Approach to the Patient with Chronic Pruritus.

Chronic pruritus (itch lasting ≥6 weeks) is a bothersome chief complaint that may present in a broad variety of diseases. Most itch-causing diagnoses fit into 1 of 5 categories (inflammatory, secondary to systemic disease, neuropathic, chronic pruritus of undetermined origin, and psychogenic itch) and this broad differential can be narrowed using key findings in the history and physical. In this article, we discuss which key findings are most pertinent for narrowing this differential and guiding further workup and treatment, as well as how to treat many itchy conditions.

Synergistic Effect and Antibiofilm Activity of a Skin and Wound Cleanser.

INTRODUCTION: Biofilm in chronic wounds impedes the wound healing process. Each biofilm has differing characteristics requiring a multifaceted approach for removal while maintaining a surrounding environment conducive to wound healing. OBJECTIVE: In this study, 3 of the components in a wound cleanser are tested to determine synergy in eradicating biofilms of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in vitro. MATERIALS AND METHODS: The 3 components assessed for synergy were ethylenediamine tetraacetic acid sodium salts (EDTA), vicinal diols (VD; ethylhexylglycerin and octane-1,2-diol), and polyhexamethylene biguanide (PHMB). Each component was assessed individually and in combination while dissolved in a base solution. The Calgary assay method was used for biofilm growth and treatment. Kull Equation analysis for synergy was conducted using viable count results. RESULTS: Synergy is defined as the interaction of components to produce a combined effect greater than the sum of their separate effects. The base solution containing all 3 components (EDTA, VD, and PHMB) reduced biofilm viability by more than 5 logs, demonstrating statistically significant synergy. The 3 components tested individually in the base solution resulted in the following: EDTA did not reduce bacteria viability; VD reduced viability by about 1 log; and PHMB reduced P aeruginosa viability by about 2.5 logs and MRSA viability by about 4 logs. Of importance, the MRSA biofilm failed to regrow in the recovery plates after combined treatment, indicating complete elimination of the biofilm bacteria. CONCLUSIONS: The experimental and calculated results indicate the 3 components (VD, EDTA, and PHMB) when used together act synergistically to eradicate MRSA and P aeruginosa biofilms in vitro.

Improving the rhinomanometry technique using benzoin tincture.

OBJECTIVE: In order to achieve a faster and more reliable anterior rhinomanometric evaluation, nasal skin was prepared using benzoin tincture solution, which provides simpler and better adhesion of the foam tape to the nasal skin. METHOD: Two consecutive anterior rhinomanometry measurements were made, one with and one without benzoin tincture application. RESULTS: The average time taken to perform classic foam tape anterior rhinomanometry without benzoin tincture application was 281.32 seconds, and the average coefficients of variation for the right and left passages were 7.48 and 7.59 per cent, respectively. When benzoin tincture was used, the average time taken for completion of the tests was 121.24 seconds, and the average coefficients of variation for the right and left passages were 2.17 and 2.32 per cent. CONCLUSION: The use of benzoin tincture to clean the nasal skin before placing foam tape shortens the procedure duration and significantly increases test reliability.

Over-the-counter treatments for acne and rosacea.

Acne and rosacea are common inflammatory processes historically classified in the same disease category, but evolving understanding of their disparate pathophysiology and exacerbating factors have generated an enormous armamentarium of therapeutic possibilities. Patients seek over-the-counter therapies first when managing cutaneous disease; therefore, this review defines ingredients considered to be effective over-the-counter acne and rosacea products, their mechanisms, and safe formulations, including botanical components, oral supplements, and other anecdotal options in this vast skin care domain.

Can microcatheters be cleaned for reuse after NBCA embolization? Cleaning technique with gelatin sponge particles.

