About potassium permanganate

Potassium permanganate may be used as a topical preparation for the care of wound or skin conditions in the community and hospital setting. Potassium permanganate is classed as ‘an oxidising agent’ which is thought to confer bactericidal properties.

Regulatory status

A licensed medicinal potassium permanganate product does not exist in the UK. It is only available as a ‘chemical product’.

Potassium permanganate is subject to the Control of Substances Hazardous to Health Regulations. This includes separate storage, additional hazard labelling, and issue only to staff and patients who have been educated to understand its safe use.

Products and preparations

The chemical product is dissolved in water to give a topical solution of 0.01% (1 in 10,000). This is applied as wet dressings or used as a bath soak. Products available are:

• Tablets for cutaneous solution:
• • AnateP 400mg tablets for cutaneous solution (Essential-Healthcare Ltd)
  • EN-Potab 400mg tablets for cutaneous solution (Ennogen Healthcare Ltd)
  • Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)
• Solutions for further dilution (available from special order manufacturers)

Using for skin conditions or wound care

Indications

The indications are not described uniformly in the medical literature and potassium permanganate’s place in therapy remains ambiguous.

The BNF describes diluted potassium permanganate as a mild antiseptic and astringent, which can be used for cleansing and deodorising exudating eczematous reactions and wounds.

According to the medical literature it is usually used for dermatology or vascular conditions, such as:

• Weeping or blistering conditions secondary to eczema or cellulitis
• Weeping or blistering conditions secondary to leg or foot ulcers

Anecdotally, it is also sometimes used in practice for Pseudomonas infections of the skin or wounds.

Clinical guidelines

Guidelines do not offer potassium permanganate as a treatment option for weeping or blistering complications related to dermatological or vascular conditions.

For venous leg ulcers, there is generally a lack of evidence for different cleansing methods, including topical antiseptic wound cleaners, in preventing infection.

For the management of eczema, NICE CKS briefly discuss that antiseptics (including potassium permanganate) can be used to lower bacterial load in atopic eczema. They don’t provide any further advice on their place in therapy.

The National Eczema Society suggest potassium permanganate as a treatment option for varicose and pompholyx eczema.

Published studies

For the management of eczema, a recent Cochrane review (2019) was unable to provide any definitive clinical practice guidance for reducing Staphylococcus aureus, due to insufficient evidence.

Evidence is lacking on the benefits of potassium permanganate solution for weeping or blistering complications related to dermatological or vascular conditions. The limited data available in the literature may be due to potassium permanganate’s classification as a chemical rather than a medicine.

Safety concerns

Risk of death or serious harm

NHS England issued a National Patient Safety Alert on the inadvertent oral administration of potassium permanganate in April 2022. This alert highlights that serious medication errors continue to be reported via the National Reporting and Learning system (NRLS). This is despite an NHS England alert in 2014 highlighting the risk of death or serious harm from accidental ingestion of potassium permanganate preparations.

Accidental ingestion

All patients who have ingested any amount of potassium permanganate should be referred urgently to hospital. Refer to Toxbase (subscription required) for further information on toxicity, features and management of toxicity.

Adverse effects

Skin contact

Potassium permanganate can cause skin irritation, redness, pain and burns with the concentrated solution. Skin hardening and staining of skin can be experienced even with dilute solutions.

Eye contact

Inadvertent exposure of the eye to concentrated solutions can cause irritation, blurred vision, redness, staining of the conjunctiva, swelling of the eyelids and local burning.

Actions to minimise risk of harm

Complete the following actions if using potassium permanganate in your organisation:

• Review the use and consider if the benefit outweighs the risk.
• Ensure your organisation is compliant with the National Patient Safety Alert (2022): Inadvertent oral administration of potassium permanganate. Healthcare settings were required to have completed actions by 04 October 2022:
  • Assess if the use of potassium permanganate can be reduced.
  • Ensure safer prescribing and labelling.
  • Ensure safe storage.
• Refer to the 2022 guidance from the British Association of Dermatologists: Recommendations to minimise risk of harm from potassium permanganate soaks. This includes advice on:
  • Formulary management, prescribing, dispensing, labelling, storage, preparation and use, and waste.
  • Information on risk assessment if the product is to be used in a persons home. It is recommended that a
    documented record should be kept with agreed mitigating actions; the risk assessment does not need to be a formal document.
• Ensure patients and carers receive a patient information leaflet on potassium permanganate solution soaks.

Update history