Understanding Plermin: What it is and how it works
Plermin is a topical gel that contains the active ingredient becaplermin, a recombinant human platelet-derived growth factor (rhPDGF-BB). This powerful growth factor plays a key role in the body's natural wound-healing processes. When applied to a diabetic foot ulcer, becaplermin helps to stimulate the proliferation of cells involved in healing, promoting the formation of new, healthy skin and helping the wound to close more effectively.
Unlike general antibiotic ointments that only combat infection, Plermin actively enhances the body's regenerative capabilities. It is an important part of a comprehensive wound care program, which also includes debridement (removal of dead tissue) and proper offloading of the affected foot. Plermin is specifically intended for use on certain diabetic ulcers that have adequate blood flow and is not typically used for pressure ulcers or ulcers caused by poor circulation.
Step-by-step instructions on how to use Plermin ointment
Following your doctor's exact instructions is paramount when using Plermin. The standard procedure involves a meticulous, once-daily application over a 12-hour period.
Preparation and hygiene
- Wash hands thoroughly: Before beginning, wash your hands with soap and water to prevent introducing bacteria to the wound.
- Clean the ulcer: Gently rinse the ulcer with a saline solution or water to remove any remaining gel from the previous treatment.
- Dry the area: The skin around the ulcer should be clean and dry before you apply the gel.
- Wash hands again: Re-wash your hands after cleaning the wound and before handling the gel applicator.
Application of the gel
- Use a non-absorbent surface: Squeeze the required amount of gel onto a clean, non-absorbent surface like wax paper. Never apply the gel directly from the tube or touch the tube's tip to any surface.
- Measure the dosage: Your doctor will provide the specific dosage based on the ulcer's size. For guidance, the dosage is often calculated based on the ulcer's length and width.
- Apply a thin, even layer: Using a clean cotton swab or another sterile applicator, spread a thin, even layer of Plermin over the entire ulcer surface. The thickness of the layer should be as directed by your healthcare provider.
Post-application and dressing
- Cover with moistened gauze: Place a piece of gauze moistened with saline solution over the treated ulcer. The gauze should cover only the ulcer, not the surrounding healthy skin.
- Secure with a dry dressing: Place a clean, dry dressing pad over the moistened gauze and wrap the area with a soft, dry bandage. Do not use adhesive tape directly on your skin.
- Allow to act for 12 hours: Leave the dressing in place for approximately 12 hours. It is crucial to use the product daily for the best benefit.
- Repeat the process: After 12 hours, remove all dressings, rinse the ulcer with saline or water, and then apply a new saline-moistened gauze dressing for the next 12 hours without any new gel.
Important precautions and side effects
As with any medication, it is essential to be aware of potential side effects and necessary precautions while using Plermin.
Precautions to consider
- For external use only: Plermin is for topical use and should not be swallowed. Avoid contact with eyes, mouth, or vagina.
- Off-loading is key: The treatment requires a comprehensive program that includes off-loading—taking the weight off the affected foot. Use of special shoes, walkers, or crutches as directed by your doctor is essential.
- Regular medical check-ups: Your doctor will need to check the ulcer's size and progress every 1-2 weeks to adjust the treatment plan accordingly. Contact your doctor if the ulcer has not reduced significantly in size after 10 weeks or is not healed after 20 weeks.
- Contraindications: Do not use Plermin if you have a known allergy to becaplermin or have cancer (neoplasm) at the application site.
Possible side effects
Common side effects associated with Plermin application include application-site reactions, such as:
- Burning sensation
- Irritation
- Itching
- Redness
If these effects are severe or persistent, contact your healthcare provider. In rare cases, a severe allergic reaction can occur, requiring immediate medical attention.
Plermin vs. other topical treatments
To understand the distinct role of Plermin in wound care, it's helpful to compare it to other common topical treatments. Plermin's mechanism as a growth factor-based therapy is different from that of traditional antibiotics or simple wound dressings.
| Feature | Plermin Gel (Becaplermin) | General Antibiotic Ointment | Simple Wound Dressing (e.g., Gauze) |
|---|---|---|---|
| Mechanism | Stimulates cell growth and healing by delivering growth factors. | Kills or inhibits bacteria to prevent infection. | Provides a protective barrier to keep the wound clean. |
| Active Ingredient | Becaplermin. | Varies (e.g., bacitracin, polymyxin B, mupirocin). | None (inactive material). |
| Primary Use | Chronic diabetic foot ulcers with adequate blood flow. | Mild bacterial skin infections, minor cuts, and scrapes. | Covering and protecting minor wounds. |
| Effect on Healing | Actively promotes wound closure and tissue regeneration. | Helps prevent infection, allowing natural healing to occur. | Provides a clean environment, but does not actively promote tissue growth. |
| Storage Requirements | Requires refrigeration (2-8°C). | Stored at room temperature. | Stored at room temperature. |
Proper storage and disposal
- Refrigeration is required: Plermin must be stored in a refrigerator at a temperature between 2° and 8°C (36° to 46°F).
- Do not freeze: Freezing the gel will damage its effectiveness, so never store it in a freezer.
- Keep it capped: Ensure the tube is tightly capped when not in use to maintain sterility.
- Check expiration: Do not use the gel past its expiration date.
- Disposal: After the treatment is complete or the product is expired, dispose of any remaining gel according to your healthcare professional's advice.
Conclusion
For individuals with specific diabetic foot ulcers, correctly using Plermin gel as prescribed is a vital component of a comprehensive treatment plan that promotes effective healing. The meticulous application process, which includes proper hygiene, and controlled dressing, is designed to maximize the gel's therapeutic benefits. By understanding the active ingredient, adhering to the application instructions, following storage requirements, and being aware of potential side effects, patients can work with their healthcare providers to achieve the best possible outcome for their wound care. It is imperative to remember that Plermin is part of a broader care strategy and should be used under close medical supervision. You can find more detailed information on Becaplermin on the Mayo Clinic website.
