[TREATMENT OF LICHENOID DERMATOSES WITH OCCLUSIVE FOIL DRESSINGS].
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Adrenal Cortex Hormones↗
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Results for “OCCLUSIVE DRESSINGS”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Comparison of the effects of semi-occlusive polyurethane dressings and hydrocolloid dressing on dermal repair: 1. Cellular changes.
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Animals↗
[The search for an "ideal" surgical dressing].
Trials of a new occlusive dressing, Op-site (Smith Nephew), were conducted on a group of patients. Op-site is a fine, transparent, elastic, self-adhesive polyurethan film. Although non-porous and therefore water- and bacteria-proof, it is permeable to gases. The existing dressings fulfil only a few of the criteria of an "ideal" dressing and in some cases actually interfere with the healthy process. The main disadvantages are: the disturbance of newly formed epithelium, when many dressings are removed, their fibres become embedded in the new tissues and cause inflammation and delayed healing. Few dressings are true bacterial barriers and the hazard of infection of the wound is always present. Recent studies of the mechanism of wound healing have indicated that a moist, not dry surrounding provides the optimum conditions for wound repair. Healing under Op-site is said to be quicker because the serous exudate permits unhindered migration of new cells across the wound bed and prevents cellular dehydration. In contrast, under dry conditions healing is delayed because the new skin cells must first cleave a path through dehydrated dermis before migrating across the wound. The Op-site wound dressing can be readily applied over the joints and allows complete freedom of movement. The skin remains dry and the wound moist, providing the ideal environment for rapid healing. The film does not adhere to the moist wound and can therefore be removed without damage to the newly formed epidermis. The adhesive is low allergic. Finally, the wound can be assessed without removing the transparent Op-site.(ABSTRACT TRUNCATED AT 250 WORDS)
Amputation, Surgical↗
Chemical peel: a change in the routine.
The use of occlusive taping following phenol chemical peel has become a standard technique. Many studies have demonstrated the effectiveness of tape occlusion in producing a deeper, more profound chemical peel. For the last 18 months, we have abandoned tape occlusion following phenol peel and have substituted an occlusive dressing using a thick layer of petroleum jelly (Vaseline). The occlusiveness provided by the petroleum jelly has proved to be almost as effective as the standard tape mask, and the results using this technique parallel those with a tape mask. The advantages of Vaseline occlusive dressing include greater patient comfort, the ability to evaluate the wound beneath the petroleum jelly, and the prevention of streaking, which can occur from uneven tape application. Eschar formation and crust separation are avoided after the peel by the constant use of facial lubricants, our preference being A & D ointment.
Chemexfoliation↗
Dressing the part.
Wound care after cutaneous surgery can play an integral role in wound healing. Wound care regimens have changed dramatically over the last 35 years as the physiology of wound healing has become better understood. Foremost is the improvement in wound healing achieved by keeping the wound occluded and moist. This observation has led to an explosion of a whole new category of occlusive dressings at the surgeon's disposal in healing postoperative wounds. These dressings have numerous applications as discussed previously. Generally, for acute surgical wounds, occlusive dressings are most useful for split-thickness wounds, such as graft donor sites and after dermabrasion, chemical peel, or laser treatment, and full-thickness wounds allowed to heal by secondary intention. Occlusive dressings may have greater benefit for the treatment of chronic ulcers of varying etiologies. The different categories of dressings share the common disadvantage of being relatively expensive. For routine sutured wounds, the authors prefer the readily available and inexpensive Telfa-type dressing combined with a topical antibiotic ointment. Topical antiseptics are useful for reducing bacterial counts on intact skin in preparation for surgery. Povidone-iodine (Betadine) and chlorhexidine gluconate (Hibiclens) have emerged as the two agents of choice. However, antiseptics have been shown to be toxic to healing tissue, and should not be used on open wounds. In contrast, topical antibiotic ointments are safe to use on open wounds, effective in preventing wound infections, and promote wound healing by maintaining a moist wound environment. The authors prefer the combination antibiotic ointment Polysporin for routine postoperative wound care. Antibiotic prophylaxis in dermatologic surgery to prevent wound infection is appropriate in certain cases. Surgery performed on grossly contaminated or infected skin requires a full 7 to 10 day course of antibiotics. Procedures in anatomic areas considered contaminated as well as in clean areas with significant environmental or patient risk factors may benefit from antibiotic prophylaxis. The choice of antibiotics should be based on the organism most likely to cause wound infection at the particular surgical site. Evidence supports giving a single preoperative dose 1 hour before surgery with a second dose possible 6 hours later if the procedure is prolonged or delayed. The risk of bacterial endocarditis after dermatologic surgery is not known. Antibiotics are indicated for any procedure on obviously infected skin, but are not routinely required for very minor procedures, such as small biopsies, on intact skin. Antibiotic prophylaxis may be prudent for those patients classified as high risk by the (AHA). The antibiotic chosen should again cover the organism most likely to cause infection. One dose can be given 1 hour before surgery and repeated 6 hours postoperatively. Finally, wound healing can be greatly impacted by what the patient does or does not do after leaving the office. Therefore, wound care instructions should be clear, detailed, and provided in both oral and written form. Information should also be provided about what to expect as the wound heals.
