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Full-thickness skin grafts are a commonly used reconstructive method following Mohs micrographic surgery. The literature varies on the most appropriate methods of suturing and securing grafts as well as best practices to dress the graft postoperatively. Our objective was to review various approaches to management of full-thickness skin grafts, including suturing the graft, securing the graft, and topical emollient use on the graft postoperatively. It was found that absorbable sutures, plain gut, provide preferable outcomes with full-thickness skin grafts. The tie-over bolster is the most-used method for securing skin grafts after placement, although several other methods have demonstrated efficacy, including the polyurethane foam, sandwich, and quilting suture methods. While various topical emollients are used in the immediate postoperative period, plain white petrolatum is the least likely to form allergic contact dermatitis.

Acute and minor skin wounds are common in daily life. However, in clinical practice, after initial management in the acute phase, the wounds are managed mainly through observation, and the patients are usually lost to follow-up. Considering a multicomponent hydrolipidic dressing (MAS063DP) long-known for its safe application in eczema and recently in laser-induced wounds, we aimed to evaluate its ability in functional recovery of impaired skin integrity during wound healing. Sixteen patients (N = 16) were enrolled and completed (n = 8 vs n = 8) this prospective, open-label, vehicle-controlled clinical trial with 12-week follow-up. Transepidermal water, skin viscoelasticity and bioimpedance analysis were measured initially, at the 1st, 4th, 8th, and 12th weeks. Improvements in these parameters were greater in the MAS063DP group (from 31.4 ± 9.0 to 16.4 ± 4.3 g/m2 h, P < .001; from 77 ± 16% to 88 ± 9%, P < .05; from 4182 ± 3823 to 2644 ± 1772 Ω) than in the white petrolatum group. No significant adverse events occurred, and all participants were more satisfied with the intervention. In this study, MAS063DP can restore skin integrity and reinstitute physiologic function as a feasible and safe intervention more markedly than management through observation during the healing process by providing protective hydrolipidic layer on the skin with simultaneous anti-inflammatory and antioxidant activities from its key ingredients such as glycyrrhetinic acid, Vitis vinifera, telmesteine, and vitamins C and E.

Background Petrolatum is often used to suppress water evaporation from the skin surface. However, its stickiness, shininess, and other factors make it inconvenient for continuous use. Objective To compare the effectiveness and usability between a newly developed petrolatum-based ointment (NOV® II Moisture Balm) and white petrolatum. Methods Twenty-nine subjects with atopic dermatitis or xeroderma with symptoms of dry skin applied NOV® II Moisture Balm on the right sides of the face and white petrolatum on the left side, respectively, for 8-12 weeks. The skin conditions (erythema, exudate/crusting, dryness, and itch) were scored, stratum corneum water content and transepidermal water loss (TEWL) were measured, and the free amino acid and thymic stromal lymphopoietin (TSLP) levels in the stratum corneum were analyzed before and end of the trial. Results Dryness, exudate/crusting, and TEWL decreased significantly on both the white petrolatum and the NOV® II Moisture Balm sides, while stratum corneum water content and the free amino acid levels in the stratum corneum increased significantly. On the NOV® II Moisture Balm side, erythema and the TSLP levels decreased significantly. In a questionnaire on usability, the subjects felt NOV® II Moisture Balm spread better and were less sticky and shiny than white petrolatum, and more subjects wanted to continue using NOV® II Moisture Balm. Conclusions NOV® II Moisture Balm was equivalent to white petrolatum in moisturizing and improving the physiologic functions of the skin, but had superior usability.

Actinic keratoses (AK) are precancerous lesions that develop on chronically sun-exposed skin. They frequently require prophylactic field treatment due to the risk of progression to squamous cell carcinoma. Topical treatment with 5-fluorouracil (5-FU) yields near complete AK resolution, yet leaves a patient with an exuberant erythematous treatment site, which may be embarrassing and/or uncomfortable. We report a case of a patient with diffuse facial AK who was treated with 5-FU twice daily for 2 weeks, resulting in fiery-red erythema and disrupted barrier indices. Application of pure ultra white petroleum jelly, an emollient preferred by dermatologists for post-operative wound healing, resulted in drastic decreased erythema and recovery time of post-treatment transepidermal water loss and hydration, compared to the contralateral, non-petrolatum-treated side. Additionally, petrolatum use did not disrupt the AK resolution endpoint. We suggest that petroleum jelly be used for the repair of 5-FU-induced barrier disruption and erythema to promote greater patient adherence.

Background The skin wound healing process is regulated by various cytokines, chemokines, and growth factors. Recent reports have demonstrated that spermine/spermidine (SPD) promote wound healing through urokinase-type plasminogen activator (uPA)/uPA receptor (uPAR) signaling in vitro. Here, we investigated whether the systemic and topical administration of SPD would accelerate the skin wound-repair process in vivo. Methods A skin wound repair model was established using C57BL/6 J mice. SPD was mixed with white petrolatum for topical administration. For systemic administration, SPD mixed with drinking water was orally administered. Changes in wound size over time were calculated using digital photography. Results Systemic and topical SPD treatment significantly accelerated skin wound healing. The administration of SPD promoted the uPA/uPAR pathway in wound sites. Moreover, topical treatment with SPD enhanced the expression of IL-6 and TNF-α in wound sites. Scratch and cell proliferation assays revealed that SPD administration accelerated scratch wound closure and cell proliferation in vitro. Conclusion These results indicate that treatment with SPD promotes skin wound healing through activation of the uPA/uPAR pathway and induction of the inflammatory response in wound sites. The administration of SPD might contribute to new effective treatments to accelerate skin wound healing.

Background/Aims: An important pillar of AD management involves moisturizer application following bathing to restore epidermal barrier function (EBF). In this study, we aim to bring additional evidence to the “soak-and-smear” regimen, comparing EBF recovery by various moisturizers following bathing in AD and healthy subjects. Methods: Volar forearms of 10 AD patients and 10 healthy controls were immersed in water for 10 minutes to simulate bathing. Immediately after bathing, ceramide-containing emollient (CER), a humectant (10% glycerin, GLY), an occlusant (white petrolatum, PETR), and aloe vera 5% extract (ALOE) were applied to separate test sites on the forearm. One test site did not receive any moisturizer and served as control. EBF parameters (hydration, TEWL, and pH) were recorded at baseline, and 15, 30, and 60-minutes post-bathing.Results: AD and controls shared similar trends. ALOE had the most significant pH decrease while GLY had the highest pH increase. Hydration significantly increased in all moisturizers compared to control. GLY led to the highest increase, peaking at 15-minutes for both AD and healthy subjects. AD subjects had higher hydration following CER than healthy subjects throughout the entire study. All four moisturizers increased TEWL compared to control, though PETR had the lowest initial TEWL increase. Conclusion: All moisturizers has an immediate effect on improving SC hydration. Their initial effects on TEWL increase recovers toward control levels by 60-minutes. Future studies are needed to examine the effect of repeated moisturizer post-bathing over longer study periods.

