Topical potassium permanganate solution use in dermatology: comparison of guidelines and clinical practice.

In this small study we wish to highlight the difference that exists between the nationally recommended dilution of 0.01% (1 in 10 000) with the dilution used in our routine patient care 0.00125% (1 in 80 000) when preparing potassium permanganate soaks. We suggest that patient and clinician education should emphasize the importance of visual assessment rather than formulaic calculations in the safe preparation of potassium permanganate solution.

Potassium permanganate: a 'desert island drug' in dermatology.

Potassium permanganate (KMnO4 ) is an astringent with oxidizing and antiseptic properties, which dates from the 17th century and has been in medical use since the early 1800s. It is available as an over-the-counter preparation and is often used as compresses and baths for various exudative dermatoses. Its advantages include lower cost, good healing rate and reduced allergenic potential. However, it can stain skin (as well as clothing and ceramics), and more serious adverse effects include chemical burns and systemic toxicity. Owing to its easy availability, there is a risk of accidental or deliberate ingestion of this drug. The focus of this article is to increase awareness among dermatologists about the clinical use and adverse effects of KMnO4 , as well as the signs and management of systemic toxicity.

[Curative effect of ozone hydrotherapy for pemphigus].

OBJECTIVE: To determine clinical curative effects of ozone therapy for pemphigus vulgaris.
 Methods: Ozone hydrotherapy was used as an aid treatment for 32 patients with pemphigus vulgaris. The hydropathic compression of potassium permanganate solution for 34 patients with pemphigus vulgaris served as a control. The main treatment for both groups were glucocorticoids and immune inhibitors. The lesions of patients, bacterial infection, usage of antibiotics, patient's satisfaction, and clinical curative effect were evaluated in the 2 groups.
 Results: There was no significant difference in the curative effect and the average length of staying at hospital between the 2 groups (P>0.05). But rate for the usage of antibiotics was significantly reduced in the group of ozone hydrotherapy (P=0.039). The patients were more satisfied in using ozone hydrotherapy than the potassium permanganate solution after 7-day therapy (P>0.05).
 Conclusion: Ozone hydrotherapy is a safe and effective aid method for pemphigus vulgaris. It can reduce the usage of antibiotics.

A clinical trial comparing parenteral oxytetracyline and enrofloxacin on time to recovery in sheep lame with acute or chronic footrot in Kashmir, India.

BACKGROUND: No clinical trials have been conducted in India on the efficacy of parenteral antibacterials to treat footrot in sheep. In addition, there are no studies worldwide on the efficacy of parenteral antibacterials to treat chronic footrot. Sixty two sheep with acute footrot and 30 sheep with chronic footrot from 7 villages in Kashmir, India were recruited into two separate trials. Sheep with acute footrot were allocated to one of three treatments using stratified random sampling: long acting parenteral oxytetracycline, long acting parenteral enrofloxacin and topical application of potassium permanganate solution (a traditional treatment used by sheep farmers in India). In a quasi pre-post intervention design, sheep with chronic footrot that had not responded to treatment with potassium permanaganate were randomly allocated to treatment with one of the two parenteral antibacterials mentioned above. Sheep with acute footrot were treated on day 0 and those with chronic footrot on days 0, 3, 6 and 9. Sheep were monitored for up to 28 days after treatment. Time to recovery from lameness and initial healing of lesions was assessed using Kaplan-Meier survival curves, nonparametric log-rank and Wilcoxon sign-rank tests. RESULTS: There was significant correlation in recovery from lameness and presence of healing lesions in sheep with acute (r = 0.94) or chronic (r = 0.98) footrot. Sheep with acute footrot which were treated with parenteral antibacterials had a significantly more rapid recovery from lameness and had healing lesions (median = 7 days) compared with those treated with topical potassium permanganate solution (less than 50% recovered in 28 days). The median time to recovery in sheep with chronic footrot treated with either antibacterial was 17 days; this was significantly lower than the median of 75 days lame before treatment with antibacterials. The median time to recovery for both acute and chronic footrot increased as the severity of lesions increased. There was no difference in time to recovery by age, body condition score, duration lame, or presence of pus in the foot within acute and chronically affected sheep. CONCLUSIONS: We conclude that use of parenteral antibacterials to treat sheep lame with either acute or chronic footrot in India is highly effective. This is likely to improve welfare and give economic benefits to the farmers.

