Exploratory cross-sectional study of the use of a green propolis-based ointment in the treatment of skin tears in elderly hospitalized patients





Aged; Bedridden persons; Ointments; Propolis; Wounds and injuries.


The purpose of this cross-sectional study was to evaluate the use of a green propolis-based ointment for the treatment of skin tears in an elderly hospitalized population. Eleven subjects over 60 years old were selected. They were admitted to a general hospital and received local treatment for skin tears during the hospital stay with a green propolis-containing ointment. Personal data was obtained from the hospital admission to identify the patient's characteristics. Body mass index, alleged allergy to propolis, use of medications, comorbid conditions, degree of dependence (Fugulin scale), and degree of frailty (Rockwood scale) were also obtained. The skin tears were classified using the STAR system. The use of a propolis-containing ointment in skin tears resulted in the improvement of hematomas in the flaps and periflaps of skin tears. In addition, it helped to prevent the colonization and proliferation of bacteria at the injury site, recovering the injured tissue and resulting in viable and quality tissue. No complaints of pain or side-effect events such as signs of tenderness or local or systemic toxicity in the treated patients were reported. The skin tear flaps, darkened by bruises that occurred during the trauma, were gradually absorbed, and the skin improved its surface appearance. The treated tissue presented new and better quality epithelium regardless of treatment time. The ointment containing propolis was effective for the treatment of skin tears. The set of results obtained supported the assumption that propolis-based ointment can be included as an effective option to treat skin tears.


Abbasi, A. J., Mohammadi, F., Bayat, M., Gema, S. M., Ghadirian, H., Seifi, H., Bayat, H., & Bahrami, N. (2018). Applications of propolis in dentistry: a review. Ethiopian journal of health sciences, 28(4), 505-512. https://doi.org/10.4314/ejhs.v28i4.16

Bankova, V., Marcucci, M. C., Simova, S., Nikolova, N., Kujumgiev, A., & Popov, S. (1996). Antibacterial diterpenic acids from Brazilian propolis. Zeitschrift für Naturforschung C, 51(5-6), 277-280.

Bankova, V., Popova, M., & Trusheva, B. (2016). New emerging fields of application of propolis. Macedonian Journal of Chemistry and Chemical Engineering, 35, 1-11. https://doi.org/10.20450/mjcce.2016.864

Barchitta, M., Maugeri, A., Favara, G., Magnano San Lio, R., Evola, G., Agodi, A., & Basile, G. (2019). Nutrition and wound healing: an overview focusing on the beneficial effects of curcumin. International journal of molecular sciences, 20(5), 1119. https://doi.org/10.3390/ijms20051119

Benbow, M. (2017). Assessment, prevention and management of skin tears. Nursing older people, 29(4), 31-39. https://doi.org/10.7748/nop.2017.e904

Bhargava, P., Grover, A., Nigam, N., Kaul, A., Doi, M., Ishida, Y., Kakuta, H., Kaul, S. C., Terao, K., & Wadhwa, R. (2018). Anticancer activity of the supercritical extract of Brazilian green propolis and its active component, Artepillin C: Bioinformatics and experimental analyses of its mechanisms of action. International Journal of Oncology, 52(3), 925-932. https://doi.org/10.3892/ijo.2018.4249

Carvalho, C., Fernandes, W. H. C., Mouttinho, T. B. F., Souza, D. M., Marcucci, M. C., & D'Alpino, P. H. P. (2019). Evidence-based studies and perspectives of the use of brazilian green and red propolis in dentistry. European journal of dentistry, 13(3), 459-465. https://doi.org/10.1055/s-0039-1700598

Carville, K., G., L., N., N., Haslehurst, P., Michael, R., Santamaria, N., & Roberts, P. (2007). STAR: a consensus for skin tear classification. Primary Intention, 15(1), 18-28.