Antibiotic Prophylaxis↗
Cromolyn sodium in 2% aqueous solution under an occlusive hydrocolloid dressing may be effective adjunctive treatment in management of pyoderma gangrenosum.
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Aged↗
Report of a multicenter clinical trial of the performance characteristics of two occlusive hydrocolloid dressings in the treatment of noninfected partial-thickness wounds.
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Clinical Trials as Topic↗
A new primary wound dressing made of polyethylene oxide gel.
Vigilon is a new primary wound dressing consisting of 96% water and polyethylene oxide. This moisture-containing, occlusive dressing absorbs its own weight in wound exudate and allows free transfer of oxygen. It is non-adherent and appears to promote better wound healing than that reported by other occlusive dressings, making it an ideal dressing for a wide variety of dermatologic surgery.
Dermabrasion↗
Clinical evaluation of a new occlusive hydrocolloid dressing.
Eighteen patients with a total of twenty-four dermal ulcers of varying causes and unresponsive to other conservative treatment were treated with a new hydrocolloid dressing. All lesions healed in less time than with other modalities. This hydrocolloid dressing is more effective than others presently available for the treatment of noninfected dermal ulcers.
Aged↗
Effective use of occlusive wound dressings.
The ever-growing range of new wound care products are designed to promote healing and prevent infection. However, nurses must be sure they read manufacturers' guidelines, or they may be doing more harm than good.
Adult↗
Effects of occlusive and semiocclusive dressings on the return of barrier function to transepidermal water loss in standardized human wounds.
Clinical observation and histologic examination of excised wounds have confirmed that occlusive dressings promote rapid wound reepithelialization. However, normalization of barrier function has not been routinely assessed in studies of occlusive dressing effects on wound healing. We examined the effects of occlusive dressings on the reestablishment of the cutaneous barrier to transepidermal water loss (TEWL) after standardized skin wounds were produced in human subjects. We confirmed previous observations that occlusive dressings augment reepithelialization. No significant improvement in the rate of reestablishment of the barrier to TEWL was measured between the covered test or uncovered control sites in each subject, however. TEWL declined in an exponential fashion after wounding. Measurements of TEWL were over twice that of adjacent normal skin when epithelialization was judged to be overtly complete and did not return to normal until 4 weeks after wounds were produced.
Adult↗
Determination of diclofenac in plasma and urine by capillary gas chromatography-mass spectrometry with possible simultaneous determination of deuterium-labelled diclofenac.
A specific and sensitive method for the determination of diclofenac at concentrations down to ca. 1 ng/ml, the limit of detection being 100 pg/ml, in human plasma and urine by gas chromatography-mass spectrometry with 2H4-labelled diclofenac as internal standard is described. The method is also suitable for the simultaneous assay of these two compounds when both are present in samples of human plasma or urine. In this case, 5-chlorodiclofenac is used as internal standard. After toluene extraction from plasma or without extraction for urine, the method involves the formation of a dimethylindolinone derivative by extractive alkylation. The technique was applied to determine low plasma concentrations and urinary excretion of labelled and unlabelled diclofenac after percutaneous applications of Voltaren Emulgel to humans applied simultaneously under occlusive dressing as deuterated diclofenac sodium, and without occlusive dressing as unlabelled diclofenac sodium.