The purpose of the present two phase 1 studies was to assess the safety, tolerability and pharmacokinetics for topical application of a novel Janus kinase (JAK) inhibitor, JTE-052, in Japanese healthy adult male volunteers and Japanese adult patients with atopic dermatitis (AD). Additionally, exploratory investigation was performed on the efficacy for disease severity and pruritus score in AD patients. In the QBX1-1 study, the cutaneous safety of JTE-052 ointment by a patch test and a photo patch test was assessed in an intra-individual comparative study using placebo ointment, white petrolatum and non-application as comparators. The study demonstrated that JTE-052 ointment would be associated with a low potential for phototoxicity but had no potential for skin irritation or photoallergy. In the QBX1-2 study, it was revealed that the systemic exposure to JTE-052 in both healthy volunteers with normal skin and AD patients with inflamed skin was low in application of not only 1% but also 3% JTE-052 ointment. JTE-052 ointments of 1% and 3% were generally safe and well tolerated in both populations. In a repeated twice-daily application for 7 days, the efficacy of JTE-052 ointment to AD patients was observed with both 1% and 3% ointments in the exploratory investigations evaluated by Eczema Area and Severity Index, Investigator's Global Assessment and Numeric Rating Scale assessments. The mean scores for each assessment declined from the baseline throughout the study. These results suggest that the treatment of JTE-052 ointment is generally safe and effective in AD patients, although further large confirmatory studies are needed.

Background: Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. Objective: In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. Methods: A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. Results: When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). Study limitations: Low number of patients Conclusion: The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.

Background Aesthetically pleasing results and fast, uneventful recovery are highly desirable after rejuvenating ablative laser procedures. Wound dressings following ablative laser procedures should ideally improve and optimize the wound healing environment. Objective The purpose of this comparative split face, single blinded, prospective observational study was to assess the efficacy and acceptability of two primary wound dressings immediately after a full face fractional CO2 laser resurfacing procedure. Methods The assessments of an innovative film-forming dressing called Stratacel (SC) vs spring thermal water + Vaseline (V+), were conducted after a standardized, single pass, full-face ablative fractional CO2 laser skin resurfacing procedure. Clinical parameters such as haemoglobin – HB; surface temperature – ST; micro-textural modifications – MT; superficial melanin – M; intra-follicular porphyrines – P, were assessed at different phases of the healing process using standardized, non-invasive technologies. Results Five female volunteers were enrolled in this in-patient, controlled pilot study. Most of the clinical parameters considered, including 3D surface texture analysis, revealed a better performance of SC vs. V+ during the early, more delicate phases of the healing process. Conclusions This preliminary study, even if performed on a small number of volunteers, confirmed a definite advantage of the tested semi-permeable film-forming formula (SC) over a more conventional post-operative skin care regime (V+). Clinical results could be explained by a better uniformity of distribution of SC over the micro-irregularities induced by ablative fractional CO2 laser resurfacing. Its thin, semi-permeable film might, in fact act as an efficient, perfectly bio-compatible, full contact, temporary skin barrier, able to protect extremely delicate healing surfaces from potential environmental irritations. This article is protected by copyright. All rights reserved.

In this symposium, we present a novel breathable protective ointment (BPO) formulation developed at the University of Shizuoka for the prevention of moisture-associated skin damage (MASD) intended for use in healthcare settings. MASD occurs when moisture is in constant contact with the skin for prolonged periods of time, causing degradation of the skin barrier. Exposure to physical or chemical stimuli in addition to moisture may lead to different types of moisture-associated dermatitis such as incontinence-associated or periwound dermatitis. Another type of moisture-associated dermatitis, diaper dermatitis, is treated with protective ointments such as white petrolatum and zinc ointment. These ointments protect the skin from irritants but also block insensible dermal perspiration, which promotes further skin maceration. Therefore, we have developed a BPO formulation from white petrolatum and calcium carbonate, which serve as a protectant and pore-forming agent, respectively. In vitro water-proof tests confirmed the skin-protective properties of the BPO, and moisture-permeation tests indicated its breathability. Moreover, the BPO protected the skin from irritants without the loss of skin hydration in rats. Our next step involves the trial of BPO in infants with diaper dermatitis. In the future, this BPO could be used as an ointment base for active pharmaceutical ingredients used to prevent MASD.

Objective: To investigate the effect of a novel topical wound-healing agent, low-concentration povidone-iodine ointment (LPIO) with a hydrophobic white petrolatum-rich base on skin-wound models in rats and rabbits. Method: The therapeutic efficacy of topically applied LPIO was compared to that of standard-concentration povidone-iodine ointment (SPIO) and non-treatment control, using a full-thickness skin-wound model in 24 hairless rats and a full-thickness skin-defect model in rabbit earlobes. The animals were kept under standardised conditions at the Central Research Laboratory of Maruishi Pharmaceutical Co. Ltd. (Osaka, Japan). Therapeutic efficacy was evaluated based on macroscopic wound-size reduction, as well as histopathological and immuno-histochemical examinations. Results: LPIO enhanced wound healing in rat full-thickness skin ulcers, reducing wound size and inflammation, when compared with that in SPIO and non-treatment control. LPIO also markedly improved wound healing in rabbit earlobe ulcers by significantly improving re-epithelialisation, compared with that in SPIO. Conclusion: The results of this study suggest that LPIO is a useful topical therapy for ulcerative lesions.

Objective : To compare the effect of natural oils and white petrolatum on skin barrier function in patients with xerosis. Design, Setting, and Participants : Randomized, open label, comparison pilot study (NCT03093597). Interventions : Participants were randomized to apply 1 of 4 moisturizers to assigned treatment areas twice daily for 2 weeks. Clinical dry skin score, stratum corneum hydration, and transepidermal water loss (TEWL) were assessed at baseline, 1 week, and 2 weeks. Results : Thirty-two participants completed the study. Neither TEWL nor hydration were statistically different among the moisturizers at each visit. All four moisturizers led to significant initial increase in TEWL at week 1 (p < 0.05) with an associated increase in hydration for coconut oil, jojoba oil, and white petrolatum. All four moisturizers led to significant increase in hydration by week 2 (p < 0.01). The preferred moisturizers were almond oil and coconut oil, which were most “liked” by 38% and 31% of the participants, respectively. The least preferred moisturizer was white petrolatum. Conclusions : Almond oil, jojoba oil, and coconut oil significantly increased hydration after 2 weeks, and are as effective as white petrolatum as daily moisturizers for xerosis. The participants preferred natural oils to white petrolatum, implying that these moisturizer options may improve patient compliance.

