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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]

Lipid-dependent Malassezia species, Candida spp. and Rhodotorula mucilaginosa have been associated with bovine parasitic otitis. This paper evaluated the susceptibility of 63 yeast isolates from cattle with otitis to a povidone iodine aqueous solution (1% and 0.5% v/v) and to an alcohol-ether solution (1:1 v/v). The effectiveness of these antiseptics was assessed using the European suspension test. Products achieving equal to or greater than 5-log reduction in numbers of the challenge organism after 5 min contact are considered to have as acceptable microbicidal effect (ME). The two antiseptic solutions achieved ME greater than 5, when tested at 1 and 5 min contact time, against the majority of yeast strains. The exceptions were alcohol and ether solution against two Candida tropicalis strains. Urea broth macrodilution method was used to determine the minimum inhibitory concentration (MIC), defined as the lowest concentration that resulted in a visually negative urease test or, in the case of Candida spp., turbidity inhibition when compared with that produced by the growth control. Analysis of the results for all 63 isolates showed Malassezia sympodialis and Rhodotorula mucilaginosa to be more susceptible to povidone iodine and Malassezia furfur strains to be less susceptible. Malassezia sympodialis was significantly more susceptible to alcohol-ether solution than other species. This study showed the in vitro efficacy of alcohol-ether solution and povidone iodine and proposes the need for clinical evaluation of the topical treatment and control of bovine otitis with these antiseptics and their effects on the ear microbiota and the ear canal. [ABSTRACT FROM AUTHOR]

Summary Background This paper is one of a series of eight systematic reviews that aim to identify effective interventions for chronic wounds. Here, antimicrobial agents are evaluated. Methods Electronic databases and other relevant sources were accessed to identify published and unpublished material. Studies were eligible for inclusion if they used concurrent controls, recruited participants with chronic wounds, evaluated an intervention designed to prevent or treat chronic wounds, and incorporated an objective assessment of wound healing. All included studies were assessed against a comprehensive checklist for methodological quality. A narrative overview was conducted. Results Thirty trials were included, 25 of randomized design. Small sample size and other methodological problems meant that findings were often difficult to interpret. Results do not support the routine use of systemic antibiotics for leg ulcers or diabetic foot ulcers without acute infection, but they may be useful as an adjunct to surgery for pilonidal sinuses. Several topical preparations may be helpful, including dimethyl sulphoxide, silver sulphadiazine, benzoyl peroxide, oxyquinoline and gentamicin. Conclusion Most of this research requires replication in larger, well designed studies to establish both clinical and cost effectiveness. [ABSTRACT FROM AUTHOR]

By introducing compulsory antiseptic measures in 1881, the Austrian Empire became a trendsetter in European midwifery legislation. Starting with the focus on puerperal infection in the 1870s, this article investigates the process from the first proposal of antiseptic regimes within a clinical setting to the dissemination of antiseptic knowledge among the midwifery profession. Competition between the leading medical men throughout the Austrian territories played a major role and influenced the way in which antiseptic measures were propagated. The article identifies the antiseptic collectives active at the leading universities of Prague and Vienna. As practical instruction during midwifery education was not regarded as sufficient, the late 1870s and 1880s saw the emergence of several instruction textbooks. Changing birth attendance routines and the innovative materials that entered midwifery practice are explored and discussed, based on these manuals, alongside evidence of midwives' reactions as published in the Austrian Midwifery Newspaper. [ABSTRACT FROM AUTHOR]

Background: Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship.Objective: This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines.Methods: Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively.Results: Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options.Conclusions: Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations.Systematic Review Registration: PROSPERO CRD42018117770. [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.

