Local Cleansing Research Articles

Non-surgical treatment of hidradenitis suppurativa: the role of cryotherapy.

Hidradenitis suppurativa is a chronic and recurrent inflammatory disease with a great impact on a patient's quality of life, due to the painful involvement of very sensitive areas, such as the groin, mammary area, and genitals, with malodourous discharge. Multiple treatment options are available; however, no single treatment is effective for all patients, and usually, a combination of medical therapy with various surgical and physical procedures is provided. Cryotherapy is not a routine technique to treat HS, although usually available in the majority of medical clinics, and is cheaper than laser and surgical treatments. The aim of this study was to evaluate the effectiveness of cryotherapy on persistent HS nodules, to reduce the burden of local disease. Retrospective observational study in all patients treated with liquid nitrogen cryotherapy for persistent nodules of hidradenitis suppurativa in the last 2 years, with at least 6 months of follow-up after the procedure. Disease severity was assessed with Hurley staging and sonographic staging according to SOS-HS (18 MHz probe, Esaote-MyLab™). The results were scored with a 0-3 points scale, as complete remission (3), partial response (2 to 1), or no response (0), after one session of treatment. Local cleansing and antiseptic treatment after the procedure was the same as previously performed in each patient, not to influence recovery. In total, 23 patients were included, with a total of 71 persistent nodules treated with a single cryotherapy session. The treatment has been effective in 63 out of 71 nodules treated (88.7%), and the patients attested that they recommend the treatment, the discomfort during recovery was minimal, and the management was not different from daily routine. Persistence was considered as having a failure rate (11.3% overall) and occurred in 7.5% of the nodules of the axillary region, 18.2% on the groin, and 11.2% for nodules of the gluteal region. Cryotherapy is a simple and effective procedure for the treatment of persistent nodules of HS not responding to medical therapy, and it is a valid alternative to local surgery or laser ablation.

Hand perforation caused by a Gafftopsail catfish (bagre marinus) in a fisherman from Northeastern Brazil

A 39-year-old male fisherman from Ceará State in Northeastern Brazil presented to the emergency room complaining of intense pain, edema, and bleeding in his left hand (Figure 1A-1B), He had a recent history of traumatism with hand perforation caused by the stinger of a gafftopsail catfish (Bagre marinus) (Figure 2A-2C). The injury occurred 4 hours prior when pulling his fishnet in the ocean. Right after the injury, the patient presented local pain and classified as eight in a visual analogue scale of pain. He denied systemic symptoms such as fever. On physical examination, he presented with two perforations separated by about 2 cm with slight bleeding (Figure 1A), local edema, and pain in his left hand (Figure 1B). Local cleansing of the lesion was performed. He was advised to apply warm compresses and used analgesics/anti-inflammatory drugs with the improvement of the inflammation. Systemic antibiotics were not necessary.

Dilute vinegar therapy for the management of spontaneous external auditory canal cholesteatoma

The purpose of this study is to evaluate the efficiency of conservative dilute vinegar therapy in the management of spontaneous external auditory canal cholesteatoma (EACC). From 2000 to 2007, 19 patients presented to our clinic with spontaneous EACC. EACC was divided into four grades based on the temporal bone computed tomography: grade I with flattening of bony external canal, grade II with partial destruction of inferior bony canal, grade III with total destruction of inferior bony canal and grade IV with bony destruction into the middle ear and mastoid cavity. Clinical findings and treatment results were recorded. Microscopic local cleansing and dilute vinegar therapy was conducted in the ears with grades I, II and III. Combined mastoid surgery and dilute vinegar therapy was conducted in four ears with stage IV. There were no recurrences after average of 31 months follow-up. Spontaneous EACC can be effectively controlled with dilute vinegar therapy after microscopic local cleansing. However, surgery must be considered in the cases which have involved the mastoid and middle ear. Dilute vinegar therapy in combination with microscopic local cleansing was effective in the management of spontaneous EACC. Dilute vinegar therapy is an easy, cost-effective, and home-based cleansing method to prevent EACC and promotes healing. However, long-term follow-up may reveal frequent recurrence of cholesteatoma debris and involvement of middle ear or mastoid cavity, and then meticulous debridement with skin graft or surgical intervention should be considered.

