ArticleLiterature Review

Acetic acid and the skin: a review of vinegar in dermatology

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Abstract

Vinegar is commonly used as a home remedy for many skin problems. It is important for dermatologists to understand the evidence supporting its use in skin disease, as well as potential adverse effects, so they can properly counsel patients on the safe use of this widely available treatment. Vinegar possesses antimicrobial and antioxidant properties that provide utility in wound care as well as bacterial and fungal infections. There is also evidence to support its use in pruritus, head lice removal, and treatment of striae gravidarum. While generally safe, inappropriate use can result in damage to the skin. In this review, we discuss the evidence supporting vinegar as a treatment for skin disease, as well as adverse events reported from misuse, to provide dermatologists the knowledge to counsel patients on the safe and appropriate use of vinegar.

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... Peningkatan konsentrasi asam asetat berpotensi toksik pada kulit. Asam asetat pada cuka diketahui dapat menyebabkan resiko kulit terbakar dan eritema terutama penggunaan oleh anak-anak(Elhage et al., 2021). 2. Kurva regresi linier antara konsentrasi cuka nanas dengan log jumlah koloni jamur M. furfur.Tabel 3. Hasil perhitungan rerata ± standar deviasi (SD) log koloni jamur M. furfur setelah Hasil uji KBM kontrol obat ketokonazol, diketahui bahwa ketokonazol mulai membunuh M. furfur pada konsentrasi terendah 2 µg/mL (Tabel 3). ...
... Vinegar is a well-known folk remedy employed as a rinse solution on the skin for cleaning off residual cnidocytes, but this recommendation is largely based on empirical knowledge [9,20]. While some research groups support the use of vinegar for cubozoans, hydrozoans, and scyphozoans [21], research aimed at clarifying its use in scyphozoan first-aid protocols warns against and contraindicates its use [22][23][24][25]. ...
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Objective: Striae happen to 50–90% of pregnant women and never disappears completely. It is, therefore, a major aesthetic concern for most women, which can cause psychological distress and disturbed body image. This study was conducted to examine the effectiveness of the topical use of apple vinegar on striae gravidarum.Methods: This randomized controlled clinical trial study was conducted on 23 women referred to health centers in Gonabad city, selected according to inclusion criteria and systematic random method. The right half of the abdomen in each participant was considered as a trial group and the left half as the control. On the trial side, apple vinegar was massaged onto striae twice daily for 1 month. Data were collected using a demographic questionnaire, checklist of striae aesthetic change, a pair of calipers and a camera and analyzed in SPSS-20 using descriptive statistics, paired t, and Wilcoxon tests at significance level p<0.05.Results: No significant change was observed in mean length and width of striae in either trial or control sides after the intervention (p>0.05). However, on the trial side, the difference between striae length and width before and after the intervention was statistically significant (p<0.001). A significant difference was observed during intervention in the reduction in striae length and width on trial side (p<0.001).Conclusion: Topical application of apple vinegar effectively reduces the size of striae. Further and longer studies with larger sample size are recommended.
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Background Recently, natural moisturizing factors (NMFs) and corneocyte surface topography were suggested as biomarkers for irritant dermatitis. Objectives To investigate how exposure to different irritants influences corneocyte surface topography, NMF levels and the barrier function of human skin in vivo. Methods Eight healthy adult volunteers were exposed to aqueous solutions of 60% n‐propanol, 0.5% sodium lauryl sulfate (SLS), 0.15% sodium hydroxide, and 2.0% acetic acid, and distilled water, in a repeated irritation test over a period of 96 hours. Erythema, transepidermal water loss (TEWL), skin hydration, the dermal texture index (DTI) and NMF levels were measured at baseline, and after 24 and 96 hours. Results SLS and sodium hydroxide had the most pronounced effects on erythema and TEWL. Although n‐propanol caused only slight changes in TEWL and erythema, it showed pronounced effects on skin hydration, NMF levels, and the DTI. NMF was the only parameter that was significantly altered by all investigated irritants. The changes in the DTI were inversely associated with NMF levels and skin hydration. Conclusion Skin barrier impairment and the inflammatory response are irritant‐specific, emphasizing the need for a multiparametric approach to the study of skin irritation. NMF levels seem to be the most sensitive parameter in detecting irritant‐induced skin barrier alterations.
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Background Wounds have since long, contributed majorly to the health-care burden. Infected long-standing non-healing wounds place many demands on the treating surgeon and are devastating for the patients physically, nutritionally, vocationally, financially, psychologically and socially. Acetic acid has long been included among agents used in the treatment of infected wounds. In this study, we have evaluated the use of acetic acid for topical application in the treatment of infected wounds. Materials and Methods A total of 100 patients with infected wounds were treated with topical application of 1% acetic acid as dressing material after appropriate cleaning. A specimen of wound swab was collected before first application and further on days 3, 7, 10 and 14. Daily dressings of wounds were done similarly. Minimum inhibitory concentration (MIC) of acetic acid against various organisms isolated was determined. Results The patients treated ranged between 9 and 60 years, with the mean age 33 years. Nearly 70% of patients were male. Aetiologies of wounds: infective 35, diabetic 25, trauma 20, burns 10, venous ulcers 5 and infected graft donor site 5. Various microorganisms isolated include Pseudomonas aeruginosa (40%), Staphylococcus aureus (2%), Acinetobacter (12%), Escherichia Coli (5%), Proteus mirabilis (3%), Klebsiella (18%), methicillin-resistant S. aureus (10%), Streptococcus (2%) and Enterococcus (1%), Citrobacter (1%). Few wounds (6%) also isolated fungi. About 28%, 64% and 8% of patients isolated no growth on culture after 7, 14 and 21 days, respectively. MIC of all isolated organisms was ≤0.5%. Conclusion pH of the wound environment plays a pivotal role in wound healing. Acetic acid with concentration of 1% has shown to be efficacious against wide range of bacteria as well as fungi, simultaneously accelerating wound healing. Acetic acid is non-toxic, inexpensive, easily available and efficient topical agent for effective elimination of wound infections caused due to multi-drug resistant, large variety of bacteria and fungus.