Background Surgical-site infections ( SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. Methods The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Results Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio ( RR) 0·61, 95 per cent c.i. 0·42 to 0·87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic ( RR 3·94, 0·46 to 34·00; very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics ( RR 0·49, 0·30 to 0·80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents ( RR 0·97, 0·52 to 1·82; very low-quality evidence). Conclusion Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to evaluate the efficacy of polyhexanide (Prontodermw®) in eliminating MRSA carriage. Methods In a 1900 bed teaching hospital, MRSA-colonized patients were randomized into a double-blind, placebo-controlled superiority trial between January 2011 and July 2014. Patients were treated with either polyhexanide or placebo applied to the anterior nares (thrice daily) and skin (once daily) for 10 days. The primary outcome was MRSA decolonization at day 28 (D28) after the end of treatment assessed by ITT responder and PP analyses (microbiological follow-up ±7 days and topical treatment ≥5 days). Secondary outcomes included safety, emergence of resistance and MRSA genotype changes. Registered trial number ISRCTN02288276. Results Of 2590 patients screened, 146 (polyhexanide group, 71; placebo group, 75) were included. ITT analysis showed that 24/71 (33.8%) patients in the polyhexanide group versus 22/75 (29.3%) in the placebo group were MRSA-free at D28 (risk difference, 4.5%; 95% CI, -10.6% to 19.5%; P?=?0.56). PP analysis confirmed the results with 19/53 (35.8%) decolonized polyhexanide-treated patients versus 17/56 (30.4%) in the placebo arm (risk difference, 5.5%; 95% CI, -12.2% to 23%; P?=?0.54). Nine serious adverse events occurred in the polyhexanide group versus 12 in the placebo group; none was attributable to study medication. Emergence of polyhexanide resistance or cross-resistance between polyhexanide and chlorhexidine was not observed. No case of exogenous recolonization by a genotypically different MRSA strain was documented. Conclusions This study suggests that under real-life conditions, a single polyhexanide decolonization course is not effective in eradicating MRSA carriage. [ABSTRACT FROM AUTHOR]

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]

Objectives: The antimicrobial efficacy of an iodine-impregnated incise drape against MRSA was evaluated in a skin model. The permeation of iodine from this drape into the skin was also assessed. Methods: The antimicrobial efficacy was evaluated in ex vivo studies following application of the surgical incise drape for various times on the surface of donor skin, which was inoculated with either 1×103 or 1×106 cfu MRSA/cm2 skin and mounted on Franz diffusion cells. In some experiments the MRSA-inoculated skin was pre-incubated for 18 h at room temperature prior to applying the drape. Permeation of iodine into the skin using this model was also determined following application of the incise drape for 6 h. Results: The iodine-impregnated drape demonstrated antimicrobial activity compared with the non-use of drape. This reached significancewhen a high inoculum of MRSA was applied with no pre-incubation period and when a low inoculum of MRSA was applied with a pre-incubation period (P=0.002 and P=0.014, respectively). Furthermore, in experiments wherein a high inoculumof MRSA was applied with no pre-incubation period, the iodine-impregnated drape demonstrated superior antimicrobial activity compared with the use of a non-antimicrobial drape (P<0.001). MIC and MBC values of iodine were attained to 1500 μm below the skin surface. Conclusions: The iodine-impregnated surgical incise drape had detectable antimicrobial activity. Furthermore, iodine penetrated into the deeper layers of the skin. This property should suppressmicrobial regrowth at and around a surgical incision site, making its use preferable to the use of a standard drape or non-use of a drape. [ABSTRACT FROM AUTHOR]

Background. Healthcare workers may come into contact with fomites that contain infectious hepatitis C virus (HCV) during preparation of plasma or following placement or removal of venous lines. Similarly, injection drugs users may come into contact with fomites. Hypothesizing that prolonged viability of HCV in fomites may contribute significantly to incidence, we determined the longevity of virus infectivity and the effectiveness of antiseptics.Methods. We determined the volume of drops misplaced during transfer of serum or plasma. Aliquots equivalent to the maximum drop volume of plasma spiked with the 2a HCV reporter virus were loaded into 24-well plates. Plates were stored uncovered at 3 temperatures: 4°C, 22°C, and 37°C for up to 6 weeks before viral infectivity was determined in a microculture assay.Results. The mean volume of an accidental drop was 29 µL (min–max of 20–33 µL). At storage temperatures 4°C and 22°C, we recovered viable HCV from the low-titer spots for up to 6 weeks of storage. The rank order of HCV virucidal activity of commonly used antiseptics was bleach (1:10) > cavicide (1:10) > ethanol (70%).Conclusions. The hypothesis of potential transmission from fomites was supported by the experimental results. The anti-HCV activity of commercial antiseptics varied. [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]

