Hirudotherapy refers to the therapeutic use of medicinal leeches (Hirudo medicinalis) and is a practice with thousands of years of history. This method, which has proven benefits particularly in reconstructive surgery within modern medicine, continues to be a subject of research in the field of dermatology.
Historical Perspective
Leech therapy is one of the oldest medical practices in human history. It was widely used in ancient Egyptian, Greek, and Ottoman medicine. After falling out of favour in the 19th century due to excessive and unindicated use, hirudotherapy once again became the focus of medical interest in the late 20th century as its scientific foundations were clarified.
Bioactive Components of Medicinal Leeches
The therapeutic effect of hirudotherapy originates from the rich bioactive content found in leech saliva:
Hirudin: The best-known component, hirudin is a potent natural anticoagulant. It directly inhibits thrombin, preventing blood clotting. This effect plays a critical role in improving tissue perfusion.
Hyaluronidase: This enzyme, which breaks down hyaluronic acid, increases tissue permeability and facilitates the spread of other bioactive substances into tissues.
Calin: This component inhibits platelet aggregation and exerts an antithrombotic effect.
Destabilase: It has fibrinolytic activity and helps dissolve existing blood clots.
Eglins and Bdellins: These are protease inhibitors with anti-inflammatory properties. They support tissue healing by suppressing the inflammatory process.
Anaesthetic Components: Local anaesthetic substances released during leech bites ensure that the application is relatively painless.
Dermatological Application Areas
Venous Congestion and Flap Surgery
The area where hirudotherapy has the strongest clinical evidence is venous congestion management in reconstructive surgery. In cases where venous return is insufficient following flap and replantation surgery, medicinal leeches are used effectively to prevent tissue loss. This indication has also been approved by the FDA.
Varicose Veins and Chronic Venous Insufficiency
Clinical observations exist indicating that hirudotherapy provides symptomatic relief in skin changes associated with chronic venous insufficiency. Reductions in oedema, pain relief, and improvement in skin trophic changes have been reported.
Inflammatory Skin Diseases
Due to the anti-inflammatory components in leech saliva, hirudotherapy is being investigated as an adjunct treatment for eczema, psoriasis, and other inflammatory dermatoses. However, the level of evidence in this area is still limited.
Keloid and Hypertrophic Scars
Hirudotherapy has been tried with the aim of improving microcirculation in scar tissue and regulating collagen metabolism, and positive outcomes have been reported in some case series.
Application Protocol and Safety
Medicinal leech application must be performed only by trained healthcare professionals under sterile conditions. Each leech is used only once, eliminating the risk of cross-infection.
Key considerations during the application include:
- The patient's coagulation profile should be evaluated
- Caution should be exercised in patients using anticoagulants
- Signs of infection at the application site should be monitored
- The risk of Aeromonas hydrophila infection should be kept in mind and prophylactic antibiotics considered when necessary
The most commonly observed side effects include prolonged bleeding at the application site, ecchymosis, itching, and rarely secondary infection.
2026 Assessment
Hirudotherapy continues to maintain its established position in reconstructive surgery while expanding its evidence base in other areas of dermatology. Research aimed at synthetically producing the bioactive peptides in leech saliva may contribute to the development of more standardised and widely accepted treatment protocols in the future. Patients are advised to consider this treatment only in appropriate clinical settings and under specialist supervision. Please contact us for pricing and consultation.