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PubMedDate not supplied

Accelerated healing and reduced need for grafting in pediatric patients with burns treated with arginine-glycine-aspartic acid peptide matrix. RGD Study Group.

Arginine-glycine-aspartic acid (RGD) peptide matrix is designed to promote dermal healing by providing a molecular scaffold that facilitates cell ingrowth and establishment of normal tissue architecture. This study investigated the effectiveness and safety of RGD peptide matrix in the treatment of partial-thickness scald burns in pediatric patients. Either topical RGD peptide matrix or control treatment with silver sulfadiazine was applied to matched burn sites daily for up to 21 days. With RGD peptide matrix application under synthetic occlusive dressing, the incidence of healing was nearly threefold higher, average time to healing 2.5 days shorter (regression estimation), extent burn closure at all treated sites 37% greater, and number of needed grafting procedures fourfold lower compared with control treatment. All these differences were statistically significant. RGD peptide matrix was well tolerated. RGD peptide matrix promoted and accelerated healing in this study and thus may be able to reduce morbidity and treatment costs of partial-thickness burns in pediatric patients.

Administration, Topical↗

PubMed1979

Disrupted desmosomes in induced lesions of familial benign chronic pemphigus.

An occlusive dressing was applied to the unaffected skin of the back of a patient with familial benign chronic pemphigus (FBCP). Small lesions of FBCP appeared after 48 h, and the ultrastructure of successive biopsies was studied. It was concluded that: (a) the initial phenomenon in FBCP is the result of an insufficiency of cellular adhesion. This confirms several previous reports. (b) desmosomes are separated in two halves, invaginated in vacuoles and later deeply included in the cell. The particular fate of these disrupted desmosomes has already been observed after the action of several enzymes on the epidermis and in Darier's disease.

Acantholysis↗

PubMed2000

Cutaneous aspergillosis and acquired immunodeficiency syndrome.

BACKGROUND: Primary cutaneous aspergillosis is an uncommon finding in patients with acquired immunodeficiency syndrome (AIDS); only 13 cases have been reported in the literature. OBSERVATIONS: We describe 11 patients with primary cutaneous aspergillosis and AIDS. There does not seem to be an age, sex, race, or human immunodeficiency virus risk factor predisposition. This is a late manifestation of AIDS; patients typically have low CD4 counts (<0.050 x 10(9)/L [<50/microL]) and other AIDS-defining illnesses. The most frequent presentation is in patients with cytomegalovirus disease and neutropenia caused by ganciclovir therapy. Lesions developed at the site of occlusive dressings for an indwelling intravenous catheter site in 10 patients. Neutrophil counts may be normal at the time of diagnosis. A minor presentation is in the patient without neutropenia as a result of traumatic inoculation. Histological findings and/or culture results are required for diagnosis. Patients develop cutaneous lesions despite prophylactic therapy with fluconazole. Lesions can be treated with excision and lifelong therapy with itraconazole. CONCLUSION: Because of the potential morbidity and mortality of cutaneous aspergillosis, a high level of suspicion and prompt institution of therapy is required.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Comparative evaluation of aloe vera in the management of burn wounds in guinea pigs.

An experimental study was designed using Hartley guinea pigs, who received full-thickness burns covering 3 percent of their body surface area by direct contact with a hot plate. A total of 40 animals were equally divided among four modalities of closed burn wound management as follows: group I: silver sulfadiazine (Silvadine); group II: aloe vera gel extract (Carrington Dermal Wound Gel); group III: salicylic acid cream (aspirin); and group IV: plain gauze occlusive dressing only. The dressings were changed daily, and the size and appearance of each burn wound were recorded until complete healing. On the sixth postburn day, quantitative burn wound cultures were made. The average time to complete healing in the control group was 50 days, and the only significant difference was found in the aloe vera-treated animals, which healed on an average of 30 days (p less than 0.02). Wound bacterial counts were effectively decreased by silver sulfadiazine (p = 0.015) and by aloe vera extract (p = 0.015). From our data it appears that aloe gel extracts permit a faster healing of burn wounds.

Administration, Topical↗

PubMedDate not supplied

A comparison of three wound dressings in patients undergoing heart surgery.

