Efficacy, biosafety, and cost-effectiveness of antiseptics described in minimally invasive dermatology: Systematic review
DOI:
https://doi.org/10.33448/rsd-v15i4.50892Keywords:
Dermatology, Anti-Infective Agents, Local, Cost-Effectiveness Analysis.Abstract
Wound bed preparation and microbial load control depend on the use of topical antiseptics, requiring a balance between efficacy, biosafety, and economic viability. The objective of this systematic review is to analyze the efficacy, biosafety, and cost-effectiveness of topical antiseptics and novel antimicrobial agents in minimally invasive dermatology. The review followed the PRISMA guidelines and was registered in PROSPERO. A search was conducted in the PubMed database for randomized clinical trials, assessing the risk of bias using the Cochrane RoB 2.0 tool. A supplementary search covered the grey literature for economic data. Advanced formulations, such as polyhexamethylene biguanide (PHMB) and silver nanoparticles (AgNPs), demonstrated clinical superiority and high cellular tolerability in accelerating the healing of complex wounds when compared to traditional therapies. 40% hydrogen peroxide proved to be highly effective and safe for non-invasive removal of seborrheic keratoses. In pharmacoeconomic analysis, modern silver dressings and PHMB generated overall savings by reducing complications, hospital stays, and dressing changes, offsetting the acquisition cost. First-line antifungals maintained high economic efficiency. It is concluded that innovative antiseptic agents offer superior efficacy and biosafety compared to classic antiseptics in dermatology. Their adoption proves cost-effective by optimizing treatment time and improving patient quality of life.
References
Aboelnaga, A., Elmasry, M., Adly, O. A., Elbadawy, M. A., Abbas, A. H., Abdelrahman, I., ... & Lohmeyer, J. A. (2018). Microbial cellulose dressing compared with silver sulphadiazine for the treatment of partial thickness burns: A prospective, randomised, clinical trial. Burns, 44(8), 1982-1988. https://doi.org/10.1016/j.burns.2018.06.007
Assadian, O., Kammerlander, G., Geyrhofer, C., Luch, G., Doppler, S., Tuchmann, F., ... & Eberlein, T. (2018). Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds. Journal of Wound Care, 27(Sup10), S10-S16. https://doi.org/10.12968/jowc.2018.27.sup10.s10
Bakr, E., Abdo, H., Abd-Elaziz, H., Abd-Elrazek, H., & Amer, M. (2020). Adapalene gel 0.1% vs ketoconazole cream 2% and their combination in treatment of pityriasis versicolor: A randomized clinical study. Dermatologic Therapy, 33(4), Article e13319. https://doi.org/10.1111/dth.13319
Baumann, L. S., Blauvelt, A., Draelos, Z. D., Kempers, S. E., Lupo, M. P., Schlessinger, J., ... & King, M. (2018). Safety and efficacy of hydrogen peroxide topical solution, 40% (w/w), in patients with seborrheic keratoses: Results from 2 identical, randomized, double-blind, placebo-controlled, phase 3 studies (A-101-SEBK-301/302). Journal of the American Academy of Dermatology, 79(5), 869-877. https://doi.org/10.1016/j.jaad.2018.05.044
Benedict, K., Smith, D. J., Chiller, T., Lipner, S. R., & Gold, J. A. W. (2024). Topical antifungal prescribing for Medicare Part D beneficiaries — United States, 2021. MMWR Morbidity and Mortality Weekly Report, 73(1), 1-5. https://doi.org/10.15585/mmwr.mm7301a1
Borges, E. L., Frison, S. S., Honorato-Sampaio, K., Guedes, A. C. M., Lima, V. L. A. N., Oliveira, O. M. M., ... & Ibiapina, A. (2018). Effect of polyhexamethylene biguanide solution on bacterial load and biofilm in venous leg ulcers: A randomized controlled trial. Journal of Wound, Ostomy and Continence Nursing, 45(5), 425-431. https://doi.org/10.1097/won.0000000000000455
