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Garcia AD, White Chu EF. The Challenge of Chronic Wounds in Older Adults. Clin Geriatr Med 2024; 40:367-373. [PMID: 38960530 DOI: 10.1016/j.cger.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Care for the older patient living with a chronic wound comes with challenges not seen in younger patients. The aging skin, impacted by the environment and intrinsic physiologic changes, makes it susceptible to injury and poor healing. Likewise, older adults' goals with regards to wound healing may vary depending on their functional abilities and quality of life. The clinician must pay attention to these nuances and collaborate with the older patient in developing a treatment plan. Careful systematic description, documentation, and communication with the patient/caregiver aids the clinician in tracking the treatment goals and potentially reducing medical liability risk.
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Affiliation(s)
- Aimee D Garcia
- Department of Medicine, Baylor College of Medicine; Wound Clinic and Consult Service, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Elizabeth Foy White Chu
- Department of Geriatrics, Oregon Health & Science University, Portland VA Health Care System, 3710 SW, US Veterans Hospital Road, Portland, OR 97239, USA
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Shukla ST, Kaushik A, Auti SA, Kumar D, Das SK. Preclinical determination of wound-healing activity of halibut oil cream in rat model of burn wound. JOURNAL OF ASIAN NATURAL PRODUCTS RESEARCH 2024:1-20. [PMID: 38949206 DOI: 10.1080/10286020.2024.2368835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
This study investigated the effects of halibut oil cream, containing omega-3 fatty acids, vitamins A and D, and hydroxyproline, on burn wound healing in rats. Acute dermal toxicity tests confirmed its nontoxicity. Wistar rats were divided into five groups: a control, a positive control treated with silver sulfadiazine 1% (SSD), and three groups treated with 3%, 9%, and 27% halibut oil cream Formulation (HBOF). The SSD and HBOF groups showed significant healing improvements compared to the control. Histopathological analysis indicated increased collagen production in the HBOF groups, suggesting halibut oil cream's potential as a topical treatment for burn wounds.
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Affiliation(s)
- S T Shukla
- Pharmaceutical Sciences, Shri JJT University, Jhunjhunu, Rajasthan, India
| | - Anu Kaushik
- Pharmaceutical Sciences, Shri JJT University, Jhunjhunu, Rajasthan, India
| | | | - Dinesh Kumar
- Pharmaceutical Sciences, Shri JJT University, Jhunjhunu, Rajasthan, India
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3
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Stras A, Grassmann A, Van Campenhout P, Deconinck E, Vanhaecke T, Desmedt B. Analysis of preservatives and fragrances in topical medical devices: The need for more stringent regulation. Contact Dermatitis 2024; 90:594-606. [PMID: 38471795 DOI: 10.1111/cod.14533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/11/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Medical devices (MDs) have a long history of use, and come with regulatory frameworks to ensure user safety. Although topically applied MDs in the form of gels and creams might be used on damaged skin, their composition is often similar to that of cosmetic products applicable to intact skin, especially in terms of preservatives and fragrances. However, unlike cosmetics, these products are not subject to compound-specific restrictions when used in MDs. OBJECTIVE This study aimed to identify and quantify preservatives and fragrances in topically applied MDs and assess their safety towards the Cosmetic Regulation (EC) 1223/2009. METHOD Sixty-nine MDs available on the EU market were subjected to previously validated liquid chromatography tandem mass spectrometry (LC-MS/MS) and gas chromatography-mass spectrometry (GC-MS) methods to identify and quantify occurring preservatives and fragrances. RESULTS Findings revealed that 32% of the examined MDs did not provide comprehensive ingredient lists, leaving users uninformed about potential risks associated with product use. Furthermore, 30% of these MDs would not meet safety standards for cosmetic products and, most significantly, 13% of the analysed samples contained ingredients that are prohibited in leave-on cosmetics. CONCLUSION Results highlight the pressing demand for more stringent requirements regarding the labelling and composition of MDs to enhance patient safety. Improved regulation and transparency can mitigate potential risks associated with the use of topically applied MDs.