PURPOSE: To study a new technique for cleaning microcatheters for reuse after NBCA embolization ("NBCA"), and to evaluate the clinical reusability of microcatheters that were cleaned with gelatin sponge particles after NBCA. MATERIALS AND METHODS: Four cleaning solution flushes for microcatheters after NBCA injection-5 % glucose ("glucose") only, Lipiodol-glucose, gelatin sponge particles ("gelatin")-glucose, and Lipiodol-gelatin-glucose-were examined experimentally. These solutions were evaluated by performing three examinations: a microcatheter resistance test based on the time taken to pass water through the microcatheter, a microcatheter resistance test based on the ease of insertion of a microguidewire, and observations of the inner surfaces of the cylinders after NBCA. Microcatheters that had already been used in NBCA were cleaned using this new technique and then applied in 20 clinical sessions (19 patients). RESULTS: There was no significant difference in water passage time between the controls and the groups that received a gelatin flush. In the resistance test based on the insertion of a microguidewire, groups that received a gelatin flush showed significantly less resistance than the groups that did not receive a gelatin flush. Observations of the inner surfaces of the cylinders indicated that cleaning with gelatin can lead to inner surfaces that are almost indistinguishable from control surfaces in terms of cleanliness. All clinical procedures involving Lipiodol-gelatin-glucose flushes were performed without any technical difficulties or complications. CONCLUSIONS: Applying the new cleaning technique utilizing gelatin sponge particles to microcatheters after NBCA ensures that they are clean enough to be reused.

Enzymatic detergent in rat peritoneum. A comparative study with physiological solution.

BACKGROUND: Peritoneal washing out with physiological solution with different substances added is useful in peritoneal infections, but the effect of enzymatic detergents, such as quaternary didecyl-dimethyl ammonium compounds (DDAC), used in the sterilization of surgical material is unknown. We undertook this study to determine histological changes (inflammation, fibrosis and new vessel formation) in the peritoneum of Wistar rats after the application of physiological solution or DDAC. METHODS: The minimum inhibitory concentration (MIC) of DDAC for E. coli (512 µg/ml) and E. faecalis (128 µg/ml) was determined. Sixty-three Wistar rats weighing 200 ± 20 g were studied. They were divided into three groups: control: 7 rats were instilled with 3 ml of physiological solution in peritoneal cavity; groups 1 and 2 were instilled with 3 ml of MIC for E. coli and E. faecalis, respectively. These groups were divided into four subgroups of seven animals. In every rat, 1 cm(2) of peritoneum was obtained at 2, 7, 14, and 21 days for histological study with hematoxylin-eosin. Ten fields were evaluated. The data obtained were analyzed with the Mann-Whitney test. RESULTS: There were no significant differences in inflammation, fibrosis and new vessel formation with the physiological solution vs. DDAC at 2, 7, 14, and 21 days (p >0.05), except for inflammation at 2 days in group 2 (p = 0.026), which remitted. CONCLUSIONS: There was no significant difference in changes in rat peritoneum after physiological solution or DDAC application.

Self-treatment with bleach by a Latino farmworker.

Skin disease is common among migrant Latino farmworkers. These workers rarely use formal health care services but commonly engage in self-treatment of their skin disease. We present a patient with dermatitis who self-treated with bleach. This patient illustrates a common practice that exacerbates skin disease and sheds light on social and cultural factors of which health care providers serving this community should be aware.

Lavender fragrance cleansing gel effects on relaxation.

Alertness, mood, and math computations were assessed in 11 healthy adults who sniffed a cosmetic cleansing gel with lavender floral blend aroma, developed to be relaxing using Mood Mapping. EEG patterns and heart rate were also recorded before, during, and after the aroma session. The lavender fragrance blend had a significant transient effect of improving mood, making people feel more relaxed, and performing the math computation faster. The self-report and physiological data are consistent with relaxation profiles during other sensory stimuli such as massage and music, as reported in the literature. The data suggest that a specific cosmetic fragrance can have a significant role in enhancing relaxation.

Delivery of vitamin E to the skin by a novel liquid skin cleanser: comparison of topical versus oral supplementation.

