Antiseptic Efficacy of a Low-Dosed Topical Triclosan/Chlorhexidine Combination Therapy in Atopic Dermatitis

Wohlrab, Johannes; Jost, G.; Abeck, Dietrich

doi:10.1159/000097653

Cited by 27 publications

(18 citation statements)

References 37 publications

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“…Topical antiseptics such as triclosan or chlorhexidine have a low sensitizing potential and show low resistance rates 70 . They can be used in emollients or syndets or as part of an additional "wet wrap dressing".…”

Section: ) Control Of Bacterial Colonizationmentioning

confidence: 99%

Atopic Dermatitis

2010

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Section: ) Control Of Bacterial Colonizationmentioning

confidence: 99%

Atopic Dermatitis

2010

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“…Many dermatological patients suffer from different types of erosive skin lesions, e.g., follicular bacterial infections [22,23] or eczema [24]. Often, local antibiotics are used instead of considering antiseptic options for treatment, although according to expert opinion, the latter are more effective and do not pose a risk of resistance development [22].…”

Section: Evidence Regarding Wound Antisepticsmentioning

confidence: 99%

Consensus on Wound Antisepsis: Update 2018

Krämer

Dissemond²,

Kim³

et al. 2017

Skin Pharmacol Physiol

240

215

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Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

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“…In dermatological preparations, it is an effective topical antiseptic to reduce colonization with Staphylococcus aureus and to treat superinfected atopic dermatitis (2,8,10,22). Despite the almost-ubiquitous occurrence of the substance, pharmacokinetic studies are sparse.…”

mentioning

confidence: 99%

Absorption, Pharmacokinetics, and Safety of Triclosan after Dermal Administration

Queckenberg

Meins

Wachall

et al. 2010

Antimicrob Agents Chemother

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We evaluated the pharmacokinetics and safety of the antimicrobial agent triclosan after dermal application of a 2% triclosan-containing cream to six volunteers. Percutaneous absorption calculated from urinary excretion was 5.9% ؎ 2.1% of the dose (mean ؎ standard deviation). The amount absorbed suggests that daily application of a standard adult dose would result in a systemic exposure 890 times lower than the relevant no-observed-adverse-effect level. Triclosan can be considered safe for use in hydrophobic creams.Triclosan is an antimicrobial agent with broad-spectrum activity against Gram-positive and Gram-negative bacteria as well as some molds and yeasts. It is bacteriostatic at low concentrations as it blocks lipid synthesis, whereas at higher concentrations (as reached in dermatological preparations) membrane destabilization and triclosan-induced K ϩ leakage lead to a rapid bactericidal effect (9, 16). Furthermore, triclosan potently inhibits the growth of Toxoplasma gondii and Plasmodium (13,20) and shows anti-inflammatory effects after topical administration (11,19).For more than 20 years, triclosan has been used widely worldwide in medical and consumer products (5, 21). In dermatological preparations, it is an effective topical antiseptic to reduce colonization with Staphylococcus aureus and to treat superinfected atopic dermatitis (2,8,10,22). Despite the almost-ubiquitous occurrence of the substance, pharmacokinetic studies are sparse.We evaluated the pharmacokinetics and safety of triclosan in a clinical study in six healthy Caucasians. The study was approved by the Ethics Committee of the University of Cologne and by the competent German authorities, and all participants gave their written informed consent. Demographic baseline characteristics are shown in Table 1. The study medication (provided by Infectopharm) was a hydrophobic cream containing 2% triclosan. Its composition corresponds to a dermatological standard preparation (NRF 11.122) which is listed in the Neues Rezeptur Formularium (German List of Recommended Standard Formulations). Approximately 60 g of the cream was massaged into the skin of the whole body except for the head and genitals. Exposure was ended by taking a shower 12 h after administration. The subjects were confined to the clinical ward under standardized conditions from 10 h prior until 48 h after study drug administration.Urinary excretion during individual sampling intervals up to 168 h postdose was used for pharmacokinetic calculations (WinNonlin version 5.01). For quantification, the sum of free triclosan and its glucuronide and sulfate metabolites (after enzymatic hydrolysis) was determined using a specific and sensitive high-performance liquid chromatographymass spectrometry approach based on published methods (15, 18). The lower and upper limits of quantification were 4.5 and 800 g/ml, respectively. Quality control samples showed good precision and accuracy throughout the measurement of study samples.In all individuals, the major fraction of absorbed triclosan was exc...

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Antiseptic Efficacy of a Low-Dosed Topical Triclosan/Chlorhexidine Combination Therapy in Atopic Dermatitis

Cited by 27 publications

References 37 publications

Atopic Dermatitis

Atopic Dermatitis

Consensus on Wound Antisepsis: Update 2018

Absorption, Pharmacokinetics, and Safety of Triclosan after Dermal Administration

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