povidone-iodine and Dermatitis--Contact

Surgical procedures are an important piece of a dermatologist's daily practice. Therefore, the optimization of post-surgical wound healing is an area of utmost importance and interest. Although low risk, one notable barrier 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 postprocedure. Traditionally, this includes both topical antibiotics and antiseptics. However, these products are not without consequence.

The overuse of topical antibiotics as prophylaxis 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 addition, 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 alternative to the more commonly used agents, as it has effective antimicrobial actions and minimal adverse effects. Therefore, the purpose of this review is to highlight several topical products used to optimize post-surgical wound healing and discuss both their efficacy and safety.

J Drugs Dermatol. 2017;16(3):209-212.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Chlorhexidine; Dermatitis, Contact; Drug Resistance, Bacterial; Humans; Hypochlorous Acid; Keratinocytes; Povidone-Iodine; Pruritus; Surgical Wound Infection; Treatment Outcome; Wound Healing

Central venous catheters (CVCs) provide secured venous access in neonates. Antimicrobial dressings applied over the CVC sites have been proposed to reduce catheter-related blood stream infection (CRBSI) by decreasing colonisation. However, there may be concerns on the local and systemic adverse effects of these dressings in neonates.. We assessed the effectiveness and safety of antimicrobial (antiseptic or antibiotic) dressings in reducing CVC-related infections in newborn infants. Had there been relevant data, we would have evaluated the effects of antimicrobial dressings in different subgroups, including infants who received different types of CVCs, infants who required CVC for different durations, infants with CVCs with and without other antimicrobial modifications, and infants who received an antimicrobial dressing with and without a clearly defined co-intervention.. We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG). We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2015, Issue 9), MEDLINE (PubMed), EMBASE (EBCHOST), CINAHL and references cited in our short-listed articles using keywords and MeSH headings, up to September 2015.. We included randomised controlled trials that compared an antimicrobial CVC dressing against no dressing or another dressing in newborn infants.. We extracted data using the standard methods of the CNRG. Two review authors independently assessed the eligibility and risk of bias of the retrieved records. We expressed our results using risk difference (RD) and risk ratio (RR) with 95% confidence intervals (CIs).. Out of 173 articles screened, three studies were included. There were two comparisons: chlorhexidine dressing following alcohol cleansing versus polyurethane dressing following povidone-iodine cleansing (one study); and silver-alginate patch versus control (two studies). A total of 855 infants from level III neonatal intensive care units (NICUs) were evaluated, 705 of whom were from a single study. All studies were at high risk of bias for blinding of care personnel or unclear risk of bias for blinding of outcome assessors. There was moderate-quality evidence for all major outcomes.The single study comparing chlorhexidine dressing/alcohol cleansing against polyurethane dressing/povidone-iodine cleansing showed no significant difference in the risk of CRBSI (RR 1.18, 95% CI 0.53 to 2.65; RD 0.01, 95% CI -0.02 to 0.03; 655 infants, moderate-quality evidence) and sepsis without a source (RR 1.06, 95% CI 0.75 to 1.52; RD 0.01, 95% CI -0.04 to 0.06; 705 infants, moderate-quality evidence). There was a significant reduction in the risk of catheter colonisation favouring chlorhexidine dressing/alcohol cleansing group (RR 0.62, 95% CI 0.45 to 0.86; RD -0.09, 95% CI -0.15 to -0.03; number needed to treat for an additional beneficial outcome (NNTB) 11, 95% CI 7 to 33; 655 infants, moderate-quality evidence). However, infants in the chlorhexidine dressing/alcohol cleansing group were significantly more likely to develop contact dermatitis, with 19 infants in the chlorhexidine dressing/alcohol cleansing group having developed contact dermatitis compared to none in the polyurethane dressing/povidone-iodine cleansing group (RR 43.06, 95% CI 2.61 to 710.44; RD 0.06, 95% CI 0.03 to 0.08; number needed to treat for an additional harmful outcome (NNTH) 17, 95% CI 13 to 33; 705 infants, moderate-quality evidence). The roles of chlorhexidine dressing in the outcomes reported were unclear, as the two assigned groups received different co-interventions in the form of different skin cleansing agents prior to catheter insertion and during each dressing change.In the other comparison, silver-alginate patch versus control, the data for CRBSI were analysed separately in two subgroups as the two included studies reported the outcome using different denominators: one using infants and another using catheters. There were no significant differences between infants who received silver-alginate patch against infants who received standard line dressing in CRBSI, whether expressed as the n. Based on moderate-quality evidence, chlorhexidine dressing/alcohol skin cleansing reduced catheter colonisation, but made no significant difference in major outcomes like sepsis and CRBSI compared to polyurethane dressing/povidone-iodine cleansing. Chlorhexidine dressing/alcohol cleansing posed a substantial risk of contact dermatitis in preterm infants, although it was unclear whether this was contributed mainly by the dressing material or the cleansing agent. While silver-alginate patch appeared safe, evidence is still insufficient for a recommendation in practice. Future research that evaluates antimicrobial dressing should ensure blinding of caregivers and outcome assessors and ensure that all participants receive the same co-interventions, such as the skin cleansing agent. Major outcomes like sepsis, CRBSI and mortality should be assessed in infants of different gestation and birth weight.