Objectives The activity of oxidants, such as halogens and active halogen compounds, decreases generally in the presence of proteinaceous material. A quantification of consumption effects was performed to judge the suitability of different representatives as antiseptics and their compatibility with pharmaceutical additives. Methods An iodometric approach served to assess the temporal loss of oxidation capacity in the presence of peptone and fetal calf serum (FCS). The tested agents comprised active halogen compounds, well-known and in particular novel chloramine-based agents indicated for the topical treatment of infections. Key findings The decrease in oxidation capacity was higher in the presence of FCS than of peptone and correlated with the reactivity of the oxidants in both cases. The highest consumption rates were for active bromine compounds followed by hypochlorous acid and heterocyclic chlorimides, such as dichloro-isocyanuric acid, while N-chlorotaurine and related amine-based analogues were least consumed. The pH dependence was only remarkable for chloramine T. Conclusions The observed consumption effects are the result of the differing oxidizing (chlorinating) potencies. Since consumption and irritation are founded on the very same reactions, representatives with low reactivity ( N-chloro amino acids) are regarded as more tolerable and retain more oxidative capacity, which provides a more sustained antimicrobial activity. [ABSTRACT FROM AUTHOR]

Aims: A new assay, much more rapid and efficient than the existing standardized tests, is introduced for the evaluation of bactericidal activity of chemical disinfectants and antiseptics under simulated practical conditions of use. Methods and Results: The bactericidal activity of biocides was quantified using a novel semi-automated assay based on the European Norm (EN) standard suspension tests but determining bacterial cell viability by intracellular adenosine tri-phosphate (ATP) content quantification instead of traditional culture-based microbiological techniques. The new test was validated by comparison to the standard suspension tests EN 1276 and EN 13727. During the validation, the linearity of the ATP detection system, limit of detection, specificity, sensitivity, relative accuracy and precision (repeatability and reproducibility) were determined. Conclusions: The validation study showed that the new assay evaluates the activity of biocides as well as the EN standard suspension tests, but it allows a large number of test conditions to be efficiently analysed. Significance and Impact of the Study: The new test can therefore be applied to accurately establish the lowest active concentration (MBCs) of disinfectants or antiseptics under simulated practical conditions of use and to compare the susceptibility of a large number of strains and conditions via inactivation curves. This is not possible in any reasonably practicable way with the EN standards considering the time and cost required for each determination. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

The article presents a meta-analysis of 24 case studies conducted in several countries from 1974 to 2007, which demonstrates the effectiveness of intraoperative povidone-iodine (PVI) antiseptic application in preventing surgical-site infection (SSI). Out of the 24 randomized controlled trials included in the analysis, in which a group of 2,465 surgical patients who were given PVI lavage was compared to a control group of 2,539 patients who received saline lavage, overall SSI rates were 13.4% in the control group and 8% in the PVI group.

Various agents have been applied topically to treat infected wounds for millennia, but their proper role remains unclear. Topical therapy affords many potential advantages but also has disadvantages. Opinions differ on which clinical signs define wound infection and on whether quantitative microbiological studies are useful. Clinically infected wounds usually require systemic antibiotic therapy, whereas clinically uninfected wounds that are healing as expected do not require antimicrobials. There is controversy over how to treat poorly healing wounds with "secondary" signs suggesting infection; these may benefit from topical antimicrobial agents. Some evidence supports using topical agents for malodorous or burn wounds. Metaanalyses and systematic reviews suggest there are few proven indications for topical antimicrobials. Use of a newer, relatively nontoxic antiseptic (eg, cadexomer iodine or silver dressings) is preferable to use of topical antibiotics, especially agents that are available for systemic use. We provide clinically relevant information on currently available topical antimicrobial agents. [ABSTRACT FROM AUTHOR]

