Treatment of chronic plaque psoriasis with herbal Unani formulations: A randomized control trial of efficacy and safety.

ETHNOPHARMACOLOGICAL RELEVANCE: Psoriasis, despite modern therapeutic options, is incurable and recurrent. In Unani (Greco-Arab) medicine, many medications and formulations have been prescribed by eminent scholars for conditions clinically similar to psoriasis, though empirical evidence is sparse. Hence, the experimental formulations ItrifalShahtra and MarhamHina were chosen to be compared to the standard therapies PUVAsol and petrolatum for their safety and efficacy. MATERIALS AND METHODS: This open-label, randomized control clinical trial was conducted on 66 male and female participants with chronic plaque psoriasis, ranging in age from 18 to 65 years. In each group, 33 participants were block randomized to either receive Unani formulations or control drugs for 12 weeks. The Unani group received oral Itrifal Shahtra (a semisolid paste) and topical MarhamHina (an ointment) twice daily, and the control group received oral 8-methoxypsoralen and topical petroleum jelly for local application. Participants of both groups were advised to get daily sunlight exposure for 5-15 min. The primary outcome measure was the change in psoriasis area and severity index (PASI) assessed at each visit. Secondary outcome measures were patient global assessment on a 100 mm VAS applied at baseline and after 12 weeks of treatment and change in subjective parameters including erythema, induration, scaling, and itching, assessed on a 5-point scale at every visit. Hemogram, LFTs, RFTs, CXR, ECG, urine, and stool tests were all assessed at baseline and after treatment for the safety of the drugs. RESULTS: The per-protocol analysis was done on 25 participants in each group. The mean ± SD of the psoriasis area severity index (PASI) significantly decreased from 27.88 ± 12.01 and 23.61 ± 9.79 at baseline to 5.01 ± 4.59 and 9.85 ± 7.16 after completion of the trial therapies in both Unani and control groups, respectively. Also, the test formulations outperformed the control drugs on clinically significant endpoints, PASI 50 and PASI 75, with all 25 participants achieving PASI 50 and 76% achieving PASI 75. CONCLUSION: The trial formulations, ItrifalShahtra and MarhamHina may be superior to control drugs PUVAsol and petrolatum in terms of safety, efficacy, and tolerability in the treatment of chronic plaque psoriasis. Thus, the Unani formulations may further be evaluated in a well-designed multicentric superiority trial with an adequate sample size.

Efficacy of a Natural Topical Skin Ointment for Managing Split-Thickness Skin Graft Donor Sites: A Pilot Double-blind Randomized Controlled Trial.

OBJECTIVE: To evaluate the safety and efficacy of a new topical skin ointment with natural ingredients (aloe vera, honey, and peppermint) for dressing skin graft donor sites. DESIGN: A double-blind, placebo-controlled, randomized clinical trial. PATIENTS AND INTERVENTION: Researchers enrolled patients who were referred for split-thickness skin graft after burns or surgical wounds on the scalp or face area. For each patient, a thin layer of skin (depth, 0.04 mm; approximate size, less than 15 × 7 cm) was harvested from the thigh by a plastic surgeon with an electric or manual dermatome. The donor sites were divided and randomized to receive either natural ointment or petroleum jelly as a topical agent to dressing. Topical agents were applied on donor site wounds on days 0, 4, 7, and 14. MAIN OUTCOME MEASURES: Wound size, pain, erythema, pruritus, patient discomfort, complications, and physician satisfaction were evaluated at each visit. MAIN RESULTS: Among 28 patients, there was no significant difference between the two treatment agents regarding the rate of wound healing (P = .415), pain (P = .081), pruritus (P = .527), and patient discomfort (P = .616). The ointment was superior to petroleum jelly in reducing wound erythema (P = .001) and was associated with significantly better treatment satisfaction (P < .001). CONCLUSIONS: The natural topical ointment investigated in this study may be an acceptable alternative to petroleum jelly in caring for split-thickness donor skin graft donor site wounds to effectively promote wound healing, prevent infection and scarring, reduce pain, and comfort the patient.

The Effect of Lauric Acid on Pathogens Colonizing the Burn Wound: A Pilot Study.