Two hundred fifty patients undergoing heart surgery were randomized in a prospective comparative study of a semiocclusive hydroactive wound dressing, an occlusive hydrocolloid dressing, and a conventional absorbent dressing. The wounds were evaluated during the 4 weeks after surgery. Color photographs were used for a blind evaluation of wound healing. The conventional absorbent dressing was more effective in wound healing, compared with the hydroactive dressing. Further, there were fewer skin changes and less redness in the wounds with the conventional dressing than with the hydroactive dressing; the differences were not significant with the hydrocolloid dressing. The conventional dressing was less painful to remove than the hydroactive and hydrocolloid dressings. More frequent dressing changes, however, were needed when using the conventional dressing. Despite this, it was the least expensive alternative.

Absorption↗

PubMed1983

Topically administered fluorouracil in vitiligo.

In 28 patients with vitiligo, 5% fluorouracil cream was applied daily to vitiliginous lesions under occlusive dressings, following an epidermal abrasion on the first day. The treated lesions became completely eroded after seven to nine days of treatment at which time treatment was stopped. Epithelialization then occurred within ten days. Repigmentation first began one to two weeks after epithelialization and occurred in all the treated lesions within two months. Eighteen (64%) of the 28 patients showed complete or almost complete repigmentation in all treated spots and five patients (18%) showed partial repigmentation. The remaining five patients (18%), including two patients with segmental vitiligo, showed no response. Of 23 patients who showed complete or partial repigmentation, three patients had recurrence of vitiligo within one year. No systemic toxicity was observed in this series of patients.

Administration, Topical↗

PubMed1999

Clobetasol under hydrocolloid occlusion in psoriasis results in a complete block of proliferation and in a rebound of lesions following discontinuation.

BACKGROUND: It is a well-established fact that very potent corticosteroids are highly effective in the treatment of psoriatic plaques, and that the addition of a hydrocolloid occlusive dressing (HCD) enhances its efficacy. It is known that topical steroids induce normal differentiation and diminish hyperproliferation during treatment of psoriatic plaques. These changes are reflected by an increase in keratin 10 (K10) and a decrease in keratin 6 (K6), respectively. However, the influence of class IV corticosteroids under HCD on K10 and K6 subpopulations has never been studied. OBJECTIVE: The present study was performed to study quantitatively the influence of a class IV topical steroid under HCD on the dynamics of K10 and K6 subpopulations. METHODS: In the present study, we treated moderately severe stable psoriatic plaques with clobetasol-17-propionate under HCD until clearance was achieved. We took biopsies prior to treatment, after clearance and at relapse. Using flow cytometry, we studied the dynamics of K10 and K6 subpopulations. RESULTS: Prior to treatment, 41.8% of all cells expressed K6. After treatment-induced clearance, this proportion decreased to 1.2%, which is below the normal range. At relapse, pre-treatment levels were observed again. A trend to an increasing number of basal cells and an increase in the proliferative activity of these basal cells at relapse compared to the stable situation prior to treatment was observed. CONCLUSION: We conclude that clobetasol under hydrocolloid occlusion induces virtually a total block of proliferation of the basal cell population and decreases hyperproliferation-associated keratins dramatically. Furthermore, based upon epidermal cell characteristics, we conclude that a rebound phenomenon occurs following discontinuation of therapy with clobetasol under hydrocolloid occlusion.

Administration, Topical↗

PubMed1994

Placebo effect of eutectic mixture of lidocaine and prilocaine (EMLA) cream in reducing venepuncture pain in children.

A randomized double-blind study was made of 60 children aged 5 to 11 years to assess the efficacy of a eutectic mixture of local anaesthetics (EMLA), lidocaine and prilocaine, and placebo cream in reducing venepuncture pain. The 5% EMLA or placebo cream, approximately 2 grams (2 ml), was applied to the anticipated venepuncture site and covered with an occlusive dressing for a least 60 minutes. The venepuncture of 20-gauge butterfly needle was done after wiping the skin dry and observing for any local reactions. The pain was evaluated by three methods, one by the investigator and the other two by the children. The results showed that there were no statistical differences in the subject characteristics and pain scores, between the EMLA and the placebo group. Most children in both groups experienced no pain to mild pain from venepuncture. The possible causes were discussed and it was concluded that the placebo effect of having cream and good doctor-children rapport reduced fear and anxiety, resulting in the reduction of venepuncture pain in children.

Anesthesiology↗

PubMed1993

Cryosurgery and topical fluorouracil: a treatment method for widespread basal cell epithelioma in basal cell nevus syndrome.