Background Angiokeratomas are benign vascular skin lesions characterised by proliferation of dilated blood vessels in the upper dermis. Some variants have been described that can affect different regions of the body including face and genitals. They may be isolated or clustered, and appear as small red-to-black papules, with a smooth epidermal surface. As the disease progresses, the lesions grow, reaching a diameter of 10 mm, and become dark red to black, with a verrucous surface. Depending on the characteristics of the lesions they can be treated with surgery or laser for aesthetic reasons. On the other hand, some investigators have also proved that topically applied rapamycin causes regression of facial angiokeratomas, giving better cosmetic results. Purpose To evaluate the efficacy and safety of the topical application of 0.4% rapamycin ointment in a facial angiokeratoma. Material and methods We report on a paediatric patient who presented with facial angiokeratomas. Rapamycin ointment was performed at a concentration of 0.4%, mixing with white petrolatum and petroleum jelly under safe conditions in a vertical laminar flow hood. Efficacy was measured in a paediatric judgement and through a monthly photographic examination. Safety was measured in terms of irritation and burning sensation. The patient was followed up for 1 year of treatment. Results The case of a male patient of 12 years of age (31 kg and 140 cm) is presented. After being approved the treatment in the Commission of pharmacy of our hospital, the patient started the treatment with one application every night. A photographic examination was performed, where an improvement was seen in the right malar zone, infraorbital, although the nasal area presented without changes. The patient had no irritation and burning sensation during treatment. The response of these vascular skin malformations to rapamycin, an mTOR inhibitor, suggests that activation of the PI3K/Akt/mTOR pathway in endothelial cells may play a role in the pathogenesis of angiokeratomas. Conclusion Topical rapamycin appears to be a promising and effective way of treating facial angiokeratomas. The major disadvantage is the cost of therapy, which is prohibitively expensive at the present time. References and/or Acknowledgements To my pharmacist colleagues No conflict of interest

Destruction of epidermal barrier function associated with atopic dermatitis or Darier's disease often causes severe secondary skin infections. Patients with skin barrier disorders often repeatedly acquire Kaposi varicelliform eruption, which is caused by herpes simplex virus, but the underlying mechanisms and effective preventive methods have yet to be found. Viral infection through an impaired epidermal barrier can be prevented by enhancing innate immunity and/or inhibiting viral entry. In this study, we established a three-dimensional skin barrier dysfunction model by silencing ATP2A2, which is mutated in some Darier's disease patients. We confirmed the loss of desmosomes and presence of histopathological clefts in the suprabasal layer. Herpes simplex virus 1 applied to the stratum corneum infected the deep epidermis. An innate immune reaction was assessed by evaluating the expression of IFNB1 and related genes. Pretreatment with polyinosinic-polycytidylic acid alone or plus the antimicrobial peptide, LL37 enhanced IFN-β production and suppressed viral replication. Furthermore, topical application of a white petrolatum ointment containing heparin, which binds viral glycoproteins related to virus entry, strongly inhibited viral replication, probably by inhibiting invasion. Our human barrier-dysfunctional model will have future application for identifying the mechanism of Kaposi varicelliform eruption onset, preventive methods, and therapies.

Arsenic is a known human carcinogen and skin manifestations are the earliest and most specific markers of chronic arsenic poisoning. A 43-year-old man from Luzon presented at the Section of Dermatology with a one-year history of hyperkeratotic papules and plaques on the palms and soles. Numerous round hypopigmented macules were scattered on the upper back. Initial 24-hour urine arsenic level was elevated at 288mcg/liter. The patient underwent successful chelation with Nacetylpenicillamine and the palmoplantar keratoses were treated with cryotherapy and topical 20% salicylic acid in white petrolatum. In cooperation with the Department of Health, a comprehensive health and environmental assessment was conducted in the affected communities. This case highlights the role of dermatologists in the diagnosis and management of this public health problem.

SummaryBackground and Aims Pruritus frequently reduces quality of life (QOL) in patients with senile xerosis. This study investigated the moisturizing and antipruritic effects of a topical emollient containing a diethylene glycol/dilinoleic acid copolymer (D/DC) in patients with pruritic senile xerosis. Methods This single-blind study involved 50 subjects, aged 50-75 years. Patients were randomized to self-applied treatment of the lower legs with 10% (n = 20) or 20% (n = 20) D/DC-containing cream, white petrolatum (n = 5), or no treatment (n = 5) thrice daily for four weeks. Clinical scores of skin dryness and scratch marks, skin conductance, and Skindex-16 were evaluated before and after treatment. The degree of pruritus was evaluated by visual analog scale (VAS) score once a week. Results Patients treated with 10% and 20% D/DC showed significant improvements in skin dryness and scratch mark scores, as well as increased skin conductance, compared with the untreated group, whereas white petrolatum treatment improved only skin dryness scores. Moreover, patients treated with 20% D/DC showed significant improvements in skin dryness scores and skin conductance compared with white petrolatum treatment. The VAS scores in the D/DC-treated and white petrolatum-treated groups were significantly lower than in the untreated group, being particularly lower after one week of treatment with 20% D/DC. Conclusion Topical application of an emollient containing D/DC is effective in improving skin dryness and pruritus in patients with senile xerosis.

The Goeckerman regimen is a unique combination therapy of UVB light and application of crude coal tar for the treatment of psoriasis, eczema, prurigo nodularis, and chronic pruritus. Coal tar is speculated to be an anti-inflammatory and a photosensitizer that can increase the effectiveness of phototherapy. In the Goeckerman regimen, patients first undergo UVB phototherapy per protocol. Then their body is covered in crude coal tar under plastic occlusion for 4–5 h. This is repeated daily, 5 days per week, for approximately 6 weeks. The efficacy of Goeckerman is superior to most other available therapies. For example, 100% of patients with severe psoriasis achieve 75% improvement or better from baseline by 12 weeks. Side effects include those of phototherapy (erythema, burning, and tanning), as well as irritation and folliculitis from tar products.

Petrolatum is widely used in cosmetics, topical pharmaceuticals and also as a vehicle in dermal toxicity studies. New Zealand white rabbits treated with white petrolatum (vehicle control) in a 2-week dermal irritation study exhibited moderate to severe erythema starting on Day 7 that subsided towards the end of the study. Histological examination of abraded and non-abraded petrolatum-treated skin obtained at termination (Day 15) revealed mild acanthosis, hyperkeratosis, dermal edema with mixed inflammatory cells in the dermis. Macroscopic and microscopic features noted in rabbits were consistent with dermal irritation to petrolatum. Wistar-Han rats, CD1 mice, C57/Bl/6J mice and Gottingen minipigs treated topically with white petrolatum did not exhibit clinical or histologic evidence of dermal irritation. Therapeutic agents developed for topical application are generally tested in rabbits during some point in development. Interpretation of skin irritation data from a single species can impact risk assessment for humans and on product labeling. Copyright © 2013 John Wiley & Sons, Ltd.

A petrolatum and zinc oxide-based ointment containing 0.25% miconazole nitrate is reported to be effective and well tolerated in the treatment of diaper dermatitis complicated by cutaneous candidiasis (DDCC). This prospective, multicenter, open-label, long-term, phase IV study investigated the potential resistance of Candida spp. to repeated topical use of 0.25% miconazole nitrate in infants age 15 months and younger with moderate to severe DDCC. For initial and recurring episodes of DDCC over the 2-year study period, subjects were treated with a 7-day course of 0.25% miconazole nitrate ointment (active components: miconazole nitrate 0.25%, zinc oxide 15%, and white petrolatum 81.35%) with a 7-day follow-up. Clinical and mycologic evaluations were conducted before treatment (day 0) and 7 days after treatment (day 14). Potential resistance to miconazole was defined using an arbitrary breakpoint of minimum inhibitory concentration of 2 μg/mL. There was no evidence of resistance to miconazole in Candida spp. after single or repeated treatment courses of 0.25% miconazole nitrate ointment. For the initial episode of DDCC, 83 of 168 subjects (49.4%) achieved a clinical cure, 77 (45.8%) achieved a mycologic cure, and 49 (29.2%) achieved an overall cure (clinical and mycologic). The overall cure rate for recurrent episodes of DDCC was similar to or numerically greater than rates observed for the initial episode. Treatment of DDCC with 0.25% miconazole nitrate ointment was effective and generally well tolerated. No evidence of the development of resistance to miconazole in Candida spp. was observed.