Aims: To identify the phenolic compounds in the leaves of Sphagnum papillosum and examine their antibacterial activity at pH appropriate for the undissociated forms. Methods and Results: Bacterial counts of overnight cultures showed that whilst growth of Staphylococcus aureus 50084 was impaired in the presence of milled leaves, the phenol-free fraction of holocellulose of S. papillosum had no bacteriostatic effect. Liquid chromatography–mass spectrometry analysis of an acetone–methanol extract of the leaves detected eight phenolic compounds. Antibacterial activity of the four dominating phenols specific to Sphagnum leaves, when assessed in vitro as minimal inhibitory concentrations (MICs), were generally >2·5 mg ml−1. MIC values of the Sphagnum-specific compound ‘sphagnum acid’ [ p-hydroxy-β-(carboxymethyl)-cinnamic acid] were >5 mg ml−1. No synergistic or antagonistic effects of the four dominating phenols were detected in plate assays. Conclusions: Sphagnum-derived phenolics exhibit antibacterial activity in vitro only at concentrations far in excess of those found in the leaves. Significance and Impact of the Study: We have both identified the phenolic compounds in S. papillosum and assessed their antibacterial activity. Our data indicate that phenolic compounds in isolation are not potent antibacterial agents and we question their potency against food-borne pathogens. [ABSTRACT FROM AUTHOR]

Trust is not automatically granted to providers of professional services. The doctors of Georgian England were, by later standards, deficient in medical knowhow, particularly before the mid-nineteenth-century scientific understanding of antiseptics, and much satirised. Nonetheless, the emergence of a coherent medical profession indicates that the picture was far more intricate and positive than the satirists implied. Patients sought care as well as cure; and medical practitioners had no problems in finding custom. This essay reassesses the apothecaries' role in the slow transition whereby reputable practitioners differentiated themselves from 'quacks'. The change was propelled by three linked processes: firstly, the intersection of expanding medical supply with insistent consumer demand, noting that demand plays a key role alongside supply; secondly, the intersection of local power-broking within Britain's growing towns with an ethos of community service, whereby apothecaries joined the ranks of 'civic worthies' and trusted care-givers; and, lastly, the intersection of shared medical knowledge among practitioners at all levels with the creation of a distinctive professional identity. As public trust grew, so Parliament was emboldened in 1815 to license the Apothecaries Society as the regulatory body for the medical rank-and-file, so launching the distinctive Anglo-American system of arm's-length state regulation. [ABSTRACT FROM AUTHOR]

Background: Preoperative bathing with an antiseptic solution is widely used to prevent surgical site infection, but trial results are conflicting. Methods: Trials were identified by searches of Medline, Embase and the Cochrane controlled trials register. Studies were eligible if they compared an antiseptic solution used in preoperative bathing with a non-antiseptic washing agent or with no bathing and if they reported data on surgical site infection. Results: Six trials with a total of 10 007 patients were included; all of them used 4 per cent chlorhexidine gluconate. Three trials with 7691 patients compared chlorhexidine with placebo. Bathing with chlorhexidine did not reduce surgical site infection rate; the relative risk (RR) was 0·91. Including only trials of high quality, the RR was 0·95. Three trials with 1443 patients compared bar soap with chlorhexidine; no differences in the surgical site infection rates were detected, and the RR was 1·02. Two trials of 1092 patients compared bathing with chlorhexidine with no washing. The surgical site wound infection rate in the two groups was similar, and the RR was 0·70. Conclusions: The evidence does not support preoperative bathing with chlorhexidine as a means of reducing surgical site wound infection. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: Akacid plus® is a new member of the polymeric guanidine family of disinfectants. It was especially developed to enhance the antimicrobial activity of this class with significantly less toxicity. The in vitro activity of Akacid plus® compared with chlorhexidine digluconate and mupirocin was tested against a total of 369 recent clinical isolates.Methods: The organisms tested by CLSI reference methods included the following: Staphylococcus aureus (98), Staphylococcus epidermidis (9), Bacillus spp. (2), Enterococcus faecalis (32), Klebsiella spp. (45), Enterobacter spp. (20), Escherichia coli (65), Salmonella spp. (6), Shigella spp. (2), Yersinia enterocolitica (1), Acinetobacter spp. (4), Proteus spp. (7), Pseudomonas aeruginosa (59), Stenotrophomonas maltophilia (4), Candida spp. (10) and Aspergillus spp. (7). In vitro selection of resistance to Akacid plus® was carried out on 24 strains. Toxicological analyses were also performed.Results: All tested agents were more effective against Staphylococcus spp. and Bacillus spp. than against E. faecalis and Gram-negative bacteria. The MIC90s of chlorhexidine and mupirocin showed a 4-fold and 32-fold increase for methicillin-resistant S. aureus in comparison with methicillin-susceptible strains, while MIC values of Akacid plus® were similar for antibiotic-susceptible and multiresistant strains. Bactericidal action of Akacid plus® was observed at 1–2× MIC. The in vitro selection of resistance test showed no increase in MIC values of Akacid plus® for any isolate after 30 passages. In addition, Akacid plus® showed low oral and dermal toxicity.Conclusions: These preliminary results demonstrate the broad antimicrobial properties of Akacid plus®, which makes it a promising tool for topical application in the prophylaxis and treatment of bacterial and fungal infections. [ABSTRACT FROM AUTHOR]