Topics: Alginates; Anti-Bacterial Agents; Anti-Infective Agents; Bandages; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Chlorhexidine; Dermatitis, Contact; Ethanol; Glucuronic Acid; Hexuronic Acids; Humans; Infant, Newborn; Polyurethanes; Povidone-Iodine; Randomized Controlled Trials as Topic; Silver Compounds

"Iodine allergy" does not exist. The concept of "iodine allergy" should be abandoned since it may result in inappropriate measures such as drug, food or environmental eviction. Immediate or non-immediate allergic hypersensitivity to iodinated contrast media is not infrequent. The corresponding allergens have not been identified. Iodine is not involved. Immediate or non-immediate allergic hypersensitivity to povidone iodine is rare. The corresponding allergen is povidone in case of immediate hypersensitivity while nonoxynol might be involved during non-immediate hypersensitivity. Seafood allergens belong to a group of muscle proteins. Immediate drug hypersensitivity or food hypersensitivity is assessed by immediate-reading skin tests while non-immediate drug hypersensitivity is investigated by delayed-reading skin testing. Combined histamine and tryptase measurement is invaluable during the diagnostic approach of immediate hypersensitivity. Other biological tests are being evaluated. Allergic hypersensitivity to iodinated contrast agents does not contraindicate the use of other iodinated drugs.

Topics: Allergens; Amiodarone; Anaphylaxis; Animals; Anti-Infective Agents, Local; Biomarkers; Contrast Media; Dermatitis, Contact; Dietary Proteins; Drug Hypersensitivity; Food Hypersensitivity; Histamine Release; Humans; Hypersensitivity, Immediate; Iodine; Iodine Compounds; Muscle Proteins; Potassium Iodide; Povidone-Iodine; Seafood; Skin Tests; Thyroxine; Tryptases

The purpose of this pilot trial was to determine whether rates of contact dermatitis following cutaneous antisepsis for central catheter placement were similar among neonates treated with chlorhexidine gluconate and povidone-iodine. Chlorhexidine gluconate absorption was also evaluated.. Infants weighing > or =1500 g and > or =7 days of age were randomized to a 10% povidone-iodine or 2% chlorhexidine gluconate site scrub before catheter placement. Primary outcomes evaluated included dermatitis, catheter colonization and chlorhexidine gluconate absorption.. A total of 48 neonates were enrolled. Colonization rates were similar among treatment groups (P<0.6). Dermatitis did not occur at chlorhexidine gluconate (central catheters, n=24; peripheral catheters, n=29) sites. Seven neonates had measurable chlorhexidine gluconate concentrations (range 13 to 100 ng ml(-1)) during catheterization.. In this small trial chlorhexidine gluconate antisepsis was tolerated by study neonates. Chlorhexidine gluconate was cutaneously absorbed. Larger trials are needed to determine efficacy and tolerance of chlorhexidine gluconate in neonates.