Bacterial Diseases of the Skin

When considering common bacterial diseases of the skin, rather distinct clinical responses to a variety of bacterial infections have been identified. In these cases, it is the specific site of infection and the attendant inflammatory responses that provide the characteristic clinical picture. When the pyoderma extends just below the stratum corneum, it is called impetigo. Nonbullous impetigo is the most common pediatric skin infection. It usually starts in a traumatized area. The typical lesion begins as an erythematous papule, after which it becomes a unilocular vesicle. When the subcorneal vesicle becomes pustular, it ruptures and eventually becomes a yellow, golden crust that is a hallmark of the disease process. Bullous impetigo is a less common form of impetigo, accounting for fewer than 30% of all impetigo cases. It occurs in infants and is characterized by rapid progression of vesicles to the formation of bullae measuring larger than 5 mm in diameter in previously untraumatized skin. Treatment of nonbullous impetigo must include intervention against the pathogen as well as improvements in the hygiene and living conditions of the patient. A fundamental tenet is to debride the crust (scab) from the wound surface using poloxamer 188. If the lesions are not widespread, topical mupirocin is the treatment of choice. Treatment of bullous impetigo is similar, except that the local cleansing and topical antibiotic must be complemented by systemic antibiotics if there is evidence of disseminating infections. Ecthyma is usually a consequence of failure to treat effectively impetigo. The untreated infection extends deep into the tissue in shallow ulcerations that often heal without scar. Treatment for ecthyma usually requires systemic antibiotics against either staphylococcus or streptococcus. Folliculitis is a pyoderma located within a hair follicle, secondary to follicular occlusion by keratin, overhydration, or either bacterial or fungal infection. Folliculitis may be divided into either a deep or a superficial type. In the superficial type, the pustule is located at the opening of the hair follicle. In the deep form, the infection may extend beyond the confines of the hair follicle, becoming a furuncle or boil. Carbuncles are aggregates of interconnected furuncles that drain through multiple openings of the skin. Treatment of folliculitis must include searching for and avoiding any factors predisposing to infection. If topical antibiotic therapy is ineffective in controlling the infection, surgical drainage of the infected skin abscess will be necessary. Paronychia is the most common bacterial infection of the hand, which often requires surgical incisional drainage. Similarly, a felon that is an infection of the distal pulp of a finger usually requires surgical drainage. Finally, cellulitis is an acute inflammatory reaction involving the skin and underlying subcutaneous tissue. It usually starts as erysipelas and may advance to lymphangitis, lymphadenitis, or gangrene,which will respond to life-saving interventions in the hospital that usually include systemic antibiotic treatment as well as surgical intervention.

A Cat Wounded by Archery Gun.

A 5-year-old Japanese domestic cat, wounded by an arrow from an archery gun was treated. The arrow entered from the medial canthus of the right eye and passed through the left scapular region. However, great vessel damage, penetration into the cranium and ocular rupture were not observed. Bleeding was minimun. The arrow could by slowly removed without post-removal bleeding. The wound was treated with local cleansing and sterilization along with systemic administration of antibiotics. Although the cat recovered, visual disturbances remained.

Pig bite in Brazil: a case series from a teaching hospital.

A retrospective survey done from 1987 till 1990 revealed that 23 patients bitten by pigs sought medical help at a teaching hospital in Uberlândia, in southeastern Brazil. Most cases (21) were from Uberlândia. The cases were evenly distributed by month and by year; most of them (14/16; 87.5%) occurred between 7.00 a.m. and 7.00 p.m. The male to female ratio was 6.7:1. Age ranged from 6 to 73 (mean 38.95 +/- SD 22.06, median 36). The bites were more common on the upper limbs, particularly on the forearms. In 11 (47.8%) cases the injury was described as deep. In most cases where information was available the injury was related to capture, transport or immobilisation of the pig for slaughter. The following medical procedures were performed: local cleansing in 19(82.6%) cases, rabies vaccine (12; 52.2%), antirabies serum (2; 8.7%), suturing (6; 26.1%) and tetanus vaccine (12; 52.2%). There was no case of infection at the bite site, neither of rabies or tetanus. By our data, the annual incidence of pig bite in Uberlândia can be estimated to be about 1.5/100,000.

Morbidity of Brown Recluse spider bites. Clinical picture, treatment and prognosis.

A retrospective review was made of 35 cases of Brown Recluse spider bites treated during a period of 21 years. The most common location of the bite was on the lower limbs, particularly the thigh. The main systemic manifestations were fever, malaise and maculopapular rash, but there were no cases of hemolysis, coagulopathy, or of renal or neurologic involvement. Signs indicating a poor prognosis appeared to be lymphangitis, generalized maculopapular rash and location of the bite on the thigh or abdomen. Most cases were treated effectively by rest, elevation of the affected part of the body, local cleansing, and prophylactic antibiotics. On the basis of this experience it was concluded that only when lesions show a necrotic area measuring 2 to 3 cm should patients be treated with systemic corticosteroids. In most such cases, administration of corticosteroids for 14-21 days proved sufficient to avoid the need for surgery. Only 5 cases required surgical intervention.

