silver nitrate
Regulatory sources consulted
Approved indications
- Caustic treatment of cutaneous warts and granulomas.
Contraindications
Absolute
- Hypersensitivity to silver nitrate or excipients; do not apply to wounded, infected, irritated, or reddened skin, moles, birthmarks or other spots, genital or facial warts, mucous membranes, the anogenital region, or large areas.
Clinical warnings
- Major warning · It is corrosive and must be strictly limited to the lesion while protecting surrounding healthy skin. Do not repeatedly treat the same point: black staining may become permanent. — CIMA/AEMPS, ficha técnica 15734
- Major warning · This card is limited to cutaneous application of the stick. Do not use it in the mouth, nose, or other mucous membranes; treatment of those sites requires a healthcare professional to confirm a specifically appropriate product and regimen. — CIMA/AEMPS, ficha técnica 15734
Drug interactions
- HighOther medicines on the same area
Mechanism: Concomitant application may alter the local caustic action.
Recommendation: Do not use other medicines on the same area.
CIMA/AEMPS, ficha técnica 15734https://cima.aemps.es/cima/dochtml/ft/15734/FT_15734.html
Adverse events
Common (≥1%)
Common: irritation, dermatitis, rash, burn, skin discoloration, or argyria
Pregnancy and lactation
Safety and effectiveness during pregnancy are unknown and no specific breastfeeding recommendation is established; the professional should individualize use.
Recent literature (PubMed)
There is no consensus regarding the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Supportive care remains the preferred approach internationally, while the efficacy of topical/systemic therapies is subject to controversy. We reviewed published guidelines and recommendations on SJS/TEN management and assessed supportive care involving topical and systemic therapies in a series of SJS patients. We included several specialty departments from different countries to determine the consensus in the management of SJS/TEN. We also included SJS patients and provided supportive care including silver nitrate at 0.5% sprayed on denuded areas, in conjunction with a single dose of subcutaneous etanercept. Based on our literature review and experience, we propose a management algorithm for SJS/TEN. Our review confirmed the importance of supportive care, including specific topical and systemic treatments, for SJS/TEN. Systemic corticotherapy, cyclosporine A, intravenous immunoglobulin, tumor necrosis factor-alpha (TNF-α) blockers, or combinations are subject to controversies. In our pilot series of seven adult patients with SJS, we obtained good clinical results within 1 week, with mucosal and skin clearance at Week 2, along with a good safety profile. This was achieved by spraying topical silver nitrate at a concentration of 0.5% on denuded areas, following a single dose of etanercept. This consensus led to the recommendation of a combination of supportive care along with several possible topical and systemic therapies for SJS/TEN. Corticosteroids, immunoglobulins, cyclosporine A, and TNF-alpha blockers were used in our centers alone or in combination, with good results associated with 0.5% topical silver nitrate. In our series of SJS patients, silver nitrate at 0.5% associated with etanercept showed a good response.
Silver metal and compounds have antibacterial properties, although their action's mechanisms are not fully understood. Scientists generally consider that silver disrupts the bacterial cell wall. It causes a structural change in the bacterial cell membrane and cytoplasm. It also stops deoxyribonucleic acid replication, resulting in inactivating enzymatic activity and cell death. The antimicrobial effect of silver-containing compounds relies on the release of bioactive silver ions. Hence, silver metal and compounds have been used in medicine to prevent infection for hundreds of years. Silver metal and compounds are also used as antibacterial agents in dentistry. Studies have shown that silver compounds are effective in the management of dental caries. Fluoride-containing silver compounds have been found in experiments to be beneficial at remineralising dental cavities. Silver diamine fluoride (SDF) can assist in preventing and arresting tooth cavities. The World Health Organization included SDF in its Model List of Essential Medicine for both adults and children in 2021. Clinicians also use SDF to manage dentine hypersensitivity as well as to inhibit growth of periodontal pathogens. However, traditional silver compounds cause tooth discolouration because of the silver-staining effect. These side effects of their applications depend on the amount applied and the frequency of application. Researchers are developing nanosilver fluoride and silver nanoparticles to overcome the staining. This review gives an overview of the antibacterial mechanism of silver compounds, namely silver nitrate, silver fluoride, SDF, silver nanoparticles, and nano silver fluoride for caries management. The outlook for the future development of silver compounds will be discussed.