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The global escalation in antibiotic resistance cases means alternative antimicrobials are essential. The aim of this study was to investigate the antimicrobial capacity of apple cider vinegar (ACV) against E. coli, S. aureus and C. albicans. The minimum dilution of ACV required for growth inhibition varied for each microbial species. For C. albicans, a 1/2 ACV had the strongest effect, S. aureus, a 1/25 dilution ACV was required, whereas for E-coli cultures, a 1/50 ACV dilution was required (p < 0.05). Monocyte co-culture with microbes alongside ACV resulted in dose dependent downregulation of inflammatory cytokines (TNFα, IL-6). Results are expressed as percentage decreases in cytokine secretion comparing ACV treated with non-ACV treated monocytes cultured with E-coli (TNFα, 99.2%; IL-6, 98%), S. aureus (TNFα, 90%; IL-6, 83%) and C. albicans (TNFα, 83.3%; IL-6, 90.1%) respectively. Proteomic analyses of microbes demonstrated that ACV impaired cell integrity, organelles and protein expression. ACV treatment resulted in an absence in expression of DNA starvation protein, citrate synthase, isocitrate and malate dehydrogenases in E-coli; chaperone protein DNak and ftsz in S. aureus and pyruvate kinase, 6-phosphogluconate dehydrogenase, fructose bisphosphate were among the enzymes absent in C.albican cultures. The results demonstrate ACV has multiple antimicrobial potential with clinical therapeutic implications.
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In this study, the antioxidant contents and the antimicrobial activities of 18 vinegar samples were investigated. For this purpose, total flavonoid contents (TFC) and total phenolic contents (TPC) of different vinegar samples were determined. In addition, total antioxidant capacities (TAC) of vinegars were analyzed using four different in vitro tests: ABTS, CUPRAC, DPPH, and FRAP, in parallel. Results obtained from antioxidant analyses showed that balsamic vinegar had the highest TFC (96 textpm 18 mg CE/100 mL) and TPC values (255 textpm 24 mg GAE/100 mL), as well as the highest TAC determined using CUPRAC (709 textpm 108 mg Trolox/100 mL) and FRAP (421 textpm 28 mg Trolox/100 mL) methods. The phenolic profiles of vinegar samples were identified by performing HPLC analysis. Among all vinegar samples studied, the most abundant phenolic compounds were determined to be gallic acid, protocatechuic acid, and p-hydroxybenzoic acid. Furthermore, antimicrobial activities of different vinegars, against Staphylococcus aureus, Salmonella Typhimurium, and Escherichia coli, were evaluated using disc diffusion method; the results of which were related to the acetic acid contents and the pH values of the vinegar samples. Balsamic vinegar was again determined to be the sample that had the highest antimicrobial activity, which showed a strong antibacterial activity against S. Typhimurium. Antibacterial activities of vinegars could partly be related to both their acetic acid contents and the pH values, and also to their phenolic contents.
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Stings from the hydrozoan species in the genus Physalia cause intense, immediate skin pain and elicit serious systemic effects. There has been much scientific debate about the most appropriate first aid for these stings, particularly with regard to whether vinegar use is appropriate (most current recommendations recommend against vinegar). We found that only a small percentage (≤1.0%) of tentacle cnidae discharge during a sting event using an ex vivo tissue model which elicits spontaneous stinging from live cnidarian tentacles. We then tested a variety of rinse solutions on both Atlantic and Pacific Physalia species to determine if they elicit cnidae discharge, further investigating any that did not cause immediate significant discharge to determine if they are able to inhibit cnidae discharge in response to chemical and physical stimuli. We found commercially available vinegars, as well as the recently developed Sting No More ® Spray, were the most effective rinse solutions, as they irreversibly inhibited cnidae discharge. However, even slight dilution of vinegar reduced its protective effects. Alcohols and folk remedies, such as urine, baking soda and shaving cream, caused varying amounts of immediate cnidae discharge and failed to inhibit further discharge, and thus likely worsen stings.