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Affiliation(s)
- Ania Stras
- Medicines and Health Products, Sciensano, Elsene, Belgium
- Department In Vitro Toxicology and Dermato-Cosmetology (IVTD), Vrije Universiteit Brussel, Jette, Belgium
| | | | | | - Eric Deconinck
- Medicines and Health Products, Sciensano, Elsene, Belgium
| | - Tamara Vanhaecke
- Department In Vitro Toxicology and Dermato-Cosmetology (IVTD), Vrije Universiteit Brussel, Jette, Belgium
| | - Bart Desmedt
- Medicines and Health Products, Sciensano, Elsene, Belgium
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Ousey K, Rippon MG, Rogers AA, Totty JP. Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review. J Wound Care 2023; 32:334-347. [PMID: 37300859 DOI: 10.12968/jowc.2023.32.6.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives. METHOD A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews. RESULTS A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage. CONCLUSION There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.
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Affiliation(s)
- Karen Ousey
- Professor Skin Integrity, Director for the Institute of Skin Integrity, and Infection Prevention, University of Huddersfield, UK
- Department of Nursing and Midwifery, Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons of Ireland, Ireland
- Chair, International Wound Infection Institute UK
- President Elect, International Skin Tear Advisory Panel, US
| | - Mark G Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Consultant, Dane River Consultancy Ltd, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | - Joshua P Totty
- NIHR Clinical Lecturer in Plastic Surgery, Hull York Medical School, UK
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Contact Dermatitis in the Inpatient Hospital Setting–an Updated Review of the Literature. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Rippon MG, Rogers AA, Ousey K, Atkin L, Williams K. The importance of periwound skin in wound healing: an overview of the evidence. J Wound Care 2022; 31:648-659. [PMID: 36001708 DOI: 10.12968/jowc.2022.31.8.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
| | | | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield.,Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Visiting Professor, RCSI, Dublin, Ireland
| | | | - Kate Williams
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Evaluation of Dermal Toxicity and Wound Healing Activity of Cnestis ferruginea Vahl ex DC. Adv Pharmacol Pharm Sci 2022; 2022:5268613. [PMID: 35656163 PMCID: PMC9152407 DOI: 10.1155/2022/5268613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 12/22/2022] Open
Abstract
Cnestisferruginea is a tropical plant, which is traditionally used in the treatment and management of various conditions including skin infections and wounds. The aim of this study was to investigate the dermal toxicity and wound healing potential of C. ferruginea. Ten millimeter full-thickness mucosal wounds were created on the dorsal midportion of the Sprague Dawley rats. Wounds were treated with 10, 5, and 2.5% w/w aqueous creams, prepared from the methanol extract of the root bark of C. ferruginea (CFM). The wound tissues were harvested on day 21 for histology studies. Compared with the untreated group, 10, 5, and 2.5% w/w CFM-treated wounds significantly reduced the wound size over the study period (
). Tissue histology revealed a healed wound with well-regenerated collagen and skin appendages with no pus cells. A skin irritation test was conducted on CFM, as well as the dermal toxicity of CFM was determined in the repeated dose and acute dermal toxicity bioassays. These tests revealed that CFM showed no toxic effect on the skin and showed that CFM was not a skin irritant. C. ferruginea exhibited wound healing activity, which gives credence to its folkloric use.
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Alavi A, Goldenberg A, Jacob S, Shelley A, Kirsner RS. Contact dermatitis: An important consideration in leg ulcers. Int J Womens Dermatol 2021; 7:298-303. [PMID: 34222587 PMCID: PMC8243149 DOI: 10.1016/j.ijwd.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
The prevalence of chronic wounds is increasing with the aging population, with 1% to 2% of the worldwide population experiencing leg ulcers and positive patch tests reported in up to 75% of this population. With the introduction of modern dressings and compression therapies, clinicians should be cognizant of the potential risk of contact dermatitis in patients with leg ulcers. Contact dermatitis (both allergic and irritant) to wound products may present as maceration, pain, and overall impaired wound healing. Herein, we review the literature on contact dermatitis to wound-care products.
