Topical application/formulation of probiotics: will it be a novel treatment approach for diabetic foot ulcer?

Treatment of chronic conditions like diabetic foot ulcer (DFU) is challenging due to increased susceptibility for infection and delayed wound healing. Complexity of existing therapy, adverse effects and microbial resistance emphasizes the need of an alternative approach for the management of DFU. The increasing body of evidence associated with probiotic application in diverse disease states merits its use in wound healing and infection too. Different probiotic strains have shown their efficacy in various infections like gut infections, oral infections and urogenital infections. Experimental studies have demonstrated probiotics' ability for gastric ulcer healing. Underlying mechanism of the above therapeutic effects of probiotics involves modulation of local and systemic immunity. The hypothesis is based on the concept that mechanism of anti-infective and ulcer healing action of probiotics will be similar in peripheral wounds and ulcers as on any other part of the body. This paper focuses on the hypothesis that topical applications/formulation of probiotics may be effective for the treatment of diabetic foot ulcers.