If it bubbles, it’s working. We’ve all heard it. A colleague once told me that if hydrogen peroxide fizzes and changes color, it’s finding the infection. It sounds logical, it looks active, but it’s one of the most damaging myths in wound care today.
Here is the clinical reality:
🔴 The Bubbling is Chemistry, Not Diagnosis The fizz is just disproportionation. When peroxide hits tissue, it meets catalase—an enzyme found in almost all human cells and many bacteria. It’s simply breaking down into water and oxygen. It doesn’t tell you if the wound is infected; it just tells you the tissue is alive (for now).
🔴 The Bleaching Effect That white, blanched color isn’t cleaning the wound. Peroxide is a massive oxidizing agent. It’s a chemical bleach that indiscriminately attacks everything in its path.
⚠️ The Hidden Cost to DFUs: While you’re watching the bubbles, the peroxide is busy killing fibroblasts and keratinocytes—the very cells required to close the wound. In a DFU, where healing is already compromised, this cytotoxicity is a recipe for stalled wounds and increased depth.
The Bottom Line: Don’t let a science fair reaction dictate your clinical path.
Note. ”Catalases generate molecular oxygen as a byproduct of the oxidation of hydrogen peroxide in a process referred to as disproportionation”
Heck DE, Shakarjian M, Kim HD, Laskin JD, Vetrano AM. Mechanisms of oxidant generation by catalase. Ann N Y Acad Sci. 2010 Aug;1203:120-5. doi: 10.1111/j.1749-6632.2010.05603.x. PMID: 20716293; PMCID: PMC4610122.
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