Treatment of Pressure Sores
J G Webster in Prevention of Pressure Sores, 2019
For most cases, it is recommended that an occlusive dressing be applied to the clean wound as the primary dressing because occlusive dressings provide an optimized wound environment and a means of protecting the wound from outside contamination (Mulder and LaPan 1988). Occlusive dressings create a moist environment which allows epithelial cells to migrate and should be gas permeable to allow the healing tissue an adequate oxygen supply (Seiler and Stähelin 1985). If the pressure sore shows clinical signs of infection, has a culture that yields greater than 105 organisms per gram of tissue, has exposed tendons or bones, or has draining sinus tracts, then an occlusive dressing should not be used (Mulder and LaPan 1988). It is also better to use a dry dressing if the sore is inactive (Torrance 1983).
Local muscle flaps in the setting of revision spine surgery: Indications, operative planning, principles, and postoperative management
Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro in Revision Spine Surgery, 2019
The occlusive, sterile dressings from the operating room are maintained for 48–72 h postoperatively unless they are saturated or soiled. After 48–72 h, the dressings are removed and the wound inspected. It is our preference to then place a new occlusive dressing over the incision, changed every 1–2 days, for the duration of the patient's hospitalization. The dressing can be removed on the day of discharge, and any wound closure strips allowed to fall off on their own. As an alternative to an occlusive dressing, an incisional subatmospheric dressing may be left in place for several days or until the patient is ready to be discharged, whichever comes first. Occlusive dressings containing chlorhexidine gluconate gel covers are left in place over the drain sites until drain removal.
Goeckerman Therapy
John Y. M. Koo, Ethan C. Levin, Argentina Leon, Jashin J. Wu, Alice B. Gottlieb in Moderate to Severe Psoriasis, 2014
Typically, patients start off the morning with an assessment of their skin. If the patient is found to be erythrodermic or exhibits intense, bright-red inflammation, a “cool down” procedure (mentioned in the section on “Cool Down Procedure”) is performed prior to starting UVB phototherapy or topical tar. Once the inflammation has decreased and there is less concern that it will be aggravated by UVB phototherapy or topical tar, the Goeckerman regimen is started. The patients are given UVB phototherapy in the morning after which topical tar and steroids are applied to the skin. The topical therapy is subsequently occluded by plastic wrap to keep the medication on the skin and to improve efficacy by allowing for better penetration of the active ingredients. After four hours, the patient can remove the occlusive dressing and wash off any remaining topical medication. If the topical therapies are left on for less than four hours, the efficacy of the treatment may be compromised. Before leaving for the day, a second iteration of topical therapy is applied (usually topical steroids or 20% liquid carbonis detergens [LCD]) or the patient is given instructions to apply it before bed.
Xylocaine® 10% Pump Spray as topical anaesthetic for venepuncture pain
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
A van Straten, AA Murray, AI Levin
A recurring theme is how to facilitate transfer of topical lignocaine across the stratum corneum.16−20 Mechanisms to enhance drug transfer across the stratum corneum include using a high drug concentration, the addition of solvent vehicles or penetration enhancers (e.g. water, ethanol, polyethylene glycol) or the application of an occlusive dressing over the treated skin area.17 Both the addition of water and the use of an occlusive dressing serve to hydrate the skin. It is unclear exactly how cutaneous hydration enhances drug penetration. Postulated mechanisms include equilibration of the water content of the stratum corneum and dermis, or that water saturation disrupts the stratum corneum’s lipid bilayer. Both ethanol and polyethylene glycol probably enhance drug transfer by altering the solvent properties of tissue.18 Ethanol is thought to cause fluidisation of intercellular lipids.19,20 Interestingly, Xylocaine® 10% Pump Spray contains 24.1% m/v ethanol 95%, polyethylene glycol 400 and purified water. Xylocaine® 10% Pump Spray’s formulation and its application using an occlusive dressing fulfils many of the aforementioned criteria to enhance cutaneous drug transfer.
Systemic medications used in treatment of common dermatological conditions: safety profile with respect to pregnancy, breast feeding and content in seminal fluid
Published in Journal of Dermatological Treatment, 2019
Sarah Madeline Brown, Khadija Aljefri, Rachel Waas, Philip Hampton
Tretinoin is a retinoid and a potent teratogen, however a certain endogenous amount is required for elements of genetic expression and embryonic development. The teratogenic effects of tretinoin are manifested with excessive levels (11). Animal studies have shown typical retinoid induced mutations with doses between 80 and 2000 times the recommended human topical dose (11). Some sources estimate that the risk of teratogenicity associated with topical tretinoin is close to zero. However, this risk is felt to be increased when topical tretinoin is used under an occlusive dressing. Presuming the skin’s maximum absorbency is 33%, the estimated maternal percentage absorbed of a 1 g of 0.1% tretinoin is about 1/7th of the percentage of vitamin A. This amount equates to the regularly available pre-natal vitamin supplementation dosage (11). Incidentally one study stated that 80% of 0.1% tretinoin remained on the skin, in comparison to 50% when a 16 h occlusive dressing was used (11).
5-aminolaevulinic acid-based photodynamic therapy induces both necrosis and apoptosis of keratinocytes in plantar warts
Published in Journal of Cosmetic and Laser Therapy, 2020
Huixia Wang, Layuan Xiong, Yumin Xia, Xiuying Wang
A cream containing 20% ALA (Shanghai Fudan-Zhangjiang Bio-Pharmaceutical Co., Shanghai, China) was topically applied in a thick layer (0.2 g/cm2). The area of coverage included the entire wart and the surrounding normal skin to a distance of 1 cm from the wart margins. The treated area was then protected from light for 3 hours with an occlusive dressing. After 3 hours, the area was irradiated with visible red light produced by a He-Ne illuminator (Beijing Kedian Laser Inc., Beijing, China) (Figure 1a). Protoporphyrin IX (PpIX) fluorescence images were taken by using a Wood’s lamp to visualize the area and a digital camera equipped with UV filter (Figure 1b). The wavelength of the He-Ne laser was set to 630 nm with an output power of 150 mW. The total energy of a single irradiation dose was 60 ~ 100 J/cm2, administered for a suitable duration of time in accordance with the size of the photo-patch area being treated. The laser light source was kept at a distance of 10 cm from the warts during treatment. PDT was performed weekly and lasted for 4 weeks.
Related Knowledge Centers
- Edema
- In Vivo
- Pneumothorax
- Dressing
- First Aid
- Gauze
- Petroleum Jelly
- Topical Medication
- Cream
- Stent