A 58-year-old man with basal cell nevus syndrome had variously sized basal cell epitheliomas (BCEs), mostly of the superficial type, on his chest, back, and lumbar areas. BCEs on the lumbar area were treated with 5-fluorouracil (5-FU) cream which was applied daily under occlusive dressings (ODT). Complete erosion occurred in the center, but not at the periphery of the lesions. In the latter regions, BCE remained. Then cryosurgery (cryo) followed by topical 5-FU (cryo + 5-FU) was tried to treat the peripheral, non-eroded lesions; this caused complete erosions. Biopsy specimens obtained 6 months after epithelization did not show any evidence of recurrence. We also tried either cryo alone or cryo + 5-FU on the chest lesions, and either 5-FU alone or cryo + 5-FU on the abdominal lesions. Cryo alone or 5-FU alone could not clear BCE, but cryo + 5-FU could. These results suggest that the cryo + 5-FU was the most effective of these therapies.

Administration, Topical↗

PubMed2000

Bacterial contamination of bath-water from spinal cord lesioned patients with pressure ulcers exercising in the water.

AIM: To evaluate the bacterial contamination of the water from the microflora of pressure ulcers in para- and tetraplegic patients, when they were exercising in water at 36 degrees C for half an hour. MATERIAL: Twelve spinal cord lesioned (SCL) patients with ulcers participated, and six of the 12 SCL patients with healed ulcers constituted a control group. METHODS: The evaluation was performed both with and without the ulcer covered with a moisture reactive occlusive dressing, DuoDERM. Bacterial samples were taken from the bath-water before and after the exercise programmes and additionally specimens were obtained from the ulcer, the patients skin and urine, and from the skin of the physiotherapist who exercised the patient. A similar procedure was carried out in the controls. RESULTS: The bacteriologic analyses showed no significant difference in the contamination of the bath-water after exercising with or without DuoDERM covering the ulcers. In half of the patients DuoDERM loosened. After all exercise programmes with or without DuoDERM dressing the water was contaminated with facultative aerobic intestinal bacteria, ie E. faecalis and Enterobacteriaceae (E. coli, Klebsiella species, Proteus species, Enterobacter species). In nearly one-third of the exercise sessions the bath-water was contaminated with P. aeruginosa before starting, and after the exercise programmes one fourth of the ulcers were colonized with these pathogens. CONCLUSION: The water specimen showed the bacteria from the intestine to be much more prominent than the bacteria coming from the ulcers. Thus the pressure ulcers were of minor importance for the bath-water and ought not to prohibit patients from the potential benefits of water exercise, but chlorination of the water in the training pool seems appropriate.

Adult↗

PubMedDate not supplied

Effects of chronic wound fluid on the bioactivity of platelet-derived growth factor in serum-free medium and its direct effect on fibroblast growth.

The fate of biologically active proteins applied to chronic wounds is almost totally unknown. Growth factors may be degraded by proteases, which are produced by both inflammatory and skin cells and by resident bacteria. However, there has been little work on the effect of chronic wound fluid on the activity of growth factors. A bioassay method has been chosen to examine the effect of incubation of platelet-derived growth factor with chronic wound fluid from leg ulcers on the in vitro growth of human dermal fibroblasts. Human dermal fibroblasts were cultured in serum-free medium, and a dose-response curve for proliferation in response to platelet-derived growth factor was obtained. Wound fluid was collected under occlusive dressings from five patients with chronic leg ulcers. Platelet-derived growth factor was incubated with chronic wound fluid at 37 degrees C for 4 hours, and the reactions arrested by snap freezing. The resultant solutions were tested for their ability to promote fibroblast proliferation. A colorimetric assay was used to monitor changes in the platelet-derived growth factor mitogenicity. The results showed that, in our standard culture conditions, chronic wound fluid always stimulated fibroblast proliferation, and, in most cases, incubation of platelet-derived growth factor with chronic wound fluid increased the stimulation compared with that produced by platelet-derived growth factor or chronic wound fluid alone.

Aged↗

PubMed1975

Effect of polysorbate 85 on human skin.

