Clinical effect of four different ointment bases on healthy cat eyes.

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 KH2 PO4 , 57.00 mg K2 HPO4 , 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.

Postoperative wound care after dermatologic procedures: a comparison of 2 commonly used petrolatum-based ointments.

An appropriate selection of topical agents for wound care is important to promote uncomplicated healing. Petrolatum-based ointments, such as Aquaphor Healing Ointment (AHO) and white petroleum jelly, are commonly employed to keep wounds moist postoperatively. While they have beneficial properties for wound healing, they also may cause wound redness and swelling. We decided to evaluate for wound reactivity postoperatively for these 2 commonly used petrolatum-based ointments. We found that surgical wounds treated with AHO had a higher incidence of wound redness (52%) than those treated with plain white petrolatum (12%).

Chronic otorrhea caused by myospherulosis in the middle ear after tympanoplasty.

OBJECTIVES: Myospherulosis is a foreign body reaction induced by the application of oil-based ointments. Myospherulosis in the ear is extremely rare. Only 4 cases have been described, all of which occurred after (repeated) mastoid surgery. METHODS: We present a case of persistent otorrhea and conductive hearing loss caused by myospherulosis in the middle ear following tympanoplasty. RESULTS: The patient underwent revision middle ear surgery with removal of abnormally thick, pale tissue in the middle ear. Histology showed a foreign body reaction with signs of myospherulosis. CONCLUSIONS: Myospherulosis is a very rare complication of the use of oil-based ointments. Surgeons should be aware that these products might cause a foreign body reaction leading to myospherulosis. In patients who have chronic otorrhea after previous mastoid or middle ear surgery, myospherulosis should be considered in the differential diagnosis.

Late opacification of a silicone intraocular lens caused by ophthalmic ointment.

A 55-year-old man had uneventful phacoemulsification with implantation of a 3-piece silicone intraocular lens (IOL). Postoperative medications included antibiotic-steroid drops and ointments. Eight months postoperatively, the patient started having recurrent episodes of anterior chamber inflammatory reaction. Suspicion that lens instability was causing the reactions led to a lens repositioning procedure 11 months after the initial surgical implantation and again at 13 months. Eighteen months postoperatively, the IOL had a "greasy" film. Despite antiinflammatory and antibiotic treatment, the clinical outcome did not improve. Twenty-seven months after implantation, the lens was exchanged with a hydrophilic acrylic IOL. The course after the exchange was uneventful. The explanted lens was examined by gross and microscopic evaluations, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and gas chromatography-mass spectrometry (GC-MS) using electronic ionization. Gross and microscopic evaluations confirmed the presence of a thin, oily film covering the IOL optic surface. Surface analyses at the level of the oily substance showed unspecific peaks of sodium, chloride, and potassium. The GC-MS analysis showed the presence of compounds characteristic of hydrocarbons, including docosane, tricosane, and tetracosane, which are commonly found in the vehicle of ophthalmic ointments. The GC-MS analysis of 1 ointment used postoperatively found matching peaks, suggesting deposition of those compounds on the IOL.

Allergic contact dermatitis caused by white petrolatum on damaged skin.

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.

Myospherulosis of the Mandible Presenting as a Multilocular Lesion: A Case Report and Review of the Literature.

Myospherulosis is an uncommon foreign body reaction that occurs in tissues exposed to antibiotic and oil-based ointments. Radiographic imaging of this lesion may suggest other diagnoses. Treatment consists of conservative surgical removal, and is usually curative. We report herein a case of myospherulosis presenting as an extremely unusual multilocular radiolucent lesion.

Intracranial myospherulosis.

A 54-year-old man developed a post-traumatic brain abscess, and antibiotic ointment was instilled into the abscess cavity. The involved tissue was subsequently excised and was shown to contain the characteristic saccules and spherules of myospherulosis. The history of ointment usage further strengthens the association of petrolatum with the development of these structures. This is the first reported case of intracranial myospherulosis.

Experimental study of the cause of myospherulosis.

To elucidate the nature of myospherulosis, the authors tried to produce this state in vitro by mixing vitamin E, oleic acid, linoleic acid, and lanolin with human blood components, such as whole blood, washed erythrocytes, plasma, and fixed erythrocytes, respectively. Myospherulosis was produced in all mixtures in these experiments. The authors concluded the following. A thin parent body wall of myospherulosis is formed initially as a result of the physical emulsion phenomenon between lipid-containing materials and blood. Erythrocytes then are enclosed in the parent body. The parent body membrane gradually is reinforced by the deposition of plasma proteins, which are insoluble in ethanol. Thereafter, the erythrocytes become endobodies by the deposition of their contents to the membrane of the parent body. The pores of the endobodies are formed in the process of erythrocyte degeneration. The contents of the erythrocytes, such as hemoglobin, would attach to the parent body. Thus myospherulosis would become complete. In humans, the characteristics of the parent body membranes differ from each other, depending on how much the hemoglobin or a part of the endobody membrane attaches to the parent body membrane.