Topics: Anti-Infective Agents, Local; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Dermatitis, Contact; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Male; Pilot Projects; Povidone-Iodine; Skin Absorption

Topics: Administration, Topical; Adolescent; Chronic Disease; Dermatitis, Contact; Erythema; Humans; Male; Mastoidectomy; Medical Illustration; Otitis Media, Suppurative; Postoperative Complications; Povidone-Iodine

Topics: Adult; Anti-Infective Agents, Local; Dermatitis, Contact; Female; Humans; Postoperative Complications; Povidone-Iodine; Purpura

We present 7 cases of postsurgical contact dermatitis due to povidone iodine. The diagnosis was based on the clinical manifestations, the history of exposure, the site of the lesions, and the results of patch tests. This type of dermatitis can develop in the area of surgery or at distant sites exposed to povidone iodine during the surgical intervention. Patch tests with 10% povidone iodine in petrolatum were positive in all patients. Based on the results of the same tests in a control group, we recommend the use of petrolatum rather than water as the vehicle for the diagnosis of this form of contact dermatitis. Repeated open application tests with a commercially available solution of povidone iodine were negative. We conclude that the presence of the solution under occlusion during surgery is necessary both for the symptoms to develop and for the diagnosis to be made. This condition may be underdiagnosed.

Topics: Adult; Aged; Anti-Infective Agents, Local; Dermatitis, Contact; Female; Humans; Male; Middle Aged; Patch Tests; Postoperative Complications; Povidone-Iodine

Silver sulfadiazine cream is a topical antibacterial agent that combines the antibacterial effects of both silver and sulfadiazine. Its reported cutaneous side effects include hypersensitivity reactions, allergic contact dermatitis, erythema multiforme, and systemic argyria. We report the case of a patient who had localized argyria develop in a scar after the use of silver sulfadiazine cream. In this case, the silver sulfadiazine cream was applied to and argyria developed within a postsurgical wound and area of severe contact dermatitis.

Topics: Administration, Cutaneous; Aged; Anti-Infective Agents; Anti-Infective Agents, Local; Argyria; Coronary Artery Bypass; Dermatitis, Contact; Drug Hypersensitivity; Humans; Postoperative Complications; Povidone-Iodine; Silver Sulfadiazine

Bacteria that adhere to damaged tissues encase themselves in a hydrated matrix of polysaccharides, forming a slimy layer known as a biofilm. This is the first report of detection of glycocalyx production by Staphylococcus aureus using confocal laser scanning microscopy (CLSM) on damaged skin tissues.. To analyse glycocalyx production by S. aureus cells on damaged skin tissues and the influence of polymorphonuclear leucocytes (PMNs) and various antimicrobial agents on its production using CLSM in cyclophosphamide (Cy)-treated (neutropenic) or non-Cy-treated (normal) mice.. S. aureus cells were inoculated on damaged skin tissues in neutropenic or normal mice with or without topical application of antimicrobial agents. S. aureus cells were stained with safranine, and positive staining with fluorescein isothiocyanate-conjugated concanavalin A was considered to indicate the presence of glycocalyx.. All S. aureus cells tested on damaged skin tissues formed microcolonies encircled by glycocalyx. The colony counts of S. aureus cells on croton oil dermatitis in normal mice treated with 2% fusidic acid ointment were about 100 times lower than those in neutropenic mice (control).. As S. aureus cells can generally produce a biofilm on damaged skin tissues, antimicrobial agents may not eradicate S. aureus cells without the help of PMNs. S. aureus glycocalyx may play a crucial role in colonization and adherence to damaged skin tissues.

Topics: Animals; Anti-Infective Agents, Local; Biofilms; Colony Count, Microbial; Dermatitis, Contact; Female; Fusidic Acid; Glycocalyx; Mice; Microscopy, Confocal; Neutropenia; Opportunistic Infections; Povidone-Iodine; Skin; Staphylococcal Infections; Staphylococcus aureus

A 5-year-old Japanese boy visited our clinic for treatment of a dark bluish papulonodular lesion on his right thigh. The histopathology of the lesion indicated angiokeratoma corporis circumscriptum naeviforme. Topical antibiotics were prescribed for occasional bleeding from the site. Frequent bleeding started in April of 1992, when erythema and itching were observed around the angiokeratoma. Histopathology of the lesion showed heavy lymphoid cell infiltration around dilated capillaries and irregular acanthosis engulfing dilated capillaries. Interestingly, there were confined masses of red blood cells in the epidermal layer as well as both in and on the horny layer. This is a feature of transepidermal elimination. This transepidermal elimination appeared to be triggered or enhanced by the concomitant contact dermatitis due to topical antibiotics. To the best of our knowledge, this is the first report of angiokeratoma in which the angiokeratoma itself reduced in size through transepidermal elimination, possibly caused by contact dermatitis.