Ten percent polysorbate 85, a nonionic surfactant, was applied on the upper arm of 15 healthy individuals under occlusive dressing daily for 4 days. The other arm was similarly treated with the ointment base (white petrolatum USP) to provide the control area. At the end of treatment, macroscopic observations indicated minor erythema in 11 cases and no visible changes were noted on the surfactant-treated areas of 4 persons or any of the control areas. No definite histologic changes were observed by microscopic evaluations. The results of biochemical assays, however, were more definitive. The content of the epidermal phospholipids was elevated within a range of 5 to 65 percent as a result of the treatment with polysorbate 85 preparation. Radioactive tracer studies indicated higher rates of 32P incorporation into epidermal phospholipids, TCA-soluble, DNA and RNA fractions of the surfactant-treated skin. Results resemble those that were documented in earlier studies with rabbit skin.

Adult↗

PubMedDate not supplied

Sequential excision and grafting of the burn injuries of 1507 patients treated between 1967 and 1986: end results and the determinants of death.

The development of a more aggressive approach to burn wound management, leading to complete excision within 72 hours after burn, has led some to conclude that total early excision is a major force behind improved survival rates. We have summarized the results of treatment of 1507 patients with burn injuries treated between 1967 and 1986. Wounds were managed with use of standard topical therapy, occlusive dressings, and staged excision and grafting of full-thickness injury or deep dermal injury (not healed by 21 days). Data were analyzed with use of a logistic-regression model because, with the exception of older patient cohorts, the data did not fit the probit model. The major determinants predicting death were the percentage of body surface area burned, age, smoke inhalation, and the percentage of full-thickness burn. Concordance was 97%. These data show that aggressive sequential wound excision and grafting produces end results comparable with those achieved with complete early burn wound excision for similar age ranges and injury. Early harvest of available donor sites in patients with large burns may be more important to survival than complete early wound excision.

Adolescent↗

PubMed2003

Oral ivermectin treatment in two cases of scabies: effective in crusted scabies induced by corticosteroid but ineffective in nail scabies.

We report two cases of scabies treated with oral ivermectin (200 micro g/kg). Case 1, a 72-year-old man, developed crusted scabies with the use of oral corticosteroids due to a misdiagnosis by an earlier physician. The patient was successfully treated with two doses of oral ivermectin at a 7 day interval with concomitant topical use of crotamiton and keratolytic agents. However, the nail scabies in this patient failed to respond to these treatments. Live mites were detected from all his toenails two weeks after the second dose of ivermectin. A complete cure of the nail scabies was achieved by occlusive dressing of 1% gamma-BHC on all toenails for one month. Case 2, a 52-year-old woman, had been treated with oral corticosteroid for mesangial nephritis. She developed common scabies, but a topical scabicide, crotamiton, was not effective. Two weeks after treatment with a single dose of oral ivermectin, eggs were still detected from a burrow on her trunk. Her treatment was completed after a further two doses of oral ivermectin were administered at 7 day intervals. In both patients, the administration of oral ivermectin did not induce any clinical or laboratory side effects. Oral ivermectin is effective for crusted scabies, but not effective for nail scabies. Two doses of oral ivermectin, administered with a one-week interval, is an appropriate treatment regimen.

Administration, Cutaneous↗

PubMed1983

Management of spontaneous umbilical hernia disruption in the cirrhotic patient.

Umbilical hernia is a common finding in cirrhotic patients with ascites. Spontaneous disruption of the hernia and attendant discharge of ascitic fluid is an unusual and rarely reported complication in these patients and is associated with an overall mortality rate of nearly 30%. During the 5-year period 1977-1982, nine patients with hepatic cirrhosis and ascites were treated for spontaneous rupture of an umbilical hernia. Ascites was attributed to alcoholic cirrhosis in all cases and was present for an average of 21 months prior to rupture. In two cases, failed peritoneovenous shunts resulted in reaccumulation of massive ascites. Initial management included sterile occlusive dressings, fluid repletion, and intravenous antibiotic administration. Hernia repair was performed an average of 4.2 days after rupture. General anesthesia was used in eight cases and local anesthesia in one case. In one instance, the hernia became incarcerated and required urgent repair. Postoperative complications, including wound infection and colonic dilatation, occurred separately in two patients (22%). One patient died of hepatic failure 28 days after operation, for an overall mortality rate of 11%. Surviving patients have been followed for an average of 8 months, and most have done well. Spontaneous rupture of umbilical hernia in patients with ascites occurs uncommonly. Operative management is indicated uniformly and can be conducted safely when the patient's condition has stabilized. The prognosis is favorable for patients with good hepatic reserve.