Assessment of Aquaflor(®) , copper sulphate and potassium permanganate for control of Aeromonas hydrophila and Flavobacterium columnare infection in sunshine bass, Morone chrysops female × Morone saxatilis male.

Two experiments were conducted to test the effectiveness of different therapeutants against a mixed infection of Aeromonas hydrophila and Flavobacterium columnare in sunshine bass. Experiment 1 evaluated copper sulphate, florfenicol-medicated feed and potassium permanganate (KMnO(4) ) against a natural mixed infection. Experiment 2 further evaluated copper sulphate as a treatment to control an experimental mixed infection. In experiment 1, naturally infected untreated fish had the lowest final survival per cent, at 71%, while florfenicol-medicated feed at 15mgkg(-1) body weight for 10days or copper sulphate at 2.1mgL(-1) (1% of the total alkalinity) for 24h produced the highest final survivals, at 90% and 88%, respectively. The final survival of the naturally infected fish administered florfenicol-medicated feed was significantly different (P<0.1) from the untreated fish. The survival curves for the florfenicol and the copper sulphate at 2.1mgL(-1) were significantly improved from the untreated fish. In experiment 2, fish were challenged by waterborne exposure to A. hydrophila and F. columnare and either not treated or treated with copper sulphate at 2.1mgL(-1) . At the end of experiment 2, the per cent survival of the challenged fish treated with copper sulphate (99%) was significantly higher (P<0.05) than the non-treated (61%). The results illustrate clear benefit of florfenicol and copper sulphate against a mixed infection of A. hydrophila and F. columnare.

What is the evidence for the use of potassium permanganate for wound care?

Topics for Drug and Therapeutics Bulletin (DTB) review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.

Evaluation of potassium permanganate against an experimental subacute infection of Flavobacterium columnare in channel catfish, Ictalurus punctatus (Rafinesque).

An experiment was performed to evaluate the efficacy of potassium permanganate (KMnO4) as a prophylactic and therapeutic treatment of an experimental subacute infection of Flavobacterium columnare in channel catfish, Ictalurus punctatus. Fish were cutaneously abraded and divided into five treatment groups: (i) challenged by waterborne exposure to F. columnare and not treated with KMnO4 (positive control), (ii) challenged and simultaneously treated with KMnO4, (iii) challenged and treated with KMnO4 at 1, 6 and 9 days post-challenge, (iv) not challenged and treated with KMnO4 at 1, 6 and 9 days post-challenge (first negative control) and (v) not challenged and not treated (second negative control). The dosing of KMnO4 was 2.0 mg L(-1) above the potassium permanganate demand for 2 h duration. The survival of the group challenged and simultaneously treated with KMnO4 (99%) was significantly higher than the positive control (78%) and was not significantly different from the negative control groups. The challenged fish treated with KMnO4 post-challenge had 7% higher survival than the positive control (85% compared with 78%), but that difference was not statistically significant. The results demonstrate that KMnO4 has a clear prophylactic value but probably a marginal therapeutic value once the infection has established.

Wound myiasis in a patient with squamous cell carcinoma.

A 60-year-old, otherwise healthy, male farmer presented to our Dermatology Department with a large ulcer on his lower right leg. The lesion had started as a small papule 6 months before, which became eroded and transformed into a rather rapidly progressive ulcer. On careful inspection, numerous larvae were found moving within the wound. The larvae were analyzed and found to be Lucilia sericata (the green bottle blowfly). The lesion was diagnosed histopathologically as squamous cell carcinoma. The myiasis was treated by submerging the wound in a dilute permanganate potassium solution.

Diagnosis and treatment of venous eczema.

Venous eczema is part of a continuum of venous disease that affects around 20% of people over 70 years of age. It is not always appropriately diagnosed and treated. This article aims to enable community nurses to understand the pathophysiology of venous disease and how to offer evidence based management to patients with this condition.