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Background The acidic pH of the stratum corneum (SC) is important for epidermal permeability barrier homeostasis. Acidification of the skin surface has been suggested as a therapeutic strategy for skin disorders such as atopic dermatitis (AD). Objective We performed an animal study to evaluate the usefulness of acidification of SC for inhibition of AD lesions and to find out if the therapeutic effect of vinegar is attributable to its herbal contents, rather than its acidity. Methods Five groups of six oxazolone-treated (Ox)-AD mice were treated for three weeks with creams of different acidity: vehicle cream alone (pH 5.5), neutralized vinegar cream (pH 7.4), pH 5.0 vinegar cream, pH 3.5 vinegar cream, and pH 3.5 hydrogen chloride (HCl) cream. Also, we have compared two groups of Ox-AD mice treated with pH 5.5 vehicle cream or pH 5.5 vinegar cream. Results Ox-AD mice treated with acidic creams exhibited fewer AD-like lesions, had significantly lower eczema scores, decreased basal by transepidermal water loss (TEWL), and increased SC hydration compared to the groups given only vehicle and neutral cream. There was no significant difference between the acidic vinegar and HCl groups. Between the groups treated with vehicle and pH 5.5 vinegar cream, there was no difference in eczema score, basal TEWL and SC hydration. Conclusion Application of topical acids, regardless of their source materials, inhibits the development of AD lesions by maintenance of skin surface pH and skin barrier function in murine model.
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There is a growing cause for concern on envenoming European species because of jellyfish blooms, climate change and globalization displacing species. Treatment of envenomation involves the prevention of further nematocyst release and relieving local and systemic symptoms. Many anecdotal treatments are available but species-specific first aid response is essential for effective treatment. However, species identification is difficult in most cases. There is evidence that oral analgesics, seawater, baking soda slurry and 42-45 °C hot water are effective against nematocyst inhibition and giving pain relief. The application of topical vinegar for 30 s is effective on stings of specific species. Treatments, which produce osmotic or pressure changes can exacerbate the initial sting and aggravate symptoms, common among many anecdotal treatments. Most available therapies are based on weak evidence and thus it is strongly recommended that randomized clinical trials are undertaken. We recommend a vital increase in directed research on the effect of environmental factors on envenoming mechanisms and to establish a species-specific treatment. Adequate signage on jellyfish stings and standardized first aid protocols with emphasis on protective equipment and avoidance of jellyfish to minimize cases should be implemented in areas at risk.
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Introduction: Localised infections, and burn wound sepsis are key concerns in the treatment of burns patients, and prevention of colonisation largely relies on biocides. Acetic acid has been shown to have good antibacterial activity against various planktonic organisms, however data is limited on efficacy, and few studies have been performed on biofilms. Objectives: We sought to investigate the antibacterial activity of acetic acid against important burn wound colonising organisms growing planktonically and as biofilms. Methods: Laboratory experiments were performed to test the ability of acetic acid to inhibit growth of pathogens, inhibit the formation of biofilms, and eradicate pre-formed biofilms. Results: Twenty-nine isolates of common wound-infecting pathogens were tested. Acetic acid was antibacterial against planktonic growth, with an minimum inhibitory concentration of 0.16-0.31% for all isolates, and was also able to prevent formation of biofilms (at 0.31%). Eradication of mature biofilms was observed for all isolates after three hours of exposure. Conclusions: This study provides evidence that acetic acid can inhibit growth of key burn wound pathogens when used at very dilute concentrations. Owing to current concerns of the reducing efficacy of systemic antibiotics, this novel biocide application offers great promise as a cheap and effective measure to treat infections in burns patients.
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Uremic pruritus is a common complication in patients with chronic kidney disease. While its cause is not known for certain, different treatments are currently applied. This study aimed to compare the effects of Avena sativa, diluted vinegar, and hydroxyzine on the reduction of uremic pruritus. In this crossover randomized clinical trial, 23 hemodialysis patients with uremic pruritus were randomly divided into 3 groups. The first group was treated with Avena sativa lotion, twice a day, for as long as 2 weeks; the second group received diluted vinegar; and the third group took hydroxyzine tablets for the same time span. After 3-day-long washout periods, the therapeutic methods were crossed over. The data were collected by a pruritus scale and a visual analogue scale, which were completed before and after the interventions. Avena sativa lotion significantly decreased the mean scores of pruritus intensity, consequences, and the verbal descriptor, although it did not have a significant effect on the frequency of pruritus and the pruritic surface. Vinegar and hydroxyzine significantly decreased all of the scores. Conclusions. Avena sativa, vinegar, and hydroxyzine were effective in decreasing pruritus. Diluted vinegar and Avena sativa can be used as a complement to hydroxyzine, which is itself a common pharmaceutical therapy.
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Antiseptics are widely used in wound management to prevent or treat wound infections due to their proven wound healing properties regardless of their cytotoxicity. The objective of this study was to determine the bactericidal effects of three antiseptics on pathogens known to cause wound infections. The study was carried out at a tertiary care hospital and a university microbiology laboratory in Sri Lanka in 2013. The three acids (acetic acid, ascorbic acid and boric acid) in increasing concentration (0.5%, 0.75% and 1%) were tested against bacterial suspensions equivalent to 0.5 McFarland standard. The Bacteria isolates used were isolated from wound and standard strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. There were 33 (68.8%) Coliforms, 10 (20.8%) Pseudomonas species, and 5 (10.4%) strains of Staphylococcus aureus. Acetic acid at concentration of 0.5% inhibited growth of 37 (77%) and 42 (87.5%) of tested isolates when exposed for 30 and 60 minutes, respectively. However 100% inhibition was achieved at four hours. At a concentration of 0.75%, 40 (83.3%) and 44 (91.7%) were inhibited when exposed for 30 and 60 minutes, respectively, with 100% inhibition at 4 hours. At concentration of 1%, 46 (95.8%) inhibition was seen at 30 minutes and 100% inhibition at 60 minutes. Ascorbic acid, at 0.5% and 0.75 % concentrations, inhibited growth of 45(93.7%) and 47(97.9%) of isolates respectively when exposed for 30 minutes. At these two concentrations, 100% inhibition was achieved when exposed for one hour. At 1% concentration, 100% inhibition was achieved at 30 minutes. Boric acid did not show bactericidal effect at concentrations of 0.5%, 0.75 % and 1%. Pseudomonas species were inhibited at 30 minutes by 0.5% acetic acid. Bactericidal effect against all the standard strains was seen with three acids at each concentration tested from 30 minutes onwards Ascorbic acid was bactericidal for all organisms tested within the shortest exposure time at the lowest concentration compared to other two acids. Despite promising bactericidal effects, further studies warrant, as ongoing debates on toxicity of acids on tissue epithelialisation. Application of antiseptics for a shorter duration could overcome this problem without losing bactericidal activity. The authors have no conflict of interest and no funding was received for this study.