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Affiliation(s)
- Afsaneh Alavi
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alina Goldenberg
- Medical Group of North County, Scripps Affiliated Medical Group, Oceanside, CA, United States
| | - Sharon Jacob
- Department of Medicine and Pediatrics (Dermatology), University of California, Riverside, CA, United States
| | - Amanda Shelley
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Robert S Kirsner
- Department of Dermatology, University of Miami, Miami, FL, United States
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Abstract
This article discusses the effects of ageing on the skin, particularly the main structural and functional changes that occur in the epidermis and dermis that make the skin more vulnerable to damage. Specific alterations that occur with ageing include slower epidermal turnover, flattening of the epidermal-dermal junction, loss of moisture and hydration as well as reduced immunity placing the skin at increased risk of damage. The discussion will also examine common periwound complications associated with ageing including; maceration, excoriation, dry skin, hyperkeratosis, callus, contact dermatitis and eczema. Strategies to manage these problems and interventions to reduce the risk of these complications include moisturising the skin to make it more resilient, debriding keratinised and callus tissue in the periwound area, appropriate choice of dressings to manage excessive exudate, careful removal of dressings as well as treating inflammatory conditions of the periwound skin.
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Affiliation(s)
- Samantha Holloway
- Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales
| | - Kirsty Mahoney
- Senior Tissue Viability Nurse and Clinical Operational programme improvement Lead, Welsh Wound Innovation Centre
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Schito AM, Piatti G, Caviglia D, Zuccari G, Alfei S. Broad-Spectrum Bactericidal Activity of a Synthetic Random Copolymer Based on 2-Methoxy-6-(4-Vinylbenzyloxy)-Benzylammonium Hydrochloride. Int J Mol Sci 2021; 22:5021. [PMID: 34065133 PMCID: PMC8125966 DOI: 10.3390/ijms22095021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022] Open
Abstract
Low-molecular-weight organic ammonium salts exert excellent antimicrobial effects by interacting lethally with bacterial membranes. Unfortunately, short-term functionality and high toxicity limit their clinical application. On the contrary, the equivalent macromolecular ammonium salts, derived from the polymerization of monomeric ammonium salts, have demonstrated improved antibacterial potency, a lower tendency to develop resistance, higher stability, long-term activity, and reduced toxicity. A water-soluble non-quaternary copolymeric ammonium salt (P7) was herein synthetized by copolymerizing 2-methoxy-6-(4-vinylbenzyloxy)-benzylammonium hydrochloride monomer with N, N-di-methyl-acrylamide. The antibacterial activity of P7 was assessed against several multidrug-resistant (MDR) clinical isolates of both Gram-positive and Gram-negative species. Except for colistin-resistant Pseudomonas aeruginosa, most isolates were susceptible to P7, also including some Gram-negative bacteria with a modified charge in the external membrane. P7 showed remarkable antibacterial activity against isolates of Enterococcus, Staphylococcus, Acinetobacter, and Pseudomonas, and on different strains of Escherichia coli and Stenotrophomonas maltophylia, regardless of their antibiotic resistance. The lowest minimal inhibitory concentrations (MICs) observed were 0.6-1.2 µM and the minimal bactericidal concentrations (MBC) were frequently overlapping with the MICs. In 24-h time-kill and turbidimetric studies, P7 displayed a rapid non-lytic bactericidal activity. P7 could therefore represent a novel and potent tool capable of counteracting infections sustained by several bacteria that are resistant to the presently available antibiotics.