Ophthalmic ointments.

The use of ointments as an ocular drug vehicle adds an important dimension to topical therapy. Ointments are well tolerated, fairly safe, and provide an excellent means for enhanced ocular contact time. In the case of certain antibiotics, this improved contact time yields increased ocular drug levels. However, experimental data indicate that corticosteroid ointments do not penetrate into the eye as well as do suspension preparations. This may relate to the binding of the drug to the ointment base and also to the particular steroid compound. Like other ophthalmic preparations, ointments may become contaminated. Ophthalmic ointments should not be instilled into eyes with open wounds. Instillation of ointments into postoperative eyes where wound closure is secure appears to be safe and effective.

Intraocular ointment after small-incision cataract surgery causing chronic uveitis and secondary glaucoma.

Anterior uveitis and secondary glaucoma resulting from intraocular ointment has not been reported. The advent of small-incision surgery has likely reduced the incidence of this complication to low levels. We report a case of anterior uveitis after small-incision cataract surgery due to an intraocular ointment base. The course of this rare case is described and the literature reviewed.

Myospherulosis following sinus surgery: pathological curiosity or important clinical entity?

OBJECTIVES/HYPOTHESIS: Myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of sinus surgery. This reaction has been associated with postoperative adhesion formation. The purpose of the study was to determine whether the occurrence of myospherulosis has an adverse effect on clinical outcome following sinus surgery. STUDY DESIGN: Case-control study at an academic medical center. METHODS: Thirty-two cases of myospherulosis were identified in 28 patients (4 with bilateral disease) who underwent sinus surgery between 1989 and 1999. Cases were staged according to histological and radiological grading systems. Clinical outcome was compared with a control group of 28 patients who had similar surgery during the same time period. RESULTS: Patients with myospherulosis were found to have a significantly higher likelihood of developing postoperative adhesions compared with control subjects (50% vs. 18%, respectively [P =.023]). Histological stage, based on the extent of lipid vacuoles and spherules (erythrocyte remnants) present in the surgical specimen, was found to correlate with disease severity based on preoperative sinus computed tomography staging (P =.009). Patients with myospherulosis tended to have a shorter interval between their last two surgeries than did control subjects (2.2 +/- 2.1 vs. 4.5 +/- 7.1 y, respectively [P =.086]). Patient age, sex, comorbid conditions, CT stage, and number of previous operations were not predictive for the occurrence of myospherulosis. CONCLUSIONS: Patients who develop myospherulosis from lipid-based packing material used during sinus surgery are more likely to form postoperative adhesions. These adhesions appear to be clinically relevant and may hasten the need for revision surgery.

Ingredients and safety of cellulite creams.

There is virtually no knowledge of the ingredients of cellulite creams in the dermatological literature. In the present study, the ingredients of cellulite creams, the frequency of their use and whether the ingredients have been reported to cause allergy were investigated. In the 32 products tested, 263 ingredients were used. On average each product contained 22 ingredients (range 4 to 31). Botanicals and emollients predominated; altogether 44 different botanicals and 39 different emollients were used in the 32 products. Caffeine, present in 14 products was the most common additive, apparently representing an "active" ingredient. In other respects the compositions of the products were similar to those of skin creams. All products contained fragrance. The creams were microbiologically pure. Concentrations of preservatives did not exceed limit values in the regulations. No formaldehyde was present (detection limit 10 ppm). The well-known allergens isothiazolinones or dibromoglutaronitril were declared only in a few products. In spite of the large number of substances used in cellulite creams, their safety seems acceptable for most users. Because, however, one fourth of the substances used have been shown to cause allergy, the risk of adverse effects should be taken into account when using cellulite creams.

Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing.

Nasal cysts are rare complications of rhinoplasty, and numerous theories exist regarding their cause. The term "paraffinoma" has been used to describe cyst formation observed after topical antibiotic ointment application with nasal packing in the immediate postoperative period. Such complications are rare but may occur because of the inherent properties of the agent used or a lack of meticulous technique (in the placement of incisions and nasal packing). Three cases of postrhinoplasty cysts with a variety of presentations, including incidental intraoperative findings, bilateral medial canthal masses, and a draining dorsal cyst, are described. Although such cysts are uncommon, techniques to prevent these unwanted sequelae should routinely be used, with the judicious application of non-petroleum-based topical antibiotic preparations.

Allergic contact dermatitis to white petrolatum.

White petrolatum is known for its nonsensitizing and nonirritating properties. Only a few cases of allergic contact dermatitis to white petrolatum have been reported. Although it is a rare event, the finding of contact sensitization to white petrolatum raises the potential problem of its usage of common topical agents or vehicles for patch testing. We herein report a case of allergic contact dermatitis to white petrolatum.