OBJECTIVE: Some of the most serious complications of burns include septic infections. Instead of fulfilling the function of a protective barrier, tissues damaged by high temperature create a niche that serves as an environment and source of nourishment for pathogens. An accepted practice is to use antibiotics to inhibit development of pathogens. Taking into consideration the characteristics of the burn wound and increasing antibiotic resistance, the search for new substances that have both antimicrobial and regenerative effects seems justified. The aim of the study was to determine the influence of lauric acid on bacteria-colonizing tissue samples taken during surgical treatment of burns. METHODS: Lauric acid was combined with 5 different ointment bases: Anhydrous Eucerin DAB, Anhydrous Eucerin II, Hydrophilic Vaseline, White Vaseline, and Lekobaza. The content of lauric acid in the ointment bases was 10% to 20% w/w. The preparations were applied onto samples of burnt skin collected during surgery. The samples were subsequently subjected to a microbiological test with the use of model strains of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. RESULTS: With one exception (White Vaseline), lauric acid showed a more pronounced effect on bacteria in 20% w/w concentration. In a 10% lauric acid concentration, no effect on bacteria was observed on the Hydrophilic Vaseline ointment base. Lauric acid had the strongest inhibiting effect on microbial growth of Gram-positive Staphylococcus aureus. Satisfactory zones of inhibition were also observed in the case of Escherichia coli. Growth inhibition of Pseudomonas aeruginosa was observed only when pure lauric acid was used. CONCLUSIONS: Due to its aseptic and regenerative effect on chemically damaged tissues, lauric acid can be a promising modifier of the burn healing process.

Advanced film-forming gel formula vs spring thermal water and white petrolatum as primary dressings after full-face ablative fractional CO2 laser resurfacing: a comparative split-face pilot study.

BACKGROUND: Aesthetically pleasing results and fast, uneventful recovery are highly desirable after rejuvenating ablative laser procedures. Wound dressings following ablative laser procedures should ideally improve and optimize the wound healing environment. OBJECTIVE: The purpose of this comparative split-face, single-blinded, prospective observational study was to assess the efficacy and acceptability of two primary wound dressings immediately after a full-face fractional CO2 laser resurfacing procedure. METHODS: The assessments of an innovative film-forming dressing called Stratacel (SC) vs spring thermal water + Vaseline (V+) were conducted after a standardized, single-pass, full-face ablative fractional CO2 laser skin resurfacing procedure. Clinical parameters, such as haemoglobin - HB; surface temperature - ST; micro-textural modifications - MT; superficial melanin - M; intrafollicular porphyrins - P, were assessed at different phases of the healing process using standardized, non-invasive technologies. RESULTS: Five female volunteers were enrolled in this inpatient, controlled pilot study. Most of the clinical parameters considered, including 3D surface texture analysis, revealed a better performance of SC vs. V+ during the early, more delicate phases of the healing process. CONCLUSIONS: This preliminary study, even if performed on a small number of volunteers, confirmed a definite advantage of the tested semipermeable film-forming formula (SC) over a more conventional postoperative skin care regime (V+). Clinical results could be explained by a better uniformity of distribution of SC over the micro-irregularities induced by ablative fractional CO2 laser resurfacing. Its thin, semipermeable film might, in fact, act as an efficient, perfectly biocompatible, full contact, temporary skin barrier, able to protect extremely delicate healing surfaces from potential environmental irritations.

In vitro method to evaluate the barrier properties of medical devices for cutaneous use.

Barrier creams (BC) are marketed as cosmetic products or locally-applied medical devices to protect skin against damages induced by chemical agents or physical insults. However, the determination of the BC effectiveness is still a matter of discussion at both the clinical and the regulatory level. In this context, this work aimed at the development of a reliable, reproducible and easy-to-perform experimental protocol for the evaluation of BC performances. Preliminarily, an in vivo method based on the measurement of trans-epidermal water loss had been matter of investigation and was discarded: it required too much time and was not robust and sensitive enough. In vitro, reduction of the permeation of caffeine (used as a model of irritant), through an epidermal membrane mounted on a Franz cell or through a reconstructed 3D human epidermis model, was evaluated. Six BC among oil in water (O/W) or water in oil (W/O) creams were investigated with respect to the petrolatum, which is an efficient impermeable barrier against hydrophilic molecules. Despite minor differences, both methods could rate the effectiveness of the tested products in preventing caffeine exposure. Both methods enable to evaluate and quantify the BC effectiveness in a simple and fast manner. Their application may help regulatory agencies to prevent the marketing of ineffective products for the benefit of consumers.