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Affiliation(s)
- Anna Maria Schito
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, I-16132 Genova, Italy; (A.M.S.); (G.P.); (D.C.)
| | - Gabriela Piatti
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, I-16132 Genova, Italy; (A.M.S.); (G.P.); (D.C.)
| | - Debora Caviglia
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, I-16132 Genova, Italy; (A.M.S.); (G.P.); (D.C.)
| | - Guendalina Zuccari
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy;
| | - Silvana Alfei
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy;
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Torfs E, Brackman G. A perspective on the safety of parabens as preservatives in wound care products. Int Wound J 2020; 18:221-232. [PMID: 33236854 PMCID: PMC8243994 DOI: 10.1111/iwj.13521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 01/19/2023] Open
Abstract
Antimicrobial and/or preservative ingredients incorporated in wound care products are subjected to certain safety restrictions. However, several of those agents, and paraben preservatives in particular, have been criticised. Conflicting reports on the potential of parabens to induce allergic contact dermatitis, and their assumed oestrogen‐like activity, raised public health concerns about their overall safety. Here, we seek to provide a balanced perspective on the most significant purported adverse health effects, and thereby allay the many misconceptions regarding the safety of parabens. Extensive and long‐term monitoring of paraben allergy frequencies illustrate that allergic reactions are quite uncommon, especially when compared with other antimicrobial and preservative agents. The estrogenic potential of parabens was illustrated to be far less potent than that of natural oestrogen receptor ligands, and the etiological significance of their presence in human tissue has not been established. The general consensus based on investigations by both the scientific community and regulatory agencies indicates that, with current safety regulations regarding their use in place, this effective and well‐documented group of preservatives should not warrant drastic measures to replace them. As such, despite the ongoing concern, it is indicated that, when used at typical concentrations, parabens are unlikely to affect human health.
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Affiliation(s)
- Eveline Torfs
- Research and Development department, Flen Health NV, Kontich, Belgium
| | - Gilles Brackman
- Research and Development department, Flen Health NV, Kontich, Belgium
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Brandenburg MM, Rocha FG, Pawloski PL, Soley BDS, Rockenbach A, Scharf DR, Heiden G, Ascari J, Cabrini DA, Otuki MF. Baccharis dracunculifolia (Asteraceae) essential oil displays anti-inflammatory activity in models of skin inflammation. JOURNAL OF ETHNOPHARMACOLOGY 2020; 259:112840. [PMID: 32268204 DOI: 10.1016/j.jep.2020.112840] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Baccharis dracunculifolia (Asteraceae) is a commonly used plant in traditional medicine known as "alecrim-do-campo". Popularly it has been used as an immunostimulant, antibiotic, anti-inflammatory among other applications. So far, only a few studies have investigated the B. dracunculifolia anti-inflammatory effect and none has investigated the effectiveness of essential oil on skin diseases. AIM OF THE STUDY The study aimed at evaluating the topical anti-inflammatory activity of B. dracunculifolia essential oil (BdEO) in mice models of acute and chronic skin inflammation. MATERIALS AND METHODS BdEO was obtained from leaves and it was analyzed with Gas Chromatograph. Topical anti-inflammatory activity of BdEO (0.1, 0.3 and 1.0 mg/ear) was evaluated in Arachidonic Acid or TPA-induced acute and chronic skin inflammation in mice. Parameters such edema, cell migration and keratinocytes proliferation were evaluated. In addition, safety and a possible mechanism of action for BdEO essential oil were also investigated. RESULTS Our results indicate that mainly terpenoids compounds compose BdEO. In addition, topical treatment with BdEO inhibited inflammatory parameters in both acute and chronic models of skin inflammation. This protective effect was associated with reduced edema formation, smaller cellular influx into the inflamed tissue and reduction of keratinocytes hyperproliferation. Although BdEO appears to exert its anti-inflammatory effect through a corticosteroid pathway, no local or systemic side effects were observed. CONCLUSION Taken together, the present results showed that the essential oil obtained by hydrodistillation from B. dracunculifolia leaf samples exhibit remarkable topical anti-inflammatory properties. Therefore, our study demonstrated evidence for BdEO topical anti-inflammatory efficacy and safety, suggesting that it could be considered for developing of a new phytotherapeutic formulation as treatment for skin diseases.
