Bensal HP for Second Intention Healing Following Mohs Micrographic Surgery or Shave Skin Biopsy: An Open-label Pilot Study
October 2016 | Volume 15 | Issue 10 | Original Article | 1197 | Copyright © October 2016
Breanne Mordorski BA,a Adam J. Friedman MD,b and Leon H. Kircik MDc
aDivision of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY bDepartment of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC cIcahn School of Medicine at Mount Sinai, New York, NY; Indiana University School of Medicine, Indianapolis, IN; Physicians Skin Care, PLLC, Louisville, KY
Dermatologists frequently create cutaneous defects that heal by second intention, yet there is no universal protocol for wound care in this setting. Several ointments commonly used for wound healing are not cost effective as they contain known contact allergens, contribute to antimicrobial resistance, and do not enhance the healing process. Recent studies indicate that Bensal HP, a commercially available ointment used for a variety of dermatologic conditions, may be useful for wound healing; although clinical data is currently limited. In this single-center open-label pilot study, Bensal HP was evaluated for second intention healing over 8 weeks following either Mohs micrographic surgery or shave skin biopsy in 20 patients. Results indicate that Bensal HP is effective for second intention healing as demonstrated by increased Global Assessment of Efficacy scores and decreased wound measurements, with 16 patients achieving full closure. Patient symptoms overall improved over the study period, and Bensal HP was well tolerated with no adverse effects associated with its use. By providing critical data regarding the safety and efficacy of Bensal HP, this study may provide useful information to guide further assessment in future large-scale comparative wound healing studies. J Drugs Dermatol.
Cutaneous biopsies are essential diagnostic and therapeutic tools in the dermatologist’s armamentarium. There are several varieties, including shave, excisional, and punch biopsies, which may be selected based on lesion location, type, or size. Shave biopsies can be accomplished quickly in the office setting and do not require sutures for closure, leaving the defect to heal via second intention.1 Another highly specialized procedure ideal for removing high-risk, locally invasive skin cancers in anatomically or cosmetically sensitive areas is Mohs micrographic surgery (MMS).2,3 Following MMS, reconstruction may be immediately performed, or in many cases dermatologic surgeons may opt for healing by second intention, which facilitates improved assessment and detection of tumor recurrence compared to defects undergoing primary closure.4-6Although dermatologists frequently create cutaneous defects that heal by second intention, there is no universal protocol for wound care in this setting. Broadly speaking, patients may be advised to use various conventional or hydrocolloid dressings with regular dressing changes to allow cleansing of the wound. Additionally, an ointment may be applied to enhance occlusion and maintain a moist environment, which aids the healing process.4 There are countless ointments that may be used for this purpose, several of which contain antibiotics, even though topical antibiotics have not been shown to decrease the risk of infection in wounds following dermatologic procedures.7 Rather, several common antibiotics found in topical ointments (bacitracin, neomycin) are known contact allergens with the potential to cause hypersensitivity reactions that may delay healing,7-10 and even some topical formulations that do not contain antibiotics include other ingredients with known sensitizing potential.8 Unfortunately, suboptimal topical agents continue to be used for wound care following dermatologic procedures, and there is a paucity of data available to discern which ointments may be safe, tolerable, and efficacious in this setting.The current pilot study aims to assess Bensal HP for second intention healing and identify trends associated with its use. Bensal HP is a commercially available ointment containing 6% benzoic acid, 3% salicylic acid, and 3% proprietary oak bark extract (QRB7). Benzoic acid is effective against gram-positive and -negative bacteria and certain fungal species while salicylic acid is a keratolytic with bacteriostatic and fungicidal properties, and oak bark extract has been used as a natural remedy to convert chronic to actively healing wounds.11-13 The components of Bensal HP are delivered in a vehicle of polyethylene glycol, a biodegradable, biocompatible substance increasingly employed in wound care products, adhesives, and hydrogels,