Introduction
The inorganic compound chlorine dioxide (CD) is a powerful oxidant. Due to its size selectivity, when used at safe concentrations (<1000 ppm), CD prevents tissue damage and causes denaturation of microbial proteins through irreversible oxidation1. To date, and since 1995, due to its broad-spectrum antimicrobial effect, CD is part of the FDA's list of food additives for water treatment and vegetable washing2.
In the field of human health in the face of the emergence of resistance to antibiotics, antivirals and antifungals, CD is an alternative antiseptic therapy for the prevention of infections in skin lesions3–8. In the dental field, the use of CD as an antiseptic is well known to help reduce gingival indices and lower the bacterial count in the oral cavity9–11. The use of CD has made it possible to establish that 1) it is safe for local application without risk of systemic intoxication, 2) it does not intervene in the healing process, 3) it is effective even at low concentrations and 4) it does not generate antimicrobial resistance1. Furthermore, CD appears to have a broad antimicrobial spectrum, with evidence of antiviral, antibacterial and antifungal effects in12–19.
Other chlorine-based oxidizing solutions such as sodium hypochlorite (NaClO), hypochlorous acid (HClO) and hypochlorite (OCl -) have been used commercially to act as an antiseptic20. However, CD has shown greater biofilm removal compared to other chlorine derivatives, with lower risk of toxicity21,22. In the veterinary medical area, CD is also used as an antiseptic for post-surgical skin treatment, and for the prevention of bovine mastitis6,23. Similarly, in the area of human medicine, CD is used as an antiseptic in irrigation therapy and the treatment of keratosis pilaris.7,8
Given the evidence that has been documented to date regarding its safety and broad antimicrobial properties, the possibility that a CD solution could have a beneficial effect as an antiseptic for skin lesions is pertinent to explore. The use of a CD solution could potentially prevent infection with potential pathogens and the proliferation of opportunistic microorganisms that can interfere with regeneration. We document four cases of patients with different skin lesions, all of whose treatment included the use of a CD solution. The resolution of the lesions, as well as the occurrence of adverse events and the manifestation of secondary lesions that could be associated with the use of DC were assessed.