Effectiveness of topical clove oil on symptomatic treatment of chronic pruritus.

BACKGROUND: Pruritus is a frequent symptom in the general population and in many skin and systemic diseases. Its frequency demonstrates a high burden and an impaired quality of life. AIM: Assessment of the efficacy of topically applied clove oil alone in the treatment of chronic pruritus. METHODS: Fifty selected subjects diagnosed with chronic pruritus due to either hepatic, renal, or diabetic causes were studied and divided into two groups of 25 patients each. Group I patients were instructed to hydrate the skin and then apply topical clove oil while group II patients applied petrolatum topically by hand; this application was done on the areas of pruritus, twice daily and for 2 weeks. The severity of the itch was assessed and compared before and after the study by 5-D itch scale. The results were analyzed by SPSS. Statistical methods such as descriptive analysis, independent-samples t-test, paired-samples t-test, and chi-square were employed. RESULTS: There was a significant improvement regarding all studied individual parameters (5-D itch scale) for the clove oil users with no significance among petrolatum users. Comparison of 5-D itch scale total score between patients of group I and patients of group II favored the improvement following the use of clove oil than using placebo (P value>.05). CONCLUSION: The topical treatment of chronic pruritus with clove oils is effective, easy to use, safe, cheap, and more acceptable for whom topical and systemic treatments tend to be irritating, contraindicated, or less well tolerated.

Long-term follow-up of pediatric trachyonychia.

Pediatric trachyonychia is an acquired nail disease that can cause distress to families. It is a poorly understood disease, and long-term follow-up data are lacking. We present an institutional review of 11 children with isolated pediatric trachyonychia followed over time. Children with the diagnosis of pediatric trachyonychia were identified and invited to participate. Pictures were taken on follow-up and a questionnaire was answered. Exclusion criteria include having another diagnosis at the initial visit that causes nail dystrophy. Eleven patients with the diagnosis of pediatric trachyonychia were available for follow-up. The mean age of appearance was 2.7 years (range 2-7 yrs) and the average follow-up was 66 months (range 10-126 mos). Nine patients were treated with potent topical corticosteroids, one used only petrolatum, and one took vitamin supplements. One patient was found to have an additional skin and hair diagnosis of alopecia areata on follow-up. On follow-up, 82% noted improvement of the nails, whereas 18% noted no change. A majority of cases of pediatric trachyonychia are isolated and improve with time, regardless of treatment.

Efficacy of petrolatum jelly for the prevention of diaper rash: a randomized clinical trial.

PURPOSE: To assess the efficacy of petrolatum jelly for the prevention of diaper rash and to evaluate the relationship between the occurrence of diaper rash and certain treatments and type of nutrition. DESIGN AND METHODS: A randomized clinical trial was carried out with two parallel groups (n = 213) at the neonatal care unit of Donostia University Hospital in San Sebastián, Guipuzcoa Province, Spain. RESULTS: There was a lower incidence of diaper rash in the experimental group with petrolatum jelly (17.1%) than the control group (22.2%), but the difference was not statistically significant (p =.39). The use of antibiotics and oral 50% glucose as well as an increased number of stools are associated with a higher incidence of diaper rash, while breastfeeding and phototherapy are protective factors. PRACTICE IMPLICATIONS: Prevention is strengthened by a better understanding of the risk factors.

Comparative study of the efficacy and tolerability of a unique topical scar product vs white petrolatum following shave biopsies.

An excess of 70 million cutaneous surgical procedures are conducted annually in the United States that may result in scarring. Skin scars are a normal outcome of the tissue repair process. However, individuals with abnormal scarring may have aesthetic, psychological, and social consequences. As a result, there is a high patient demand for products that will reduce the scarring. The principles underlying scar formation are now better understood. Products are being developed to address those critical components of the wound-healing process, namely inflammation, hydration, and collagen maturation. A multicomponent scar product was previously shown effective in preventing exaggerated scarring in patients undergoing various surgical procedures. The present outpatient study was conducted in patients undergoing shave biopsies. Following reepithelialization, this investigator-blinded, randomized, 8-week trial compared twice-daily application of either the scar product or the standard of care, white petrolatum. Evaluation visits were conducted at baseline and at weeks, 1, 2, 4 and 8. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at each visit, and subjects completed a self-assessment questionnaire regarding treatment effectiveness and satisfaction. Twenty-eight subjects completed the 8-week study. The scar product provided earlier improvements than the white petrolatum. At week 1, 70% of subjects receiving the scar product demonstrated at least 50% global improvement in scar appearance vs only 42% of the subjects receiving white petrolatum. The more rapid improvement was accompanied by greater reductions in stinging/burning and itching with the scar product at all visits. Importantly, there was also greater subject satisfaction with the scar product at all visits. This scar product may be useful in hastening the healing of cutaneous shave biopsies and reducing the stinging/burning and itching associated with the normal healing process.

