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Antiseptics and dyes are used widely in the treatment of wounds. Early papers at the beginning of this century described their benefits to wound healing, especially to infected wounds. Only Mobacken and Zederfelt (1973) reported the contrary. They examined the formation of wound granulation in subcutaneously implanted viscose cellulose sponges after treatment with dyes. Their data indicated inhibition, but quantitative histological data were not given. The method described in this paper demonstrates the possibility of a quantitative analysis of wound healing. [ABSTRACT FROM AUTHOR]

The article presents a paper "Allergic Hypersensitivity to an Antiseptic Soap," by I.H. Blank. A new antiseptic soap contains tetramethylthiuram disulphide, which is also used in the rubber industry as an accelerator. Patch-testing 5 patients known to be allergically sensitive to thiuram sulphide compounds with the soap itself and in 8% solution provoked a vesicular reaction.

Infection is the likeliest single cause of delayed healing in healing of chronic open wounds by secondary intention. If neglected it can progress from contamination to colonization and local infection through to systemic infection, sepsis and multiple organ dysfunction syndrome, and it can be life-threatening. Infection in chronic wounds is not as easy to define as in acute wounds, and is complicated by the presence of biofilms. There is, as yet, no diagnostic for biofilm presence, but it contributes to excessive inflammation - through excessive and prolonged stimulation of nitric oxide, inflammatory cytokines and free radicals - and activation of immune complexes and complement, leading to a delay in healing. Control of biofilm is a key part of chronic wound management. Maintenance debridement and use of topical antimicrobials (antiseptics) are more effective than antibiotics, which should be reserved for treating spreading local and systemic infection. The continuing rise of antimicrobial resistance to antibiotics should lead us to reserve their use for these indications, as no new effective antibiotics are in the research pipeline. Antiseptics are effective through many mechanisms of action, unlike antibiotics, which makes the development of resistance to them unlikely. There is little evidence to support the theoretical risk that antiseptics select resistant pathogens. However, the use of antiseptic dressings for preventing and managing biofilm and infection progression needs further research involving well-designed, randomized controlled trials. [ABSTRACT FROM AUTHOR]

The time until a patient achieves a relevant improvement during the treatment of a skin disease is important for selecting a therapy, but has been largely neglected in reviews and guidelines. The aim of this systematic review was to determine the time until the onset of action ( TOA) of topical acne treatments. The primary outcome was the TOA defined as the time until a 25% reduction in the mean number of inflammatory lesions had been achieved. A systematic literature search in Medline and Embase was carried out. Clinical trials that evaluated head-to-head comparisons of treatments in patients suffering from mild-to-moderate papulopustular acne were included. Abstract and full-text screening and data extraction were done independently by two investigators. With respect to inflammatory lesions, different concentrations of benzoyl peroxide ( BPO) or adapalene did not seem to influence the TOA. BPO seemed to act more quickly than isotretinoin and tretinoin. Adapalene showed a shorter TOA than isotretinoin. Conflicting results were seen when comparing adapalene with tretinoin, with a tendency for adapalene to be faster. Clindamycin/ BPO seemed to act more quickly than adapalene. Inconsistent results were seen for the comparison of clindamycin/ BPO and BPO alone with a slight indication of a shorter TOA for clindamycin/ BPO. Adapalene/ BPO and clindamycin/ BPO showed comparable TOA. When interpreting the data, the different study designs and the limited study quality need to be taken into account. Further research is needed to identify treatments that offer an early onset of action and possibly help to optimize patients' adherence. TOA should be considered as an additional outcome in acne trials. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors). To evaluate the effectiveness of a special silk fabric (MICROAIR Derma Silk®) in the treatment of young children affected by AD with acute lesions at the time of examination. Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination. At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0·003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18·6; P = 0·001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0·112). The use of special silk clothes may be useful in the management of AD in children. [ABSTRACT FROM AUTHOR]

The effects of minoxidil in vitro were studied using fibroblasts grown from the lesional skin of patients with lichen sclerosus et atrophicus, morphoea and from the skin of normal individuals. The proliferation of all fibroblast lines over 3 days was inhibited in proportion to the concentration of minoxidil, being 20% or less of controls at 1 mM, where cell viability was only marginally reduced (84±2% vs. 88±2% (SEM) in controls). At 5 mM there was usually a net loss of cells and only 72% of those remaining were viable. In contrast, minoxidil at 0.1–1 mM stimulated the proliferation of foreskin keratinocytes by up to 1.30%. Contraction of collagen lattices containing the three types of fibroblasts was inhibited by 22–26% with 1 mM minoxidil after 5 days and by 50–94% with 5 mM. Secretion of glycosaminoglycans by normal fibroblasts showed concentration-dependent reduction, being 2.5±6% of that of untreated cultures with 1 mM minoxidil. These findings show that minoxidil has a range of inhibitory effects on both normal and abnormal skin fibroblasts in vitro, which contrast with its stimulation of skin epithelial cells, and support suggestions that it may provide a useful topical treatment for keloids and other fibroses. [ABSTRACT FROM AUTHOR]

The article focuses on a paper suggesting that acrodermatitis enteropathica successfully treated with diodoquin. Although the question whether this rare syndrome is a congenital-developmental dystrophy akin to epidermolysis bullosa, a monilia infection or some effect of intestinal infestation with lamblia, is not precisely answered by this additional success with an intestinal antiseptic containing iodine which is said not to be absorbed, it is here attractively presented with lucid argument.

The article presents an open-label study which determined the safety and efficacy of topical treatment with terbinafine in Transfersome (TDT 067) in patients with onychomycosis. The researchers assessed the subungual samples at primary endpoints and nail growth using standardized methodology. The study found that efficacy rates are low compared with oral antifungal agents due to the formulations that failed to achieve adequate concentrations of active ingredients at the site of infection.

Reports of chemical burns beneath tourniquets during orthopaedic procedures led us to explore the irritant effects produced by the skin antiseptics used during such procedures. A sphygmomanometer and tourniquet, at a pressure of 200 mmHg for 30 min, was used to create pressure and ischaemia which were then examined separately for their respective effects on irritant inflammation in normal subjects and those with atopic eczema. As no inflammation could be demonstrated with the antiseptics, we subsequently used the known irritant chemical anthralin to examine the effect of ischaemia with and without pressure. Site-related variation in anthralin-induced inflammation was observed but there was no demonstrable effect of either pressure or ischaemia on the inflammatory response. Therefore, as we are unable to show a relationship between ischaemia with or without pressure and irritant inflammation, we conclude that burns under tourniquets are likely to be idiosyncratic reactions and their further investigation requires examination of the individuals affected. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor focusing on azelaic acid in lentigo maligna.