White petrolatum is frequently used as an oleaginous base, but has a drawback of poor usability. In this trial, white petrolatum was prepared at a lower melting point to improve its usability. Characteristic pharmaceutical values such as melting point, yield, and consistency were compared between a conventional product and ophthalmic white petrolatum. Usability was compared by administering a survey questionnaire and evaluating the comparable moisturizing effect by conductivity in humans. The melting point and yield value of the improved product were significantly lower compared with other white petrolatum products. In the survey, the improved product was rated excellent in five criteria. On a scale of 1 to 5, the average values for the five criteria for the improved product were 4.7, while the conventional product and ophthalmic white petrolatum were rated 3.0 and 3.5, respectively. No difference in moisturizing effect was observed among all petrolatums after application, from day 1 to day 14. In conclusion, the improved white petrolatum demonstrated better usability, and the moisturizing effect was equivalent to conventional product, suggesting that the use of this improved product may lead to improved adherence.

Summary Background Dermatological procedures can result in disfiguring bruises that resolve slowly. Objectives To assess the comparative utility of topical formulations in hastening the resolution of skin bruising. Methods Healthy volunteers, age range 21–65 years, were enrolled for this double (patient and rater) blinded randomized controlled trial. For each subject, four standard bruises of 7 mm diameter each were created on the bilateral upper inner arms, 5 cm apart, two per arm, using a 595-nm pulsed-dye laser (Vbeam; Candela Corp., Wayland, MA, U.S.A.). Randomization was used to assign one topical agent (5% vitamin K, 1% vitamin K and 0·3% retinol, 20% arnica, or white petrolatum) to exactly one bruise per subject, which was then treated under occlusion twice a day for 2 weeks. A dermatologist not involved with subject assignment rated bruises [visual analogue scale, 0 (least)–10 (most)] in standardized photographs immediately after bruise creation and at week 2. Results There was significant difference in the change in the rater bruising score associated with the four treatments (anova, P = 0·016). Pairwise comparisons indicated that the mean improvement associated with 20% arnica was greater than with white petrolatum (P = 0·003), and the improvement with arnica was greater than with the mixture of 1% vitamin K and 0·3% retinol (P = 0·01). Improvement with arnica was not greater than with 5% vitamin K cream, however. Conclusions Topical 20% arnica ointment may be able to reduce bruising more effectively than placebo and more effectively than low-concentration vitamin K formulations, such as 1% vitamin K with 0·3% retinol.

Background: Denture adhesive is widely used in elderly people who wear complete dentures. Chinese herbal medicine has long been used for the treatment of oral disease. The addition of herbal medicine to denture adhesive might be used to develop an adhesive which is effective for xerostomia patients. Purpose: The purpose of this study was to evaluate physical properties and cytototoxicity of herbal medicine components in denture adhesive. Methods: This study used a combination of 35wt% PVM-MA, 20wt% CMC, 40wt% white petrolatum and 5wt% liquid paraffin as base materials. Three kinds of herbal medicine components: Maimendong (Ophiopogon), Fuling (Hoelen) and Dongkuizi (Cluster mallow seed) were added to base materials of 1wt%, 5wt% and 10wt%. The initial viscosity was measured using a controlled-stress rheometer (AR-G2). The adhesive strength was quantified according to ISO-10873 recommended procedures. All data was analyzed independently by one-way Anova combined with a Turkey’s multiple comparison test at a 5% level of significance. Results: Significant differences were observed between materials in initial viscosity (p < 0.05). Specifically, samples containing 5wt% and 10wt% of Maimendong (Ophiopogon) showed higher values compared with the control samples. The larger the amounts of herbal medicine components, the greater the changes in the adhesive strength of denture adhesives over time. The denture adhesives containing herbal medicine components do not have a cytotoxic effect and are safe for use in actual clinical practice. Conclusion: The study showed that the addition of herbal medicine components does not affect physical properties (i.e. initial viscosity and adhesive strength) of denture adhesive and cytotoxicity in fibroblast cells.

Dermatologists can decrease unnecessary use of antimicrobial agents by avoiding them in situations wherein good evidence indicates that they are ineffective. Controlled trials indicate that antimicrobial agents are unhelpful in treating cutaneous abscesses, inflamed epidermal cysts, uninfected atopic eczema, and cutaneous ulcers caused by venous insufficiency or diabetes in the absence of significant contiguous soft-tissue inflammation. Prophylactic antibiotics are rarely appropriate for routine dermatologic surgery and are not indicated for patients who have prosthetic joints or vascular grafts. They are recommended only for a small group of patients who have abnormal cardiac valves, and then only with surgery involving clearly infected skin or soft-tissue. Topical antibiotics are no better than white petrolatum in covering sutured wounds, and with moist occlusive dressings, no ointment is necessary.

Allergic contact dermatitis associated with topical antimicrobial agents is an increasing problem in the postoperative wound care period. We reviewed the topical antimicrobial agents most commonly used postoperatively in North America and Europe, examined the incidence of allergic contact dermatitis from each agent, and provided guidelines for the use of topical antimicrobials on closed and open wounds in the postoperative period. Neomycin was the most common cause of allergic contact dermatitis both in the general patch-tested population (11%) and in the postsurgical population. Bacitracin was also a common culprit, although at a lower rate (8%). There is a risk of co-reactivity between these two agents. Polymyxin B and mupirocin were not significant allergens. The rate of postoperative infectious complications in dermatologic surgery (1-2%) was similar to the rate of allergic contact dermatitis from topical antimicrobials (1.6-2.3%). We concluded that for closed wounds, the use of topical neomycin postoperatively should be avoided. White petrolatum is an efficacious and cost-effective alternative for closed wounds. For open wounds, topical antimicrobials that do not contain neomycin should be recommended.

Objective To describe the effects of long-term treatment with four different eye ointment bases (OBs) in cats. Animals studied Ten healthy cats. Procedures The study was performed in two periods. Four different OBs were tested. Hundred grams of OB contained the following: OB-A: 35.17 g liquid paraffin (lp), 64.83 g white petrolatum (wp); OB-B: 10.03 g lp, 84.95 g wp 5.02 g lanolin; OB-C: 18.34 g lp, 51.40 g wp, 25.00 mg KH2PO4, 57.00 mg K2HPO4, 18.90 g eucerinum anhydricum, 11.28 g water for injections; and OB-D: 70 g unguentum lanalcoli, 20 g lp, 10 g aqua conservans. One eye was treated, and the other served as a negative control. Cats received the OBs TID for 28 days. The two study periods were separated by a 4-month washout phase. Samples for conjunctival impression cytology, swabs for bacteriologic and mycologic examination, and cytobrush samples for FHV-1 and Chlamydophila felis PCR detection were obtained. Both eyes were examined daily. Severity of ocular symptoms was scored using a modified Draize eye irritation test. A total of five eyes were treated with OB-A, five with OB-B, four with OB-C, and five with OB-D. Results Treated eyes had significantly higher clinical scores. Eyes receiving OB-A had the highest overall clinical score. The results of bacteriologic and mycologic examination concur with the previously published data. All samples tested were negative for FHV-1 and Chlamydophila felis. There was no significant difference between treated and control eyes upon cytological examination. Conclusion The application of OBs resulted in clinical symptoms in treated eyes. The long-term use of ointments is not well tolerated in cats and may lead to ocular irritation.

