Dermatologists perform over 25 million in-office procedures per year, said Zoe Draelos, MD, a board-certified dermatologist in private practice in High Point, NC, during her presentation on optimizing post-dermatologic procedural care. She presented Thursday morning at the Fall Clinical Dermatology Conference in Las Vegas, NV.
In dermatology, many wounds heal by secondary intention, which is best accomplished by removing any impediments to healing, such as infections, and maintaining an environment that is conducive to repair, which includes leaving wound edges opened, keeping the wound surface moist, and insulating the wound. This is typically achieved using semi-occlusive dressings, she added, which prevent scab formation and help accelerate reepithelization.
In her presentation, Dr Draelos reviewed a study of 169 post-operative handouts that showed 84% recommended petrolatum and 43% recommended topical antibiotic use. According to the CDC, wounds created in dermatology offices are categorized as class 1 wounds, meaning they are clean and created in aseptic conditions. Because of this, CDC does not recommend antibiotics for dermatologic procedures, said Dr Draelos. Dermatologists prescribe approximately 4.9% of antibiotics, despite only representing 1% of health care.
Dr Draelos reviewed several studies that assessed the rates of infection from in-office dermatologic procedures. Overall, the infection rate ranged from 0.2% to 2.5%, said Dr Draelos, with none of the studies showing differences among patients treated with topical antibiotics compared with healing ointments.
In addition, Dr Draelos discussed the results of a study that showed non-medicated petrolatum ointment was associated with faster barrier repair and early wound healing compared with an antibiotic. Another study showed no difference between a healing ointment compared with polymyxin/bacitracin ointment. Healing ointment was similar to polymyxin/bacitracin ointment for seborrheic keratosis, added Dr Draelos.
Topical antibiotics are not recommended for Class 1 wounds, said Dr Draelos, adding that infection rates from dermatologic procedures were low and treatment with topical antibiotics did not differ from petrolatum ointments.
Antibiotics can induce allergic contact dermatitis, which is another reason to reconsider their use for post-procedure care in dermatology. Neosporin and bacitracin were ranked in the top 10 causes of allergic contact dermatitis by the American Contact Dermatitis Society for over 20 years, said Dr Draelos. In a Cochrane review of 3 studies with 3042 patients, no patients treated with petrolatum ointment experienced allergic contact dermatitis compared with 5 patients treated with antibiotics.
Semi-occlusive dressings promote wound healing better than fully occlusive dressings, said Dr Draelos. The concentration for semi-occlusive dressing of petrolatum is 41% to 54%.
Lanolin alcohol, which is used in wound care, can cause allergic contact dermatitis. However, the lanolin alcohol used in healing ointment had low rates of positive reactions, said Dr Draelos. Quality has a great deal to do with allergic potential, she added, noting that there has been no reporting of allergic contact dermatitis caused by healing ointment in clinical and patch studies.
Dr Draelos concluded her presentation with evidence-based recommendations for wound care:
- Clean the wound daily with mild cleanser.
- Use a semi-occlusive, petrolatum-based ointment and apply daily as needed to keep wound surface moist.
- Dress wound as appropriate.
- Avoid using topical antibiotics.
Draelos Z. Optimizing post-dermatological procedural wound care. Presented at: 2019 Fall Clinical Dermatology Conference; Oct 17, 2019; Las Vegas.