To summarize current knowledge regarding management of hypergranulation in the context of gender-affirming vaginoplasty. There have been no studies to date examining hypergranulation treatment options following vaginoplasty. Evidence from the literature on this complication in other settings and the opinions of authorities and experts in this area were used to inform this review. Hypergranulation is a common complication of vaginoplasty, but many care providers may not know how to identify or treat it. This short report will review hypergranulation after vaginoplasty, including risk factors, identification, and treatment options such as douching, silver nitrate, and topical steroids. By increasing clinicians' knowledge of this pervasive complication, patients' postsurgical care and outcomes can be improved. Résumer les connaissances actuelles sur la prise en charge de l’hypergranulation dans le contexte d’une vaginoplastie d’affirmation de genre. Aucune étude n’a examiné jusqu’à présent les options de traitement de l’hypergranulation consécutive à une vaginoplastie. Les données probantes issues de la littérature sur cette complication dans d’autres contextes, et l’avis d’autorités et d’experts du domaine ont servi à éclairer les lignes directrices présentées dans cette revue. L’hypergranulation est une complication fréquente de la vaginoplastie, mais beaucoup de fournisseurs de soins peuvent ne pas savoir comment la détecter ou la traiter. Ce bref rapport examine l’hypergranulation consécutive à la vaginoplastie, y compris les facteurs de risque, sa détection et les options de traitement, comme la douche vaginale, le nitrate d’argent et les stéroïdes topiques. En augmentant les connaissances des cliniciens sur cette complication répandue, on peut améliorer les soins postopératoires et les résultats des patientes.
The relationship between wound irrigation and healing has been recognized for centuries. However, there is little evidence and no official recommendations from any health care organization regarding best wound irrigation practices. This is the first review of wound irrigation that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence into a practical format. In this comprehensive review, the authors outline the irrigation fluids and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize irrigation effectiveness, and propose evidence-based guidelines to improve wound healing outcomes and enhance the consistency of wound irrigation. Thirty-one high-quality studies with a combined total of 61,808 patients were included. Based on the current evidence provided by this review, the authors propose the following guidelines: (1) acute soft-tissue wounds should receive continuous gravity flow irrigation with polyhexanide; (2) complex wounds should receive continuous negative-pressure wound therapy with instillation with polyhexanide; (3) infected wounds should receive continuous negative-pressure wound therapy with instillation with silver nitrate, polyhexanide, acetic acid, or povidone-iodine; (4) breast implant wounds should receive gravity lavage with povidone-iodine or antibiotics; and (5) surgical-site infection rates can be reduced with intraoperative povidone-iodine irrigation.
Hemorrhagic cystitis (HC) can be one of the most challenging clinical scenarios for urologists to manage. It most commonly occurs as a toxicity of pelvic radiation therapy or in patients treated with the oxazaphosphorine class of chemotherapy. Successful management of HC necessitates a stepwise approach with a thorough understanding of the various treatment options. Once ensuring hemodynamic stability, conservative management includes establishing bladder drainage, manual clot evacuation, and continuous bladder irrigation through a large-bore urethral catheter. If gross hematuria persists, operative cystoscopy with bladder clot evacuation is often required. There are multiple intravesical options for treating HC, including alum, aminocaproic acid, prostaglandins, silver nitrate, and formalin. Formalin is an intravesical option that has caustic effects on the bladder mucosa and is most often reserved as a last-line intravesical treatment. Non-intravesical management tools include hyperbaric oxygen therapy and oral pentosan polysulfate. If needed, nephrostomy tube placement or superselective angioembolization of the anterior division of the internal iliac artery can be performed. Finally, cystectomy with urinary diversion is a definitive, albeit invasive, treatment option for refractory HC. While there is no standardized algorithm, treatment modalities typically progress from less to more invasive. Clinical judgement and shared decision-making with the patient are required when choosing therapies for managing HC, as success rates are variable and some treatments may have significant or irreversible effects.