Summary Background Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by elevated serum levels of IgE. AD is associated with Th2 cytokines including interleukin (IL)-4, IL-5, IL-13 and IL-10. Systemic administration of suplatast tosilate (IPD) is currently used to treat Th2 cytokine-mediated AD. Objectives To evaluate the effect of topical IPD on skin lesions of AD using a genetically engineered AD mouse model (K14/caspase-1 transgenic mouse: KCASP1Tg). Methods IPD ointment (3%) and white petrolatum (WP) were applied to KCASP1Tg mice every other day from 6 to 14 weeks after birth. Histopathological analysis of skin lesions and measurement of mRNA expression of cytokines in skin lesions and spleen cells were carried out. We also compared changes in serum parameters between IPD-treated and WP-treated KCASP1Tg mice. Results WP-treated mice developed dermatitis at 8 weeks after birth. However, skin lesions in IPD-treated mice were limited. Histopathologically, skin lesions in WP-treated KCASP1Tg mice showed marked inflammatory changes with increased mast cell infiltration. However, mice treated with IPD showed minimum skin lesions with scarce mast cell infiltration. WP-treated KCASP1Tg mice had significant elevation in the serum levels of histamine, IgE and IL-18 as compared with IPD-treated KCASP1Tg mice. mRNA expression of IL-4 and IL-5 in the skin lesions from WP-treated KCASP1Tg mice was significantly higher than in those from IPD-treated mice. In the spleen, the expression of IL-4, IL-5 and interferon-γ was significantly increased in WP-treated KCASP1Tg mice as compared with their IPD-treated counterparts. Conclusions This study shows that topical therapy with IPD inhibits the expression of IL-4 and IL-5 and ameliorates skin manifestations in an AD mouse model, suggesting the potential usefulness of topical IPD for the treatment of AD.

Objective. To present the first reported case series of plasma cell vulvitis successfully treated with topical misoprostol. Materials and Methods. Three women with vulvar pain and lesions secondary to plasma cell vulvitis refractory to conventional therapy were treated with topical misoprostol compounded in white petrolatum. Results. All three patients had resolution of pain and lesions within 6 weeks of starting topical misoprostol. All patients tolerated the 0.01% concentration; however, local side effects were seen with the higher 0.02% concentration. Conclusions. Plasma cell vulvitis is a rare and painful vulvar disorder that it is often refractory to therapy. All three patients in this case series were successfully treated with topical misoprostol. The immunosuppressive effects of misoprostol are hypothesized to be the mechanisms of action of this novel therapy for plasma cell vulvitis.

Background Certain moisturizers can improve skin barrier function in atopic dermatitis. The effect of topical nicotinamide on atopic dry skin is unknown. We examined the effect of topical nicotinamide on atopic dry skin and compared the results with the effect of white petrolatum in a left–right comparison study. Methods Twenty-eight patients with atopic dermatitis, with symmetrical lesions of dry skin on both forearms, were enrolled, and were instructed to apply nicotinamide cream containing 2% nicotinamide on the left forearm and white petrolatum on the right forearm, twice daily over a 4- or 8-week treatment period. Transepidermal water loss and stratum corneum hydration were measured by instrumental devices. The amount of the stratum corneum exfoliated by tape stripping (desquamation index) was determined by an image analyzer. Results Nicotinamide significantly decreased transepidermal water loss, but white petrolatum did not show any significant effect. Both nicotinamide and white petrolatum increased stratum corneum hydration, but nicotinamide was significantly more effective than white petrolatum. The desquamation index was positively correlated with stratum corneum hydration at baseline and gradually increased in the nicotinamide group, but not in the white petrolatum group. Conclusions Nicotinamide cream is a more effective moisturizer than white petrolatum on atopic dry skin, and may be used as a treatment adjunct in atopic dermatitis.

We report on an unexpected sensitization to petrolatum diagnosed with the occurrence of multiple nonrelevant and false-positive drug patch-tests performed while investigating a patient suffering from many cutaneous adverse drug reactions. All the positive drug patch-tests were prepared with GILBERT vaseline. This petrolatum reaction is positive as it was tested with five other brands of petrolatums a few months later. As the same petrolatums, but from different batches were tested, patch-tests with GILBERT petrolatum were doubtful, while other petrolatums were positive. White petrolatum is a mixture of semisolid hydrocarbons of the methane series. The sensitizing impurities of petrolatum are polycyclic aromatic hydrocarbons, e.g. phenanthrene derivatives. The purity of petrolatum depends on both the petroleum stock and on the production and packaging methods. Even if rare, contact sensitization to petrolatum can disturb the interpretation of drug patch-tests. It is necessary in the interpretation of drug patch-tests to test both in petrolatum and other vehicles and with all the different petrolatums used in preparing the material for drug patch-tests. So, it is essential to advise the patients sensitized to petrolatum to remove all the topical drugs, such as all the cosmetics, which contain petrolatum in their formulation.

We surveyed the prescriptions from the Department of Dermatology in a city hospital to determine the status of the use of admixtures of corticosteroid ointments with other ointments. Thirty percent of the prescriptions of topical ointment therapy for outpatients of the Department were for admixture ointments. They were prescribed for patients aged 2 months to over 90 years. The mixing ratios of corticosteroid ointments with other ointments were 1:1 to 5:3. One-to-one dilution was most frequently used. Corticosteroid ointments classified into strongest, very strong, strong and medium groups were used for admixtures. We studied the effect of admixture ointments on carrageenan-induced edema in rat hind paws to assess the anti-inflammatory activity of these admixtures. DermovateTM, its 1:3-diluted preparation with white petrolatum and 1:1-diluted preparation of LidomexTM with white petrolatum exerted significant anti-inflammatory activity (p

Casarotto RA, Adamowski JC, Fallopa F, Bacanelli F. Coupling agents in therapeutic ultrasound: acoustic and thermal behavior. Arch Phys Med Rehabil 2004;85:162–5. Objective To compare transmissivity data and thermal behavior of 4 coupling media. Design Experimental. Setting Postgraduate rehabilitation program in Brazil. Specimens Four coupling media: gel, mineral oil, white petrolatum, and degassed water. Interventions Not applicable. Main outcome measures The transmission, attenuation, reflection coefficient, and acoustic impedance of gel, mineral oil, white petrolatum, and degassed water were measured with a density measurement cell. The temperature variation in the therapeutic ultrasound transducer was measured with a thermocouple. Results The transmissivity data showed that the water and gel presented the highest transmission coefficient, the lowest reflection, and an attenuation coefficient and acoustic impedance close to that of the skin. The thermal data revealed the highest heating in the transducer during the insonation with white petrolatum and mineral oil, resulting from the thermal conductivity features of each medium. Conclusions Transmissivity data obtained showed that water and gel present the best acoustic features. In ultrasound therapy, with the direct contact technique using thin layers of coupling agents, any product may be used, because the effect of the attenuation coefficient does not play a significant role when layers are as thin as those used in this experiment.

