps to keep the wound environment moist, which is important for optimizing the activity of the collagenase enzyme. The ointment is applied once a day, but if the dressing becomes soiled, it should be changed and the ointment reapplied more frequently as directed. Treatment continues until the dead tissue is removed and a base of healthy granulation tissue is established.
Potential Side Effects and Interactions
The use of Santyl ointment can be associated with potential side effects, which are localized to the site of application. Patients may experience a temporary stinging or burning sensation upon application. Redness or irritation of the skin surrounding the wound has also been noted, particularly if the ointment is not confined to the target area. While uncommon, the breakdown of tissue could increase the risk of a systemic bacterial infection, so monitoring for signs like fever or chills is important.
The effectiveness of the ointment can be impacted by interactions with other substances. The collagenase enzyme is sensitive to its chemical environment and functions best within a specific pH range of 6 to 8. Its enzymatic activity can be inactivated by certain chemical agents, especially antiseptics that contain heavy metals. Products containing silver, mercury, and lead can interfere with the ointment’s work.
Because of these interactions, it is important to avoid using certain cleansers or topical treatments concurrently with Santyl. For instance, solutions like povidone-iodine can decrease the effects of collagenase and should not be used with the ointment. Patients should inform their healthcare provider of all medications being used on or near the wound to prevent rendering the treatment ineffective.