Brasil. Ministério da Saúde. (2022). Relatório de recomendação: Uso de limiares de custo-efetividade nas decisões em saúde. CONITEC. https://www.gov.br/conitec/pt-br/midias/pdf/2022/20221106_relatorio-uso-de-limiares-de-custo-efetividade-nas-decisoes-em-saude.pdf
Brasil. Ministério da Saúde. (c2024). Painel de Preços da Saúde (BPS). Recuperado em 3 de março, 2026, de https://infoms.saude.gov.br/extensions/SEIDIGI_DEMAS_BPS/SEIDIGI_DEMAS_BPS.html
Chen, B., Liu, Y., Liu, Y., & Xu, S. (2023). Distribution characteristics of pathogens in different stages of pressure ulcers and the therapeutic effect of linear polarized polychromatic light combined with silver sulfadiazine cream. Medicine, 102(42), Article e35772. https://doi.org/10.1097/md.0000000000035772
Consórcio Intermunicipal de Saúde da Região do Médio Paraopeba [ICISMEP]. (2025). Ata de registro de preços nº 306/2025: Med Center Comercial Ltda. https://icismep.mg.gov.br/wp-content/uploads/2025/01/ATA-DE-REGISTRO-DE-PRECOS-No-306-MED-CENTER-1.pdf
Cooper, D. M., Bojke, C., & Ghosh, P. (2023). Cost-effectiveness of PHMB & betaine wound bed preparation compared with standard care in venous leg ulcers: A cost-utility analysis in the United Kingdom. Journal of Tissue Viability, 32(2), 262-269. https://doi.org/10.1016/j.jtv.2023.03.001
Deeming, S., Dolja-Gore, X., Gani, J., Carroll, R., Lott, N., Attia, J., ... & Higgins, I. (2024). Optimal antiseptic skin preparation agents for minimizing surgical site infection following surgery: Cost and cost-effectiveness analysis. BJS Open, 8(1), Article zrad160. https://doi.org/10.1093/bjsopen/zrad160
DrugPatentWatch. (2026). Drug price trends for silver sulfadiazine. thinkBiotech LLC. Recuperado em 3 de março, 2026, de https://www.drugpatentwatch.com/p/drug-price/drugname/silver+sulfadiazine
DuBois, J. C., Jarratt, M., Beger, B. B., Bradshaw, M., Powala, C. V., & Shanler, S. D. (2018). A-101, a proprietary topical formulation of high-concentration hydrogen peroxide solution: A randomized, double-blind, vehicle-controlled, parallel group study of the dose-response profile in subjects with seborrheic keratosis of the face. Dermatologic Surgery, 44(3), 330-340. https://doi.org/10.1097/dss.0000000000001302
El-Gohary, M., van Zuuren, E. J., Fedorowicz, Z., Burgess, H., Doney, L., Stuart, B., ... & Moore, M. (2014). Topical antifungal treatments for tinea cruris and tinea corporis. Cochrane Database of Systematic Reviews, 2014(8), Article CD009992. https://doi.org/10.1002/14651858.CD009992.pub2
Essa, M. S., Ahmad, K. S., Zayed, M. E., & Ibrahim, S. G. (2021). Comparative study between silver nanoparticles dressing (SilvrSTAT Gel) and conventional dressing in diabetic foot ulcer healing: A prospective randomized study. The International Journal of Lower Extremity Wounds, 22(1), 48-55. https://doi.org/10.1177/1534734620988217
Etsy. (c2024). Spray facial de ácido hipocloroso (120ml). Recuperado em 2 de março, 2026, de https://www.etsy.com/pt/listing/4397616260/spray-facial-de-acido-hipocloroso-120ml
Farmacia Tili. (c2026). Nizoral 2% 30 g cream. Recuperado em 3 de março, 2026, de https://www.dottortili.com/en/products/nizoral-2-30-g-cream
Fernández-Rodríguez, D., Cho, J., Chisari, E., Citardi, M. J., & Parvizi, J. (2024). Nasal microbiome and the effect of nasal decolonization with a novel povidone-iodine antiseptic solution: A prospective and randomized clinical trial. Scientific Reports, 14, Article 16738. https://doi.org/10.1038/s41598-023-46792-8
Fuhr, R., Cook, D., Ridden, J., Nield, K., Leigh, E., Cook, J., ... & Ghannoum, M. (2022). Results from a Phase 1/2 trial of BB2603, a terbinafine-based topical nano-formulation, in onychomycosis and tinea pedis. Mycoses, 65(6), 661-669. https://doi.org/10.1111/myc.13448
Haesler, E. (2020). Evidence summary: Octenidine for chronic wounds. Wound Practice and Research, 28(1), 42-44. https://doi.org/10.33235/wpr.28.1.42-44
Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Juni, P., Moher, D., Oxman, A. D., ... & Sterne, J. A. C. (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 343, Article d5928. https://doi.org/10.1136/bmj.d5928
Kane, S. P. (2025). Ketoconazole: Drug usage statistics, ClinCalc DrugStats database (Versão 2025.08). ClinCalc. https://clincalc.com/DrugStats/Drugs/Ketoconazole
Kim, P. J., Fernandez, L., Obst, M. A., Chaffin, A., Faust, E., Lantis, J., ... & Wolcott, R. (2024). Multidisciplinary expert consensus statements and recommendations for use of hypochlorous acid as a solution for negative pressure wound therapy with instillation. Wounds, 36(4), 108-114. https://doi.org/10.25270/wnds/23143
Krishna, K. V., & Madhavi, S. (2025). Preoperative skin antisepsis with povidone-iodine versus chlorhexidine: A prospective comparative study on surgical site infection prevention. European Journal of Cardiovascular Medicine, 15(8), 304-308. https://healthcare-bulletin.co.uk/article/preoperative-skin-antisepsis-with-povidone-iodine-versus-chlorhexidine-a-prospective-comparative-study-on-surgical-site-infection-prevention-4000/
Lee, I., Agarwal, R. K., Lee, B. Y., Fishman, N. O., & Umscheid, C. A. (2010). Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infection Control & Hospital Epidemiology, 31(12), 1219-1229. https://doi.org/10.1086/657134
Li, L. G., Zhao, H. X., Wang, H. Y., Ding, L. F., Wang, Y. H., Wang, Y., ... & Liu, J. (2024). The value of sequential application of hydrogen peroxide, povidone-iodine and physiological saline in reducing postoperative infections after total knee arthroplasty: A prospective, randomized, controlled study. The Knee, 47, 53-62. https://doi.org/10.1016/j.knee.2023.12.015
Limtanyakul, P., Smithrithee, R., Wongwitthayakool, P., Taweechotipatr, M., Chottechathammanee, P., & Wattanasirichaigoon, S. (2025). Comparison of green-synthesized silver nanoparticle shampoo created by Moringa and bergamot extraction versus 2% ketoconazole shampoo for scalp seborrheic dermatitis: A prospective, randomized, double-blinded, controlled trial. Dermatologic Therapy, 2025, Article 7166552. https://doi.org/10.1155/dth/7166552
Lin, L., Bi, H., Wang, X., & Shi, X. (2023). Impact of platelet-rich fibrin combined with silver nanoparticle dressing on healing time and therapeutic efficacy of chronic refractory wounds. Alternative Therapies in Health and Medicine, 29(6), 264-267.
Lydecker, A. D., Kim, J. J., Robinson, G. L., Johnson, J. K., Brown, C. H., Petruccelli, C. C., ... & Thom, K. A. (2025). Chlorhexidine vs routine foot washing to prevent diabetic foot ulcers: A randomized clinical trial. JAMA Network Open, 8(2), Article e2460087. https://doi.org/10.1001/jamanetworkopen.2024.60087
Magazine Médica. (c2026). Página inicial. Recuperado em 3 de março, 2026, de https://magazinemedica.com.br/
Município de Porto Lucena. (2026). Relatório de compra: Pedido de compra 000303/2025: Estudo técnico preliminar e termo de referência. Secretaria Municipal de Saúde. https://pncp.gov.br/pncp-api/v1/orgaos/87613659000100/compras/2026/1/arquivos/1
Município de Rio Bonito do Iguaçu. (2025). Edital de pregão eletrônico nº 65/2025: Registro de preços para aquisição de medicamentos. Secretaria Municipal de Saúde. https://riobonito.pr.gov.br/uploads/files/Edital_65-2025_-_Medicamentos_7194_20250917144625.pdf
MyDr.XM. (c2024). Schulke & Mayr Octenisept solution. Recuperado em 3 de março, 2026, de https://mydrxm.com/products/schulke-mayr-octenisept-solution
NHS Business Services Authority. (2026). Drug tariff updates. Recuperado em 3 de março, 2026, de https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff/drug-tariff-updates
Nímia, H. H., Carvalho, V. F., Isaac, C., Souza, F. Á., Gemperli, R., & Paggiaro, A. O. (2019). Comparative study of silver sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis. Burns, 45(2), 282-292. https://doi.org/10.1016/j.burns.2018.05.014
