Nidhi Sharma, Sandipan Dhar, Abhishek De, Kiran Godse, D S Krupa Shankar, Vijay Zawar, Mukesh Girdhar, Bela Shah

Abstract

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder affecting 15–20% of children and 1–10% of adults. Staphylococcus aureus (S. aureus) infection is the most frequent complication of AD and is involved in the worsening of the disease. Systemic and topical antibiotics are used in the treatment for AD but there are concerns over increasing resistance. Bleach (sodium hypochlorite, NaOCl) baths are an inexpensive, widely accessible, alternative antibiotic treatment that may not worsen antibiotic resistance. Bleach baths are used as adjunctive treatment in AD patients to treat superinfections, although their mechanism of action is not well understood. Balancing safety concerns with efficacious treatment should be important especially for AD where the majority of patients are in pediatrics age groups. Studies available in PubMed databases were included in this review. Most suggested bleach bath improves clinical symptoms of AD and restores surface microbiome by eradicating bacteria, most notably S. aureus. Some studies have noted that this antimicrobial effect has reduced the need for topical corticosteroids. In addition, bleach seems to have strong anti-inflammatory and antipruritic effects. Overall, bleach baths seem to be safe on human skin, without disrupting the epidermal barrier function. The review concluded, although there are some advantages of use of bleach baths, more studies to investigate long-term efficacy and safety of bleach baths are required before fixing its role in the treatment of AD especially in the context of the Indian scenario.

Key Words: Atopic dermatitis, bleach baths, sodium hypochlorite

Nicole Natarelli, BA ¹ , Yvonne Nong, MS ^2,3,4 , Jessica Maloh, ND ^2,3 , Raja Sivamani, MD, MS, AP ^{2,3,5,6 a}

¹ Morsani College of Medicine, University of South Florida, Tampa, Florida, 2 Pacific Skin Institute, Sacramento, CA, 3 Zen Dermatology, Sacramento,

CA, ⁴ Michigan State University College of Human Medicine, Flint, Michigan, 5 Department of Dermatology, University of California-Davis, Sacramento,

CA , ⁶ College of Medicine, California Northstate University, Elk Grove, CA

Keywords: hypochlorous acid, integrative dermatology, wound healing, scar management, infection, atopic dermatitis, pruritus

Relevance

Hypochlorous acid (HClO) is a weak acid and powerful oxidant traditionally used as an active ingredient in various sanitizers and disinfectants. HClO is produced endogenously from activated leukocytes, and it was first exogenously synthesized in 1834, later to be used medicinally as a wound disinfectant during World War I and II.

Objective

In this review, we aim to review the literature assessing the efficacy and safety of dermatologic uses of topical hypochlorous acid.

Methods

A PubMed search for articles with the following keywords was performed: “hypochlorous acid” AND “dermatology” OR “dermis” OR “dermal.” Forty-one reports were included in the efficacy and safety analysis.

Results

Hypochlorous acid exhibits antimicrobial properties and has been demonstrated to promote re-epithelialization in wound healing with low cytotoxicity to keratinocytes and fibroblasts. Recent work has highlighted its anti-inflammatory properties via modulation of the NF-kβ signaling pathway and downregulation of inflammatory cytokines; reports have discussed its application for the management of various inflammatory skin conditions including atopic dermatitis and psoriasis.

Conclusion

Dermatologic application of hypochlorous acid includes infection prevention, wound care and scar management, inflammatory modulation, treatment in atopic dermatitis and pruritus. Emerging research has discussed potential applications in acne vulgaris, seborrheic dermatitis, and tumor suppression.

Le´o-Paul Tricou,^1–3 Marie-Lynn Al-Hawat,¹ Katia Cherifi,¹ Gabriela Manrique,¹ Benjamin R. Freedman,^4,* and Simon Matoori^1,*

¹Faculte´ de Pharmacie, Universite´ de Montre´al, Montre´al, Canada.

²ISPB Faculte´ de Pharmacie, Universite´ Claude Bernard Lyon 1, Lyon, France.

³Chemical Engineering Department, Polytechnique Montreal, Montre´al, Canada.

⁴Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,

Massachusetts, USA.

Significance: Chronic diabetic wounds on the lower extremities (diabetic foot ulcers, DFU) are one of the most prevalent and life-threatening complications of diabetes, responsible for significant loss of quality of life and cost to the health care system. Available pharmacologic treatments fail to achieve com plete healing in many patients. Recent studies and investigational treatments have highlighted the potential of modulating wound pH in DFU.

Recent Advances: Data from in vitro, preclinical, and clinical studies highlight the role of pH in the pathophysiology of DFU, and topical administration of pH-lowering agents have shown promise as a therapeutic strategy for diabetic wounds. In this critical review, we describe the role of pH in DFU patho-physiology and present selected low-molecular-weight and hydrogel-based pH-modulating systems for wound healing and infection control in diabetic.

Critical Issues: The molecular mechanisms leading to pH alterations in diabetic wounds are complex and may differ between in vitro models, animal models of diabetes, and the human pathophysiology. Wound pH-lowering bandages for DFU therapy must be tested in established animal models of diabetic wound healing and patients with diabetes to establish a comprehensive benefit-risk profile.

Future Directions: As our understanding of the role of pH in the pathophysiology of diabetic wounds is deepening, new treatments for this therapeutic target are being developed and will be tested in preclinical and clinical studies. These therapeutic systems will establish a target product profile for pH-lowering treatments such as an optimal pH profile for each wound healing stage. Thus, controlling wound bed pH could become a powerful tool to accelerate chronic diabetic wound healing.

Keywords: pH management, diabetic wound healing, diabetes, pH-lowering strategies, pH modulation, acidic wound dressings

H.Guan¹,M.Nuth¹, S.R. Weiss², A. Fausto², Y. Liu³, H. Koo³, M.S. Wolff⁴ , and R.P. Ricciardi^1,5

Abstract

The COVID-19 pandemic has escalated the risk of SARS-CoV-2 transmission in the dental practice, especially as droplet-aerosol particles are generated by high-speed instruments. This has heightened awareness of other orally transmitted viruses, including influenza and herpes simplex virus 1 (HSV1), which are capable of threatening life and impairing health. While current disinfection procedures commonly use surface wipe-downs to reduce viral transmission, they are not fully effective. Consequently, this provides the opportunity for a spectrum of emitted viruses to reside airborne for hours and upon surfaces for days. The objective of this study was to develop an experimental platform to identify a safe and effective virucide with the ability to rapidly destroy oral viruses transported within droplets and aerosols. Our test method employed mixing viruses and virucides in a fine-mist bottle atomizer to mimic the generation of oral droplet-aerosols. The results revealed that human betacoronavirus OC43 (related to SARS-CoV-2), human influenza virus (H1N1), and HSV1 from atomizer-produced droplet-aerosols were each fully destroyed by only 100 ppm of hypochlorous acid (HOCl) within 30 s, which was the shortest time point of exposure to the virucide. Importantly, 100 ppm HOCl introduced into the oral cavity is known to be safe for humans. In conclusion, this frontline approach establishes the potential of using 100 ppm HOCl in waterlines to continuously irrigate the oral cavity during dental procedures to expeditiously destroy harmful viruses transmitted within aerosols and droplets to protect practitioners, staff, and other patients.

Keywords: virucide, saliva, infection, high-speed instruments, waterlines, prevention