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Green nails, also known as chloronychia or green nail syndrome, are characterized by green discoloration of the nail plate (greenish-yellow, greenish-brown, greenish-black), proximal chronic non-tender paronychia, and distolateral onycholysis. The cause is Pseudomonas aeruginosa infection of the nail plate in persons whose hands are constantly exposed to water, soaps, and detergents or are subject to mechanical trauma, especially in the elderly. Green or black coloration of the nails should raise suspicion for Pseudomonas infection and be treated with an oral quinolone (ciprofloxacin), particularly in aged patients. We present three cases of green nails in elderly persons.
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Effective and economical mycobactericidal disinfectants are needed to kill both Mycobacterium tuberculosis and non-M. tuberculosis mycobacteria. We found that acetic acid (vinegar) efficiently kills M. tuberculosis after 30 min of exposure to a 6% acetic acid solution. The activity is not due to pH alone, and propionic acid also appears to be bactericidal. M. bolletii and M. massiliense nontuberculous mycobacteria were more resistant, although a 30-min exposure to 10% acetic acid resulted in at least a 6-log10 reduction of viable bacteria. Acetic acid (vinegar) is an effective mycobactericidal disinfectant that should also be active against most other bacteria. These findings are consistent with and extend the results of studies performed in the early and mid-20th century on the disinfectant capacity of organic acids. IMPORTANCE Mycobacteria are best known for causing tuberculosis and leprosy, but infections with nontuberculous mycobacteria are an increasing problem after surgical or cosmetic procedures or in the lungs of cystic fibrosis and immunosuppressed patients. Killing mycobacteria is important because Mycobacterium tuberculosis strains can be multidrug resistant and therefore potentially fatal biohazards, and environmental mycobacteria must be thoroughly eliminated from surgical implements and respiratory equipment. Currently used mycobactericidal disinfectants can be toxic, unstable, and expensive. We fortuitously found that acetic acid kills mycobacteria and then showed that it is an effective mycobactericidal agent, even against the very resistant, clinically important Mycobacterium abscessus complex. Vinegar has been used for thousands of years as a common disinfectant, and if it can kill mycobacteria, the most disinfectant-resistant bacteria, it may prove to be a broadly effective, economical biocide with potential usefulness in health care settings and laboratories, especially in resource-poor countries.
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A perceived recent increase in global jellyfish abundance has been portrayed as a symptom of degraded oceans. This perception is based primarily on a few case studies and anecdotal evidence, but a formal analysis of global temporal trends in jellyfish populations has been missing. Here, we analyze all available long-term datasets on changes in jellyfish abundance across multiple coastal stations, using linear and logistic mixed models and effect-size analysis to showthat there is norobust evidence for a global increase in jellyfish. Although there has been a small linear increase in jellyfish since the 1970s, this trend was unsubstantiated by effect-size analysis that showed no difference in the proportion of increasing vs. decreasing jellyfish populations over all time periods examined. Rather, the strongest nonrandom trend indicated jellyfish populations undergo larger, worldwide oscillations with an approximate 20-y periodicity, including a rising phase during the 1990s that contributed to the perception of a global increase in jellyfish abundance. Sustained monitoring is required over the next decade to elucidate with statistical confidence whether the weak increasing linear trend in jellyfish after 1970 is an actual shift in the baseline or part of an oscillation. Irrespective of the nature of increase, given the potential damage posed by jellyfish blooms to fisheries, tourism, and other human industries, our findings foretell recurrent phases of rise and fall in jellyfish populations that society should be prepared to face.
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Head louse infestation, or pediculosis capitis, caused by Pediculus humanus var. capitis, is a common health concern in pediatric age group. An itching of the scalp is the chief symptom, whereas presence of viable nits confirms the diagnosis of head louse infestation. Secondary bacterial infection with impetignization with cervical and occipital lymphadenopathy can complicate the clinical scenario with physician misdiagnosing pediculosis to a primary bacterial infection. Screening and treatment of all close contacts is necessary for an adequate management of pediculosis. Medical management of head louse infestation requires proper application of topical pediculicidal agents', chiefly permethrin lotion and wet combing with a fine toothcomb. Severe cases with high parasitic load justify the use of either oral cotrimoxazole or Ivermectin. Other described technique involves a single application of hot air for 30 minutes. Radical but culturally unacceptable method would be shaving of scalp in resistant cases. Environmental fogging with insecticides is neither necessary nor recommended.