An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial.

BACKGROUND: Atopic dermatitis (AD) is a prevalent skin disorder with significant cost of treatment. Several prescription device moisturizers have been approved by the FDA to treat AD but are significantly more expensive than well-crafted over-the-counter (OTC) moisturizers. No studies have been performed to compare both the clinical efficacy and cost-efficacy of these prescription devices to OTC moisturizers. PURPOSE: The purpose of this study is to compare the clinical efficacy and cost-efficacy of a glycyrrhetinic acid-containing barrier repair cream (BRC-Gly, Atopiclair®), a ceramide-dominant barrier repair cream (BRC-Cer, EpiCeram®) and an OTC petroleum-based skin protectant moisturizer (OTC-Pet, Aquaphor Healing Ointment®) as monotherapy for mild-to-moderate AD in children. METHODS: Thirty-nine patients, age 2-17 years, with mild-to-moderate AD were randomized 1:1:1 to receive one of three treatments-BRC-Gly, BRC-Cer or OTC-Pet-with instructions to apply the treatment three times daily for three weeks. Disease severity and improvement was assessed at baseline and on days 7 and 21. RESULTS: No statistically significant difference for any efficacy assessment was found between the three groups at each time point. The OTC-Pet was found to be at least 47 times more cost-effective than BRC-Gly or BRC-Cer. LIMITATIONS: The relatively small sample size of 39 subjects was not sufficient to establish OTC-Pet as superior treatment in AD. CONCLUSIONS: OTC-Pet is as effective in treating mild-to-moderate AD as both BRC-Gly and BRC-Cer and is at least 47 times more cost-effective. NAME OF REGISTRY: II-AF-ATD-Aquaphor, Comparing the Efficacy and Cost-Effectiveness of Aquaphor to Atopiclair and EpiCeram in Children with Mild to Moderate Atopic Dermatitis. REGISTRATION IDENTIFIER: NCT01093469.

Accelerated resolution of laser-induced bruising with topical 20% arnica: a rater-blinded randomized controlled trial.

BACKGROUND: Dermatological procedures can result in disfiguring bruises that resolve slowly. OBJECTIVES: To assess the comparative utility of topical formulations in hastening the resolution of skin bruising. METHODS: Healthy volunteers, age range 21-65 years, were enrolled for this double (patient and rater) blinded randomized controlled trial. For each subject, four standard bruises of 7 mm diameter each were created on the bilateral upper inner arms, 5 cm apart, two per arm, using a 595-nm pulsed-dye laser (Vbeam; Candela Corp., Wayland, MA, U.S.A.). Randomization was used to assign one topical agent (5% vitamin K, 1% vitamin K and 0·3% retinol, 20% arnica, or white petrolatum) to exactly one bruise per subject, which was then treated under occlusion twice a day for 2 weeks. A dermatologist not involved with subject assignment rated bruises [visual analogue scale, 0 (least)-10 (most)] in standardized photographs immediately after bruise creation and at week 2. RESULTS: There was significant difference in the change in the rater bruising score associated with the four treatments (anova, P=0·016). Pairwise comparisons indicated that the mean improvement associated with 20% arnica was greater than with white petrolatum (P=0·003), and the improvement with arnica was greater than with the mixture of 1% vitamin K and 0·3% retinol (P=0·01). Improvement with arnica was not greater than with 5% vitamin K cream, however. CONCLUSIONS: Topical 20% arnica ointment may be able to reduce bruising more effectively than placebo and more effectively than low-concentration vitamin K formulations, such as 1% vitamin K with 0·3% retinol.

Aquacel Ag with Vaseline gauze in the management of toxic epidermal necrolysis (TEN).

