Diabetic foot ulcer (DFU) is a severely debilitating, amputation, and even life-threatening complication of diabetes. The current DFU management approaches include providing a moist environment locally, control of infection, vascular surgery, pressure relief, and combing with reconstructive surgery. In the past 30 years, there has been no well-proven local drug available.
Fespixon cream is a newly licensed drug specifically developed to treat DFU. The cream contains 1.25% of PA-F4, Plectranthus amboinicus extract, and S1, Centella Asiatica extract. In-vitro and in-vivo studies have shown that the cream can alter the polarization of macrophages in chronic wounds by inhibiting inflammation and promoting the specific-chemokines-induced transition of the microenvironment dominated by M1-macrophages into that dominated by M2-macrophages. M2-macrophages can exert the functions of (1) promoting angiogenesis and increase blood flow by regulating VEGF; (2) releasing TGF to recruit the stem cells to the lesion for tissue regeneration and promote fibroblast proliferation; (3) synthesizing collagen via hydroxyproline and trigger extracellular matrix collagen deposition as to achieve complete healing of wounds.
Fespixon cream showed a clinically and statistically superior therapeutic efficacy in the treatment of DFUs in a randomized, multi-regional clinical trial. Fespixon cream, acting as a macrophage regulator, differences from moisture-retaining dressings can provide treatments with an active-healing ability for patients with chronic DFUs.
We herein propose a new DFU management guideline based on our development. V-vessel evaluation and management, either angioplasty or bypass surgery, should be done to solve diabetic angiopathy. I-infection control, oral or IV antibiotics, is used for DFU superimposed infection. P-pressure relief represents off-loading treatment for all diabetic patients. D-debridement should be carried out to improve the local wound environment. F-Fespixon cream topical administration can be used at home and in primary care to reduce health care burden and promote complete wound healing. The “VIPDF” also means that each diabetic foot patient should be taken care of like a VIP.

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