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Wound care is the cornerstone of treatment for patients with epidermolysis bullosa (EB); however, there are currently no guidelines to help practitioners care for these patients. The objective of this study was to generate a list of recommendations that will enable practitioners to better care for patients with EB. An expert panel generated a list of recommendations based on the best evidence available. The recommendations were translated into a survey, and sent to other EB experts to generate consensus using an online-based modified Delphi method. The list was refined and grouped into themes and specific recommendations. There were 15 respondents (45% response rate), with significant experience in the EB field (>10 years [67%]). Respondents included physicians (67%), nurses (17%), and allied health professionals (7%). There was more than 85% agreement for all the proposed items. These were further refined and grouped into 5 main themes (assessment and management of factors that impair healing, patient-centered concerns, local wound care, development of an individualized care plan, and organizational support) and 17 specific recommendations. There is a paucity of scientific evidence with most recommendations based on expert opinion. These recommendations will provide practitioners with a framework for caring for these patients. Additional scientific research including effectiveness studies for everyday practice and expert consensus, may further refine these recommendations.
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Background/objectives: Epidermolysis bullosa (EB) comprises a group of inherited skin blistering diseases. There is currently no cure, and management includes skin protection and prevention of infection. To date, there has been no systematic investigation of home skin care practices among EB patients on a multicenter scale. Methods: This cross-sectional, observational study included data collected from patients with EB enrolled in the Epidermolysis Bullosa Characterization and Clinical Outcomes Database (EBCCOD) who provided answers to a patient-directed questionnaire between January 1, 2017, and December 31, 2017. Results: Of 202 respondents, 130 (64.4%) had dystrophic EB, 51 (25.2%) had EB simplex, 21 (7.4%) had junctional EB, 3 (1.5%) had Kindler syndrome, and 3 (1.5%) had an unspecified subtype. Seventy-eight patients reported cleansing in plain water only (39%). Of those who used an additive in their cleansing water, 75 (57%) added salt, 71 (54%) added bleach, 36 (27%) added vinegar, and 34 (26%) endorsed the use of an "other" additive (multiple additives possible). Reported concentrations of additives ranged widely from 0.002% sodium hypochlorite and 0.002% acetic acid solutions, which are thought to have negligible effects on microbes, to 0.09% sodium hypochlorite and 0.156% acetic acid, concentrations shown to be cytotoxic. One hundred eighty-eight patients answered questions regarding topical product use (93%). Of those, 131 reported topical antimicrobial use (70%). Mupirocin and bacitracin were the most commonly reported topical antibiotics (59, 58 [31.4%, 30.9%], respectively). Conclusions: These findings highlight the variety of skin care routines and frequent use of topical antimicrobials among EB patients and have potential implications for antibiotic resistance. The reported range of bleach and vinegar additives to cleansing water, including cytotoxic concentrations, emphasizes the need for clear and optimized skin cleansing recommendations.
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Background/objectives: Atopic dermatitis (AD) is a common chronic inflammatory skin condition associated with high transepidermal water loss, high skin pH, and Staphylococcus aureus skin colonization. The treatment of AD with bath additives remains highly debated. Recent evidence suggests that dilute apple cider vinegar (ACV) may improve skin barrier integrity in AD, but its safety and efficacy are not well studied. This pilot split-arm study analyzed the effect of dilute apple cider vinegar soaks on skin barrier integrity in patients with atopic dermatitis as measured by skin transepidermal water loss and skin pH. Methods: A total of 22 subjects (11 AD and 11 healthy controls) were enrolled. Subjects soaked both of their forearms for 14 days, with one arm in dilute ACV (0.5% acetic acid) and the other in water 10 minutes daily. Transepidermal water loss and pH were measured pre- and post-treatment. Results: In both groups, transepidermal water loss increased and pH decreased at 0 minutes post-ACV treatment, but these effects were not sustained at 60 minutes. In total, 72.7% (16/22) of subjects reported mild side effects from ACV with improvement after discontinuing the soaks. Conclusions: Dilute ACV soaks have no significant effect on skin barrier integrity but caused skin irritation in a majority of subjects. Study limitations include analysis of a single brand, dilution, and application of ACV. Future studies are needed to explore whether lower concentrations of ACV soaks or other applications such as a leave-on acidic ointment could improve skin barrier integrity in a safe, nonirritating way.
