compared with either white petrolatum–treated or AHO-treated wounds (P?.009 and P?.030, respectively; Figure 1).
Topical postoperative wound care involves maintaining a protected wound and a clean, moisturized surface. The standard of care includes cleaning with either a cleanser or water, applying a topical ointment, and covering the wound with a dressing.1 Above all, maintaining a moist environment is important in postoperative wound care.
Some frequently used ointments contain antibiotics, such as neomycin and bacitracin, which are known to cause wound irritation as result of contact dermatitis. Antibiotic ointments have not been found to offer advantages over petrolatum in the process of wound healing.2 In a landmark study, no significant differences in the rate of wound infections in dermatologic surgery wounds randomized to postoperative wound care with bacitracin or white petrolatum.2-3 In general, the rate of surgical-site infections with a clean surgical technique is exceedingly low (0.91%), and the use of topical antibiotics is not necessary for the prevention of infections.4,5
Despite their high incidence of contact dermatitis, topical antibiotics are still commonly being used in dermatologic practice (6%).6 As part of our postoperative wound-care regimen, we (the authors) do not use antibiotic ointments. We only use petrolatum-based ointments.
Two frequently used petrolatum-based ointments are Aquaphor (AHO) and Vaseline (100% white petrolatum). Park et al reported AHO to be the most commonly used postoperative ointment (60%), followed by petrolatum (34%).7 We decided to evaluate for wound reactivity postoperatively for these 2 commonly used petrolatum-based ointments.
We found that surgical wounds treated with AHO had a higher incidence of redness (52%) than those treated with plain white petrolatum (12%). Patients who did not apply ointment to their
wounds had a low incidence of redness similar to patients who used plain white petrolatum. The wound reactivity with redness and swelling is most likely due to contact dermatitis. Some AHO ingredients, such as lanolin, a wool wax alcohol, and bisabolol, a sesquiterpene alcohol, are well-known allergens.8
Adverse effects of contact allergies may be minimized with an appropriate selection of topical agents for wound care. Surgical wounds require the most favorable postoperative topical care to ensure patient satisfaction. Ideally, the treatment should promote healing with minimal or no irritation.
Postoperative wound redness and swelling decreased with the use of plain white petrolatum compared with AHO. Nonantibiotic ointments are preferred over those containing antibiotics for postoperative wound care.
The authors have no relevant conflicts of interest to disclose.
- Del Rosso JQ. Wound care in the dermatology office: where are we in 2011? J Am Acad Dermatol. 2011;64(3 Suppl):S1-S7.
- Smack DP, Harrington AC, Dunn C, et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA. 1996;276(12):972-977.
- Campbell RM, Perlis CS, Fisher E, Gloster HM Jr. Gentamicin ointment versus petrolatum for management of auricular wounds. Dermatol Surg. 2005;31(6):664-669.
- Rogers HD, Desciak EB, Marcus RP, Wang S, MacKay-Wiggan J, Eliezri YD. Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence of prophylactic antibiotics. J Am Acad Dermatol 2010;63(5):842-851
- Trookman NS, Rizer RL, Weber T. Treatment of minor wounds from dermatologic procedures: a comparison of three topical wound care ointments using a laser wound model. J Am Acad Dermatol. 2011;64(3 Suppl):S8-S15.
- Levender MM, Davis SA, Kwatra SG, Williford PM, Feldman SR. Use of topical antibiotics as prophylaxis in clean dermatologic procedures. J Am Acad Dermatol. 2012;66(3):445-451.
- Park SS, Khalid AN, Graber NJ, Fedok FG. Current trends in facial resurfacing: a survey of American Academy of Facial Plastic and Reconstructive Surgery members. Arch Facial Plast Surg. 2010;12(1):65-67.
- Jacob SE, Hsu JW. Reactions to Aquaphor: is bisabolol the culprit? Pediatr Dermatol. 2010;27(1):103-104.
Address for Correspondence
Leonard H. Goldberg MDgoldb1@dermsurgery.org