Pyoderma gangrenosum and malignant pyoderma in Nigeria

Five patients (four black Nigerian males and one Polynesian) with pyoderma gangrenosum (PG) were seen between May 1974 and March 1984, at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Their age range was 12-42 years (mean 25.6 years). The female expatriate Polynesian patient had PG localized to the upper back while the other four patients had severe and extensive PG lesions. Local cleansing and dressing of the ulcers combined with appropriate systemic antibiotics produced healing in two of these patients. The empirical addition of dapsone and rifampicin led to complete healing in two others, but only transient remission in one patient who, after 22 years of disease activity, died at home from an aggressive and accelerated form of the disease best described as 'malignant pyoderma' gangrenosum.

Intraperitoneal Povidone-lodine

<h3>To the Editor.—</h3> The remarks by Dr Roslyn¹concerning intraperitoneal povidone-iodine (PVP-I) require comment. We have not sought Food and Drug Administration approval for peritoneal irrigation with PVP-I, the active component of our Betadine preparations, and its utility for this purpose remains to be defined. However, we must question portions of Dr Roslyn's response. One reason is the acknowledged difficulty in comparing results of the numerous studies that involved peritoneal lavage with PVP-I, each of which used varying methodologies. Many variables affect these results, including the way systemic antibiotics are used, the thoroughness of local cleansing, the degree of contamination, and the patient's general condition. Nevertheless, a substantial body of literature, both clinical and preclinical, supports intra-abdominal use of PVP-I at appropriate concentrations. Dr Rosyln's reference to an experimental model in which this use was associated with increased mortality concerned a study involving dogs (reference 3). Some investigators have

How I Manage Pilonidal Disease

In brief: Pilonidal disease is a typical foreign-body reaction. Free hair migrates into the intergluteal fold in the sacral coccygeal area and perforates the skin, which sets up a point of entry for further hair buildup. The hair ball causes no reaction or symptoms until it is invaded by pathogens. Abscess, draining sinuses, and cellulitis then develop. Treatment is an outpatient procedure and is essentially the same whether there is a cyst, sinus granuloma, or abscess. It may be necessary to infiltrate over the area and allow purulent sanguineous material to drain out before irrigating the area. A small foreign-body snare is used to extract the hair. Recurrences can be prevented by emphasizing the importance of shaving and local cleansing.

Gas in soft tissues of forearm in an 18-year-old emotionally disturbed diabetic

<h3>History</h3> An emotionally disturbed 18-year-old diabetic woman was admitted to the hospital because of a "sore" on her right forearm of ten days' duration, for which she had been taking erythromycin estolate orally in addition to local cleansing of the infected area with hydrogen peroxide. Physical examination showed a 3×3-cm noninflamed ulcer on the volar aspect of the right forearm. Crepitation was detected along the right upper extremity. Vital signs were normal. A roentgenogram of the right forearm demonstrated the typical stigmata of gas in the soft tissues of the forearm. A metallic foreign body suggesting the tip of a needle is observed in the soft tissues near the wrist (Figure). <h3>Diagnosis</h3> Gas in soft tissues of forearm due to self-injection of air. <h3>Comment</h3> The patient had a history of psychiatric problems. Although she irrigated her wound of the forearm with hydrogen peroxide, she admitted to injecting air into the

Gas in Soft Tissues of Forearm in an 18-Year-Old Emotionally Disturbed Diabetic

<h3>History</h3> An emotionally disturbed 18-year-old diabetic woman was admitted to the hospital because of a "sore" on her right forearm of ten days' duration, for which she had been taking erythromycin estolate orally in addition to local cleansing of the infected area with hydrogen peroxide. Physical examination showed a 3×3-cm noninflamed ulcer on the volar aspect of the right forearm. Crepitation was detected along the right upper extremity. Vital signs were normal. A roentgenogram of the right forearm demonstrated the typical stigmata of gas in the soft tissues of the forearm. A metallic foreign body suggesting the tip of a needle is observed in the soft tissues near the wrist (Figure). <h3>Diagnosis</h3> Gas in soft tissues of forearm due to self-injection of air. <h3>Comment</h3> The patient had a history of psychiatric problems. Although she irrigated her wound of the forearm with hydrogen peroxide, she admitted to injecting air into the

Otomycosis in Burma, and its treatment.

Otomycosis of the auditory canal is common in Burma. Of 346 cases of otitis externa seen in a hospital outpatient clinic during two consecutive rainy seasons, 189 were due to fungus infection. Aspergillus species were the fungi isolated most frequently. Infection was most commonly due to self-manipulation. Itching and tinnitus were common complaints. Treatment by local cleansing and application of antifungal agents was effective, 10% 5-fluorocytosine ointment being most successful.