Topics: Angiokeratoma; Capillaries; Child, Preschool; Dermatitis, Contact; Epidermis; Erythrocytes; Humans; Male; Neomycin; Povidone-Iodine; Skin Neoplasms

Topics: Aged; Chronic Disease; Dermatitis, Contact; Dermatitis, Occupational; Female; Hand Dermatoses; Humans; Middle Aged; Povidone-Iodine

Topics: Adult; Child; Dermatitis, Contact; Drug Eruptions; Erythema Multiforme; Humans; Male; Plants, Medicinal; Povidone-Iodine

Eight patients are described with adverse skin reactions to povidone-iodine-containing preparations (Betadine). Patch test reactions were positive to povidone-iodine 5 or 10 per cent in petrolatum or to Betadine Solution, Ointment, or Scrub. In five of eight patients, also tested with potassium iodide in concentrations ranging from 5 to 20 per cent in petrolatum, the reactions were negative. Open tests with iodine tincture performed in three patients were completely negative. Allergy to povidone-iodine seems not to be based on sensitization to iodine.

Topics: Dermatitis, Contact; Eczema; Humans; Patch Tests; Povidone; Povidone-Iodine; Time Factors

Topics: Child, Preschool; Dermatitis, Contact; Female; Humans; Povidone; Povidone-Iodine

2 patients with leg ulcers got worse after the application of a compound mixture of sugar and povidone-iodine (sugar/PI compound). Because they had been suffering from stasis dermatitis, symptoms of contact dermatitis were ambiguous. Patch tests showed positive reactions to 10% povidone-iodine in water and 5% potassium iodide in water, with no response to sugar. They were also tested with sugar/PI compound, containing 3% povidone-iodine, resulting in another positive reaction. They improved after the application of sugar/PI compound was discontinued. Contact dermatitis from topical agents should be considered as more probable than angry back syndrome in cases of leg ulcer.

Topics: Aged; Aged, 80 and over; Dermatitis, Contact; Drug Combinations; Female; Humans; Leg Ulcer; Middle Aged; Patch Tests; Povidone; Povidone-Iodine; Sucrose

Topics: Betamethasone; Dermatitis, Contact; Humans; Male; Middle Aged; Povidone; Povidone-Iodine; Skin Tests

Allergic contact dermatitis to PVP iodine is rare. Such an occurrence in a 81-year-old woman is reported. Extensive blistering dermatitis developed after local application of a PVP iodine solution. As in all previously described cases of allergic contact dermatitis from PVP iodine, it was a reaction not to the PVP but the free iodine. More important than contact reactions are hyperthyroidism or thyrotoxic crises due to percutaneous or transmucous absorption of iodine or iodide in susceptible persons.

Topics: Aged; Dermatitis, Contact; Female; Humans; Povidone; Povidone-Iodine

A patient developed an erythematous papular, vesicular rash after application of povidone-iodine 10% solution used as a surgical antiseptic. Patch testing revealed positive responses to povidone iodine 10 and 5% in water; 25 controls were negative. Patch testing with iodine, 0.5% in ethanol gave negative results.

Topics: Adult; Dermatitis, Contact; Female; Humans; Patch Tests; Povidone; Povidone-Iodine

Topics: Abattoirs; Adult; Dermatitis, Contact; Dermatitis, Occupational; Humans; Male; Povidone; Povidone-Iodine

Topics: Adult; Aged; Dermatitis, Contact; Drug Eruptions; Humans; Male; Middle Aged; Povidone; Povidone-Iodine

Topics: Adult; Dermatitis, Contact; Female; Humans; Hysterectomy; Lymph Node Excision; Povidone; Povidone-Iodine; Preoperative Care; Skin; Sterilization; Uterine Cervical Neoplasms