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Wound healing
through topical
approaches to
improve surgical
outcomes
Journal of Drugs in Dermatology
Take-home message
•
In this review article, little evidence
was found to support the use of
empiric topical antibiotics to pre-
vent infection in clean postsurgical
wounds. Additionally, topical anti-
biotics often cause irritant and
allergic contact dermatitis.
•
The authors suggest hypochlorous
acid as an alternative to chlorhex-
idine due to its lower risk of side
effects.
Abstract
Surgical procedures are an important piece
of a dermatologist’s daily practice. There-
fore, the optimization of post-surgical wound
healing is an area of utmost importance and
interest. Although low risk, one notable bar-
rier to proper wound healing is surgical site
infection.
In an attempt to mitigate this risk and improve
surgical outcomes, multiple topical products
continue to be used both pre- and postproce-
dure. Traditionally, this includes both topical
antibiotics and antiseptics. However, these
products are not without consequence.
The overuse of topical antibiotics as prophy-
laxis for infection has contributed to increased
bacterial resistance, and in fact is no longer
recommended by the American Academy of
Dermatology in clean post surgical wounds.
Topical antiseptics, including chlorhexidine
and povidone-iodine, can have a cytotoxic
effect on keratinocytes and may actually
impede wound healing as a result. In addi-
tion, chlorhexidine in particular can produce
both otologic and ocular toxic effects when
used on the face. Emerging products, such as
hypochlorous acid, may be a potential alter-
native to the more commonly used agents,
as it has effective antimicrobial actions and
minimal adverse effects. Therefore, the pur-
pose of this review is to highlight several
topical products used to optimize post-sur-
gical wound healing and discuss both their
efficacy and safety.
Topical approaches to improve surgical
outcomes and wound healing: a review of
efficacy and safety.
J Drugs Dermatol
2017
Mar 01;16(3)209-212, K Totoraitis, JL Cohen,
A Friedman.
Depression associated with
increased risk of psoriatic
arthritis among patients with
psoriasis
Journal of Investigative Dermatology
Take-home message
•
Given that major depressive disorder (MDD) has been associated with increased
systemic inflammation, this study investigated whether patients who develop MDD
are at increased risk of psoriatic arthritis (PsA) by following 73,337 individuals with
psoriasis for up to 25 years until the development of PsA. Patients with psoriasis who
developed MDD were at significantly increased risk of subsequently developing
PsA compared with patients who did not develop MDD, even after adjusting for
multiple factors (HR, 1.37; P=0.021).
•
These data suggest that depression may be associated with increased risk of
developing PsA among patients with psoriasis. Patients with psoriasis may benefit
from heightened prevention and management of depression.
Abstract
The factors that contribute to the development
of psoriatic arthritis (PsA) among patients with
psoriasis are not well known; however, systemic
inflammation is believed to be important. On the
basis of recent laboratory work demonstrating that
major depressive disorder (MDD) is associated
with increased systemic inflammation, we hypoth-
esized that patients with psoriasis who develop
MDD are at increased risk of subsequently devel-
oping PsA. We utilized The Health Improvement
Network, a primary care medical records data-
base, to identify 73,447 individuals with psoriasis.
Patients were followed up to 25 years until the
development of the primary outcome of PsA or
the censor date. The exposure of interest was the
development of MDD. Cox proportional-hazards
models showed that patients with psoriasis who
developed MDD were at significantly increased
risk of subsequently developing PsA compared
with patients who did not develop MDD, even
after accounting for numerous covariates (haz-
ard ratio 1.37, 95% confidence interval 1.05–1.80,
P = 0.021). This result was maintained through
numerous sensitivity analyses. These data sup-
port the hypothesis that MDD increases the risk
of developing PsA among patients with psoriasis,
suggesting a need for heightened prevention and
management of MDD in patients with psoriasis.
Depression is associated with an increased risk
of psoriatic arthritis among patients with psoria-
sis: a population-based study.
J Invest Dermatol
2017 Feb 22;[EPub Ahead of Print], RT Lewinson,
IA Vallerand, MW Lowerison, et al.
COMMENT
By Francisco A Tausk
MD
A
number of studies have linked the
occurrence of psoriasis and major
depressive disorder (MDD), which
may be supported by recent findings
showing that MDD is associated with a
state of enhanced inflammation, presum-
ably mediated by TNFα, which is elevated
in both disorders. In the present report,
Lewinson et al mined the British database
THIN to assess those individuals suffering
from psoriasis and MDD, noting that they
were more predisposed to develop pso-
riatic arthritis. Indeed, they found that the
risk of psoriatic arthritis associated with
depression has an unadjusted hazard ratio
of 1.56. Because depressed people tend
to have poor health habits (sedentary life-
style, unhealthy diet), it is not possible to
be certain that MDD is independently the
primary risk factor. However, we can con-
clude that depression appears to play a
role in the appearance of comorbid arthri-
tis in patients with psoriasis.
It behooves clinicians to determine the
presence of MDD in their patients with
psoriasis, which can be performed with
very brief, well-validated, 2- to 3-question
tests. Those individuals who are depressed
should be treated appropriately in order to
minimise the chance of developing arthri-
tis. A referral to a psychiatrist/psychologist
may well help your patients, and save the
healthcare system consid-
erable resources.
Dr Tausk is Professor
of Dermatology and
Psychiatry at the University
of Rochester in New York.
GENERAL DERMATOLOGY
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PRACTICEUPDATE DERMATOLOGY