Treatment of acute ulcerative (vincent’s) gingivitis

Drugs, local cleansing and surgery may all be needed in the treatment of acute ulcerative gingivitis. Certain drugs, administered topically or systemically, relieve pain and arrest bleeding. Healing is also helped by removing debris from the teeth early. After the acute phase is over surgery is often necessary to lessen the risk of recurrence by recontouring the deformed gingivae.

Epidermoid cyst of the terminal phalanx of the hand. Case report and brief review

EPIDERMOID CYSTS of the bony skeleton of the hand and specifically of the phalanges have been periodically described since Sonntag's original report in 1923.¹Less than 50 cases have been reported in the literature. As it is a comparatively uncommon entity, the addition of a new case and a brief review of the clinical features is considered pertinent. <h3>Report of a Case</h3> A 38-year-old married, oil company employee had crushed his middle three fingers between two pipes while at work on June 30, 1962. Initial treatment consisted of local cleansing and application of a topical ointment but without x-ray examination. The wounds apparently healed uneventfully, but subsequently, the middle-digit nail plate developed a longitudinal fissure and the fingertip was intermittently painful and swollen. Pain was aggravated even by light touch and became progressively worse in the six weeks prior to seeking medical attention on May 7, 1963. Past history

Epidermoid Cyst of the Terminal Phalanx of the Hand

EPIDERMOID CYSTS of the bony skeleton of the hand and specifically of the phalanges have been periodically described since Sonntag's original report in 1923.¹Less than 50 cases have been reported in the literature. As it is a comparatively uncommon entity, the addition of a new case and a brief review of the clinical features is considered pertinent. <h3>Report of a Case</h3> A 38-year-old married, oil company employee had crushed his middle three fingers between two pipes while at work on June 30, 1962. Initial treatment consisted of local cleansing and application of a topical ointment but without x-ray examination. The wounds apparently healed uneventfully, but subsequently, the middle-digit nail plate developed a longitudinal fissure and the fingertip was intermittently painful and swollen. Pain was aggravated even by light touch and became progressively worse in the six weeks prior to seeking medical attention on May 7, 1963. Past history

Oral therapy for Pruritus Ani

1. 42 Cases of Pruritus Ani were treated, with oral medication and local applications. 2. History of the duration of symptoms varied from 1 to 30 years. Three cases also had Pruritus Vulvae. 3. A formula containing Takadiastase and Sodium Dilantin made an effective combination. Dilantin alone did not control the condition. 4. Soap and water are avoided at first, and local cleansing is done with olive oil. Laundry is to be done only with the finer soaps. 5. Silver Nitrate is accurately applied to the skin fissures as well as those within the anal canal. Judgment must be exercised as to the quantity used and the strength of the solution. 6. Alcohol, mineral oil, condiments and fried foods are omitted entirely. 7. Duration of treatment varies with individual cases. Those who are constipated are slower to recover. 8. A recent review of the literature on the subject of Pruritus Ani has failed to disclose any previous treatment of this type.

CHEMICAL STUDIES OF ACUTE POISONING FROM MERCURY BICHLORIDE

I. ELIMINATION OF MERCURY DURING TREATMENT The outcome of acute poisoning with mercury bichloride depends chiefly on the amount of mercury absorbed. Prompt emesis is therefore the most efficient treatment. 1 This should be supplemented as soon as possible with copious gastric lavage. Further elimination of the mercury has been sought by repeating the gastric lavage through the subsequent days, by extensive colonic irrigations and by pushing the consumption of fluids to secure diuresis. Local cleansing is a part of the therapeutic intent, but the expected removal of mercury generally has a large share in inciting the prescribing of these measures. As there are apparently no data on how effectively this object is accomplished and on how much mercury is really removed by such treatment, it appeared worth while to undertake these studies. They include the quantitative determination of mercury, by the method described by Booth 2 and ourselves, in

TREATMENT OF FUSOSPIRILLARY INFECTIONS OF THE MOUTH IN CHILDREN

The reported success of many local agents of widely differing chemical composition in the treatment of fusospirillary infections of the mouth, such as ulcerative gingivitis and ulcerative tonsillitis, may be explained, in part at least, as being due to the effectiveness of simple removal of debris and perhaps also to the promotion of local nonspecific tissue and leukocyte stimulation. The long list of such local agents includes hydrogen peroxide, potassium chlorate, chromic acid, methylene blue, silver nitrate, various combinations of ipecac or emetin with arsenic and glycerin, and solutions or suspensions of one or another of the arsphenamine series. The most recent addition to the list is sodium perborate, advocated in the form of a paste by Bloodgood. 1 While doubtless the condition in a majority of cases will sooner or later yield to local chemical treatment and in some cases to simple thorough local cleansing, in a considerable number