Ointment complications

Treatment of small abrasions, irritations, skin burns and erosions with the l-(chloromethyl)silatrane ointment removed inflammation. Healing completed 1.5—2 times faster than on treatment with Vishnevsky ointment, synthomycin emulsion and other preparations. Healing of small wounds usually occurred under the crust to form a soft cicatrice. No complications were observed on using l-(chloro-methyl)silatrane. 

Solutions are the most commonly used mode of delivery for topical ocular medications. Solutions or suspensions are usually preferred over ointments, because the former are more easily instilled, interfere less with vision, and have fewer potential complications. Disadvantages of topically applied solutions include short ocular contact... 

A small, multicenter, open-label, randomized study showed that patients with early HZO who received topical acyclovir ointment had a higher rate of significant ocular complications after one month than patients receiving oral acyclovir (Neoh et al.). 

In patients with severe lid involvement, lubricating ointments should be instilled into the cul-de-sac to prevent complications arising from exposure or trichiasis. An oculoplastic surgeon should manage scarring and contraction of lid tissue that creates cicatricial ectropion, lid retraction, lid margin deformity, or severe corneal complications. 

Anal fissures are often intensely painful due to sphincter spasm. Anaesthetic ointments and stool softening agents have been widely used, with surgery (lateral internal sphinterotomy) for severely affected cases, but this procedure can cause incontinence from loss of sphincter control. An alternative is topical application of nitrate which heals two-thirds of fissures. Preparations should be diluted to 0.2% as such use may be complicated by headache tolerance can develop. Intrasphincteric injection of botulinum toxin has also been shown to be effective. 

An 84-year-old man with diabetic nephropathy and end-stage renal disease began continuous ambulatory peritoneal dialysis and over the next year had four episodes of exit-site infection and peritonitis and used mupirocin ointment. The exit-site catheter became dilated and during an episode of infection for which he used mupirocin on 6 successive days, a longitudinal rupture developed in the peritoneal catheter, which was removed. The peritoneal liquid contained Escherichia coli and Proteus mirabilis and the catheter tip contained E. coli and Enterobacter cloacae. He was treated with ciprofloxacin, without complications, and after 1 month a new peritoneal catheter was inserted. 

Percutaneous absorption may be increased substantially in newborns because of an underdeveloped epidermal barrier (stratum comeum) and increased skin hydration. The increased permeability can produce toxic effects after the topical use of hexachlorophene soaps and powders, salicyhc acid ointment, and rubbing alcohol. Interestingly, a study has shown that a therapeutic serum concentration of theophylline can be achieved to control apnea in premature infants of less than 30 weeks gestation after a topical apphcation of gel containing a standard dose of theophylline. " The use of this route of administration may minimize the unpredictability of oral and intramuscular absorption and complications of intravenous drug administration for certain drugs. 

Herpes zoster ophthalmicus is a latent reactivation of a varicella zoster infection in the first division of the trigeminal cranial nerve. Systemic acyclovir, valacyclovir, and famciclovir te. effective in reducing the severity and complications of herpes zoster ophthalmicus. Currently, there are no ophthalmic preparations of acyclovir approved by the FDA, although an ophthalmic ointment is available for investigational use. 

Vidarabine is used mainly in human HSV-1 and HSV-2 encephalitis, decreasing the mortality rate from 70 to 30%. Whitley et al. (57) reported that early vidarabine therapy is helpful in controlling complications of localized or disseminated herpes zoster in immunocompromised patients. Vidarabine also is useful in neonatal herpes labialis or genitalis, vaccinia virus, adenovirus, RNA viruses, papovavirus, CMV, and smallpox virus infections. Given the efficacy of vidarabine in certain viral infections, the U.S. FDA approved a 3% ointment for the treatment of herpes simplex keratoconjunctivitis and recurrent epithelial keratitis, and a 2% IV injection for the treatment of herpes simplex encephalitis and herpes zoster infections (Table 43.3). A topical ophthalmic preparation of vidarabine is useful in herpes simplex keratitis but shows little promise in herpes simplex labialis or genitalis. The monophosphate esters of vidarabine are more water-soluble and can be used in smaller volumes and even intramuscularly. These esters are under clinical investigation for the treatment of hepatitis B, systemic and cutaneous herpes simplex, and herpes zoster virus infections in immunocompromised patients. 

Tegner E (1976) Contact allergy to corticosteroids. Int J Dermatol 15 530-523 Thompson G, Maibach HI, Epstein J (1977) Allergic contact dermatitis from sunscreen preparations complicating photodermatitis. Arch Dermatol 113 1252-1253 Thormann J, Kaaber K (1978) Contact sensitivity to phenylbutazone ointment (butazolidine). Contact Dermatitis 4 235-236 Thormann J, Wildenhoff KE (1980) Contact allergy to idoxuridine. Contact Dermatitis 6 170-191... 

Lanolin, wool fat, wool wax the fatty or more correctly waxy substance secreted by the skin of the sheep, m-p. 36-42°C. L constitutes up to 50% of the wei t of raw wool. It is a complicated mixture of fatty adds, alcohols, fats and waxy substances. The latter are chiefly esters of steroids (cholesterol and lanoster-ol) and long chain aliphatic alcohols with higher fatty acids, which are 6-hydroxylated or carry a terminal isopropyl or isobutyl residue. L. is obtained from raw wool by extraction with organic solvents or soap solutions. It forms water-in-oil suspensions, and is used widely in the pharmaceutical and cosmetics industries (as Adeps Lanae) as an ointment base. 

Abrams SM, Degnan TJ, Vinciguerra V (1980) Marrow aplasia following topical application of chloramphenicol eye ointment. Arch Intern Med 140 576-577 Adriani J, Zepernick R (1964) Clinical effectiveness of drugs used for topical anesthesia. JAMA 118 711 Albert T, Lewis N, Warpeha R (1982) Late pulmonary complications with use of mafenide acetate. J Burn Care Rehabil 3... 

It had been demonstrated all too often in the literature (Ashcraft et al., 1970 Bernard t al., 1971 Curry et al., 1971) that failure to comply with the principles and procedures outlined by our team for the execution of safe and effective intravenous hyperalimentation will result in an inordinately high rate of metabolic, mechanical and infectious complications. In order to minimize the development of inflammation and infection at the catheter-skin exit site, the dressing is changed at least three times a week the skin around the catheter is treated with tincture of iodine or other antiseptic solutions and fresh antimicrobial ointment is applied. 

Another serious complication encountered in early manufacture was that the lead tubes into which the ointment was filled contaminated the product. Tubes made from aluminum or even from tin would have been preferable, but those metals were in short supply. The Dewey and Almy Chemical Co., Cambridge, Mass., developed a satisfactory lining for the tube, consisting of a combination of wax and synthetic rubber. This tube was put into production by several manufacturers, including the Peerless... 

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