Article
Background/Objectives Skin infection is common in atopic dermatitis (AD), often necessitating treatment with systemic antibiotics. Topical adjunctive therapies such as dilute bleach baths are increasingly recommended, and topical dilute acetic acid (AA) has not been widely studied. The objective of this study was to evaluate whether various topical anti‐infective bathing recommendations were associated with decreased systemic antibiotic exposure in pediatric AD, as well as evaluate topical anti‐infective recommendations over time within our institution. Methods Clinical data were extracted from charts of pediatric patients from 1/1/2000 to 12/31/2005 and 1/1/2009 to 12/31/2014 who visited outpatient dermatology clinics at Mayo Clinic, Rochester, a tertiary referral center. Recommendations for topical anti‐infectives (dilute AA, dilute bleach, other, or none) at any time after patient had clinically proven or suspected AD superinfection were recorded as exposures to topical anti‐infective. Primary outcome was the number of systemic antibiotic courses in a 1‐year period. Results Of 1111 patients with AD, 753 met inclusion criteria (303 in 2000‐2005; 450 in 2009‐2014). Of these, 351 (46.6%) had culture‐proven or clinically suspected superinfection. Topical anti‐infective recommendations increased between the time periods (23.3% to 79.2%; P < 0.001) and number of courses of systemic antibiotics decreased (1.9 per year vs 1.5 per year, P = 0.010). Number of systemic antibiotic courses did not differ between those who received bathing recommendations and those who did not, nor between different anti‐infective groups (P = 0.398). Conclusions Practice behaviors have changed, and topical anti‐infectives are now commonly recommended. Neither dilute AA nor bleach baths were associated with fewer subsequent exposures to systemic antibiotics in the treatment of pediatric AD.
Article
Introduction: Onychomycosis is a fungal nail infection, frequently caused by dermatophytes, which occurs in 2-14% of Western adults. The present study was set up to evaluate the efficacy and safety of a water-based, peelable nail polish (daily application), which acidifies the nail environment, versus a 5% amorolfine nail lacquer (weekly application) for topical treatment of mild-to-moderate onychomycosis. Methods: One hundred two adults were randomized in this open, prospective, blinded trial. Clinical efficacy was evaluated at baseline and days 30, 60, 120, and 180, respectively. All patients underwent microbiological testing (at baseline and study end). The primary objective of this trial was the change in the percentage of healthy nail surface at day 180. Results: The percentage of healthy surface between baseline and day 180 increased with 11.8% in the test product group and 13.2% in the amorolfine group, which were statistically comparable. Other onychomycosis-related parameters (dystrophy, discolouration, thickening, and healthy aspect, respectively) showed significant (p < 0.05) improvement after 180 days (versus baseline) with both treatments. Clinical performance was further confirmed by the frequency of patients showing onychomycosis improvement or success at the end of the study: 96.0% (test product) versus 79.6% (amorolfine). Microbiological results and improved quality of life confirmed clinical performance. Both treatments were well tolerated and appreciated for their properties and efficacy. Conclusion: The present trial confirmed the clinical performance of daily acidification of the nail, as reflected by (1) a comparable increase of percentage of healthy nail surface following treatment with the test product versus amorolfine, (2) the overall improvement of other onychomycosis-related parameters, (3) user convenience, and (4) absence of side effects. These data indicate that daily application of an aqueous, acetic acid-based, peelable solution can be a convenient, safe, and equally effective alternative for the topical management of onychomycosis. Trial registration: ClinicalTrials.gov identifier; NCT03382717 FUNDING: Oystershell Laboratories.
Article
These are the days when one would go online first seeking home remedies before seeing a doctor. Apple cider vinegar (ACV) is one such popular yet scientifically under-validated remedy. Our results prove the unequivocal antimicrobial activity of ACV to be true at full strength concentrations. However, the activity cannot be generalised because although strong antibacterial activity was observed at 25% concentrations, in terms of antifungal activity, yeasts, especially Candida were found to be less susceptible. The antimicrobial/antioxidant properties are ascertained to the total phenolic contents of ACV, as confirmed by our characterisation of the bioactive compounds and antioxidant activity. When checking for its cytotoxicity, ACV exhibited toxicity even at concentrations as low as 0.7%. These results indicate that there is no question of generalising the idea of ACV usage, instead more in vitro and in vivo validations are necessary in order to precisely weigh the pros and cons of ACV.
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In this proof of concept study, 50 lesions from 15 patients with multiple seborrheic keratoses (SKs) were treated with a novel aqueous solution containing nitric acid, zinc and copper salts, and organic acids (acetic, lactic, and oxalic acid). Treatment consisted in the application of an amount of the solution sufficient to obtain a whitening/yellowish reaction. Application of the nitric–zinc solution was performed every other week until clinical and dermoscopic clearance or crust formation, for a maximum of 4 applications. Efficacy evaluation was performed at 8 weeks (T1) and 6 months (T2). All subjects, who reported no or minimal discomfort during and after the application of the solution, completed the study. At T1, a complete clinical and dermoscopic resolution was observed in 37 lesions after an average of 3 applications/lesion (range 2–4). A partial response, with minimal persistent residual spots, was detected in the remaining 13 lesions. All patients with complete clearance showed no relapses at a 6-month follow-up (T2). The positive preliminary results indicate that this novel solution may represent a promising alternative option for SKs especially in patients not keen or eligible to undergo invasive tissue-destructive procedures.
