Minor cuts and abrasions are common in our daily lives. We want to heal them quickly and easily. However, we often take the healing process for granted. The healing process in acute wounds, especially small surface-level wounds, is often overlooked. It is assumed that these wounds will heal naturally without any issues¹. However, it's important to provide proper care for minor wounds like small cuts, grazes, or abrasions to avoid complications, especially infections¹. In this article, we’ll explore the science of acute wound healing and discuss at-home wound care strategies.

The Science Behind the Acute Wound Healing Process

Acute wound healing is a complex and ever-changing process that involves the interaction of various cell populations with the surrounding environment of the extracellular matrix¹. Ultimately, this process normally leads to the restoration of the injured tissue's structure and function.

The healing of acute wounds occurs in three overlapping phases¹ (as shown in Figure 1):

• The inflammatory reaction
• Proliferation
• Remodeling

Figure 1. Korting, H. C., Schöllmann, C., & White, R. J. (2011). Management of minor acute cutaneous wounds: importance of wound healing in a moist environment. Journal of the European Academy of Dermatology and Venereology, 25(2), 130-137.

These phases are controlled by cytokines and growth factors, which are released by cells near the wound or produced by the wound itself¹. When tissue is injured, it often damages the microvasculature, causing blood to leak into the wound area, followed by the rapid constriction of the injured blood vessels¹. At first, the blood-filled wound is sealed by a fibrin coagulum consisting mainly of fibrin, fibronectin, vitronectin, and thrombospondin¹. If the wound's surface dries out, it forms a hard scab that helps bond and protect the wound¹. Afterward, the first phase of wound healing, the inflammatory process, can begin.

In the initial stage of wound healing, particularly within the first 24 to 48 hours after the injury, neutrophil granulocytes are the first responders¹. Then, between 48 to 72 hours after the wound occurs, monocytes and macrophages are attracted to the wound area by cytokines and growth factors¹. Their main role is to remove harmful microorganisms and debris¹. It's worth noting that macrophages play a crucial role in regulating the repair process within the wound area¹. They not only release additional cytokines and growth factors but also recruit fibroblasts, keratinocytes, and endothelial cells to repair damaged blood vessels¹. Additionally, they release enzymes like collagenases to aid in tissue repair¹.

During the proliferative phase, which starts approximately 4 to 5 days after the wound occurs, the epithelium begins to cover the wound surface¹. At the same time, granulation tissue grows and fills the wound space, assisted by wound contraction. This process eventually leads to the wound being filled with new connective tissue, consisting of proliferating fibroblasts, endothelial vessels, and a freshly formed extracellular matrix¹. Moreover, new blood vessels form. Once this new tissue is established within the wound, the remodelling phase begins, aiming to reorganize the structural integrity and functional competence of the tissue¹.

At-Home Wound Care: What the Experts Have to Say

1. Antiseptics

Quick Take:

• Topical antiseptics such as hydrogen peroxide and povidone-iodine may be effective at removing pathogens and bacterias, but their strong antiseptic properties may also contribute to hindering the skin’s natural wound healing process³.
• Hypochlorous acid (HOCl) is an alternative antiseptic solution with efficacious properties that does not impede on the skin’s natural healing process⁴.

Hypochlorous Acid: An Alternative Antiseptic Solution

In the past, the treatment of sudden skin wounds often involved using various cleansing agents, such as hydrogen peroxide and povidone-iodine³. These chemicals have been found to hinder the movement and growth of fibroblasts in a manner that depends on their concentration³. Using them in their undiluted form is not advisable³.

While other antiseptic solutions may hinder the skin’s natural healing process, pure hypochlorous acid solutions, such as BIHOCL PureCleanse, present an exciting new prospect in the world of wound antiseptic cleansers. Pure hypochlorous acid (HOCl), a substance naturally produced by human neutrophils, exhibits lower cytotoxicity compared to other antiseptic agents⁴. Its mode of action involves disrupting both the cytoplasmic membrane and cell wall of bacteria⁴. Due to its small molecular size and absence of an electrical charge, it is not repelled by the negatively charged surface of bacteria⁴. HOCl demonstrates effectiveness against a broad spectrum of bacterial types, including those capable of producing spores⁴. Additionally, it has the capacity to mitigate the odour and discomfort associated with chronic wounds, serves as an efficient anti-inflammatory and anti-itch solution, enhances oxygen levels within wounds, and disrupts bacterial biofilms⁴.