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Affiliation(s)
| | | | | | - Bruna da Silva Soley
- Department of Pharmacology, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Andressa Rockenbach
- Phytochemistry Laboratory, Universidade Tecnológica Federal do Paraná, Santa Helena, PR, Brazil.
| | - Dilamara Riva Scharf
- Chromatography Laboratory, Universidade Regional de Blumenau, Blumenau, SC, Brazil.
| | - Gustavo Heiden
- Embrapa Clima Temperado, Rodovia BR 392, km 78. Pelotas, RS, Brazil.
| | - Jociani Ascari
- Phytochemistry Laboratory, Universidade Tecnológica Federal do Paraná, Santa Helena, PR, Brazil.
| | | | - Michel Fleith Otuki
- Department of Pharmacology, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Mwiiri FK, Brandner JM, Daniels R. Electrospun Bioactive Wound Dressing Containing Colloidal Dispersions of Birch Bark Dry Extract. Pharmaceutics 2020; 12:pharmaceutics12080770. [PMID: 32823875 PMCID: PMC7463733 DOI: 10.3390/pharmaceutics12080770] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/02/2022] Open
Abstract
Novel birch bark dry extract (TE)-loaded polyvinyl alcohol (PVA) fiber mats intended for wound therapy were developed through an electrospinning process. Colloidal dispersions containing TE as the active substance were prepared by the high-pressure homogenization (HPH) technique using hydrogenated phospholipids as stabilizer. Subsequently, the colloidal dispersions were blended with aqueous PVA solutions in the ratio of 60:40 (wt.%) and electrospun to form the nanofiber mats. Fiber morphology examined using scanning electron microscopy (SEM) indicated that fibers were uniform and achieved diameters in the size range of 300–1586 nm. Confocal Raman spectral imaging gave good evidence that triterpenes were encapsulated within the electrospun mats. In vitro drug release and ex vivo permeation studies indicated that the electrospun nanofibers showed a sustained release of betulin, the main component of birch bark dry extract, making the examined dressings highly applicable for several wound care applications. Ex vivo wound healing studies proved that electrospun fiber mats containing TE accelerated wound healing significantly more than TE oleogel, which was comparable to an authorized product that consists of TE and sunflower oil and has proved to enhance wound healing. Therefore, our results conclude that the developed TE-PVA-based dressings show promising potential for wound therapy, an area where effective remedy is needed.
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Affiliation(s)
- Francis Kamau Mwiiri
- Department of Pharmaceutical Technology, Eberhard Karls University, Auf der Morgenstelle 8, 72076 Tuebingen, Germany;
| | - Johanna M. Brandner
- Department of Dermatology and Venerology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Rolf Daniels
- Department of Pharmaceutical Technology, Eberhard Karls University, Auf der Morgenstelle 8, 72076 Tuebingen, Germany;
- Correspondence: ; Tel.: +49-7071-297-2462; Fax: +49-7071-295-531
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Abstract
BACKGROUND Dermatologists routinely perform office-based surgical procedures that result in cutaneous wounds. Wound care instructions are an important resource for postoperative patients. As there is no consensus on the ideal wound care regimen after dermatologic procedures, recommendations may vary. OBJECTIVE To evaluate the current recommendations for wound care following dermatologic procedures. METHODS The authors conducted a cross-sectional assessment of dermatology wound care handouts available online. The handouts were evaluated based on predefined parameters: topical agent recommendations for wound healing, caution against topical antibiotic use, and discussion of scarring, infection, bleeding, analgesia, and lifestyle considerations. RESULTS A total of 169 handouts were evaluated. The majority (84%) recommended the application of petrolatum-based products, specifically Vaseline (75%) and Aquaphor (43%). Nearly half (43%) recommended the use of topical antibiotics, whereas 24% advised patients to avoid antibiotic ointments. Handouts variably addressed scarring (36%), infection (72%), bleeding (69%), pain (66%), and lifestyle modifications (64%). CONCLUSION The instructions provided in dermatology patient handouts are highly variable, with various topical agents being recommended for wound healing. Topical antibiotics are not indicated for prophylaxis in clean dermatologic procedures but are still widely used. Greater efforts should be made to ensure that patients receive consistent and evidence-based wound care guidance.
