chronic trophic ulcer, insulin, leprosy, topical insulin, pilot study, plantar, trophic ulcer



  1. Singh, Mehak MD
  2. Pawar, Manoj MD


BACKGROUND: Chronic trophic ulcers (CTUs), especially those located over the plantar region, are a leading cause of deformity and disability in patients with leprosy. Despite the various treatment modalities available, CTUs can be chronic and refractory to treatment. The successful use of topical insulin in various types of wounds led researchers to evaluate its safety and efficacy in the treatment of plantar CTUs.


METHODS: Forty-two patients who had completed a multidrug treatment for leprosy were recruited and randomized into two groups. In the test group, 23 patients received 10 units (0.1 mL) of topical insulin (Actrapid) in 1 mL of normal saline twice daily over treated areas. The placebo group (n = 19) received topical normal saline only. The primary end point was the proportion of patients with complete wound closure by 12 weeks. Secondary end points included time to healing, wound area reduction, Physician Global Assessment of Efficacy scores, and Dermatology Life Quality Index scores at the end of 12 weeks.


RESULTS: The majority of CTUs (80%) were situated over the forefoot; the metatarsal head of the hallux was the most common site (86%). Wound healing was faster (0.61 +/- 0.31 vs 0.14 +/- 0.42 cm2 per week, P < .0001), and the number of days to complete healing was significantly shorter in the test group compared with the placebo group (31.5 +/- 17.6 vs 44.3 +/- 16.2 days, P = .02). The only observed adverse effect in the test group was white granular deposits over the CTU (n = 10).


CONCLUSIONS: Topical insulin therapy may be a safe, efficacious, cheap, and easily available treatment option in CTUs among patients with leprosy.