Wound Care Information Network




March 8, 2007


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 Previous email questions & their replies are listed below. Remember, replies have not been validated for accuracy or truthfulness.

My boyfriend was out in the desert riding his dirtbike and crashed into a cholla cactus about 20 miles per hour. He had hundreds of thorns stuck throughout his upper body. He now has red, raised bumps and dark, large bruises everywhere! He says that his whole body hurts and his symptoms aren't changing. He doesn't have heath insurance so, going to the doctor is a bit out of the question. If there is anyone out there that has ANY ideas to help him out, please feel free. Thank you.
~Theresa, Arizona

No one could reasonably offer an appropriate suggestion for this. Since he still has pain, so many things could be going on, potentially beyond the skin.  Look in your area for clinics with sliding-scale fees. That way a doctor can examine him in person and he can pay what he can afford.


Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS

I am the ADON in a LTC facility. CMS is no longer reimbursing for Xenaderm or Granulex because of the trypsin in those products. Any suggestions for alternatives??

The best thing to do is focus on prevention. If you use a moisture barrier, keep the skin dry and moisturized, and turn the patient (basic good care), then they probably won't develop the redness or partial thickness breakdown you are treating with Xenaderm. When you do get it, continue with the moisture barrier to help it resolve. If you were using Granulex to debride a wound, then use a debriding ointment/cream. Keep in mind that you don't want to debride stable, intact heel eschars (see any pressure ulcer guidelines for support).

Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS


Kelly, I, too have the same problem. I am also an ADON in a LTC facility and a WCC. I realize that the FDA says that the trypsin is ineffective but I sure would beg to differ with them!! We are in a real bind here because it has Xenaderm has become a "household" product for us. We have tryed a generic form - Allen Derm-T ointment but it is not nearly as effective and it is still very expensive. Some of the Medicare D's are not covering it either. It has the same ingredients as Xenaderm. We have started using Sensicare by Convatec but we need to use more and it is also expensive for our tight pocketbooks. We have also found that some Med D insurance companies are not covering Panafil either which is another staple product of ours! Us LTC facilities do have special issues with finances, that is for sure. Well, God bless our work and our endeavors to find products that going to work and affordable to us!!


My name is Judy I have been working in wound care about 2 years—Bourdreaux’s Butt Paste has similar contents as Xenaderm but not the trypsin. I know it works on diaper rash.

Judy RN

Read my reply to Sarah. I think it will also help with your question.
Sandy Bruns RN BSN CWON


Proderm Spray by Bertek Pharmaceuticals has balsam peru but no trypsin.

Not signed


In my facility I use Flanders Buttocks Ointment, which contains peruvian balsam, an ingredient also found in Xenaderm. Flanders is just as effective as Xenaderm, it is available without a prescription, at a fraction of the cost. We have had excellent results with this ointment.

Debby Hans RN CWS


I've had great success with Calmoseptine Ointment. They will send you free samples, too. unsigned


OFF-LOAD, OFF-LOAD, OFF-LOAD!!! You can Granulex all you want BID or TID, but if you don't releive pressure a pressure sore will occur. If shearing and/or friction is a concern, manage it with a transparent dressing or a hydrocolloid but you still must off-load with pillows/heel-lift boots and limit the head of the bed to no more than 30 degrees (unless receiving a meal or it is contraindicated). I have seen orders for skin preps TID, I think of the amount of nursing time for a skin prep to be applied BID or TID when it is only necessary again to off-load.
Yolanda, RN, WCC


Best alternatives for these products are:

1) Nutrashield by Medline
2) Proshield by Healthpoint
3) Products that are high in silicone oils, i.e. Dimethicone, Cyclomethicone
4) An old favorite,..A&D ointment

Mary Bruno CWOCN

I was wondering what you feel about the FDA discontinuing reimbursement for Xenaderm? Will the inability to use this product that the FDA has deemed "ineffective" change the way you treat patients.

Sarah Ramsay M.S
Absolutely Not! I didn't care much for Xenaderm first of all because it needed to be applied BID (requiring more nursing time and pain to the patient) and also, it dessicated the wound bed. It was marketed as a skin barrier by a rep in our area, however, it is not a skin barrier. It did form a barrier when used on a stage II, but when a resident is incontinent, I wondered how effective the barrier really was. I tried it on a few patients, but after two weeks it was d/c'd and new orders were received. Our resident's stage II's still healed without Xenaderm.



Check with your pharmacy. The inpatient pharmacy has substituted a generic that is less expensive. Another alternative that we used before Xenaderm was covered by Medicaid is CriticAid by Sween and it is available now in a clear formula. It will adhere to denuded skin but does not contain the enzyme in Xenaderm. Before CriticAid we mixed stomahesive powder with Aquaphor ointment to create our own paste. I believe it was 1 bottle of stomahesive powder (Convatec) to an 12 oz jar of Aquaphor. All of them worked!
Sandy Bruns RN BSN CWON

Good morning,

I am a nursing student. I am currently writing up a care plan on a patient for school and I am running into trouble finding a rationale for the use of Xeroform. Hopefully you can help/direct me in the right direction.

This past week, I had a patient with PVD. He already had a Left above the knee amputation due to PVD.
His right lower limb had open non-healing draining wounds. The wounds were mostly superficial, not deep, but there was serosanguineous drainage along with some yellowish malodorous exudate. It had an odor to it, but I wouldn't classify it as an infected odor.

My question is this: The infectious disease MD decided to apply Xeroform dressing to the wounds along with loosely wrapped cling.

What is the reasoning for using the Xeroform on this type of wound? I do hope that you can help.

Thank you!
Xeroform is a non-adherent dressing with a mild drying and antiseptic effect from the bismuth. There are other dressing options that might be more appropriate and effective to manage the infection and drainage, such as cadexomer iodine, silver products, foams, alginates, hydrofibers, etc. In this case, it might have been used because that doctor was more familiar with it than with modern advanced dressings.

Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS

Sounds like the physician is using xeroform dressings to support the theory of moist wound healing.

Debby Hans RN CWS


Xeroform is a petrolatum impregnated gauze that is used to help lessen the bioburden of a wound, and since it is impreganted with petrolatum, it is non-adherent to the wound bed. This property helps with dressing changes since it decreases the risk of the dressings sticking and fragile new tissue being damaged when the old dressings are pulled away from the wound. Hope this helps you. Brenda Gladfelter, RN, WCC


Oh to be a student again! The Infectious Disease physician was using the Iodoform because he was probably treating a pseudomonas aeuruginsas organism. That is his specialty - organisms and infections. As for "smelling" an infection - don't rely on your nose. A culture of the wound is in order. You are to smell a wound after thorough cleansing to document an "odor." Good luck! K.Bucci RN/WCC/CHT


I would say the purpose is both to absorb the drainage & to decrease the bacterial count in the wound bed or to decrease the bioburden. Read the brochure for the product to find out how it works in the wound or the science behind the product for a more lengthy discussion of the indications & actions of the product. If there is a sales rep for the manufacturer in your area that is also an excellant resource for information re this product.
Sandy Bruns RN BSN CWON

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