UNLABELLED: Toxic epidermal necrolysis (TEN) is a rare condition with potentially high mortality and involves severe exfoliative disease of the skin and mucous membranes induced by drugs. The reported fatality of TEN varies widely from 20% to 60%. The technique for TEN wound coverage described in this article involves the use of various dressings. PATIENTS AND METHODS: Nine women with histologically confirmed TEN (>30% total body surface area, TBSA) were treated at our burn intensive care unit. All patients received hydrotherapy and wounds were covered with Aquacel Ag and Vaseline gauzes onlay. Following this, elastic cotton bandage was wrapped around the dressing. The dressing was changed and the wound evaluated twice a week. Efficacy was established by the wound achieving>or=95% re-epithelialisation of the study area. RESULTS: The mean age was 60.1 years (range from 7 to 88 years). The percentage of body surface area affected by epidermal slough ranged from 30% to 85% TBSA, with a mean of 51%. One patient expired due to severe sepsis on day 3. Eight patients achieved over 95% wound healing. All wounds healed well without the need for skin grafting. However, two of them expired on day 14 and day 20 because of pneumonia and retention of carbon dioxide, respectively. The average duration to achieve 95% wound healing was 10.4 days in eight cases (range from 7 to 14 days). No adverse reactions were noted. CONCLUSION: Aquacel Ag dressing can be easily removed during hydrotherapy. The wound pain is reduced. By changing the dressing just twice a week, we were able to evaluate the wound directly, decrease the odour and increase the quality of life of the patients. In addition, lower frequency of dressing changes decreases the manpower requirements and is cost effective. Use of Aquacel Ag with Vaseline gauze is a good alternative for the management of TEN wounds.

Effect of virgin fatty oil of Pistacia lentiscus on experimental burn wound's healing in rabbits.

This study aimed to assess the efficiency of the virgin fatty oil of Pistacia lentiscus (PLVFO) for burn wounds healing. It was carried out on 6 adult male New Zealand rabbits. Four burn wounds of deep third degree were made on the back of each animal. The first was not treated and served as control (CRL group); the others were covered immediately after burning procedure by 0.5g of one of the following products: Vaseline gel (VAS group), Madecassol(®) cream 1% (MAD group) or 1ml of PLVFO (PLVFO group). The treatments were repeated once daily until complete healing. For four days post burns, the percentage of wound contraction was assessed. Also, the different healing times were noted. The results showed that both PLVFO and Madecassol(®) significantly accelerated wound healing activity compared to wounds dressed with Vaseline and the untreated wounds. However, the level of wound contraction was significantly higher and the healing time was faster in PLVFO group than those of the MAD group, VAS group and CRL group. The different epithelization periods obtained in days were respectively: 30±3.94 (PLVFO group), 33.5±3.78 (MAD group), 34.66±3.88 (VAS group) and 37.16±3.54 (CRL group). We conclude that Pistacia lentiscus virgin fatty oil promotes significantly (p< 0.05) wound contraction and reduces epithelization period in rabbit model.

The comparative study of solvents to expedite removal of bitumen.

Hot-bitumen burn is a unique case in all types of burns. This melting substance is difficult to remove when it adheres to the skin and solidifies. It causes burns and sticks to the skin when it is cooled to the skin temperature. Some reports are available on many kinds of solvents for the removal of solid bitumen. However, there have thus far been no comparative studies. It is necessary to seek for an optimum method to remove bitumen without consuming so much time and with minimum injury to the skin. The selected solvents in this study were petrolatum, olive oil, salad oil, butter, Neosporin ointment and De-solv-it. They were often reported as being effective for hot-bitumen burn injuries with little irritation for a damaged skin. It is easy to purchase them commercially. Each solvent was poured over the bitumen in a test tube. Afterwards, the concentrations of the bitumen in the solvents were quantified with the fluorescence measurement technique. We consider De-solv-it is the one of the best solvent for the removal of bitumen and highly recommended for hot-bitumen burns. The results of this study suggest that dressing change should be done every 4 to 8 h or as frequently as needed until the bitumen is entirely removed.

Home remedies to control head lice: assessment of home remedies to control the human head louse, Pediculus humanus capitis (Anoplura: Pediculidae).