2. Moist Environment for Optimal Wound Healing

Quick Take:

• Leaving a wound to dry heal and form a scab may seem harmless, however, it may not not be an optimal environment for healing¹.
• Furthermore, this approach to wound care may lead to other complications, including but not limited to scarring¹.

In the past, dry wound healing environments have been considered standard approaches to healing small wounds¹. However, contemporary approaches to managing recent, shallow wounds prioritize quick restoration of skin integrity while ensuring good aesthetics¹. It is widely recognized in medicine that moist wound healing is the most effective way to achieve this¹. Healing in a moist environment speeds up the process, reduces pain, and may improve scar appearance¹. Several factors contribute to improved wound healing in a moist environment. For example, it facilitates skin cell movement, accelerates skin cell differentiation for faster wound closure, promotes blood vessel growth, and supports the availability of growth factors and enzymes essential for healing¹.

Clinical studies have shown that fluid from wounds healing in a moist environment stimulates the growth of important cell types, such as keratinocytes, fibroblasts, and endothelial cells, indicating increased availability of growth factors needed for the repair process¹. A moist environment for wound healing can be achieved through a number of different techniques, including but not limited to moistened dressings and the application of hydrogels, hydrocolloid gel-style bandages, or topical occlusives such as petrolatum¹.

Should You Reach for the Antibiotic Ointment?

Quick Take:

• Antibiotic ointments can serve an antibacterial purpose, and they may also lead to a moistened wound healing environment³.
• The frequent application of these agents may lead to antibiotic resistant strains of bacteria and in some individuals may lead to the development of skin reactions, such as contact dermatitis, or other allergic responses³.

Traditionally, dermatological procedures involving superficial wounds often included the use of topical antibiotics³. This approach was rooted in early studies suggesting that such antibiotics could reduce the risk of infection and enhance the healing process³. In contemporary practice, there's also a growing emphasis on maintaining a moist environment around the wound, many antibiotic ointments serve this purpose, which is why they have been commonly employed³. However, in 1996, a significant study challenged this conventional wisdom. It found that only 0.09% of patients treated with bacitracin developed infections compared to 1.5% in the group using white petrolatum, indicating that topical antibiotics might not be necessary for uncomplicated skin wounds³. Additionally, other research showed no significant differences in healing or infection rates when comparing various ointments, such as Aquaphor Healing Ointment and Polysporin¹⁻³.

Outside of the general efficacy, using topical antibiotics too frequently can lead to several issues; including the emergence of antibiotic-resistant bacteria¹⁻³. Notably, exposure to mupirocin increases the risk of methicillin-resistant Staphylococcus aureus (MRSA) resistance³. A study revealed that high-level mupirocin resistance increased significantly over time¹⁻³. Researchers have also found that topical antibiotic ointments can trigger allergic reactions on the skin¹⁻³. For instance, some patients treated with bacitracin developed allergic contact dermatitis. While the prevalence of such allergic reactions to these antimicrobial ointments in the general population is not well-documented, some individuals exhibit sensitivity to them¹⁻³. Another rare but severe allergic response to topical antibiotics, particularly bacitracin, is anaphylaxis¹⁻³.

Hard to Bandage Areas: Liquid Adhesive Bandages

Quick Take

• Small wounds, such as paper cuts, may be tricky to bandage and easier to leave alone².
• Liquid adhesive bandages present an effective alternative for this tough to treat areas that prevent infection and lead to optimal healing².

When it comes to a small, hard-to-bandage minor wounds, such as paper cuts, liquid adhesive bandages may present an effective solution to preventing infection during the healing process². In a 2008 randomized, controlled study² scholars found that liquid adhesive bandage formulations were equally as effective as traditional bandages at promoting healing. The scholars concluded that the liquid adhesive bandages were easy-to-use and gave rapid control of bleeding and pain, and lastly, formed a film that stayed on hard-to-bandage wound areas well².

Final Thoughts

Minor cuts and abrasions happen, but when it comes to the healing process, our bodies put in a lot of effort to make that healing happen.

When it comes to treating minor wounds at home, there are a variety of perspectives on what the best way to heal a minor wound is. Continued developments in wound care products and scientific advancements allow us new perspectives and approaches to treating wounds for the most optimal of outcomes. Pure hypochlorous acid solutions, such as BIHOCL PureCleanse, present an alternative antiseptic solution that is safe and effective for minor wound treatment and can be used as a combination therapy to ensure optimal wound healing outcomes.

Ultimately, if you have concerns or questions, or other medical conditions that may present challenges to the healing process, you should always consult your medical practitioner.