Background: Atopic dermatitis is considered to be developed by the IgE-mediated immediate allergy and by the delayed hypersensitivity to causative allergens. We have previously reported that IgE-mediated type I allergy to mites contributed to the development of skin eruptions on atopic model mice (NC mice). Objective: This time, we studied the delayed hypersensitivity skin reaction to mites in NC/F mice. Methods: We conducted 48-hour closed patch testing with Myocoptes musculinus (kekuidani) that is a parasite in NC/F mice and BALB/C mice. Results: At both the 48- and 72-hour readings, 7 (87.5%) out of 8 NC/F mice tested showed positive reactions to M. musculinus. All BALB/C mice showed negative reactions to M. musculinus. All animals showed negative reactions to white petrolatum. Conclusion: Our previous data and results of this study give positive proof that both IgE-mediated immediate allergy and cell-mediated delayed hypersensitivity to a mite antigen contribute to the development of skin eruptions on NC/F mice resembling human atopic dermatitis.

Background We identified 19 patients with facial atopic eczema who failed to respond to tacrolimus (FK506) ointment, although tacrolimus ointment has shown excellent benefit for the treatment of recalcitrant facial erythema in most patients with atopic dermatitis. Objectives We attempted to determine the efficacy of an original lotion formulation of tacrolimus for facial atopic dermatitis resistant to tacrolimus ointment. Patients/methods Recalcitrant facial erythema of these 19 patients was treated with an original tacrolimus lotion preparation for 6 months. Patch testing with white petrolatum was performed in both the 19 patients and in 30 other atopic dermatitis patients who had experienced excellent results with tacrolimus ointment. Results Of the 19 resistant patients, those whose symptoms were greatly or moderately improved by the lotion were 95%, 89% and 89% after 2 weeks, 3 months and 6 months of treatment, respectively. Further, patch testing to petrolatum showed positive reactions in several (six of 19) patients, compared with none of 30 controls with atopic eczema that had responded to topical tacrolimus ointment. Conclusions The tacrolimus lotion had a significant effect on the recalcitrant facial erythema in adult patients with atopic dermatitis who were resistant to tacrolimus ointment. We suggest that one reason for the unresponsiveness to tacrolimus ointment may be because of contact sensitivity to white petrolatum.

Background: Patch testing with dust mite antigens might identify mite-sensitive individuals, particularly those with atopic dermatitis who can benefit from avoidance measures. Currently available dust mite allergens have not been well studied. Objective: To determine the proper dilution of 20% Dermatophagoides pteronyssinus/farinae mix antigen (Chemotechnique, Malmo, Sweden) for use in closed patch testing. Methods: Eighteen nonatopic, healthy control subjects were patch-tested to the 20% concentration, yielding 15 (83%) positive reactions, most showing a decrescendo or persistent pattern suggesting an inordinately high number of false positive reactions. Dilutions of 1.25% to 0.1% in white petrolatum were used in patch testing 8 atopic dermatitis and 11 respiratory atopy patients, and 12 nonatopic controls. Results: Positive reaction rates to the 0.25% and 0.1% concentrations, respectively, were 87.5% and 62.5% for atopic dermatitis, 54% and 18% for respiratory atopy, and 33% and 8% for healthy controls. Using Fisher's exact test, the 0.1% diliution was shown to significantly differentiate rates of positivity among the 3 groups, particularly between atopic dermatitis subjects and healthy controls. Conclusion: We find that a 0.1% dilution of 20% D. pteronyssinus/farinae mix antigen (Chemotechnique) to be useful in identifying mite-allergic individuals with atopic dermatitis.

Background: Adapalene is a naphthoic acid derivative with retinoid activity that is effective in the treatment of mild to moderate acne vulgaris. Objective: This study assessed the cumulative irritation potential of adapalene gel (0.1%) and adapalene cream (0.1%) compared with that of erythromycin (4%)/tretinoin (0.025%) solution, erythromycin (4%)/tretinoin (0.025%) gel, erythromycin (2%)/isotretinoin (0.05%) gel, and white petrolatum (negative control). Methods: This was a single-center, randomized, controlled, investigator-blinded, intraindividual comparison study in healthy subjects with normal skin. The cumulative irritation assay (patch test) was used to assess the potential for irritation (including erythema) of the treatments. Each subject received all study treatments, randomly applied under occlusion (patch), to sites on either side of the midline on the mid-thoracic area of the back. All patches were applied to the same sites throughout the study, unless the degree of reaction to the treatment or adhesive necessitated removal. For 3 weeks, each test material was applied daily, Monday through Friday, for ∼24 hours; the Friday patches were left in place over the weekend for ∼72 hours. Results: All 36 subjects (26 men, 10 women; age, 18–49 years [mean, 30 years]) completed the study. In the course of the study, all subjects had ≥1 application discontinued prematurely on ≥1 site due to intolerance. There were no discontinuations with white petrolatum. All erythromycin/tretinoin gel patches were discontinued at day 10; 35 of 36 erythromycin/isotretinoin gel patches were discontinued at day 9; and 35 of 36 erythromycin/tretinoin solution patches were discontinued at day 11 or day 17. The adapalene products, although slightly more irritating (mean cumulative irritation index, 0.25–1) than white petrolatum, were significantly less irritating than the erythromycin/tretinoin and erythromycin/isotretinoin products ( P Conclusions: Adapalene gel and cream were well tolerated, with possible benefits for compliance. Their low irritation potential should be considered when prescribing a topical retinoid for the treatment of acne vulgaris.

Tacrolimus (FK506) ointment has a good therapeutic effect on atopic dermatitis. The efficacy of Tacrolimus ointment, however, depends on the percutaneous adsorption of tacrolimus. To examine the influence of the ointment base on the percutaneous adsorption of tacrolimus, we performed a quantitative analysis of tacrolimus in the skin using an IMX (microparticle enzyme immunoassay) system. We prepared tacrolimus ointments using five kinds of ointment bases, i.e., Carbopol gel, White Petrolatum, Hydrophilic Ointment, Plastibase and Macrogol ointment. The concentration of tacrolimus in the rat abdominal skin were then determined 14 hours after the topical application of the different ointments to the rat skin by using the IMX system, and the effect of the various ointment bases was thus evaluated. As a result, the amount of tacrolimus in the skin measured 14 hours after topical application was as follows : Carbopol gel >White Petrolatum >Hydrophilic Ointment≅Plastibase > Macrogol ointment.

