Hydrogel-Based Platforms for Chronic Wounds Help Address Infection

The persistent challenge of chronic wounds, which include diabetic foot ulcers, venous leg ulcers, and pressure injuries, currently impacts millions of patients globally and imposes an annual burden on health care systems of approximately $148 billion. A central theme is the formation of microbial biofilms, documented in approximately 78% of chronic wounds, where bacteria encased in extracellular polymeric matrices can tolerate antimicrobial concentrations up to 1000-fold higher than free-floating cells.¹

“The research literature on hydrogel-based wound dressings has expanded rapidly in recent years, and several reviews have contributed valuable perspectives on specific aspects of the field,” the authors said.¹ “Recent work has addressed antibacterial hydrogel formulations and their mechanisms of action, advancements in dressing materials including stimuli-responsive systems, smart dressings designed to combat antibiotic resistance, and hydrogel-based sensing and diagnostic platforms.”

Hydrogel-based platforms are emerging as a sophisticated solution to this crisis, offering integrated strategies that simultaneously address infection, biofilm persistence, and impaired tissue regeneration. These platforms consist of 3-dimensional crosslinked polymer networks that can absorb and retain large volumes of water, thereby maintaining the moist environment essential for epithelial cell migration.¹

For the community pharmacist, who often serves as the first point of contact for wound care, understanding these advanced materials is becoming increasingly critical. Recent survey data indicates a significant knowledge gap in the pharmacy workforce, particularly regarding modern dressings such as hydrogels, where only 9.7% of surveyed pharmacy staff could correctly identify various dressing types and their applications. Although pharmacists generally demonstrate higher overall knowledge than nonpharmacist staff, the expanding scope of practice for pharmacists necessitates a deeper grasp of how hydrogels function as antimicrobial delivery vehicles.²

The design of a hydrogel platform determines its effectiveness, as the choice between natural polymers like chitosan and alginate or synthetic polymers like polyethylene glycol affects both biocompatibility and drug release kinetics. Chitosan is particularly noteworthy because it provides intrinsic broad-spectrum antimicrobial activity through the electrostatic disruption of bacterial membranes, although its efficacy can be limited by the alkaline pH typically found in chronic wounds.^1,3,4

In contrast, synthetic polymers offer greater mechanical reproducibility but require deliberate functionalization to interact with cells or release therapeutic payloads. The crosslinking strategy used to form the gel—whether physical, chemical, or enzymatic—further determines its stability and how it will degrade when exposed to the high protease activity characteristic of the chronic wound environment.¹

Antimicrobial delivery within these hydrogel systems has historically focused on silver, antibiotics, and antimicrobial peptides. Silver nanoparticles remain the most studied agent because they can be engineered to penetrate the extracellular matrix of a biofilm, although their therapeutic window is narrow due to potential cytotoxicity to human fibroblasts and keratinocytes.¹

A more advanced strategy involves stimuli-responsive hydrogels that act as smart dressings, releasing their antimicrobial payload only when triggered by specific environmental signals like an alkaline pH or the presence of bacterial enzymes. This approach aims to deliver high local concentrations of medication exactly where needed while minimizing systemic side effects and the risk of fostering antimicrobial resistance.^1,4

A fundamental shift in wound care research now treats biofilm management as a distinct therapeutic target rather than merely a subset of antimicrobial delivery. Beyond simply killing bacteria, new hydrogel strategies aim to actively disrupt the structural integrity of the biofilm through enzymatic degradation using agents like DNase I or dispersin B.¹

Other cutting-edge techniques include quorum-sensing inhibition, which disrupts the chemical communication bacteria use to coordinate biofilm formation, and antiadhesive surface engineering that prevents initial bacterial colonization of the dressing. These multimodal "disrupt-kill-heal" platforms represent the cutting edge of laboratory innovation, though they currently remain mostly in the preclinical pipeline.¹

Despite the wealth of innovation in the research literature, a significant translational gap exists between the laboratory and the pharmacy shelf. Most currently available commercial hydrogels are simple moisture-retaining formulations, although the multifunctional, exosome-loaded, or stimuli-responsive systems discussed in academic reviews face steep regulatory and manufacturing hurdles. Regulatory agencies often classify hydrogels containing active drugs as combination products, requiring significantly more expensive and time-consuming approval pathways than simple devices. Furthermore, the high cost and cold-chain requirements for biological payloads often limit their accessibility in the primary care settings where they are needed most.¹

Pharmacists play a role in bridging this gap by guiding safer home care and helping patients recognize red flags such as spreading redness, foul odors, or systemic fever that require urgent medical attention. This support is especially valuable for diabetic patients, whose slow recovery and impaired circulation make them highly susceptible to unnoticed skin breakdown and subsequent infection.⁵

As the field moves toward more personalized and evidence-based practices, the integration of structured training into pharmacy curricula will be essential to ensure that the frontline of health care can effectively deploy the next generation of antimicrobial hydrogel technologies. Ultimately, the goal is to transform wound care from passive coverage to an active, rehabilitative process that reduces the global social and economic strain of chronic infections.^2,5

“Hydrogels maintain a moist wound environment that favors healing over dry dressing alternatives; this is established beyond reasonable doubt, even if the effect size in clinical trials is more modest than mechanistic arguments might predict,” the authors concluded.¹

READ MORE: Wound Care Resource Center

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REFERENCES

1. Mihai GM, Martin L, Radu L, et al. Hydrogel-Based Platforms for Wound Care: Integrated Strategies for Antimicrobial Delivery and Biofilm Management. Gels. 2026;12(5):398. Published 2026 May 5. doi:10.3390/gels12050398

2. Cheung DHK, Schneider CR, Collins JC, Um IS. Wound Care Knowledge of Community Pharmacists and Pharmacy Staff: A Cross-Sectional Survey. Int Wound J. 2025;22(9):e70766. doi:10.1111/iwj.70766

3. Gounden V, Singh M. Hydrogels and Wound Healing: Current and Future Prospects. Gels. 2024;10(1):43. Published 2024 Jan 5. doi:10.3390/gels10010043

4. Miron A, Giurcaneanu C, Mihai MM, et al. Antimicrobial Biomaterials for Chronic Wound Care. Pharmaceutics. 2023;15(6):1606. Published 2023 May 28. doi:10.3390/pharmaceutics15061606

5. Citizen Pharmacy. How pharmacies support patients with wound care management. April 14, 2026. Accessed June 9, 2026. https://citizenpharmacy.com/blog/how-pharmacies-support-patients-with-wound-care-management/