Comparing the use of a novel antibiotic-free film-forming topical wound dressing versus a topical triple antibiotic in dermatologic surgical procedures including Mohs micrographic surgery.

BACKGROUND: There is no universally accepted protocol of topical wound care after cutaneous surgical procedures. The current practice is to use petrolatum-based products, commonly containing topical antibiotics. The rise in antibiotic-resistant bacteria and increased risk of allergic and contact dermatitis due to the use of topical antibiotics is well established. OBJECTIVE: To compare the prevalence of contact dermatitis, the infection rate and the subjective measures of healing of a novel, antibiotic-free, film-forming silicone-based wound dressing to a topical triple antibiotic petrolatum-based ointment in patients undergoing invasive dermatological interventions in two arms: (1) Mohs micrographic surgery (MMS) and (2) a combination of various routine dermatologic surgical procedures. DESIGN: The 231 patients were enrolled in this open-label, randomized, single-blinded study. Patients applied the products immediately after surgery and daily afterwards. Clinicians evaluated the surgical site for infection or contact dermatitis at all follow-up visits. Acute wound healing progression was assessed using a rating scale against clinical experience and expected results from -4 (much worse) to +4 (much better). RESULTS: Contact dermatitis was significantly decreased in the wound dressing group compared to the topical antibiotic group (0 vs 15.9%, P < 0.001). There was no difference between the study arms (Mohs vs. non-Mohs, P = 0.242). Infection rate was not significantly different between the groups (P > 0.05) and between the study arms (P > 0.05). Assessor-rated secondary outcomes like healing time, healing quality, erythema and new tissue quality were significantly better in the wound dressing group, while comfort and perceived overall satisfaction were better in the antibiotic group. Patient-rated outcomes did not show any difference between groups and between study arms. CONCLUSION: The wound dressing used in this study is a topical silicone gel preparation and presents a viable alternative to topical antibiotics for postoperative wound care without enhancing the risk of infection.

Dermabrasion: therapy and prophylaxis of the photoaged face.

BACKGROUND: For many years dermabrasion has been used for the treatment of photoaged facial skin. However, there is a paucity of correlative studies that document the beneficial histopathologic effects of dermabrasion with clinical changes. Moreover, long-term follow-up and comparative studies that document these therapeutic results are lacking. OBJECTIVE: Our purpose was to study patients with photoaged facial skin by comparing the preoperative and postoperative clinical and histopathologic changes that occur as a result of surgical dermabrasion of aged and photodamaged facial skin. METHODS: Twelve patients 40 years of age and older with significant photoaging and dermatoheliosis were treated with full-face dermabrasion. Predermabrasion biopsy specimens were compared with matched postdermabrasion biopsy specimens taken at various time intervals from 6 months to 8 years after dermabrasion. RESULTS: Microscopic normalization of the actinically damaged epidermis and papillary dermis was manifested clinically by the replacement of dermatoheliosis with supple, smooth-textured facial skin that remained clinically evident well beyond 8 years after dermabrasion. In addition, the necessity for the continued treatment of premalignant and malignant lesions was virtually eliminated during the 8-year postdermabrasion period. CONCLUSION: Not only is dermabrasion a beneficial therapeutic option for aged and photo-damaged skin, but it also is a valid means of prophylaxis against neoplastic changes.

Bullous systemic lupus erythematosus.

Two patients with bullous systemic lupus erythematosus are reported. In one, the disease appears to have been caused by hydralazine. The cutaneous lesions of bullous SLE have not been previously reported in drug-induced lupus.