Ointments are traditionally used in Finland for protection against facial frostbite. Recent epidemiological reports showed unexpectedly, however, that the use of ointments is a statistically considerable risk factor for frostbite of the face and ears. The effects of 4 different emollients on facial temperature were studied in 46 acute cold exposures. The voluntary test persons sat in a cold chamber after emollients were applied thickly on half of the face, while the other half acted as an untreated control. Thermistors and an infrared scanner were used to measure skin temperature of symmetrical areas of the face. The thermal sensations on the corresponding sites were also recorded. Test emollients more often had an objectively cooling than a warming effect on facial skin. However, white petrolatum often produced a subjectively warming skin sensation. "Protective" ointments may cause a false sensation of safety, leading to increased risk of frostbite due to neglect of other protective measures.

background. The speed of wound healing and the duration of erythema are the primary complaints after laser skin resurfacing. Antioxidants have been shown to enhance the healing of wounds by reducing free radical damage. Reepithelialization is also enhanced by the moist environment produced by occlusive dressings. objective. This study was conducted to compare two occlusive agents: white petrolatum and “melting” petrolatum. Another arm of the study evaluated the use of melting petrolatum with and without a triad of topical antioxidants (TTA). results. Plain white petrolatum proved superior to melting petrolatum in time required for reepithelialization as well as in discomfort. Crusting and pain were decreased with white petrolatum but duration of erythema was equivalent. Wound healing was enhanced when TTA was added. Time for reepithelialization, duration of crusting and scabbing, pain, redness, and swelling were decreased when TTA was added to topical therapy. conclusion. TTA compound enhances and hastens wound healing. White petrolatum as a base occlusive vehicle shortens reepithelialization compared with “melting” petrolatum.

Petrolatum rarely causes hypersensitivity reactions. We report a case of a 51-year-old white man with allergic contact dermatitis due to white petrolatum on damaged skin. The patient, who presented with a history of hand dermatitis and intolerance to ointments for years, was patch-tested with white petrolatum on scratched skin. Patch tests with the European Standard series, preservatives, steroids, vehicles, and emulsifiers were also performed. The patch-test reaction to white petrolatum on scratched skin was positive at 48 and 96 hours. All other patch-test results were negative.

Dermatology, A 75-year-old Japanese man with photodistributed erythematous lichen planus like eruptions visited the dermatology clinic of Kobe University in November 1994. He had had an operation for gastric cancer in July 1992, and thereafter he had been taking 600 mg/d of tegafur. In July 1994, he was exposed to the sun for 2 h and the following day noticed an itchy rash in the areas exposed to the sun. He consulted his surgeon and stopped i taking the tegafur In October. Thereafter his eruption gradually improved. A biopsy J specimen taken on the initial visit to our hospital, 22 days after the cessation of tegafur, revealed perivascular collections of mononuclear cells in the upper dermis and slight liquefaction degeneration of the epidermal basal cells with some civatte bodies. Immunofluorescent staining showed no deposits of immunoglobulins or complements. Photosensitivity studies were performed with a bank of 7 fluorescent sunlamps (Toshiba FL20SE) emitting 280–370 nm (nnainly UVB energy, peaKing at 305 nm) and a bank ot 14 fluorescent black lights (Toshiba FL32SBL) emitting 300–420 nm (mainly UVA energy peaking at 365 nm). His minimal erythema doses (MEDs) of 58.5 mJ/cm2 in UVB and of large dose of UVA over 12.6 J/cm2 were in the normal range. Patch tests and two sets of photopatch tests were made with 5% tegafur and 5-fluorouracil (5-FU) in white petrolatum using Finn chambers. One set was exposed to 6.3 J/cm2 of UVA, and a second set to a suberythemal dose of UVB, 40 mJ/cm2, after 24 h of closed patch tests. Twenty four hours after UV irradiation for photopatch tests, and 48 h after the initial patch for patch tests, the reaction was evaluated. No abnormal reactions in patch and photopatch tests were detected. Tegafur was readministered at a dose of 200 mg every eight hours. After a total dose of 2400 mg (day 4), the skin of the back was exposed to UVB (6–120 mJ/cm2) and UVA (2–12.6 J/cm2) two hours after the last oral intake of tegafur. No decrease in MED or any abnormal reaction was observed. After a total of 3600 mg (day 6), a new skin site on the back was exposed to 3 MED of UVB. The next day (day 7, after a total dose of 4200 mg), 3 MED of UVB was irradiated on the same site and 5 MED of UVB was irradiated at a new site. Lastly, after a total dose of 4800 mg (day 8), 3 MED and 5 MED of UVB was again irradiated on the same sites that were irradiated on the previous day, and 10 MED UVB and 21 J/cm2 UVA were irradiated at new individual sites. Eight days after the last irradiation (day 16, after 9600 mg of drug intake) the 10 MED UVB irradiated site revealed miliar-sized papules with a faint red hue after sunburn reaction. Simultaneously, an edematous erythema recurred on the face, neck, upper back, and hands, where the rash had previously been, without exposure to UVB or UVA. These tests were conducted while the patient was hospitalized and he was very careful not to be exposed to the sun, even through glass. The biopsy specimens of 10 MED irradiated sites and the flare-up lesion of his upper back revealed liquefaction degeneration of the epidermal basal cells with civatte bodies. Immunofluorescent staining study showed IgM, IgA, and C4 deposition of the civatte bodies in the flare-up lesion which had not been exposed to any UV irradiation.

Both the pharmaceutical evaluation and clinical utilization of vancomycin ointment have been investigated in the topical treatment of methicillin-resistant staphylococcus aureus (MRSA) infection. An ointment containing 2.5% of vancomycin hydrochloride was prepared using a base consisting of white petrolatum and liquid paraffin. The spreadability was 324 dyn/cm2 at 25±2°C and 65±5% RH. The particle sizes of vancomycin hydrochloride in the ointment were distributed within 10-30μm. Vancomycin hydrochloride was stable for 4 weeks at 5, 20 and 40°C. The ointment was topically applied to the infectious region of a artificial bone graft. The treatment with the vancomycin ointment was found to be effective against MRSA infection. Since no substantial distribution was observed in the blood, the effect was also shown to be regionally restricted. In addition, no appearance of vancomycin resistance after using the ointment has yet been observed in this patient.These above findings thus indicate that vancomycin ointment is effective, useful and safe for the treatment of topical MRSA infection.

A loggerhead sea turtle (Caretta caretta) was suspected of ingesting rubber suction cups during rehabilitation following a cold-stun event. Survey radiographs were inconclusive. Computed tomography (CT) was performed to determine whether the objects had been ingested after traditional radiographs failed to resolve the material. The items were identified, and a partial obstruction was diagnosed. The case was managed with medical therapy using white petrolatum and light mineral oil administered to the turtle in fish for 3 wk. The CT exam was repeated 2 wk into the therapy. A persistent partial obstruction was identified; however, progression of the foreign objects through the intestinal tract was evident and continued medical mangement was deemed appropriate. The foreign bodies were passed with feces 26 days after ingestion.

Ketoprofen (KP) is a potent non-steroidal anti-inflammatory drug which is used for the treatment of rheumatoid arthritis. The oral administration of KP can cause gastric irritation and renal adverse effects. Topical application of the drug can bypass gastrointestinal disturbances and provide relatively consistent drug levels at the site of action. Since the efficacy of an ointment depends on the type of ointment base and the concentration of the drug, four different bases (white petrolatum, cold cream, hydrophilic ointment and Carbopol 940 gel) were used at 1, 3, 5, 7 and 10% concentrations of KP to evaluate the effect of ointment base and concentration. The general rank order of the drug release was found to be: Carbopol gel > hydrophilic ointment > cold cream > white petrolatum. There was a positive correlation between the concentration of KP and release rate for all bases except Carbopol gel. The in vivo percutaneous absorption of KP from different ointment bases at 3% concentration was studied by carrageenan-induced paw edema in mice. The rank order of the percent edema inhibition was as follows: Carbopol gel ≥ hydrophilic ointment > cold cream > white petrolatum. There was a good correlation between the in vitro and in vivo results.