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Background: In addition to the release of lead and cadmium from ceramic and glass vessels, (acceptable limits being set by the EU 84/500/EC Directive), other harmful metals can migrate, such as nickel and chromium. Permissible migration limits for these latter metals however have not yet been set in the EU legislation. Both the toxic properties of nickel and chromium and the measures taken by the European Commission Working Group on Food Contact Materials for verifying permissible migration limits for lead, cadmium and other metals from ceramics have acted as drivers for studies on nickel and chromium release from ceramic and glass tableware. Objective: To investigate the migration of nickel and chromium into food simulants from ceramic and glassware, available on the Polish market, which are intended for coming into contact with food. Potential consumer exposure can thereby be estimated from the release of these elements into food. Materials and methods: Tableware consisted of ceramics and glass vessels generally available on the domestic market, with inner surfaces being mainly coloured and with rim decorations. Migration of nickel and chromium studied from the ceramics was carried out in 4% acetic acid (24 ± 0.5 hrs at 22 ± 2°C), whilst that from glassware in 4% acetic acid (24 ± 0.5 hrs at 22 ± 2°C) and 0.5% citric acid (2 ± 0.1 hrs at 70 ± 2°C). The concentrations of metals which had migrated into the test solutions were measured by using flame atomic absorption spectrometry (FAAS). This analytical procedure had been previously validated by measuring nickel and chromium released into food simulants from ceramic and glass tableware where working ranges, detection limits, quantification limits, repeatability, accuracy, mean recovery and uncertainty were established. Results: Migration of nickel and chromium was measured from 172 ceramic and 52 and glass vessels samples, with all results being below the limits of quantification (LOQ = 0.02 mg/L), excepting one instance where a 0.04 mg/L concentration of nickel was found. The validated methods for measuring chromium achieved the following parameters; 0.02 to 0.80 mg/L operating range, 0.01 mg/L detection limit, 0.02 mg/L limit of quantification, 6% repeatability, 2.8% accuracy, 102% average recovery and 11% uncertainty. For the nickel method the corresponding parameters were 0.02 to 0.80 mg/L work- ing range, 0.02 mg/L limit of quantification, 0.01 mg/L detection limit, 5% repeatability, 6.5% accuracy, 101% average recovery and 12% uncertainty. Conclusions: The tested ceramics and glassware did not pose a threat to human health regarding migration of nickel and chromium, and thus any potential exposure to these metals released from these products into food will be small. However, due to the toxicity of these metals, the migration of nickel and chromium is still required for articles coming into contact with food, which includes metalware. Key words: ceramic tableware, ceramics, glassware, food contact articles, nickel, chromium leaching, migration.
Article
Vinegars are liquid products produced from the alcoholic and subsequent acetous fermentation of carbohydrate sources. They have been used as remedies in many cultures and have been reported to provide beneficial health effects when consumed regularly. Such benefits are due to various types of polyphenols, micronutrients and other bioactive compounds found in vinegars that contribute to their pharmacological effects, among them, antimicrobial, antidiabetic, antioxidative, antiobesity and antihypertensive effects. There are many types of vinegars worldwide, including black vinegar, rice vinegar, balsamic vinegar and white wine vinegar. All these vinegars are produced using different raw materials, yeast strains and fermentation procedures, thus giving them their own unique tastes and flavours. The main volatile compound in vinegar is acetic acid, which gives vinegar its strong, sour aroma and flavour. Other volatile compounds present in vinegars are mainly alcohols, acids, esters, aldehydes and ketones. The diversity of vinegars allows extensive applications in food.
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In brief: Millions of divers, swimmers, and other ocean-goers may encounter jellyfish. If they are stung, they may need either first aid if the case is mild, or extensive treatment if they suffer anaphylaxis, cardiorespiratory problems, or long-term reactions. Some severe cases may even be fatal. The author describes the mechanisms of envenomation and tissue reaction and discusses how to recognize and treat both the immediate and late sequelae.
Article
Introduction: Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of the ear canal, and is more common in swimmers, humid environments, people with absence of ear wax or with narrow ear canals, hearing-aid users, and after mechanical trauma. Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical and prophylactic treatments for otitis externa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results: We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: oral antibiotics, specialist aural toilet, topical acetic acid drops or spray, topical aluminium acetate drops, topical antibacterials, topical antifungals, topical anti-infective agents, topical corticosteroids, and water exclusion.
Article
In the United States, chronic ulcers - including decubitus, vascular, inflammatory, and rheumatologic subtypes - affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers.
Article
Background Fruit-derived organic compounds and detergents are relevant exposure factors for occupational contact dermatitis in the food industry. Although individuals with atopic dermatitis (AD) are at risk for development of occupational contact dermatitis, there have been no controlled studies on the effects of repeated exposure to multiple irritants, relevant for the food industry, in atopic skin.Objectives The aim of the study was to investigate the outcomes of repeated exposure to a fruit-derived organic acid and a detergent in AD compared to healthy volunteers.Methods The volunteers were exposed to 2.0% acetic acid (AcA) and/or 0.5% sodium lauryl sulfate (SLS) in controlled tandem repeated irritation test. The outcomes were assessed by measurements of erythema, transepidermal water loss (TEWL) and natural moisturizing factor (NMF) levels.ResultsIn the AD volunteers, repeated AcA exposure led to barrier disruption and significant TEWL increase; no significant differences after the same exposure in the healthy controls were found. Repeated exposure to SLS and the irritant tandems enhanced the reactions and resulted in a significantly higher increase in TEWL in the AD compared to the control group. Cumulative irritant exposure reduced the NMF levels in both groups.Conclusions Differences in the severity of irritant-induced barrier impairment in atopic individuals contribute to the risk for occupational contact dermatitis in result of multiple exposures to food-derived irritants and detergents.
Article
"Natural home remedies" for nevi removal found on the Internet can be ineffective, or worse, dangerous. Children and teens, in particular, may be more likely to attempt self-treatment in order to avoid discussing their concerns with their parents. Here, the authors report a case of an adolescent who presented with a chemical burn after following an Internet-based protocol for nevi removal using apple cider vinegar.
