Clinical Application of Moist Burn Cream in Dermatology Department of Dermatology, Guangdong Dermatology Hospital, He Renliang
He Ren-Liang Huang Taoyuan
Department of Dermatologic Surgery and Skin Oncology, Guangdong Provincial Dermatology Hospital (510095)
Abstract】Objective: To review the clinical application of moist burn cream in dermatology and explore the mechanism of action. METHODS: A comprehensive analysis method of literature review was used. RESULTS: Moist burn creams were widely used in a variety of skin diseases caused by abnormal skin barrier function. CONCLUSION: The theory of skin barrier function provides a theoretical basis for the clinical application of moist burn cream in dermatology, and moist burn cream has an important role in repairing skin barrier function, but more rigorous theoretical research is needed.
【Key words】Moist burn cream; dermatology; clinical application
Skin Regenerative Medicine and Therapy, also known as Burns Regenerative Medicine and Therapy (Burns Regenerative Medicine and Therapy, once known as Burn Moist Exposure Therapy), refers to the use of moistened burn cream (MEBO) through a series of technical operations hydrolysis, enzymatic digestion, acidification, saponification, esterification, and lipidation of necrotic tissue to liquefy and expel the necrotic skin tissue, while initiating the orderly proliferation of skin potential stem cells such as K19, thereby repairing the wound [1]. Numerous studies have shown that skin regeneration techniques play an important role in the treatment of burns and chronic ulcers [2].
The most important function of human skin is to create an effective barrier that isolates the organism from external harmful factors. The stratum corneum is the outermost layer of the skin and consists of keratinocytes and thin layers of lipids with a unique structure. In recent studies, the stratum corneum has been compared to a brick wall, with keratin-forming cells forming the “bricks” and a matrix of specific lipids between the cells as the “mortar”, i.e., “brick and mortar structure ” [3]. In clinical practice, impaired skin barrier function is present throughout the etiopathology of many related skin diseases [4], and impaired skin barrier function is mainly manifested by loss of skin moisture, i.e., dryness, flaking, and pruritus such as eczema, atopic dermatitis, psoriasis, ichthyosis, and other skin diseases; it can also induce or aggravate immune inflammatory reactions such as eczema, atopic dermatitis, psoriasis, and other immune skin diseases; it can also induce Bacterial infections: such as erythrodermic secondary infections, etc. In turn, impaired barrier function is the pathological basis and aggravating factor of these dermatoses, forming a vicious circle that leads to a prolonged course of the disease and even makes its treatment difficult, causing a great impact on the physical and mental health of patients and their quality of life [5].
Based on the above pathogenesis, the author believes that the treatment of such skin diseases should be facilitated by sealing the skin from water loss, absorbing water from the dermis and air to replenish the epidermis, moisturizing the skin, and repairing the damaged skin barrier structure. In the process of skin regenerative medicine therapy, the amount of water evaporation is close to that of normal skin, and the trauma surface is close to neutral. At the same time, the ester protein fibrous membrane formed on the trauma surface is a semi-permeable membrane, which has good material exchange and drainage effect while protecting the trauma surface, thus creating a physiological moist environment (isotonic, isotonic and isophilic) for the regeneration of trauma tissue cells, which provides a theoretical basis for the application of MEBO in dermatological diseases. This provides a theoretical basis for the application of MEBO in dermatological diseases. In recent years, MEBO has been gradually used in the treatment of various skin diseases with abnormal skin barrier function, which is summarized in a review.
I. Application in allergic skin diseases
Atopic dermatitis (AD) is a multifactorial recurrent chronic skin inflammation, and the pathogenesis of AD may be related to epidermal barrier function disorder leading to dry skin and IgE-mediated allergic reactions against food and environmental allergens. A scholar [6] selected 84 patients with atopic dermatitis in infancy and childhood, randomly divided into 42 cases each in the treatment group and the control group, with topical application of MEBO in the treatment group and topical application of zinc oxide ointment in the control group, and after one month of treatment, the total effective rate was 71.43% in the treatment group and 50.00% in the control group, and the difference in efficacy between the two groups before and after treatment was statistically significant. A foreign study [7] found that the use of moisturizers can reduce the symptoms of AD in children, and concluded that the alteration of skin barrier function is an indicator of disease activity. Therefore MEBO can keep the skin of AD patients moist and can alleviate and improve the symptoms.
MEBO can effectively isolate the contact between air and trauma, avoiding the irritation and damage to trauma from exposure, drying and air contact, and also promote the recovery of local microcirculation, reduce the irritation and compression of nerve endings by tissue hypoxia and edema, and thus have anti-itch and analgesic effects, and also have better efficacy in the treatment of hormone-dependent dermatitis, diaper dermatitis, eczema, and contact dermatitis [8-11].