Dithranol (D) is used as a therapeutic topical agent to treat psoriasis, although it produces inflammation and staining of skin and clothing. D-induced irritation has been evaluated by visual scoring and by bioengineering techniques, evidencing modifications of the inflammatory parameters, but no alterations of the skin barrier. The aim of our study was to evaluate the irritant reactions induced by D using ultrasound, and to compare the B-scanning data with visual assessments and colorimetric measurements. 13 healthy women underwent 2, 3-h patch tests with, respectively, 0.02% and 0.1% D in white petrolatum and 1 24-h patch test with 2% sodium lauryl sulfate (SLS). For assessing skin reactions, clinical judgement, colorimetry and echography were employed. Echographic images were evaluated by skin thickness measurements and segmentation procedures, using an 0-30 interval, marking the hyporeflecting areas in the dermis, and a 201-255 interval, assessing the hyperreflecting components of the image (both epidermal and dermal). In all subjects, D produced uniform reactions, the intensity varying according to concentration. Both echographic parameters of inflammation (skin thickness and 0-30 areas) showed an increase at all times of assessment. The 201-255D/0-30 pixel ratio, describing the distribution of dermal edema, indicated that strong inflammatory reactions, such as those caused by the application of 0.1% D, are accompanied by edema in the lower portion of the dermis. Finally, in contrast to SLS reactions, where a 24-h reduction in epidermal reflectivity was observable, D reactions appeared with an accentuation of the 201-255 epidermal band at 24-96-h examinations.

The safety and efficacy of Collagenase ABC® ointment (containing 250 units/g white petrolatum clostridiopeptidase A) in the debridement of stage III pressure sores in 50 patients were examined in a phase II, prospective, open, uncontrolled study. Ulcer size, odour, pus, inflammation and necrosis were assessed prior to study entry and after a maximum of 28 days’ treatment with the ointment, applied twice daily. All the clinical features assessed (odour, pus, inflammation, necrosis) showed progressive and highly statistically significant reductions throughout the treatment period, most notably with respect to the reduction of necrotic tissue present on the wound. The estimated area of the ulcer showed a small but significant reduction in size. All reported adverse events were recorded as being of ‘doubtful’ relationship to the test therapy, except for one case of pain at the wound site, which was classified as ‘possibly’ related. Laboratory investigations (full blood count, serum biochemistry) revealed no signs of toxicity. In the majority of patients, the ointment was considered ‘reasonably easy to apply’ and of ‘good’ acceptability by the nursing staff responsible for the application of the ointment and on patient monitoring.

Chitin is a polymer of D-glucosamine, beta-poly-N-acetyl D-glucosamine. The chitin derivative, 70% deacetylated chitin (DAC-70), shows immunopotentiating activity. DAC-70 ointment 3.5% in a white petrolatum base was used to treat defined areas of four patients with senile exfoliative erythroderma following eczema. The effects of DAC-70 were compared with those of glyteer (0.2% soybean tar ointment) with 0.1% dexamethasone. In all patients erythroderma ceased spreading within 1 to 2 weeks in all treated areas. Thus, topically applied 3.5% DAC-70 may be of similar value to glyteer in the treatment of exfoliative erythroderma following eczema.

Introduction The standard postsurgical treatment of wounds after dermatologic procedures is currently limited. Topical corticosteroids have been used successfully in postoperative management of ophthalmologic surgeries that involve the skin of the eyelid. In particular, tobramycin 0.3%/dexamethasone 0.1% ophthalmic ointment is considered the “gold standard” of steroid-antibiotic fixed combinations and is marketed worldwide as an agent used to control postsurgical inflammation and prevent postsurgical infection. The purpose of this study is to evaluate both the efficacy and safety of tobramycin–dexamethasone ointment for the postsurgical management of Mohs or dermatologic surgery in comparison to white petrolatum. Methods The authors employed a half-scar study in which patients who underwent skin cancer removal surgery were given tobramycin–dexamethasone ointment and white petrolatum to apply to each half of their wound for 2 weeks. The study was double blinded, and physicians and the patients independently evaluated the scars for cosmetic appearance at 2 and 6 weeks postoperatively. The evaluation criteria included judging which side of the wound looked better based on color, thickness, and discomfort. Results Eighteen patients were enrolled, of which 13 patients completed the three phases of the study. After 6 weeks the wounds did not show a statistically significant difference in color, thickness, or discomfort on either side. Conclusion Results obtained to date suggest that the application of tobramycin–dexamethasone ointment to wounds after dermatologic surgery does not promote better wound healing than white petrolatum. These findings indicate that a topical steroid and antibiotic ointment may not be an effective intervention in improving postoperative outcomes in dermatologic surgeries.

30 patients were treated with daily application of calcitriol (1 alpha, 25-dihydroxyvitamin D3) ointment 15 micrograms/g in white petrolatum. The patients were divided into three groups according to the size of their total area of psoriasis. They were treated for 6 weeks, and investigated first with weekly and then with two-weekly estimations of calcium metabolism (serum calcium, 24-hour urinary calcium, parathyroid hormone, 25-hydroxyvitamin D3 and calcitriol). Ninety percent of the patients cleared or improved and there were no significant side effects or local intolerance. Cosmetic acceptance was good. No clinically significant changes in calcium metabolism were observed in spite of calcitriol application ranging between 73.98 and 306.10 micrograms daily (normal daily synthesis being 1-2 micrograms).

Objective:The authors discuss a case of conjunctival irritation and epiphora in a patient who had undergone dacryocystorhinostomy three years earlier.Method:Case report, and a review of the world literature concerning lacrimal canalicular air regurgitation after dacryocystorhinostomy.Results:A 70-year-old woman, who used continuous positive airway pressure therapy during sleep, complained of epiphora and conjunctival irritation. She had undergone dacryocystorhinostomy three years earlier. Her right eye had an augmented tear meniscus, with a predominantly medial conjunctival irritation. Conjunctival irritation from lacrimal canalicular air regurgitation was diagnosed. White petrolatum and mineral oil ophthalmic ointment was prescribed, applied topically before sleeping. After one month of treatment, complete relief of symptoms was obtained.Conclusion:There is little current information on managing such patients. It is imperative to discuss this potential complication when considering nasolacrimal surgery in patients using continuous positive airway pressure therapy.

We report the case of a 41-year-old female showing severe hair loss approximately 90% after the use of a hair dye. These symptoms developed six days after the use of a hair dye containing PPD. A patch test showed a (++) reaction at 48 h to 1% PPD in petrolatum, whereas all metals and white petrolatum were negative. She was therefore diagnosed with contact dermatitis due to PPD, resulting in hair loss. The skin lesions gradually improved after starting treatment with the systemic corticosteroids. The possibility that allergic contact dermatitis from hair dyes may be responsible for telogen effluvium should always be considered in a patient with increased hair loss.