Chronic ulcers are defined as a breakdown of the long-term cutaneous barrier or frequent recurrence of breakdowns. Dressings are a form of treatment and, in view of the variety and high cost of the products on the market, three agents were selected for this investigation, regarding their efficacy and cost/benefit ratio. The objective of the investigation was to evaluate and compare the efficacy, costs, and benefits of carboxymethylcellulose in paste at 20% (CMC 20%), trichloroacetic acid at 90% (TCA 90%), and Unna boot for treatment of chronic venous ulcers. Three groups of 30 patients each were chosen randomly for ambulatory treatment with TCA 90% (G1), CMC 20% (G2), and Unna boot (G3). The evolution of the cicatricial process of each group separately and between groups was analyzed with measurement of the lesion areas in square centimeters (cm2) and observation of the amount of exudate from observation of the photographic record, until their healing, in the maximum period of 20 weeks. A significant reduction of lesion areas in all groups was observed (P=.0001), with a median reduction of 7.6 cm[2] (38.1%) for G1, 3.9 cm[2] (38.8%) for G2, and 16.2 cm[2] (77.8%) for G3. There was a significant difference in the absolute delta of the lesion areas (P=.0001) of the groups. The three types of treatments promoted effective improvement, with acquisition and utilization of all three products in the public health services being recommended.

Venous ulcers cause considerable morbidity. A 45-year-old man reported with non healing ulcer since 15 years. Patch tests revealed multiple sensitivity. Infection was first controlled with antibiotics and antiseptics. Dressing with modified Unna's boot made with zinc oxide 40% and glycerine paste 60% resulted in formation of healthy granulation tissue. Pinch grafting was subsequently done to promote epithelization. We recommend the use of Unna's paste instead of more expensive synthetic and occlusive and semi occlusive dressing to promote granulation tissue and pinch grafting after bed is ready to hasten epithelization.

Pruritus, as a chronic lesion caused by sulfur mustard, is a common problem among chemical weapons veterans. Numerous treatments like antihistamines, local anesthetics, and corticosteroids have been prescribed in order to control pruritus in these patients, while long- term and widespread use of each one of them has its own restrictions. Nowadays different mixtures, including Unna's Boot, are being used. They are effective and have limited adverse effects. So in this study we compared this product with corticosteroids. In this double-blind randomized clinical trial in Baqyiatallah hospital, 90 veterans were included and randomly divided into three groups. Subjects of each group received one of the Betamethasone %1 cream, Unna's Boot cream, or placebo cream for three weeks. They used their medication on an itching area of body, one finger tip unit every night. To evaluate the drugs' efficacy we used pruritus score index and Visual Analysis Score index. From 90 patients, 75 patients completely used the medication and the other 15 subjects were excluded from the study. All three drugs caused significant decrease in both pruritus score and VAS (p < .001). Betamethasone and Unna's Boot were significantly more effective than placebo and despite more efficacy of betamethasone rather than Unna's Boot, they did not have any significant differences (p > .05). Pruritus is a chronic lesion in veterans that needs long-term conservation treatment. Regarding definite side effects of local long-term therapy with corticosteroids and nearly equal efficacy of Unna's Boot and betamethasone, Unna's Boot seems to be a better choice in controlling sulfur mustard-related pruritus compared with betamethason.

Non-elastic compression has been used to treat venous insufficiency of the lower extremities for more than 150 years. The best and most recognized example is the Unna boot. When compared with other dressings, the Unna boot has performed as well as or better than other forms of compression. While the Unna boot is used worldwide, a 3- or 4-layer dressing has emerged as the dressing of choice in treating severe chronic venous insufficiency in the United States and English-speaking European countries. In the United States, non-elastic compression can also be applied as a CircAid legging. This semirigid support has been compared with heavyweight class 3 below-knee medical stockings. At 2 and 6 hours after application, inelastic compression maintained limb size and reduced venous volume better than did stockings. At 6 hours, the ejection fraction of the calf muscle pump was increased and venous filling index significantly improved with inelastic compression compared with stockings. Comparison of elastic stockings with short-stretch bandages has also been completed. The short-stretch bandage was found to be similar but not identical to the semirigid inelastic support device. The studies have shown that venous filling index improved by short-stretch bandaging and that venous reflux time was prolonged more by the short-stretch bandages than by stockings. The findings of these studies demonstrate that the inelastic support dressing mimics the action of the Unna boot in providing counter-pressure to perforating vein outflow. This may improve cutaneous and subcutaneous microcirculation in a manner similar to perforating vein surgery, which has been shown to accelerate leg ulcer healing.

In this study the author describes the results of venous stasis ulcers treatment using Unna's boot and activated coal and silver in 47 patients aged 30-80. Total treatment time was from 2 to 16 weeks, with the average of 6 days between two consecutive bandages. Among these 47 patients, 87% have had their wounds healed, 8.5% have been unsuccessful in healing them and 4.5% have dropped the treatment, the main profits observed were the decrease of bandage number, patients and Public Health Service money saving and treatment compliance.