Trolamine-Containing Topical Emulsion: Clinical Applications ... - Cutis

Drug Therapy TopicsABFigure 3. Patient with curettage and electrodesiccation of a basal cell carcinoma on the left postauricular surface followedby second-intention healing before (A) and 14 days after application of trolamine-containing topical emulsion (B).wounds that occur after surgical procedures, aretopical antibiotics, which frequently contain neomycinand/or bacitracin, and petrolatum-based ointments.Topical antibiotics are prophylactically usedwith the hope of preventing wound infection. Ointmentformulations produce a moist environment thatis believed to be conducive to wound healing.Trolamine-containing topical emulsion differsfrom petrolatum-based occlusive agents in that theformer provides a moist environment to the woundsite and also promotes wound healing throughstimulation of macrophage recruitment and modulationof the cytokine profile in the wound region. Byincreasing the IL-1:IL-6 ratio, trolamine-containingtopical emulsion enhances formation of granulationtissue and collagen synthesis. 4,5Although there is no definitive data to supportthe benefit of prophylactic use of topical antibioticsafter common dermatologic procedures performedin the ambulatory setting, topical neomycin- and/or bacitracin-containing formulations are oftenrecommended postoperatively as well as for thetreatment of dermal wounds, such as leg ulcers. 1,2,14Trolamine-containing topical emulsion differs fromtopical neomycin and bacitracin because the latter2 agents are well-recognized as common causes ofcontact allergy. 15 Additionally, topical antibioticsused after dermatologic surgical procedures have beenshown to exhibit little to no benefit in preventinginfection and appear to select for emergence of gramnegativeorganisms when infection does occur. 1,14CommentTrolamine-containing topical emulsion is an oilin-waterformulation that has been used in bothEurope and the United States for more than3 decades in the treatment of a variety of cutaneoustraumas, such as full-thickness wounds; superficialwounds, including those that are postoperative; dermalulcers; radiation dermatitis; minor abrasions; andAK treatment sites after cryotherapy. Wound healingis promoted, at least in part, by macrophage recruitmentto wound sites, which exhibits a variety offunctions including stimulation of granulation tissueVOLUME 81, MARCH 2008 213