Deuterium↗
A study to compare the overall performance of two hydrocolloid dressings on partial thickness wounds.
This study was conducted to compare the overall performance of a test dressing (RestoreTM Wound Care Dressing, Hollister Incorporated), because it is newer to the market, to a control dressing (Duoderm, Convatec, A Squibb Company) a product that is more established in the market. The study was random, unblinded, controlled and utilized a sample of subjects with non-infected dermal ulcers and partial-thickness wounds. Compared to the control dressing, the test dressing was more absorbent, easier to use and wore twice as long. This dressing was also more flexible, conformable, adhesive and durable. Significantly less barrier residue remained on the wound bed and/or periwound area with the test dressing, and significantly more wounds were evaluated as healed or improved. The clinical data strongly established the superior performance of the test dressing over the control occlusive dressing.
Equipment Design↗
Complications of laser resurfacing. Methods of prevention and management.
BACKGROUND: Modern skin resurfacing began with wire brush surgery. The short-pulse carbon dioxide (CO2) lasers provide an alternative approach for facial rejuvenation. However, the potential for the same complications exist. OBJECTIVES: To review the more common complications, the reasons for their development, and their possible avoidance. METHODS: After pre-op evaluation and skin conditioning, a protocol for resurfacing was followed with standardized settings on the Ultrapulse CO2 laser. On the glabrous skin 300 mJ of energy and 60 W of power were used. On the eyelid skin the settings were reduced to 250 mJ and 50 W. After three passes with the Computer Pattern Generator (CPG), a semi-occlusive dressing was applied for the first 5 days after surgery. Then, a bland petrolatum ointment was applied for an additional 5 days. Finally, a moisturizer with sunscreen or a bleaching cream was used. RESULTS: It was possible at these energy fluences to avoid excessive collagen denaturation and to facilitate wound healing with occlusive dressing. However, complications still occurred. Examples of these are presented in detail. CONCLUSION: Complications can be minimized with patient education, using optimal laser settings, applying occlusive dressings, and recognizing pending problems early.
Adult↗
A review of the etiology and treatment of skin ulcers with wound dressings: comparison of the effects of occlusive and nonocclusive dressings.
This article reviews the etiology and treatment of skin ulceration caused by external pressure, vascular insufficiency, and diabetes. In the case of pressure sores, compression of skin against bone may cause ischemic injury to underlying fat and muscle that precedes necrosis of dermis and epidermis. Venous and arterial insufficiency lead to leg ulcers as a result of incompetency of the valves in the veins connecting the superficial to the deep venous systems and atherosclerosis, respectively. Diabetics are susceptible to foot ulcers because of atherosclerosis and the resulting occlusive arterial disease and peripheral neuropathy. Once the underlying medical condition is solved, occlusive and nonocclusive wound dressings can be used in an attempt to promote healing. A review of the literature of animal and clinical studies suggests that both occlusive and nonocclusive wound dressings promote healing compared with air-exposed wounds. Dressings that absorb wound fluid offer some advantages over those that do not absorb large quantities of fluid in heavily exudative wounds and may require less frequent dressing changes. However, the chemistry of the material that comprises the wound dressing seems unimportant unless the material is biologically active. It is likely that the next generation of wound dressings will be composed of a moisture-retaining material coupled with material that has biological activity.
Animals↗
Opposing effects of glycerol on the protective function of the horny layer against irritants and on the penetration of hexyl nicotinate.