Identifies and summarizes evidence for the effectiveness of dressings and topical agents in the management of surgical wounds healing by secondary intention. Association of the use of gauze with significantly more nursing time than foam in two of three trials; Preference for foam to gauze in terms of discomfort during dressing changes and nursing time required; Scarcity of evidence about care of postoperative wounds.

a. nostro, m.a. cannatelli, i. morelli, a.d. musolino, f. scuderi, f. pizzimentiand v. alonzo. 2004. To verify the efficiency of Calamintha officinalis essential oil as natural preservative in two current formulations. The 1·0 and 2·0% (v/v) C. officinalis essential oil was assayed for its preservative activity in two product types (cream and shampoo). The microbial challenge test was performed following the standards proposed by the European Pharmacopoeia Commission (E.P.) concerning topical preparations using standard micro-organisms and in addition wild strains, either in single or mixed cultures were used. The results clearly demonstrated that the C. officinalis essential oil at 2·0% concentration reduced the microbial inoculum satisfying the criterion A of the E.P. in the cream formulation and the criterion B in the shampoo formulation. Standard and wild strains showed a behaviour similar, both in cream and in shampoo formulation, with no significant difference (gerarchic variance, P > 0·05). C. officinalis essential oil confirmed its preservative properties but at higher concentration than that shown in previous studies on cetomacrogol cream. The nature of the formulation in which an essential oil is incorporated as preservative could have considerable effect on its efficacy. [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]

Investigates the outbreak of six postinjection joint infections in July 1999 caused by Mycobacterium abscessus as reported to the Texas Department of Health in Austin. Use of benzalkonium chloride (BC) as an antiseptic which contributes to serious outbreaks of disease; Resistance of patients' strain to BC.

Summary Background: Anal incontinence due to internal sphincter dysfunction is not amenable to simple surgical repair. The α-adrenergic agonist phenylephrine produces contraction of the internal sphincter and raises resting pressure when applied topically in healthy volunteers. The effect of topical phenylephrine in the treatment of faecal incontinence due to internal sphincter dysfunction was investigated. Methods: Thirty-six patients (22 women) aged 28–81 (mean 58) years with faecal incontinence and ultrasonographically structurally normal anal sphincter muscles were treated with topical 10 per cent phenylephrine and placebo gels, allocated in random order in a double-blind crossover study. Maximum resting anal sphincter pressure and anodermal blood flow were measured. A symptom questionnaire was completed and incontinence score determined using a validated scale. Results: There were no significant differences in incontinence score, resting anal pressure and anodermal blood flow between the active and placebo treatments. Six patients on active treatment and two on placebo experienced more than 75 per cent subjective improvement. Three patients developed allergic dermatitis to phenylephrine. Conclusion: This is the first study of the use of a topical pharmacological agent to treat faecal incontinence. This concentration of topical phenylephrine did not produce a significant improvement in symptoms or function. A subgroup of patients may respond. Further studies are required with increased concentrations. [ABSTRACT FROM AUTHOR]

SummaryBackground: Pruritus ani is a common and socially embarrassing condition which is often poorly managed. It is often classified as idiopathic where the symptoms are usually transitory or secondary when a more persistent itch is experienced. The aim of this study was to establish the cause of pruritus ani in a group of patients referred to a combined colorectal and dermatological clinic, and to determine the most appropriate treatment. Methods: Forty consecutive patients with pruritus ani were referred over a 6-month period from either the general practitioner or another hospital consultant to a combined colorectal and dermatological clinic. They were assessed by history, completion of a general health questionnaire, full examination of the skin, digital rectal examination, proctoscopy, sigmoidoscopy and patch testing. Patients were treated according to clinical findings at assessment. Results: Thirty-four patients had a recognizable dermatosis, three had superficial perianal fissuring and three had a normal perineum; two required surgical intervention. Eighteen patients had a positive reaction when patch tested. All patients have shown an improvement or complete resolution of symptoms with treatment. Conclusion: This series has shown that the majority of patients presenting with pruritus ani have a dermatosis as the underlying cause of their symptoms and that many of them have developed contact sensitivities to the various topical medications used. These findings suggest that referral to a dermatologist in the first instance may be more appropriate. [ABSTRACT FROM AUTHOR]