Topical supplementation represents an attractive approach to mitigate environmentally induced deficiencies of skin vitamin E (alpha-tocopherol). We report here the impact of natural sunlight on stratum corneum (SC) vitamin E and also compare the effectiveness of dietary supplementation to topical application as a way to increase vitamin E in the superficial layers of the SC. The effects of natural sunlight, 30 minutes of midday sunlight, were measured on two separate occasions. Vitamin E in the surface layers of the SC was measured by HPLC after ethanol extraction. Under these relevant conditions, vitamin E in the superficial SC was reduced in a dose-dependent manner by 50-65%. In a followup study, panelists entered into a randomized, double-blind, vehicle-controlled study. In this study, one group washed their skin once daily for one minute with a commercially available body wash containing 0.15% vitamin E and 0.10% vitamin E acetate, while the second group used a body wash without vitamin E but also supplemented their diet with 400 IU alpha-tocopherol (18 x RDI). Not surprisingly, only dietary supplementation increased serum vitamin E (approximately twofold). Although both treatment modalities increased SC vitamin E, topical delivery was significantly more effective (53-fold vs baseline) than dietary delivery (eightfold vs baseline). Moreover, only topical delivery increased SC vitamin E acetate (19-fold vs baseline). The results reported here indicate that vitamin E in the superficial layers of the SC is depleted readily by even a brief exposure to sunlight and that use of a vitamin E body wash can substantially increase the vitamin E in this superficial layer more effectively than dietary supplementation.

Evaluation of dietary supplements of lipase, detergent, and crude porcine pancreas on fat utilization by young broiler chicks.

The purpose of Experiment 1 was to improve the digestibility of fat through the use of supplemental lipase enzymes. A 2 x 3 factorial arrangement of treatments involving two levels of animal-vegetable blend fat (AV) (4 and 8%) and three enzyme treatments, namely none; Pancreatic, 0.714%; and Pancreatin, 0.714%, were randomly allocated within a battery brooder. There was an increase in diet ME and apparent fat digestibility when Pancreatic and Pancreatin enzymes were used (P < 0.01). However, both enzymes caused lower feed intake and lower BW gain (P < 0.01). In Experiment 2, Pancreatic enzyme was used at graded levels of 0, 0.214, 0.429, 0.643, 0.857, and 1.071%, involving 4% dietary AV fat. The ME values were greater as the enzyme level increased (P < 0.01). However, as found in Experiment 1 lower feed intake and BW gain were observed with all enzyme levels compared with the control group. There was a linear effect on feed intake and BW gain (P < 0.01) and a quadratic effect on apparent fat digestibility (P < 0.05) and feed utilization (P < 0.01). Experiment 3 was designed to test the effect of Pancreatic enzyme at 0 or 1.339% in combination with two levels of detergent, namely 0 and 10% (with 4% added AV). The detergent used consisted of a mixture of 95% Span 60 and 5% Tween 60. In general, there was no significant effect of detergent (P > 0.05). Experiment 4 was conducted to test the effect of supplementation of graded levels of ground crude porcine pancreas at 0, 0.321, 0.535, 0.750, 0.964, 1.178, or 1.392% of the diet on performance of male broiler chicks to confirm the anorexic effect caused by supplementing with Pancreatic enzyme. In general, there was no significant effect of feeding crude porcine pancreas on the performance of male broiler chicks (P > 0.05). In these studies, lipase enzymes improved fat digestion, although it is suspected that associated reduced feed intake may be associated with contaminants such as cholecystokinin hormone.

Clinical evaluation of pediatric ethylene glycol monobutyl ether poisonings.