Carville, K., Leslie, G., Osseiran-Moisson, R., Newall, N., & Lewin, G. (2014). The effectiveness of a twice-daily skin-moisturising regimen for reducing the incidence of skin tears. International wound journal, 11(4), 446-453. https://doi.org/10.1111/iwj.12326

Chang, Y. Y., Carville, K., & Tay, A. C. (2016). The prevalence of skin tears in the acute care setting in Singapore. International wound journal, 13(5), 977-983. https://doi.org/10.1111/iwj.12572

Clarkson, D. M. (2013). The role of ‘care bundles’ in healthcare. British Journal of Healthcare Management, 19(2), 63-68. https://doi.org/10.12968/bjhc.2013.19.2.63

Dilokthornsakul, W., Kosiyaporn, R., Wuttipongwaragon, R., & Dilokthornsakul, P. (2022). Potential effects of propolis and honey in COVID-19 prevention and treatment: A systematic review of in silico and clinical studies. Journal of Integrative Medicine, 20(2), 114-125. https://doi.org/10.1016/j.joim.2022.01.008

Ferreira, J. M., Fernandes-Silva, C. C., Salatino, A., Negri, G., & Message, D. (2017). New propolis type from north-east Brazil: chemical composition, antioxidant activity and botanical origin. Journal of the Science of Food and Agriculture, 97(11), 3552-3558. https://doi.org/10.1002/jsfa.8210

Hardie, C., & Wick, J. Y. (2020). Skin tears in older people. The Senior care pharmacist, 35(9), 379-387. https://doi.org/10.4140/TCP.n.2020.379

Jeon, J. G., Rosalen, P. L., Falsetta, M. L., & Koo, H. (2011). Natural products in caries research: current (limited) knowledge, challenges and future perspective. Caries research, 45(3), 243-263. https://doi.org/10.1159/000327250

Jones, V., Grey, J. E., & Harding, K. G. (2006). Wound dressings. BMJ, 332(7544), 777-780. https://doi.org/10.1136/bmj.332.7544.777

Koya-Miyata, S., Arai, N., Mizote, A., Taniguchi, Y., Ushio, S., Iwaki, K., & Fukuda, S. (2009). Propolis prevents diet-induced hyperlipidemia and mitigates weight gain in diet-induced obesity in mice. Biological and Pharmaceutical Bulletin, 32(12), 2022-2028. https://doi.org/10.1248/bpb.32.2022

Koyano, Y., Nakagami, G., Iizaka, S., Minematsu, T., Noguchi, H., Tamai, N., Mugita, Y., Kitamura, A., Tabata, K., Abe, M., Murayama, R., Sugama, J., & Sanada, H. (2016). Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan. International wound journal, 13(2), 189-197. https://doi.org/10.1111/iwj.12251

Koyano, Y., Nakagami, G., Iizaka, S., Sugama, J., & Sanada, H. (2017). Skin property can predict the development of skin tears among elderly patients: a prospective cohort study. International wound journal, 14(4), 691-697. https://doi.org/10.1111/iwj.12675

Krasner, D. (1995). Wound care: how to use the red-yellow-black system. The American journal of nursing, 95(5), 44-47.

Lacas, A., & Rockwood, K. (2012). Frailty in primary care: a review of its conceptualization and implications for practice. BMC Medicine, 10(1), 4. https://doi.org/10.1186/1741-7015-10-4

Langemo, D. K., Williams, A., & Edwards, K. (2019). Skin tears: Prevention and management. Nursing, 49(4), 66-69. https://doi.org/10.1097/01.NURSE.0000554309.45660.ca7

LeBlanc, K., & Baranoski, S. (2017). Skin tears: finally recognized. Advances in skin & wound care, 30(2), 62-63. https://doi.org/10.1097/01.ASW.0000511435.99585.0d

LeBlanc, K., Baranoski, S., Christensen, D., Langemo, D., Edwards, K., Holloway, S., Gloeckner, M., Williams, A., Campbell, K., Alam, T., & Woo, K. Y. (2016). The Art of Dressing Selection: A Consensus Statement on Skin Tears and Best Practice. Advances in skin & wound care, 29(1), 32-46. https://doi.org/10.1097/01.ASW.0000475308.06130.df

Leblanc, K., Christensen, D., Cook, J., Culhane, B., & Gutierrez, O. (2013). Prevalence of skin tears in a long-term care facility. Journal of wound, ostomy, and continence nursing, 40(6), 580-584. https://doi.org/10.1097/WON.0b013e3182a9c111

Marcucci, M. C. (1995). Propolis: chemical composition, biological properties and therapeutic activity. Apidologie, 26(2), 83-99.

Marcucci, M. C., Sawaya, A. C. H. F., Custódio, A. R., Paulino, N., & Eberlin, M. N. (2008). HPLC and ESI-MS typification: new approaches for natural therapy with Brazilian propolis. Scientific evidence of the use of propolis in ethnomedicine. In N. Orsolic (Ed.), Scientific evidence of the use of propolis in ethnomedicine (pp. 33-54). Kerala, India: Transworld Research Network.

