Mohs surgeons preferred petrolatum as postsurgical emollient

Issue: December 10, 2012

ATLANTA — Emollients with low risk for sensitization are being used more frequently than topical antimicrobials following routine closure of Mohs micrographic surgery-related wounds, according to study results presented at the American Society for Dermatologic Surgery’s annual meeting.

Often, after simple biopsies or incisions, dermatologists apply topical antibacterials, but “there’s no real study to show they need to do that, given the low rates of infection and the high rates of allergic contact dermatitis with topical antimicrobials,” researcher Rajiv I. Nijhawan, MD, a dermatology resident at St. Luke’s-Roosevelt Hospital Center in New York, told Healio.com. “So, what we recommend … from simple procedures to large flaps is to just use plain petrolatum for postoperative wound care. To keep it simple is the best.”

Rajiv I. Nijhawan

Researchers conducted an anonymous Web-based, 10-question survey of 857 members of the American College of Mohs Surgery, focusing on postoperative emollient use for wounds following routine primary closure of a Mohs/surgical defect, wounds following flap closure, wounds left to heal by secondary intervention and wounds closed with a skin graft. Recommended topical emollients for home care and whether patients were asked not to apply specific emollients also were included in the survey.

Of 294 respondents (34.3%), petrolatum was the most commonly used emollient placed on a wound before the patient left the office (53.1%), followed by Aquaphor (19.4%) and bacitracin (8.2%) (P<.0001). Petrolatum (69.4%) was most recommended to patients to keep the wound moist, followed by Aquaphor (38.4%), bacitracin (10.0%), bactroban (9.2%), polymyxin (8.8%), neomycin (2.0%) and gentamycin (1.0%) (P<.0001). The three most common emollients that respondents requested patients not to use were neomycin (92.8%), polymyxin (44.3%) and bacitracin (44.3%) (P<.0001).

“It was surprising that there are still so many dermatologists who are applying topical bacitracin, which has a very high risk for contact dermatitis,” Nijhawan said. “They’re not just recommending it at home; they’re applying it immediately postoperatively as well.”

For more information:

Nijhawan RI. “The Use of Topical Emollients in Post-Operative Wound Care Among Mohs Surgeons.” Presented at: American Society for Dermatologic Surgery 2012 Annual Meeting; Oct.11-15, Atlanta.