Main Research Findings

Silver sulfadiazine is a widely used antibacterial agent for the treatment of burns. However, some studies have reported side effects associated with the use of silver sulfadiazine. 10 reported that Furacin Soluble Dressing, which was used as an alternative to silver sulfadiazine, caused an unexpected toxicity syndrome of hyperosmolality, metabolic gap acidosis, hypercalcemia, and ultimately renal failure. 2 reported that the use of silver sulfadiazine in severely burned patients resulted in elevated serum and urine levels of sulfadiazine and propylene glycol, and an immune response to sulfadiazine was observed. 14 reported that silver nanoparticles can affect human keratinocyte cells, and that high concentrations of silver ions in silver nanoparticles promote the formation of intracellular radicals and reduce the concentration of antioxidants. 6 reported a case of localized argyria developing in a scar after the use of silver sulfadiazine cream. 13 reported that cubosome hydrogels loaded with silver sulfadiazine may be more effective and have fewer side effects than commercially available creams for the treatment of burns. 18 reported that silver nylon fabric has the effect of inhibiting the growth of bacteria in burn wounds. 19 reported a case of cerium-induced granulomatous dermatitis. 5 reported that nanoscale silver has broader antimicrobial activity and fewer toxicological side effects than silver sulfadiazine. 8 reported a case in which silver-coated Acticoat dressing caused elevated liver enzymes and argyria-like symptoms in a burn patient. 11 reported that Sea buckthorn (Hippophae rhamnoides L.) seed oil promotes wound healing in rats and is safe. 17 reported a case of necrotizing peripheral vasculitis/vasculopathy following the use of cocaine laced with levamisole. 9 reported that sulfadiazine is excreted in the urine when silver sulfadiazine is applied to burns in children. 15 reported that curcumin-containing propylene glycol nanoliposomes promote wound healing in rats and have antibacterial effects. 16 reported that non-dermal irritating hyperosmotic nanoemulsions reduce treatment times in a contamination model of wound healing. 3 reported that applying cerium nitrate plus silver sulfadiazine to deep dermal burns causes superficial connective tissue calcification. 4 reported that morphine-infused silver sulfadiazine (MISS) cream may have the potential to reduce burn pain. 12 reported that an internet survey of burn center directors around the world found that silver sulfadiazine 1% cream, other antimicrobial ointments and creams, and impregnated gauze dressings are commonly used for the treatment of partial-thickness burns and donor sites. 1 reported that a study evaluating the side effects of sildenafil in young healthy volunteers found side effects such as heart palpitations and flushing. 7 reported side effects associated with the use of silver sulfadiazine cream, such as allergic reactions to the sulfadiazine moiety, silver staining of the treated burn wound, hyperosmolality, methemoglobinemia, and hemolysis due to a congenital lack of glucose-6-phosphate dehydrogenase.

Reasons for Side Effects

Side effects of silver sulfadiazine are thought to be caused by allergic reactions to silver or sulfadiazine, argyria due to silver absorption, skin irritation caused by base ingredients such as propylene glycol, and so on. 6 , 10 , 14 , 2 , 7

Common Side Effects

Allergic Reactions

Silver sulfadiazine is a sulfa drug, and people with sulfa drug allergies may experience allergic reactions such as rashes and hives. 7 , 9

Argyria

Long-term use of silver sulfadiazine can cause argyria, a condition in which silver deposits in the skin and internal organs, causing the skin to turn bluish-gray. 7 , 6 , 8

Hyperosmolality

Silver sulfadiazine cream is hyperosmotic, and applying it over a wide area can cause hyperosmolality by drawing fluid from tissues in the body. 7 , 10

Methemoglobinemia

Silver sulfadiazine can cause methemoglobinemia. Methemoglobinemia is a condition in which hemoglobin in the blood cannot bind to oxygen, resulting in symptoms such as shortness of breath and pallor. 7

Hemolysis

People with glucose-6-phosphate dehydrogenase deficiency may experience hemolysis when using silver sulfadiazine. Hemolysis is the breakdown of red blood cells, resulting in symptoms such as anemia and jaundice. 7

Skin irritation

Propylene glycol, a base ingredient in silver sulfadiazine cream, can cause skin irritation. 14

Other side effects

Use of silver sulfadiazine can cause side effects such as leukopenia, fever, and liver abnormalities. 2 , 8 , 9

Side Effects Measures

Allergic reactions

You should tell your doctor if you have any sulfa drug allergies before using silver sulfadiazine. If you experience an allergic reaction, stop using silver sulfadiazine and consult your doctor. 7 , 9

Argyria

To prevent argyria, it is important to use silver sulfadiazine for as short a time as possible and in the minimum amount necessary. If you notice any changes in skin color or symptoms of argyria while using silver sulfadiazine, consult your doctor. 7 , 6 , 8

Hyperosmolality

To prevent hyperosmolality, you need to stay well hydrated. If you are applying silver sulfadiazine over a wide area, consult your doctor. 7 , 10

Methemoglobinemia

If you experience symptoms of methemoglobinemia, consult your doctor. 7

Hemolysis

People with glucose-6-phosphate dehydrogenase deficiency should avoid using silver sulfadiazine. 7

Skin irritation

If you experience skin irritation, stop using silver sulfadiazine and consult your doctor. 14

Comparison Between Studies

Commonalities

Many studies have reported that silver sulfadiazine is an effective antibacterial agent for the treatment of burn wounds. However, some studies have reported side effects associated with the use of silver sulfadiazine. These side effects include allergic reactions, argyria, hyperosmolality, methemoglobinemia, hemolysis, and skin irritation. 10 , 2 , 14 , 6 , 13 , 18 , 19 , 5 , 8 , 11 , 17 , 9 , 15 , 16 , 3 , 4 , 12 , 1 , 7

Differences

The incidence and severity of side effects of silver sulfadiazine vary depending on the study. Different studies also have different interpretations of the causes of silver sulfadiazine side effects. 10 , 2 , 14 , 6 , 13 , 18 , 19 , 5 , 8 , 11 , 17 , 9 , 15 , 16 , 3 , 4 , 12 , 1 , 7

Precautions for Real-Life Applications

Silver sulfadiazine is an effective antibacterial agent for the treatment of burns, but it is important to remember that there is a risk of side effects. When using silver sulfadiazine, it is important to consult a doctor and understand the proper usage and precautions. 7 , 10 , 14 , 6 , 13 , 18 , 19 , 5 , 8 , 11 , 17 , 9 , 15 , 16 , 3 , 4 , 12 , 1 , 7

Limitations of Current Research

Research on the side effects of silver sulfadiazine is still insufficient. In particular, further research is needed on the effects of long-term use of silver sulfadiazine and the effects of silver sulfadiazine after absorption into the body. 7 , 10 , 14 , 6 , 13 , 18 , 19 , 5 , 8 , 11 , 17 , 9 , 15 , 16 , 3 , 4 , 12 , 1 , 7

Future Research Directions

To gain a deeper understanding of the side effects of silver sulfadiazine, the following research is considered necessary.

• Research on the effects of long-term use of silver sulfadiazine
• Research on the effects of silver sulfadiazine after absorption into the body
• Development of new treatment methods to reduce the side effects of silver sulfadiazine

Conclusion

Silver sulfadiazine is an effective antibacterial agent for the treatment of burns, but it is important to remember that there is a risk of side effects. When using silver sulfadiazine, it is important to consult a doctor and understand the proper usage and precautions. 7 , 10 , 14 , 6 , 13 , 18 , 19 , 5 , 8 , 11 , 17 , 9 , 15 , 16 , 3 , 4 , 12 , 1 , 7