Effect of topical application of medicinal grade petrolatum on various species of laboratory animals and man.

Medicinal grade yellow and white petrolatum (soft paraffin) were tested for dermatoxic effects on laboratory animals and man. Yellow petrolatum produced redness, thickening of skin, hyperkeratosis and reversible total hair loss in rabbit and rat but no dermatoxic effect was observed in man and dog. White petrolatum which is similar in composition to yellow petrolatum produced less redness and keratosis. Refluxing of yellow soft paraffin with 95% alcohol could dissolve out dermatoxic fraction. The results have been discussed and it is suggested that drugs with petrolatum as ointment base should not be tested on rats and rabbits as petrolatum itself is dermatoxic in these species.

Allergic contact dermatitis in patients with anogenital complaints.

OBJECTIVE: Allergic contact dermatitis is a common anogenital disease. STUDY DESIGN: The results of patch testing performed on 1,008 patients evaluated for allergic anogenital contact dermatitis from 21 dermatologic departments in the Information Network of Departments of Dermatology (IVDK) from 1992 to 1997 were analyzed. RESULTS: A final diagnosis of allergic contact dermatitis was made in 351 patients (34.8%). Irritant contact dermatitis was diagnosed in 230 patients (22.8%) and other, nonspecified forms of perianal eczema in 228 patients (22.6%). The remaining cases were due to other distinct dermatologic diseases. Analyzing patch test data from this large group of patients showed that the allergen spectrum resembled that of all patients (54,000) tested from 1992 to 1997. However, dibucaine HCl ranked fourth among contact allergens in the study population. Positive reactions to (chloro-)-methyl-isothiazolinone and to benzocaine were observed more frequently among patients with anogenital complaints as compared to the total IVDK population (3.7% vs. 2.5% and 2.7% vs. 1.5%, respectively). In general, active agents of topical medications and popular remedies, preservatives and ointment bases appeared to cause allergic reactions most frequently. CONCLUSION: Patients with chronic anogenital diseases seem to have a high risk of becoming sensitized. For patch testing we recommend the standard series, dibucaine HCl, propolis, bufexamac and other ingredients from topical preparations according to the patient's history.

[Leg ulcer and allergic eczematous contact dermatitis incidence of contact allergies induced by topical therapy (author's transl)]. / Ulcus crurus und allergisches Kontaktekzem. Untersuchungen über die Häufigkeit lokalterapeutisch induzierter Kontaktallergien

In the IInd Department of Dermatology, Vienna University, 200 patients (143 female, 57 male) suffering from leg ulcers due to chronic venous insufficiency underwent patch testing with routine allergens, vehicles and their ingredients, as well as topical antibiotics. 114 patients (57%) had contact allergy. Balsam of Peru heads the list of allergens with postive reactions in 22%, closely followed by oil/water emulsions such as Drointin (21%), Ultrasicc (20%) and Ung. emulsificans aqu. (15,5%). The causative agents in these preparations were emulsifiers on the one hand (Lanette O, E, N) and preservatives (parabens) on the other hand. In comparison, allergic reactions to water/oil emulsions were less common. The low index of sensitivity to local antibiotics was also surprising. The results of the present study, in accordance with other reports in the literature, underline the need (1) for full label diclosure of cosmetics and topically-applied drugs and (2) for patch-testing every patient suffering from leg ulcers of long duration.

Sinonasal myospherulosis and paraffin retention cysts suggested by CT: report of a case.

Sinonasal myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of paranasal sinus surgery. Rare cases have been sporadically reported. We report a case found in a 79-year-old female 8 months after functional endoscopic sinus surgery during which sinus cavities had been packed with gauze coated with Terra-Cortril (a paraffin-based tetracycline/steroid ointment). The preoperative diagnosis was suggested during CT of the paranasal sinuses by the presence of macroscopic paraffin retention cysts having a characteristic fat density. To our knowledge, our case represents the first report of sinonasal myospherulosis suggested by CT.

A case of eyelid paraffinoma that developed after endoscopic sinus surgery.

Paraffin has been used as a liquid prosthesis for medical purposes, and is still the base material in some ointments. However, it sometimes causes foreign-body reaction resulting in paraffinoma. We present a case of paraffinoma in a 64-year-old woman, which occurred in the eyelid after endoscopic sinus surgery for chronic sinusitis. During surgery, a small perforation developed in the left lamina papyracea, and therefore tetracycline ointment gauze was inserted. Two days after discharge, her left eyelid became swollen. The result of an open biopsy was paraffinoma. Total resection of the tumor was performed, and at the time of writing there has been no recurrence for 1 year after surgery.