We describe the results of a single-centre, double-blind, vehicle-controlled, parallel group study on the quantitative effects of 2% fusidic acid lotion (Fucidin ® lotion) in facial acne vulgaris. The trial was completed by 52 patients aged 15-25 years with mild to moderate acne who had been randomized to either Fucidin ® Lotion (n = 25) or its base (n = 27). Primary outcome measures included colony counts of Propionibacterium acnes and micrococcaceae and measurements of skin surface lipid free fatty acids and sebum excretion rate. Clinical assessment was based on the acne grade, count of inflamed and non-inflamed lesions and evidence of a primary irritant dermatitis. There was a variable but gradual reduction in lesion counts with the maximum improvement at 12 weeks for inflamed lesions, where the reduction was 19.9% for fusidic acid and 24.7% for the placebo. The non-inflamed lesions decreased by 10.8% in the fusidic acid group and increased by 15.9% in the placebo group; this difference was not statistically significant. Although the fusidic acid reduced the micrococcaceae count by 1 log cycle, inferring adequate compliance, there was no reduction in the counts of P. acnes, surface free fatty acids or sebum excretion rate. This study has failed to explain the mechanism of action of topical fusidic acid. [ABSTRACT FROM AUTHOR]

A retrospective review of patch test results from all new patients wit venous leg ulcers was performed for the preceding 11 months. Eighty one patients referred from general practitioners and district nurses with venous stasis ulcers were included. Positive patch tests were found in 54 patients (67%), including a continued high incidence of allergy to lanolin and topical antibiotics. Multiple allergies were found in 48 patients (58%). In addition, a new problem of allergy to cetearyl alcohol, a constituent of commonly used creams and paste bandages, was identified in 13 patients. There is a continuing high incidence of contact sensitivity in patients with venous stasis ulcers which has important implications for the management of these patients. [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.

The article focuses on the prevention of infections related to open fractures. The frequency with which infection complicates open fractures has been reported to be as high as 50%. A critical element in prevention of these infections is aggressive immediate debridement and irrigation, in an attempt to physically remove devitalized tissue and microbial contamination. A variety of irrigating solutions have been used. Some data suggest that antiseptics, such as povidone-iodine and chlorhexidine, may be cytotoxic. The relative efficacy of 2 other types of irrigant, antibiotic solutions and detergents has now been evaluated.

Background: Phenylephrine is an α[sub 1]-adrenergic agonist which causes contraction of human internal anal sphincter muscle in vitro. Its intra-arterial administration in animals has been shown to increase resting sphincter pressure in vivo. In this study the effect of topical application of phenylephrine on resting anal pressure in healthy human volunteers was investigated. Methods: Twelve healthy volunteers had measurements of maximum resting sphincter pressure (MRP) and anodermal blood flow taken before and after topical application of increasing concentrations of phenylephrine gel to the anus. To determine the duration of effect of the agent, readings were taken throughout the day after a single application. Results: There was a dose-dependent rise in the resting anal sphincter pressure, with a small 8 per cent rise after 5 per cent phenylephrine (P = 0·012) and a larger 33 per cent rise with 10 per cent phenylephrine (mean(s.d.) MRP 85(12) cmH[sub 2]O before versus 127(12) cmH[sub 2]O after treatment, P < 0·0001). Thereafter no additional response was noted with higher concentrations of phenylephrine. The median duration of action of a single application of 10 per cent phenylephrine was 7 (range from 6 to more than 8) h. Conclusion: Topical application of 10 per cent phenylephrine gel to the anus produces a significant rise in the resting anal sphincter pressure in healthy human volunteers. This represents a potential novel therapeutic approach to the treatment of passive faecal incontinence associated with a low resting anal sphincter pressure. [ABSTRACT FROM AUTHOR]