Ethylene glycol butyl ether, CAS 111-76-2, an ingredient in many popular commercial window/glass cleaners, is known to produce equal if not greater toxicity than ethylene glycol when administered to animals. Treatment recommendations for human poisonings are based upon animal data and include the use of ethanol therapy to inhibit the production of toxic metabolites. No human experiential data exist to accurately assess human toxicity or to verify treatment modalities. A 5 month retrospective review of all glass cleaner ingestions reported to a regional poison information center disclosed 24 pediatric patients, ages 7 mo to 9 y, who ingested 5-300 mL of a liquid glass cleaning product containing ethylene glycol butyl ether. All ingestions were reported within 5 min of ingestion, and all 24 children were asymptomatic at that time and subsequently. The product concentrations of ethylene glycol butyl ether ranged from 0.5% to 9.9%. Two of the 24 children ingested > 15 mL and were treated by gastric emptying and 24 h hospital observation. Neither hospitalized child suffered symptoms consistent with hemolysis, nervous system depression, acidosis, or renal compromise. Dilution with oral fluids at home is considered appropriate treatment of pediatric ingestions of < 10 mL of a commercial liquid glass/window cleaners containing < 10% ethylene glycol butyl ether.

[A comparative study of methods of preparing the colon for a double-contrast study: Prepacol versus ricinus capsules with a cleansing enema]. / Vergleichende Studie zur Vorbereitung der Doppelkontrastuntersuchung des Kolons: Prepacol versus Rizinuskapseln mit Reinigungseinlauf.

In a controlled study, we analyzed the efficiency of cleansing out the colon and the best contrast medium of two different regimens (total n = 237) for preparing the colon for double-contrast examination. The recommendations regarding diet and liquid intake, contrast medium and examination technique were identical in both groups. The combination laxative Prepacol without cleansing enema resulted in a more thoroughly cleaned colon that ricinol with cleansing enema (very good/good cleanliness: Prepacol, 92.4%; ricinol, 83.2%, p less than 0.05). However, the quality of contrast medium (good: Prepacol 71.2% as opposed to ricinol 74.8%) was (independent of the preparation method) below standard regarding cleansing of the colon. Better patient compliance was accomplished by Prepacol because the medication was easier to take, and omitting the cleansing enema was a reduction in burden for both patients and medical staff. Written instructions for diet is essential and was of help to the patients.

Studies on the effect of toothpaste rinses on plaque regrowth. (II). Triclosan with and without zinc citrate formulations.

Encouraging findings have been reported for the effects of Triclosan/zinc citrate toothpastes on plaque regrowth and in some studies gingival health. To date, commercially-available toothpastes contain 0.2% Triclosan with or without 0.5% zinc citrate. The aim of this study was to evaluate the effects on 4-day plaque regrowth, of a number of 0.2% Triclosan toothpastes with or without zinc citrate. All of the toothpastes contained varying levels of anionic detergent sodium lauryl sulphate and were compared with a commercially available toothpaste without Triclosan or zinc citrate and a 0.2% chlorhexidine mouthrinse. The toothpastes were used as slurry twice a day and plaque regrowth scored by area and the criteria of the debris index. Plaque inhibition was significantly greater with the chlorhexidine mouthrinse than with all of the toothpastes. There were no significant differences in plaque scores between any of the toothpastes. It would appear that at the concentration of 0.2% Triclosan with or without 0.5% zinc citrate provides little if any additional benefit to plaque inhibition to that produced by a conventional toothpaste containing sodium lauryl sulphate.

Detergent enema: a cause of caustic colitis.

A 5-year-old boy developed acute colitis followed by stricture formation as a result of a detergent enema. The acute phase of the caustic induced colitis was reproduced in the dog and the rat using full strength and diluted detergent enemas. The severity of the experimental colitis was shown to be directly related to the concentration of the detergent.

Decontamination procedures for skin exposed to phenolic substances.

Spraying or swabbing with a mixture of polyethylene glycol 300/industrial methylated spirits (PEG-300/IMS) (2:1 by volume) has been shown to substantially reduce mortality, systemic effects, and skin burns resulting from skin contamination by phenol, cumene hydroperoxide, or phenol/acetone cleavage product. The skin-damaging potentials of sodium hydroxide and sulfuric acid have also been investigated. PEG-300/IMS(2:1 by volume) mixture was found, in rats, to be slightly less effective than water as means of decontamination. The PEG-300/IMS mixture has been shown not to cause eye irritation, and so should not present a hazard where this mixture is used as a decontaminant spray.