As the frequency and level of pediculicide resistance increases throughout the world, the need for novel solutions to control pediculosis has intensified. The development and registration of new pesticides has become so costly that many chemical companies are unwilling to pursue it and health-care providers now face a serious lack of new commercial pediculicides. Many infested people resort to using "home-remedy" approaches that have not been scientifically tested. In this article, we examined the potential value of six purportedly effective "home remedies" (vinegar, isopropyl alcohol, olive oil, mayonnaise, melted butter, and petroleum jelly) to treat head louse infestations and the likelihood of drowning lice by water submersion. Results indicated that only the application of petroleum jelly caused significant louse mortality but no treatment prevented lice from laying eggs. Most home remedy products did little to kill eggs, despite prolonged exposure. Petroleum jelly caused the greatest egg mortality, allowing only 6% to hatch. It was extremely difficult to drown lice, despite extended periods (i.e., 8 hr) of water submersion, suggesting that killing lice by depriving them of oxygen is inefficient. None of the home remedy products we surveyed was an effective means of louse control. This suggests that when treatment failure occurs, an increased amount of time and effort should be focused on alternative chemical pediculicides and/or manual louse removal (i.e., combing) rather than using any of these products.

Ensayo clínico y de laboratorio de una crema de calendula en el Post Resurfacing Láser / Clinical laboratory trials of a calendula cream Following Laser Resurfacing

Con el fin de estudiar las características macro y microscópicas de la piel después del resurfacing láser, tratada con una crema cuyo principal componente es la caléndula, sé planteó un estudio experimental en la oreja del conejo. También, en pacientes, la fase del post resurfacing se siguió clínicamente, comparándola con áreas no tratadas con dicha crema. Para este estudio, las 2 orejas de un grupo de conejos fueron tratadas con igual técnica de resurfacing, empleando un aparato Derma-K, que combina los láser de Erbium:YAG y CO2. La programación empleada fue: Er:YAG 29 J/cm2, CO2 5W, 50 ms de duración del pulso y 50 por ciento de sobreposición de los disparos. Se utilizó una pieza de mano colimada con un haz de 3mm de diámetro y se realizó solo un pase láser.En cada animal, tras el resurfacing, se trató sólo una orejas con la crema de caléndula, utilizando la otra como control con vaselina estéril. En los días siguientes se identificaron las diferencias macroscópicas y se anotaron los cambios apreciados en las fotografías realizadas desde el microscopio. Comparativamente, la piel tratada con caléndula mostró mejor y más rápida recuperación, con evidentes diferencias en la red neo-vascular formada y también en la reepitelización controlada por biopsias. El estudio clínico se realizó en diez pacientes divididas en 2 grupos. En ambos se utilizaron idénticos parámetros de resurfacing y cuidados post-tratamiento que en la experimentación animal. Cinco pacientes fueron tratados con la crema de caléndula y los otros cinco con vaselina estéril. En la valoración de las diferencias de la piel, se observó que en los resurfacing tratados con vaselina la reepitelización se conseguía más tardíamente y la desaparición del eritema era más lenta (AU)

Efficacy and safety of a topically applied Avène spring water spray in the healing of facial skin after laser resurfacing.

BACKGROUND: Although laser resurfacing is a well-accepted treatment, tolerance problems may preclude patient's acceptance of the procedure. Post-laser protracted erythema is a prime problem, associated with the symptoms of pain, itching, stinging and tightening. OBJECTIVE: The present study was conducted to evaluate a low-salt medical spring water (Avène, Avène-les-Bains, France), in conjunction with the standard use of an emollient, to improve tolerance by hydrating the postlaser skin. METHODS: A controlled, randomized, open-labeled, multicentric and two parallel group study was completed after 84 days in 74 patients, 34 applying a petrolatum ointment alone (control group), and 40 applying petrolatum ointment in association with the Avène spring water spray ad libitum (water group). RESULTS: The water spray showed a pronounced effect on reducing erythema, from the second week of postlaser onwards, with a statistically significant difference in favor of the water group compared with the control group (p < or = 0.04 from day 14 to day 84, except a non-significant trend on day 28). In addition, the water spray was found to significantly reduce itching on day 28 (p < 0.05), and stinging and tightening on day 14 and day 21 (p < 0.05). Pain was not modified by the water. CONCLUSION: Topical water appears to be a helpful adjunctive treatment to petrolatum ointment for counteracting erythema, itching, stinging and tightening during the postlaser treatment period.