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Abstract
BACKGROUND Both surgical personnel and patients undergoing procedures are exposed regularly to different antiseptic chemicals in various forms. Little is known about the ingredients in these antiseptics and the risk these products may provoke allergic contact dermatitis. OBJECTIVE The aim of the study was to identify and characterize common allergens in surgical scrubs and patient surgical cleansers that health care workers and surgical patients may encounter in the perioperative period. METHODS DailyMed website was searched using numerous terms for surgical disinfectants. Products used for health care worker handwashing/scrubbing or patient surgical cleansing/disinfecting were included. Each product's ingredients were recorded; those found on the 2017 American Contact Dermatitis Society (ACDS) Core Allergen Series were noted from each product. CONCLUSIONS A total of 1940 products were identified, of which 267 were included in the analysis. A total of 66.3% contained iodine, 25.8% contained chlorhexidine digluconate, and 2.6% contained chloroxylenol. Within the group analyzed, 1586 ingredients were identified. Of these, 241 were ACDS Core Series allergens. Most products contained a single ACDS allergen. There were significant differences in allergens based on product type and active ingredient, with iodine-containing products having the fewest number of allergens. The most common ACDS allergens found were cocamide diethanolamide (22.5%), fragrance (21.7%), lanolin (19.5%), propylene glycol (6.7%), alkyl glucosides (6.0%), and sorbic acid derivatives (5.6%).
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Affiliation(s)
- Jamie P Schlarbaum
- From the Park Nicollet Contact Dermatitis Clinic
- University of Minnesota Medical School
| | - Sara A Hylwa
- From the Park Nicollet Contact Dermatitis Clinic
- Department of Dermatology, University of Minnesota, Minneapolis
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Abstract
OBJECTIVE To determine the frequency of self-reported hand dermatitis and the factors influencing its prevalence among nursing students. METHODS Researchers collected demographic data and used a self-assessment form to identify dermatologic symptoms. The questionnaires were distributed to the students and collected again after the students completed the forms. RESULTS Hand dermatitis was present in 20.9% of nursing students. The most common symptoms were irritation/pruritus, redness/cracking, flaking/rash, swelling, and vesicles in hands. The grade of the student, the presence of allergy complaints, and medication used to treat dermatitis were statistically significantly associated with dermatitis prevalence. The use of gloves and cleansing agents used in handwashing were factors linked to hand dermatitis. CONCLUSIONS Hand dermatitis increases in parallel with the increase of clinical practice hours among nursing students. Familial and environmental factors also increase the risk of hand dermatitis.
