How it Works: Pop Pop Fizz Fizz, What a Wonderful Relief Hydrogen Peroxide Is…or is it?

By Jarrod Beachum, PA-C

In this week’s How it Works blog, I wanted to talk about hydrogen peroxide, better known as the stuff in the brown bottle. While it has many useful applications, its use in medicine has come under increased scrutiny as more effective and less harmful methods of wound care have been developed. Here is a brief overview of How it Works, and why it may not be your go-to wound cleanser anymore.

First formulated in the early 1900’s, it has been used as an antiseptic, bleaching agent, and tooth whitener. Its chemical structure is H₂O₂, meaning it has two hydrogen atoms and two oxygen atoms. This structure makes it a good oxidizer, which means that is accepts electrons during a chemical reaction. In its pure state, it is a powerful and unstable chemical used as a propellant for rockets! However, you aren’t pouring rocket fuel into your boo-boos. Hydrogen peroxide for home use is only 3% H₂O_2, and the rest is distilled water. Higher concentrations can be found in dentistry and hair bleach.

H₂O₂ works on wounds by a couple different methods: cleaning and killing. First, there is an enzyme released by broken cells called catalase. When catalase meets H₂O₂, it causes one of the oxygen atoms to break off, releasing it as a gas, while the remaining H₂O remains as water. Because it is such a quick reaction, a lot of oxygen gets released at once, causing it to foam up. The foam and remaining water help to lift any small particles in the wound up and away. The second way it works is by destroying the cell walls of the bacteria present in the wound. That extra oxygen atom is unstable, and so it steals an electron from the bacteria (or other pathogens too), causing it to either die or be unable to divide.

Sounds great huh? Not so fast! H₂O₂ does not discriminate. It is just a simple chemical that is unstable, and if you learned anything in chemistry, unstable things are needy. So, they will take electrons from anything, including our own healthy cells! That’s right. When you pour that fountain of fun into a wound you aren’t only killing bacteria, but you are causing minor damage to the healthy surrounding tissue. For most people, this isn’t that big of a deal. I myself still use it to clean a wound if I have it handy. However, research has shown that can actually DELAY or PREVENT wound healing in diabetics and the immunocompromised. In fact, even one application can be problematic in those populations. Wound care specialists recommend using just mild soap and water, and get it evaluated afterwards. They are taking it even further now and suggesting that it not be used at all by anyone and should go the way of the Dodo bird.

Of course, this treatment is ingrained in our society, and it is unlikely to change because most people won’t have bad outcomes. For a generally healthy person, a minor wound cleansed one time with H₂O₂ will likely be ok. As a clinician, I always advise my patients that H₂O₂ is one-and-done for a wound. I remember distinctly a patient I had early on in my career who came to me distraught over a non-healing wound. She had called a medical hot-line about it, and she was instructed to go to the ER and may likely need surgery, or worse. Well, she came to 45 Urgent Care instead. After a quick history, I found out that she had been cleaning it daily for a month with H₂O₂! After explaining everything I wrote about today, I asked her to trust me and return home with one simple instruction: put down the bottle. Within about a week or so of only water, soap, and air drying, the wound had closed up and was healing. Final verdict: it probably is ok to use, but so is just good old soap and water.

As always, come see us at 45 Urgent Care if you ever have any questions about this or anything else.