One of the most common agents used is silver sulfadiazine (SSD). It is a thick white cream applied one to two times per day. Historically, it was thought to function by decreasing bacterial colonization of the wound. This cream does have antibacterial activity, but there are no well-designed trials that demonstrate improvement in wound healing or reduction of infection. Plus, there are multiple adverse effects, which will be discussed shortly.
How does SSD actually work?SSD creates a pseudoeschar around the wound, which can actually cause microbial colonization around the outer edges. This pseudoeschar requires removal at the edges to allow wound monitoring and skin growth. Once new skin growth, or re-epithelialization, begins, SSD should be stopped. SSD has also been observed in studies to be ineffective in wounds greater than 50% of total body surface area, especially with Gram negative bacteria.
SSD can’t be used in women who are pregnant or breastfeeding.
It should also be avoided on the face or around the eyes, as it can cause significant ocular toxicity and scarring.
It is also toxic to pediatric patients under the age of two months.
What does the research on SSD actually show?
A 2008 Cochrane review demonstrated that SSD delays wound healing time and increases the need for dressing changes and the authors provide evidence for other treatment options. Similarly, a 2006 article by Hussain et al showed that there is no direct evidence of improved healing or reduction in infection by using SSD.