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Fumarola S, Allaway R, Callaghan R, Collier M, Downie F, Geraghty J, Kiernan S, Spratt F, Bianchi J, Bethell E, Downe A, Griffin J, Hughes M, King B, LeBlanc K, Savine L, Stubbs N, Voegeli D. Overlooked and underestimated: medical adhesive-related skin injuries. J Wound Care 2020; 29:S1-S24. [DOI: 10.12968/jowc.2020.29.sup3c.s1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sian Fumarola
- Senior Clinical Nurse Specialist, Tissue Viability and Continence, University Hospitals of North Midlands NHS Trust, UK
| | - Rachel Allaway
- Tissue Viability Clinical Nurse Specialist, Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Rosie Callaghan
- Tissue Viability Lead, Worcestershire Health and Care NHS Trust, UK
| | - Mark Collier
- Nurse Consultant and Associate Lecturer, Tissue Viability, UK
| | - Fiona Downie
- Formerly Nurse Consultant, Tissue Viability, Royal Papworth Hospital NHS Foundation Trust, UK
| | - Jemell Geraghty
- Nurse Consultant, Tissue Viability, Camden Health Improvement Practice; Clinical Nurse Specialist, HCA Healthcare (Princess Grace); Visiting Clinical Teacher King's College Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, UK
| | - Sarah Kiernan
- Consultant Nurse, Tissue Viability, Forest Primary Care Centre, London, UK
| | - Fran Spratt
- Lead Nurse Tissue Viability, University Hospital Southampton NHS Foundation Trust, UK
| | - Janice Bianchi
- Independent Tissue Viability Nurse; Dermatology Educator and Honorary Lecturer, Glasgow University, UK
| | - Elaine Bethell
- Lead Nurse, Tissue Viability, Royal Orthopaedic Hospital, Birmingham, UK
| | - Annette Downe
- Epidermolysis Bullosa Clinical Nurse Specialist, St Thomas' Hospital, London, UK
| | - Jackie Griffin
- Tissue Viability Clinical Nurse Specialist, NHS Wales, UK
| | - Maria Hughes
- Independent Tissue Viability Consultant and Queens Nurse, UK
| | - Brenda King
- Nurse Consultant, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Kimberly LeBlanc
- Chair, Wound Ostomy Continence Institute and Association of Nurses Specialized in Wound Ostomy Continence, Canada
| | - Louise Savine
- Tissue Viability Lead Nurse, Imperial College Healthcare NHS Trust, London, UK
| | - Nikki Stubbs
- Clinical Project Lead for Integrated Wound Clinics, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Voegeli
- Visiting Professor, Faculty of Health and Wellbeing, University of Winchester
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Jockenhöfer F, Zaremba A, Wehrmann C, Benson S, Ständer S, Dissemond J. Pruritus in patients with chronic leg ulcers: A frequent and often neglected problem. Int Wound J 2019; 16:1464-1470. [DOI: 10.1111/iwj.13215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Finja Jockenhöfer
- Department of Dermatology, Venereology and AllergologyUniversity Hospital of Essen Germany
| | - Anne Zaremba
- Department of Dermatology, Venereology and AllergologyUniversity Hospital of Essen Germany
| | - Caren Wehrmann
- Department of Dermatology and VenereologyVivantes Hospital Neukölln Berlin Germany
| | - Sven Benson
- Institute for Medical Psychology and Behavioural ImmunobiologyUniversity Hospital of Essen Germany
| | - Sonja Ständer
- Competence Centre of chronic pruritus (CCP), Department of DermatologyUniversity Hospital of Münster Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and AllergologyUniversity Hospital of Essen Germany
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Allergic Contact Dermatitis to a Self-adherent Bandage Wrap in a Formaldehyde-allergic Patient. Dermatitis 2019; 30:169-170. [DOI: 10.1097/der.0000000000000448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mauro M, Fortina AB, Corradin T, Marino A, Bovenzi M, Filon FL. Sensitization to, and allergic contact dermatitis caused by, colophonium in north-eastern Italy in 1996 to 2016 with a focus on occupational exposures. Contact Dermatitis 2018; 79:303-309. [PMID: 30182476 DOI: 10.1111/cod.13089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colophonium is a natural substance derived from Pineaceae trees. It is used in a wide range of consumer and occupational products because of its tackiness, and is a known sensitizer. OBJECTIVES To analyse the temporal trend of contact allergy to colophonium in north-eastern Italy, and to evaluate the associations with occupations in our geographical area. METHODOLOGY From 1996 to 2016, 27 381 patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were documented by use of a standardized questionnaire in 6 departments of dermatology or occupational medicine. RESULTS The overall prevalence of colophonium sensitization was 1.67%; the prevalence was significantly higher in women (1.75%) than in men (1.49%). No significant differences among departments were observed. We found significant associations between colophonium sensitization and being a student (odds ratio [OR] 4.64; 95% confidence interval [CI]: 1.04-20.6), being a farmer or fishermen (OR 3.63; 95%CI: 1.21-10.84), being a housekeeper (OR 2.02; 95%CI: 1.08-3.77), and being retired (OR 2.06; 95%CI: 1.08-3.92). CONCLUSION Our study showed that contact allergy to colophonium is still relevant in north-eastern Italy. The frequency of sensitization has dropped significantly over a period of 10 years, but students and farmers/fishermen still have sensitization prevalences above 3.5%. Our results are in line with European data.
