The clinical and bacteriological efficacy of topical cadexomer iodine on venous leg ulcers colonised with Pseudomonas aeruginosa was evaluated in an open, uncontrolled, multicentre pilot study. Nineteen patients with venous leg ulcers (median ulcer area 15.5 cm2) were treated with cadexomer iodine paste and short-stretch bandaging for 12 weeks or until the ulcer was healed within that period. Bacteriological cultures for growth of Pseudomonas aeruginosa and ulcer area measurements were regularly performed during the study period. Seven patients were withdrawn during the study period for the following reasons: pain in the ulcer (n = 2), ulcer enlargement (n = 2), treatment of cellulitis in non-study ulcer with a systemic antibiotic that is effective against Pseudomonas aeruginosa (n = 1), increased thyroid-stimulating hormone level (n = 1) and poor compliance (n = 1). In addition, one patient was erroneously withdrawn. After one week's treatment, 11 out of 17 patients (65%) had a negative culture of Pseudomonas aeruginosa. At 12 weeks, six out of eight patients (75%) had a negative culture and complete healing was achieved in three patients (16%). The median ulcer area reduction obtained at 12 weeks was 32.9%. The results indicate that cadexomer iodine paste might be the treatment of choice for venous leg ulcers colonised with Pseudomonas aeruginosa. However, a larger controlled clinical study is needed for final evaluation.