Adult↗

PubMed1998

Topical D-myo-inositol-1,2,6-trisphosphate and hexylbetaine treatment reduces albumin extravasation in experimental rat skin burn injury.

The anti-inflammatory agent D-myo-inositol-1,2,6-trisphosphate (1,2,6-IP3) has shown beneficial effects in experimental burns following systemic administration. The purpose of this study was to investigate the effect of topical 1,2,6-IP3 cream on a standardised full-thickness 1 cm2 burn injury in rats. The experimental cream contained a transcutaneous absorption enhancer, hexylbetaine. Five different treatment groups were used. Two experimental groups of burned rats received either 1,2,6-IP3 cream with hexylbetaine (n = 10) or without hexylbetaine (n = 10). Two burned control groups were treated either with hexylbetaine cream (n = 10) or placebo cream (n = 10), while a third control group was untreated (n = 14). The various creams (0.5 g) were administered to the experimental burn area and allowed to remain for 3 h covered with an occlusive dressing. Spectrophotometrical quantification of Evans blue albumin extravasation was used to evaluate the effect of the experimental creams on vascular permeability following the burn trauma. Results showed a significant reduction of albumin extravasation both by 1,2,6-IP3 (p<0.05) and by hexylbetaine alone (p<0.01), as compared to placebo cream-treated animals. The transcutaneous absorption enhancer hexylbetaine did not further improve the effect of 1,2,6-IP3 on burn oedema. In conclusion, both topical 1,2,6-IP3 and hexylbetaine induced a significant reduction of albumin extravasation in burned skin. The effect of 1,2,6-IP3 could be related to previously shown anti-inflammatory actions of the agent, while the mechanisms of actions of hexylbetaine remain to be investigated.

Administration, Topical↗

PubMed1989

In vivo assessment of percutaneous local anaesthetic preparations.

This study has demonstrated greater efficacy of a new percutaneous amethocaine preparation relative to Eutectic Mixture of Local Anaesthetics (EMLA). Initially, a double-blinded trial was undertaken on each preparation individually against placebo, as the recommended method of application was different for EMLA (2.5 g applied for 60 min under an occlusive dressing) and the amethocaine formulation (0.5 g applied for 30 min). Thereafter, the two preparations were compared directly, in a double-blinded study using a standardized application for both formulations. The results indicated that both preparations provided significant (chi-square; P less than 0.001) percutaneous local anaesthesia when compared with placebo. The amethocaine preparation produced significant anaesthesia (chi-square, P less than 0.001) after 30 min application. Furthermore, the amethocaine formulation demonstrated both increased rapidity of action and increased duration of effect, as determined by a two-tailed unpaired t test, in comparison with EMLA when application times of both 30 and 60 min were used for each preparation. The results of this study indicate that the amethocaine preparation provided more rapid and prolonged anaesthesia than EMLA.

Administration, Cutaneous↗

PubMed1990

Antipsoriatic therapies inhibit epidermal plasminogen activator activity.

Urokinase (UK, Mr 55,000) and tissue-type plasminogen activator (tPA, Mr 74,000) are serine proteinases involved in many biological processes, ie, cell migration, neoplastic transformation, and extracellular proteolysis. Cutaneous fibrinolytic activity (dependent on the activity of UK and tPA) was studied with the autohistographic fibrin film method in 40 patients affected by psoriasis vulgaris before and after topical (anthralin, betamethasone valerate, hydrocolloid occlusive dressing) or systemic psoralen-ultraviolet-light (PUVA) treatments. Autohistographic studies also were performed after apposition of monoclonal antibodies directed against the catalytic site of UK and tPA. Finally, UK and tPA were localized immunohistochemically in the psoriatic plaques and in controls using the immunoperoxidase procedure based on the biotin/avidin system. UK and tPA immunoreactivity was present in the cytoplasm and around the outlines of keratinocytes in the psoriatic patches before treatment and in the patches not cleared after treatment, while it was not detectable in normal epidermis, in the unaffected psoriatic epidermis, and in the cleared psoriatic skin. Cutaneous fibrinolytic activity was present in the cases in which UK and tPA were detected histochemically and, in the psoriatic epidermis, it was abolished by preincubation with anti-tPA but not with anti-UK antibodies. This study suggests that established topical and systemic treatments for psoriasis possess UK and tPA antagonist activity.

Adult↗