Maruyama, H., Sumitou, Y., Sakamoto, T., Araki, Y., & Hara, H. (2009). Antihypertensive effects of flavonoids isolated from brazilian green propolis in spontaneously hypertensive rats. Biological and Pharmaceutical Bulletin, 32(7), 1244-1250. https://doi.org/10.1248/bpb.32.1244

Matochek, M. H. M., Tomaz, P. L. S., Oliveira, T. S., Polassi, M. R., Alonso, R. C. B., Scremin, F. M., Sauro, S., Marcucci, M. C., & D'Alpino, P. H. P. (2020). Influence of a propolis-based irrigant solution on gap formation and bond strength of posts bonded to root canal dentin using different resin cements. Dent Mater J, 39(3), 490-499. https://doi.org/10.4012/dmj.2019-111

McInulty, L. (2017). Prevention and management of skin tears in older people. Emergency nurse, 25(3), 32-39. https://doi.org/10.7748/en.2017.e1687

Munro, E. L., Hickling, D. F., Williams, D. M., & Bell, J. J. (2018). Malnutrition is independently associated with skin tears in hospital inpatient setting-Findings of a 6-year point prevalence audit. International wound journal, 15(4), 527-533. https://doi.org/10.1111/iwj.12893

Palombo, E. A. (2011). Traditional medicinal plant extracts and natural products with activity against oral bacteria: potential application in the prevention and treatment of oral diseases. Evidence-based complementary and alternative medicine, 2011, 680354. https://doi.org/10.1093/ecam/nep067

Paulino, N., Teixeira, C., Martins, R., Scremin, A., Dirsch, V. M., Vollmar, A. M., Abreu, S. R., de Castro, S. L., & Marcucci, M. C. (2006). Evaluation of the analgesic and anti-inflammatory effects of a Brazilian green propolis. Planta Medica, 72(10), 899-906. https://doi.org/10.1055/s-2006-947185

Perissinotto, E., Pisent, C., Sergi, G., Grigoletto, F., & Enzi, G. (2007). Anthropometric measurements in the elderly: age and gender differences. British Journal of Nutrition, 87(2), 177-186. https://doi.org/10.1079/BJN2001487

Popova, M., Silici, S., Kaftanoglu, O., & Bankova, V. (2005). Antibacterial activity of Turkish propolis and its qualitative and quantitative chemical composition. Phytomedicine, 12(3), 221-228. https://doi.org/10.1016/j.phymed.2003.09.007

Santos, F., Rogenski, N. M. B., Baptista, C. M. C., & Fugulin, F. M. T. (2007). Patient classification system: a proposal to complement the instrument by Fugulin et al.. Revista latino-americana de enfermagem, 15(5), 980-985. https://doi.org/10.1590/S0104-11692007000500015

Santos, V. R. (2012). Propolis: alternative medicine for the treatment of oral microbial diseases. In H. Sakagami (Ed.), Alternative Medicine (pp. 133-169): IntechOpen.

Skiveren, J., Wahlers, B., & Bermark, S. (2017). Prevalence of skin tears in the extremities among elderly residents at a nursing home in Denmark. Journal of wound care, 26(Sup2), S32-S36. https://doi.org/10.12968/jowc.2017.26.Sup2.S32

Souza, L. M., Teixeira, G. D. S., Silva, D. M. D., Ruiz, L. D. S., Coppola, I. D. S., & Meirelles, L. (2021). Prevalence of skin tears in hospitalized adults and older adults. Revista da Escola de Enfermagem da USP, 55, e03683. https://doi.org/10.1590/S1980-220X2019025103683

Stephen-Haynes, J. (2012). Skin tears: achieving positive clinical and financial outcomes. British journal of community nursing, Suppl, S6, S8, S10 passim. https://doi.org/10.12968/bjcn.2012.17.sup3.s6

Stephen-Haynes, J. (2020). The what, who, why and how of skin tears in the community and care homes. British journal of nursing, 29(20), S14-S17. https://doi.org/10.12968/bjon.2020.29.20.S14