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Affiliation(s)
- Marcella Mauro
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Anna Belloni Fortina
- Padua Hospital Internal Medicine Department - DIMED, Paediatric Dermatology Unit, University of Padua, Padova, Italy
| | - Teresa Corradin
- Pordenone Hospital - Internal and Specialistic Department, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Alessandro Marino
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Massimo Bovenzi
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Francesca Larese Filon
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
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21
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Lei Y, Zhou S, Dong C, Zhang A, Lin Y. PDMS tri-block copolymers bearing quaternary ammonium salts for epidermal antimicrobial agents: Synthesis, surface adsorption and non-skin-penetration. REACT FUNCT POLYM 2018. [DOI: 10.1016/j.reactfunctpolym.2018.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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22
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Lam PL, Lee KKH, Wong RSM, Cheng GYM, Bian ZX, Chui CH, Gambari R. Recent advances on topical antimicrobials for skin and soft tissue infections and their safety concerns. Crit Rev Microbiol 2018; 44:40-78. [PMID: 28423970 DOI: 10.1080/1040841x.2017.1313811] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Antimicrobial resistance of disease-related microorganisms is considered a worldwide prevalent and serious issue which increases the failure of treatment outcomes and leads to high mortality. Considering that the increased resistance to systemic antimicrobial therapy often needs of the use of more toxic agents, topical antimicrobial therapy emerges as an attractive route for the treatment of infectious diseases. The topical antimicrobial therapy is based on the absorption of high drug doses in a readily accessible skin surface, resulting in a reduction of microbial proliferation at infected skin sites. Topical antimicrobials retain the following features: (a) they are able to escape the enzymatic degradation and rapid clearance in the gastrointestinal tract or the first-pass metabolism during oral administration; (b) alleviate the physical discomfort related to intravenous injection; (c) reduce possible adverse effects and drug interactions of systemic administrations; (d) increase patient compliance and convenience; and (e) reduce the treatment costs. Novel antimicrobials for topical application have been widely exploited to control the emergence of drug-resistant microorganisms. This review provides a description of antimicrobial resistance, common microorganisms causing skin and soft tissue infections, topical delivery route of antimicrobials, safety concerns of topical antimicrobials, recent advances, challenges and future prospective in topical antimicrobial development.
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Affiliation(s)
- P L Lam
- a Department of Applied Biology and Chemical Technology, State Key Laboratory of Chirosciences , The Hong Kong Polytechnic University , Hong Kong , P.R. China
| | - K K H Lee
- b Department of Medicine and Therapeutics, School of Biomedical Sciences, MOE Key Laboratory for Regenerative Medicine , The Chinese University of Hong Kong , Hong Kong , P.R. China
| | - R S M Wong
- b Department of Medicine and Therapeutics, School of Biomedical Sciences, MOE Key Laboratory for Regenerative Medicine , The Chinese University of Hong Kong , Hong Kong , P.R. China
| | - G Y M Cheng
- c Faculty of Health Sciences , University of Macau , Macau , P.R. China
| | - Z X Bian
- d Clinical Division, School of Chinese Medicine , Hong Kong Baptist University , Hong Kong , P.R. China
| | - C H Chui
- a Department of Applied Biology and Chemical Technology, State Key Laboratory of Chirosciences , The Hong Kong Polytechnic University , Hong Kong , P.R. China
- d Clinical Division, School of Chinese Medicine , Hong Kong Baptist University , Hong Kong , P.R. China
| | - R Gambari
- e Department of Life Sciences and Biotechnology, Centre of Biotechnology , University of Ferrara , Ferrara , Italy
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