Surgical antiseptics

The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.     

Inhibition of histamine-induced pruritus by topical tricyclic antidepressants

Frequent antihistaminic side effects noted during treatment of depression by tricyclic drugs, as well as the high affinity of tricyclic antidepressants for H₁ receptors in mouse neuroblastoma cells, suggest possibly useful antihistaminic properties. We investigated the antipruritic activity of topically applied 5% solutions of doxepin hydrochloride (Adapin; Sinequan) and amitriptyline hydrochloride (Elavil) and compared such activity to that of a 5% solution of diphenhydramine and vehicle alone. Test solutions were applied to 25-cm² areas on the flexor forearms of forty subjects, and the development of itch to single drops of eight dilutions of histamine phosphate instilled in each area was reported over a 3-minute period. The lowest concentration of histamine able to elicit unequivocal itching in each treated area was the histamine itch threshold (HIT). Doxepin, amitriptyline, and diphenhydramine all produced significantly higher mean and median HITs (p < 0.01) than did vehicle control. Sixty-eight percent of subjects had a HIT ≥2 × 10^?4 mg/ml in doxepin-treated areas versus 58% for amitriptyline, 53% for diphenhydramine, and 25% for vehicle. Our data suggest that tricyclic antidepressants are effective topical antipruritic agents.     

Quinacrine hydrochloride drug eruption (tropical lichenoid dermatitis). Its early and late sequelae and its malignant potential: a review

The totality of effects of a particular drug on patients cannot be truly assessed until many patients have taken it. In order to assess the side effects of any drug, many thousands of patients may have to be observed, and the observation may have to extend over decades. Quinacrine hydrochloride (quinacrine) was used as a malarial-suppressive drug by allied soldiers during World War II. The most commonly occurring side effect was a drug eruption. This at times led to permanent sequelae at an early stage. Further observation revealed late sequelae occurring 7 to 17 years after the war. Two of these late sequelae were observed to become malignant, and in most cases the palmar aspect was involved. This is an area which rarely shows malignant change. It has been observed that quinacrine can be instrumental in inducing skin cancers as late as 34 years after its ingestion.     

Implantation technics for injectable collagen. Two and one-half years of personal clinical experience

The successful use of injectable collagen, a xenogeneic material indicated as a tissue replacement for correcting certain soft tissue anomalies, depends primarily on appropriate lesion selection and proper technic. Treatment with injectable collagen yields best results in soft, distensible lesions with relatively smooth margins. Lesions most amenable to correction include acne scars, steroid- or disease-induced areas of atrophy, glabellar furrows, nasolabial lines, postrhinoplasty irregularities, and depressed skin grafts. Optimal correction with the fewest number of injections is chiefly dependent upon deliberate overcorrection and superficial intradermal placement of the material. Outlined here are my experiences with over 1,000 patients treated with injectable collagen for a variety of soft tissue deficiencies.     

Comedogenicity of current therapeutic products, cosmetics, and ingredients in the rabbit ear

Cosmetics continue to be used by acne-prone individuals. Often as more acne develops, more cosmetics are applied. In order to protect against this natural tendency, physicians should provide more patient information on the currently available products and ingredients. This presentation is designed to help in that effort. The data presented were gleaned from the rabbit ear assay, which is not an ideal animal model but is the best we have. If an ingredient is negative in the rabbit ear assay, we feel it is safe on the acne-prone skin. A strong, positive ingredient or cosmetic should be avoided. Ingredient offenders include isopropyl myristate and its analogs, such as isopropyl palmitate, isopropyl isostearate, butyl stearate, isostearyl neopentanoate, myristyl myristate, decyl oleate, octyl stearate, octyl palmitate or isocetyl stearate, and new introductions by the cosmetic industry, such as propylene glycol-2 (PPG-2) myristyl propionate. Lanolins continue to be a problem, especially derivatives such as acetylated or ethoxylated lanolins. Our most troublesome recent finding is the comedogenic potential of the D & C Red dyes. They are universally used in the cosmetic industry, especially in blushers. This may explain the predominance of cosmetic acne in the cheekbone area. All of these D & C Red dyes tested to date, the xanthenes, monoazoanilines, fluorans, and indigoids, are comedogenic. Actually, this is not surprising as they are coal tar derivatives. The natural red pigment, carmine, is noncomedogenic and can serve as a substitute for D & C dyes in blushers. Many finished products are comedogenic. Most troublesome to the dermatologists are the therapeutic tools that we use, such as Liquimat, Retin-A cream, Hytone, Staticin, Sulfoxl, Desquam-X, and Persadox HP cream. These should be reformulated. We have been unable to confirm that precipitated sulfur (U.S.P.) is a potent comedogen in the rabbit ear assay. Clinically, we still find sulfur quite effective as an adjuvant to the benzoyl peroxide therapy for the treatment of acne vulgaris. We would suggest that the bias against sulfur be reconsidered.     

Dermatologic signs in toxic shock syndrome--clues to diagnosis

A diffuse scarlatiniform erythroderma, bulbar conjunctival hyperemia, and striking palmar edema were impressive findings in two patients who developed toxic shock syndrome (TSS). In addition to the rash which is always seen, the latter two features have been observed in high frequency in this condition and when present are useful aids in the diagnosis of this disease.     

Pigmentary changes in Seckel's syndrome.

Seckel's syndrome consists of multiple congenital anomalies, including bird-headed dwarfism, mental deficiency, and skeletal and ophthalmic defects. We report a patient with this syndrome who demonstrated pigmentary changes, including streaks of brown pigmentation on the neck, groin, and axillae. Histologic examination revealed pigment incontinence.     

Punctate hyperkeratosis of the palms and soles. An ultrastructural study

Punctate hyperkeratosis of the palms and soles is an uncommon autosomal dominant condition. We report a 65-year-old man with this condition and review the literature. With electron microscopy, we have examined both clinically affected and adjacent clinically unaffected palmar skin. The only ultrastructural differences noted were a thicker keratin layer and hypertrophic nucleoli in the basal cell layer and stratum spinosum in the clinically affected skin. This nucleolar hypertrophy suggests that there may be increased metabolic activity in the clinically affected skin which is contributing to the abnormal keratinization.