Okokon, E. O., Verbeek, J. H., Ruotsalainen, J. H., Ojo, O. A., & Bakhoya, V. N. (2015). Topical antifungals for seborrhoeic dermatitis. Cochrane Database of Systematic Reviews, 2015(5), Article CD008138. https://doi.org/10.1002/14651858.CD008138.pub3
Ongsri, P., Na Bangchang, N., Saengthong-Aram, P., Leeyaphan, C., Pattanaprichakul, P., & Bunyaratavej, S. (2024). Efficacy of 1% clotrimazole powder monotherapy for treating tinea cruris: A comparative randomized study. Military Medicine, 189(11-12), Article e2494. https://doi.org/10.1093/milmed/usae105
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2022). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Revista Panamericana de Salud Pública, 46, Article e112. https://doi.org/10.1136/bmj.n71
Praxisdienst. (c2024). Octenilin wound gel. Recuperado em 3 de março, 2026, de https://www.praxisdienst.com/it-en/prodotto/octenilin-wound-gel/130634
Rizzo, E. J., Mallow, P. J., Noble, A. J., & Foster, K. (2024). Cost analysis of pure hypochlorous acid preserved wound cleanser versus mafenide for the irrigation of burn wounds. ClinicoEconomics and Outcomes Research, 16, 747-752. https://doi.org/10.2147/ceor.s476201
Rousel, J., Saghari, M., Pagan, L., Nădăban, A., Gambrah, T., Theelen, B., ... & Burggraaf, J. (2023). Treatment with the topical antimicrobial peptide Omiganan in mild-to-moderate facial seborrheic dermatitis versus ketoconazole and placebo: Results of a randomized controlled proof-of-concept trial. International Journal of Molecular Sciences, 24(18), Article 14315. https://doi.org/10.3390/ijms241814315
Sepaskhah, M., Sadat, M. S., Pakshir, K., & Bagheri, Z. (2017). Comparative efficacy of topical application of tacrolimus and clotrimazole in the treatment of pityriasis versicolor: A single blind, randomised clinical trial. Mycoses, 60(6), 338-342. https://doi.org/10.1111/myc.12598
Sepaskhah, M., Shamshiri, F., & Bagheri, Z. (2026). Comparison of the effectiveness of ivermectin 1% cream and ketoconazole 2% cream in treating facial seborrheic dermatitis: A double-blind, randomized, controlled clinical trial. Health Science Reports, 9, Article e71816. https://doi.org/10.1002/hsr2.71816
Supsamutchai, C., Jirasiritham, J., Punmeechao, P., Pornwaragorn, C., & Wilasrusmee, C. (2024). The efficacy of combination of sodium hypochlorite (NaOCL)/hypochlorous acid (HOCL) in wound management: A systematic review and network meta-analysis. F1000Research, 13, Article 1260. https://doi.org/10.12688/f1000research.148610.1
Teng, V. C., Madjid, A., Widita, W., & Djawad, K. (2025). The efficacy and safety of polyhexanide compared to other wound dressings in patients with various wound types: A systematic review and meta-analysis. Wound Practice and Research, 33(3), 122-138. https://doi.org/10.3235/wpr.33.3.122-138
Vitse, J., Tchero, H., Meaume, S., Dompmartin, A., Malloizel-Delaunay, J., Géri, C., ... & Retibi, A. (2018). Silver sulfadiazine and cerium nitrate in ischemic skin necrosis of the leg and foot: Results of a prospective randomized controlled study. The International Journal of Lower Extremity Wounds, 17(3), 151-160. https://doi.org/10.1177/1534734618795534
WithPower. (n.d.). Clotrimazole vs. Ketoconazole: Which antifungal is right for you? Recuperado em 2 de março, 2026, de https://www.withpower.com/guides/clotrimazole-vs-ketoconazole-d37a
Yang, S., Li, Z., Wu, F., Sun, L., He, Y., & Wang, C. (2025). Chlorhexidine versus povidone-iodine for surgical site infection prevention: An updated meta-analysis and trial sequential analysis of randomized controlled trials. Frontiers in Medicine, 12, Article 1641815. https://doi.org/10.3389/fmed.2025.1641815
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