BACKGROUND: It is known that glycerol in an oil-in-water emulsion has a protective effect against irritating substances. OBJECTIVE: To answer the question: is the protection effect of glycerol based on a regenerative process? METHODS: Upon irritation by either tape stripping or acetone treatment, we applied glycerol to the skin surface under an occlusive dressing to create transepidermal water movement. As a control we used water under the occlusive dressing on the contralateral forearm. After 5 h we compared the barrier function using biological tests. RESULTS: A significant improvement of the protective barrier function was observed in the glycerol-treated areas, as shown by the alkali resistance and by the irritant effect of dimethyl sulfoxide (DMSO) as well as sodium lauryl sulfate. Surprisingly, at the same time penetration of hexyl nicotinate improved on the glycerol-treated areas. A direct physicochemical protection effect on the surface of the skin was ruled out in additional studies using NaOH and DMSO. CONCLUSIONS: Under the given conditions glycerol leads to a more rapid reconstitution of the protective skin barrier and initiates a regenerative skin protection. In contrast to that, it is acting as a penetration enhancer.
Adult↗
Management of toenail onychomycosis with 2% butenafine and 20% urea cream: a placebo-controlled, double-blind study.
Onychomycosis is an increasingly common and recalcitrant fungal nail infection world-wide. The purpose of this placebo-controlled, double-blind study was to determine the clinical efficacy, chemical avulsion, and tolerability of 2% butenafine hydrochloride and 20% urea incorporated in a cream to cure toenail onychomycosis in a preselected population. Sixty patients (38M, 22F), ranging between 18 and 60 years (mean 27.4), with more than 25% involvement of the big toenail were enrolled in the study. The diagnosis of onychomycosis was established by mycologic identification and reconfirmed by positive fungal culture. A precoded 25-g tube was randomly assigned to each patient (50 active and 10 placebo) with instructions to apply the trial medication to their infected toenail twice daily with an occlusive dressing for one week. The affected nail was removed with a nail clipper. No occlusive dressing was maintained after the initial one week regimen. To assess the chemical avulsion of the infected toenail, mycologic cure, clinical effectiveness of the treatment, and overall success, patients were examined twice a week for 16 weeks and thereafter on a weekly basis for a further 36 weeks. The treatment was well tolerated by all the patients throughout the study, with no dropouts. Marked improvement was seen in 73.3% patients after weeks 8, 16 and 24 with clinically and mycologically confirmed negative fungal culture. Code disclosure revealed that active butenafine and urea cream cured significantly more patients than placebo (88% versus 0%; p < 0.0001). Of the 60 patients 91.6% reported no drug-related adverse symptoms. Five patients reported non-objective mild inflammation without discontinuation of the treatment. During one year follow-up of the study phase, none of the cured patients had a relapse. In conclusion, the mycologic and overall assessment of this study demonstrate that 2% butenafine HCl and 20% urea incorporated in a cream for keratinolysis is safe to use and significantly more effective than placebo in curing big toenail onychomycosis.
Administration, Cutaneous↗
Hydration, not silicone, modulates the effects of keratinocytes on fibroblasts.
Topical silicone gel or silicone cream with occlusive dressing has proved to be an efficacious method for the treatment and prevention of hypertrophic scars and keloids, but how this action is triggered remains unknown. Hydration of the epidermis and/or the cellular effects of the released low-molecular-weight silicone oil have been suggested as possible mechanisms. In order to further elucidate the mechanism, we used an in vitro keratinocyte-fibroblast coculture model to investigate the cellular effects of silicone and hydration. In this model, the condition of clinical usage of topical silicone gel or cream or the condition of hydration exerted by occlusive dressing could be mimicked. The model consisted of two chambers separated by a semipermeable membrane, in which a fully differentiated stratified epithelium is present in the upper chamber and medium and monolayer fibroblasts are located in the lower chamber. The keratinocytes were nourished from the basal side only, while the apical surface was submerged in silicone oil, paraffin, Hanks' balanced salt solution, or medium (hydration); or it was exposed to air (control). In the hydration-treated group, the proliferation of fibroblasts measured as [3H]thymidine incorporation and their collagen, glycosaminoglycan production was significantly inhibited when compared with the controls, but exposure of the keratinocyters to silicone oil or paraffin did not influence fibroblast behavior. The results suggest that hydration, not silicone, modulates the in vitro keratinocyte-fibroblast interaction. This may be one possible mechanism by which topical silicone or occlusive dressing treatment may affect the development of hypertrophic scars and keloids.
Cell Division↗