Topical antimicrobials in the control of wound bioburden.

Bacterial colonization and infection are important factors in compromised wound healing, particularly in chronic wounds. Although "best practice" for controlling these factors currently is not defined, systemic antibiotics are generally accepted as the preferred choice for treating infection, provided ischemia does not reduce their bioavailability. However, widespread use of systemic and topical antibiotics is associated with the emergence of resistant bacterial strains such as methicillin-resistant Staphylococcus aureus. Colonization of wounds presents a double problem--potentially delayed healing and a potential source for cross-contamination. The judicious use of dressings, notably those containing certain antiseptic agents, can be a valuable option to control infection and promote healing. A review of the literature underscores the importance of considering the antiseptic route as part of a concerted approach to wound management and infection control.

Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

The current status of antimycotics in the treatment of local mycoses.

The drugs used in the treatment of superficial mycoses include substances with an indirect affect on the organisms such as the keratolytics as well as antifungal compounds. The antifungals include specific inhibitory compounds such as the polyene or imidazole antibiotics and substances with a wider spectrum of antiseptic activity. High cure rates (80-90%) can be achieved by most specific antifungals although this can be affected by the host response and the location of the infection. The orally active antifungals used in superficial disease, ketoconazole and griseofulvin, can be used in conditions unresponsive or inaccessible to topical therapy, such as chronic superficial candidosis and tinea capitis. However, the treatment of onychomycosis, particularly affecting toe nails, is highly unsatisfactory. There is therefore an important place for new drugs and new methods of applying them in the treatment of superficial (local) mycoses.

Pyoderma gangrenosum--a literature review.

Pyoderma gangrenosum is an ulcerative skin disorder with typical clinical characteristics. Histologic and laboratory findings are nonspecific. Pyoderma gangrenosum is associated with internal disorders including inflammatory bowel disease, paraproteinemias, leukemias, and arthritis. The pathogenesis of pyoderma gangrenosum is unknown, although a partial defect of cell-mediated immunity may exist. Treatment includes bedrest, local care, sulfonamides, sulfones, and corticosteroids.

Bilateral pyoderma gangrenosum of the hand: treatment with dapsone.

The first reported case of bilateral pyoderma gangrenosum of the hands is presented. One lesion was treated with wound care only, with spontaneous healing after two months. The contralateral lesion which occurred one month later was treated with wound care and oral dapsone. Healing occurred between four and six weeks after the start of dapsone. It is suggested that this acts by limiting the necrotizing process, thus allowing earlier epithelialization. Pyoderma gangrenosum is rare, and treatment is non-surgical. It is important that it is recognized to avoid extension of the necrotizing process through ill-advised surgery.

Fungal infections of the skin in children.

Fungal infections of the skin in children are common and may mimic many other dermatoses. Diagnostic techniques are simple and inexpensive; Wood's light examination, KOH wet mounts, and preferably fungal culture should be performed on all suspected lesions.

[Sezary's syndrome. 4 cases observed at the University Hospital Center of Treichville (Abidjan, Ivory Coast)]. / Le syndrome de Sezary. A propos de 4 cas observés au Centre Hospitalier Universitaire de Treichville (Abidjan-Côte d'Ivoire).

Authors report four cases of Sezary's syndrome over a period of eight years. The frequency is 1.2 for one hundred thousand consultations registered and 1.4 for one thousand patients. Three about 4 cases are younger than literature reports. On a clinical point of view we have noted no particular point.

Toxic epidermal necrolysis.

Although Ms Weeks was supported throughout this period, we were concerned that she would require further psychological help. At the end of her stay she decided that she did not require help. However, she knew that if at a later date she changed her mind, it would be arranged. Ms Weeks was offered an appointment with the Red Cross camouflage service, which was on hand to offer advice about appropriate techniques to hide the hyperpigmentation on her face and other exposed areas, but this again was declined. Ms Weeks was in ICU for three-and-a-half weeks and her skin healed well. She was left with multihyperpigmented skin, which over time may resolve itself.