Paraffin-embedded tulle nets as a simple dressing technique for patients with pemphigus

Abstract

Pemphigus, a blistering disease, commonly presents with extensive, superficial, painful, moist, cutaneous erosions requiring appropriate systemic therapy and scrupulous high-quality wound care. Historically, paraffin waxes have been used for the treatment of wounds and burns. Despite the availability of nonadherent dressings, they are often difficult to secure to the wet wound bed. 1,2 SOLUTION We practice a simple dressing method developed by Mohan Gharpuray, FRCP (Maharashtra Medical Foundation, Pune, India), to secure dressings in pemphigus using custom-made sterile gauze sheets doused with liberal quantities of liquid paraffin in a stainless steel dressing drum and sterilized in a double-drum autoclave. First, normal saline soaks are used to remove crusts. Second, after the wound is gently dabbed dry, paraffin-embedded tulle nets are directly applied over it. Adhesive tape can provoke new lesions when removed, akin to Nikolsky's sign, and should be avoided. Third, the liquid-paraffin-impregnated sterile gauze sheets are draped as a double layer across the shoulders like a shawl, wrapped around the waist like a beach towel, and secured with a knot instead of tape (Figs 1 and 2). This semiocclusive dressing minimizes accidental shearing and provides moisture to the wound bed, promoting re-epithelialization while allowing free drainage of the wounds. It does not disturb the healing epithelium during subsequent dressings. Thus, it is very easy to prepare, apply, secure, and remove, offering significant improvement in quality of life for a patient with pemphigus.

Topical care in pemphigus wounds: A systematic review of the literature

“…One study suggested paraffin‐embedded tulle nets for pemphigus wounds. This modality was considered an easy to apply and remove dressing for PV wounds offering significant improvement in patients' quality of life 10 …”

“…It is a safe and easy-to-apply alternative without having any severe adverse effects. 10 Based on our study, there is a sparse number of randomized controlled studies (RCT)s evaluating the efficacy of topical dressings in the management of pemphigus lesions. Due to the few available studies in this field, a definite suggestion cannot be made, which can be considered as the limitation of our study.…”

“…As a semiocclusive dressing, it provides moisture to the wound bed while promoting re‐epithelialization. It is a safe and easy‐to‐apply alternative without having any severe adverse effects 10 …”

“…This modality was considered an easy to apply and remove dressing for PV wounds offering significant improvement in patients' quality of life. 10…”