Stotts, N. A., Rodeheaver, G. T., Thomas, D. R., Frantz, R. A., Bartolucci, A. A., Sussman, C., Ferrell, B. A., Cuddigan, J., & Maklebust, J. (2001). An instrument to measure healing in pressure ulcers: development and validation of the pressure ulcer scale for healing (PUSH). The journals of gerontology. Series A, Biological sciences and medical sciences, 56(12), M795-799. https://doi.org/10.1093/gerona/56.12.m795

Strazzieri-Pulido, K. C., Peres, G. R., Campanili, T. C., & de Gouveia Santos, V. L. (2017). Incidence of skin tears and risk factors: a systematic literature review. Journal of wound, ostomy, and continence nursing, 44(1), 29-33. https://doi.org/10.1097/WON.0000000000000288

Strazzieri-Pulido, K. C., Santos, V. L., & Carville, K. (2015). Cultural adaptation, content validity and inter-rater reliability of the "STAR Skin Tear Classification System". Revista latino-americana de enfermagem, 23(1), 155-161. https://doi.org/10.1590/0104-1169.3523.2537

Szliszka, E., Kucharska, A. Z., Sokol-Letowska, A., Mertas, A., Czuba, Z. P., & Krol, W. (2013). Chemical composition and anti-inflammatory effect of ethanolic extract of Brazilian green propolis on activated J774A.1 macrophages. Evidence-based complementary and alternative medicine, 2013, 976415. https://doi.org/10.1155/2013/976415

Theou, O., Pérez-Zepeda, M. U., van der Valk, A. M., Searle, S. D., Howlett, S. E., & Rockwood, K. (2021). A classification tree to assist with routine scoring of the Clinical Frailty Scale. Age and Ageing, 50(4), 1406-1411. https://doi.org/10.1093/ageing/afab006

Van Tiggelen, H., LeBlanc, K., Campbell, K., Woo, K., Baranoski, S., Chang, Y. Y., Dunk, A. M., Gloeckner, M., Hevia, H., Holloway, S., Idensohn, P., Karadag, A., Koren, E., Kottner, J., Langemo, D., Ousey, K., Pokorna, A., Romanelli, M., Santos, V., Smet, S., Tariq, G., et al. (2020). Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries. The British journal of dermatology, 183(1), 146-154. https://doi.org/10.1111/bjd.18604

Veiga, R. S., De Mendonca, S., Mendes, P. B., Paulino, N., Mimica, M. J., Lagareiro Netto, A. A., Lira, I. S., Lopez, B. G., Negrao, V., & Marcucci, M. C. (2017). Artepillin C and phenolic compounds responsible for antimicrobial and antioxidant activity of green propolis and Baccharis dracunculifolia DC. Journal of applied microbiology, 122(4), 911-920. https://doi.org/10.1111/jam.13400

Wang, C. C., Wang, Y. X., Yu, N. Q., Hu, D., Wang, X. Y., Chen, X. G., Liao, Y. W., Yao, J., Wang, H., He, L., & Wu, L. (2017). Brazilian green propolis extract synergizes with protoporphyrin IX-mediated photodynamic therapy via enhancement of intracellular accumulation of protoporphyrin IX and attenuation of NF-kappaB and COX-2. Molecules, 22(5). https://doi.org/10.3390/molecules22050732

Więckiewicz, W., Miernik, M., Więckiewicz, M., & Morawiec, T. (2013). Does propolis help to maintain oral health? Evidence-based complementary and alternative medicine, 2013, 351062-351062. https://doi.org/10.1155/2013/351062

Woo, K., & LeBlanc, K. (2018). Prevalence of skin tears among frail older adults living in Canadian long-term care facilities. International journal of palliative nursing, 24(6), 288-294. https://doi.org/10.12968/ijpn.2018.24.6.288

Yuan, H., Ma, Q., Ye, L., & Piao, G. (2016). The traditional medicine and modern medicine from natural products. Molecules, 21(5), 559.: https://doi.org/10.3390/molecules21050559




How to Cite

SANTOS, J. T. .; MARCUCCI, M. C.; SANTOS, M. L. dos .; D’ALPINO, P. H. P. . Exploratory cross-sectional study of the use of a green propolis-based ointment in the treatment of skin tears in elderly hospitalized patients. Research, Society and Development, [S. l.], v. 12, n. 4, p. e12412441061, 2023. DOI: 10.33448/rsd-v12i4.41061. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/41061. Acesso em: 2 jun. 2023.



Health Sciences