Second, the application in infectious skin diseases
Herpes zoster (HZ) is an infectious skin disease caused by varicella-zoster virus, which is mainly characterized by clustered blisters with clustered bands along the peripheral nerve distribution of one side of the nerve, with obvious neuralgia. The site of skin injury is closely related to the peripheral nerve distribution, and the local pain is particularly intense clinically. Some authors [12] used MEBO gauze on the herpes zoster treatment group to apply localized wet compresses 1-2 times a day, applying MEBO to the herpes zoster and covering the MEBO with petroleum jelly gauze to reduce evaporation. In the control group, 2% gentian violet cotton balls were applied to the herpes 3-4 times a day, and the application should be made so that the solution was evenly spread over the herpes zoster. The results showed that the degree of lesion improvement and pain relief in the observation group was significantly better than that in the control group, and the difference between the two groups was statistically significant. It showed that MEBO has an inward penetrating effect, can cause protein coagulation and denaturation, and to a stronger killing of pathogenic microorganisms and good pain relieving and muscle generating effect.
In addition, MEBO also has significant efficacy in the treatment of neonatal impetigo [13].MEBO can be applied in infectious skin diseases to isolate the stimulation of foreign bodies to the trauma, isolate the trauma metabolites to the trauma itself and the contamination of the trauma by external pathogenic bacteria; the active ingredient baicalin has the function of improving local microcirculation, can reduce the stimulation of nerve endings caused by local tissue edema, and reduce local The β-sitosterol in its active ingredient has anti-inflammatory effect, and the bacteria metabolism is slowed down in the microenvironment formed by MEBO, and the growth and reproduction rate is slowed down and the number is reduced, which leads to the reduction of bacterial virulence and effectively prevents the invasion of other pathogenic bacteria and other effects [14]; it can provide a moist environment close to the physiological environment for the trauma surface, which can play the role of skin barrier and has a protective effect on the trauma surface and can promote the healing of the trauma surface.
III. Application in herpetic skin diseases
Blister Tetter (BT) is an immune maculopapular skin disease characterized by flaccid levels on normal-looking skin and mucous membranes, which are prone to breakage and infection and cause serious complications. Fan Kui [15] randomly divided 20 patients with aspergillosis into MEBO treatment group and conventional drug exchange observation group, 10 cases in the treatment group were treated with MEBO and infrared irradiation drug exchange in addition to conventional debridement care method, and 10 cases in the control group were treated with conventional debridement method drug exchange. The total efficiency and the average healing days were observed. The results showed that 6 cases in the treatment group were cured, 2 cases were effective, 1 case was effective and 1 case was ineffective, and the total effective rate was 90%; 4 cases in the observation group were cured, 2 cases were effective, 1 case was effective and 3 cases were ineffective, and the total effective rate was 70%. The difference between the total effective rate of the two groups was statistically significant, and the treatment group was better than the control group. The difference in the mean healing days was statistically significant by measurement, and the mean healing days in the treatment group was lower than that in the control group. In maculopapular skin diseases, the framework dosage form of MEBO provides the necessary moist environment for optimal healing and epithelial regeneration of the wounds, and its nutrients, such as sugars and polysaccharides, fats and fatty acids, proteins, amino acids, vitamins, etc., provide the necessary nutrients for skin barrier repair.
IV. Application after various laser procedures
CO2 fractional laser treatment has become an important treatment in dermatology. Some authors [16] randomly divided 40 patients with superficial scar treated with CO2 fractional laser into experimental and control groups, and the experimental group used MEBO to care for the trauma and the control group used mupirocin ointment to care for the trauma, and compared the pain index, trauma healing time, Vancouver Scar Scale score and the incidence of hyperpigmentation in the two groups. The results showed that the patients in the experimental group had better pain index, wound healing time, Vancouver Scar Scale score and hyperpigmentation rate than the control group, and the differences were statistically significant. It is concluded that the use of MEBO for wound care after CO2 fractional laser treatment of superficial scar can reduce wound pain, promote wound healing, enhance scar treatment effect and reduce the occurrence of hyperpigmentation.
Similarly, MEBO is also suitable for the repair of wounds after various freezing, microwave, and high-frequency electrical treatments for several possible reasons: 1. Maintaining proper humidity is beneficial to wound recovery; 2. Moderate bandaging can reduce the interference of external adverse stimuli on wound repair, especially it can reduce UV-induced skin melanin deposition, uneven pigmentation caused by bad scratching habits, and reduce scar formation, etc.
In summary, the theory of skin barrier function provides a theoretical basis for the clinical application of MEBO in dermatology. The author believes that skin diseases that manifest as damaged skin barrier structure can all be considered for the use of skin regenerative medical technology. The strategy of using regenerative medicine technology is different for different skin diseases, which may be different from the treatment plan for burns, but regardless of the method used, it is necessary to ensure that the tissue cells can be adequately repaired. Due to the variety of skin diseases and their different causes, regenerative medicine is not applicable to all skin diseases and cannot completely replace other treatment methods. Since the application of regenerative medicine technology in dermatology is still in the exploratory stage, it is important for physicians using this technology to conduct a comprehensive and objective assessment of the patient prior to treatment in order to develop a reasonable treatment plan.
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