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• Three topical antibiotics and four antiseptics (1% povidone-iodine, 0.25% acetic acid, 3% hydrogen peroxide, and 0.5% sodium hypochlorite) were directly applied to cultured human fibroblasts to quantitatively assess their cytotoxicity. The four antiseptics were found to be cytotoxic; all of the cytotoxic agents except hydrogen peroxide were subsequently found to adversely affect wound healing in an animal model. Comparison of bactericidal and cytotoxic effects of serial dilutions of these four topical agents indicated the cellular toxicity of hydrogen peroxide and acetic acid exceeded their bactericidal potency. Bactericidal noncytotoxic dilutions of povidone-iodine and sodium hypochlorite were identified. These experiments provide evidence that 1% povidone-iodine, 3% hydrogen peroxide, 0.5% sodium hypochlorite, and 0.25% acetic acid are unsuitable for use in wound care. This sequence of experiments could be used to identify bactericidal, noncytotoxic agents prior to their clinical use.(Arch Surg 1985;120:267-270)
Article
Vinegar contains about 5% acetic acid in water, varying amounts of fixed fruit acids, colouring matter, salts and a few other fermentation products which impart characteristic flavour and aroma to the product. Vinegar traditionally has been used as a food preservative. Vinegar production methods could range from traditional methods employing wooden casks (Orleans Process) and surface culture (Generator Process) to submerged fermentation. Vinegar is the product made from the conversion of ethyl alcohol to acetic acid by a genus of bacteria Acetobacter. Many technical devices have been developed to improve the industrial production of vinegar. Generally, these improvements increase the speed of the transformation of ethanol into acetic acid in the presence of acetic acid bacteria. In this review a detailed description on vinegar production, methods of production, different substrates and microorganisms used for its production, and the chemistry of vinegar is presented.
Article
Inclusion criteria: All patients with chronic wounds infected with P. aeruginosa. Exclusion criteria: Wounds due to massive burns, suspected malignancy, immunocompromised individuals and individuals with sepsis. A total of 32 patients enrolled in the study. Subjects were randomised equally to the 1% acetic acid group and saline dressing group. None of the patients received any systemic antibiotics during the study period and received twice daily dressings. The endpoint of the treatment was wounds free of P. aeruginosa. The duration of treatment required to eliminate the Pseudomonas from the wounds in the acetic acid group was on an average 7 days less than that required by the saline group. P value was <0·001. In the 1% acetic acid group irrespective of the sensitivity of the organism to antibiotics, Pseudomonas organisms were eliminated within the same time period - 4·5 days. In the saline group, susceptible organisms were eliminated within 11·5 days and multidrug-resistant organisms were eliminated by 15·5 days. 1% acetic acid is a simple, safe and effective topical antiseptic that can be used in the elimination of P. aeruginosa from chronic infected wounds.
Article
This manuscript highlights and critically analyses clinical and forensic signs related to chemical burns. Signs that may lead to suspicion of a particular chemical are thoroughly discussed regarding its underlying mechanisms. Burns due to sulfuric, hydrofluoric, nitric, hydrochloric (muriatic) and acetic (including derivatives) acids, hydrogen sulphide, sodium (caustic soda) and calcium (cement) hydroxides, paraquat, burns after inflation and rupture of airbags, povidone–iodine, chlorhexidine/alcohol (in preterm infants), laxatives, and vesicants (warfare agents), will be reviewed since these are the most common agents found in daily practice, for which relevant and timed information may be helpful in formulating an emergency treatment protocols and toxicological analysis.
Article
PurposeTo evaluate the in vitro antifungal activity of apple cider vinegar on Candida spp. involved in denture stomatitis.Material and Methods The microdilution technique was used to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of apple cider vinegar containing 4% maleic acid, and nystatin (control). Further tests of microbial kinetics and inhibition of adherence to acrylic resin were performed testing different concentrations (MIC, MICx2, MICx4) of the products at time intervals of 0, 30, 60, 120 and 180 minutes. A roughness meter was used to measure the changes in surface roughness; color change of the acrylic resin specimens exposed to the test products in different concentrations and time intervals were also evaluated.ResultsApple cider vinegar (4%) showed MIC of 2500 μg/ml and MFC of 2500, 5000, and 10,000 μg/ml depending on the strain tested. Nystatin showed MIC of 3.125 μg/ml and strain-dependent MFC values ranging from 3.125 to 12.5 μg/ml. The microbial kinetic assay showed a statistical difference between apple cider vinegar and nystatin (p < 0.0001). After 30 minutes of exposure, apple cider vinegar showed fungicidal effect at MICx4, whereas nystatin maintained its fungistatic effect. Apple cider vinegar showed greater inhibition of adherence (p < 0.001) compared to control. Apple cider vinegar did not significantly alter the surface roughness of the acrylic resin specimens compared to nystatin (p > 0.05), and both had no influence on their color.Conclusion Apple cider vinegar showed antifungal properties against Candida spp., thus representing a possible therapeutic alternative for patients with denture stomatitis.
Article
Toxicological studies show that oral doses of nickel and chromium can cause cutaneous adverse reactions such as dermatitis. Additional dietary sources, such as leaching from stainless steel cookware during food preparation, are not well characterized. This study examined stainless steel grades, cooking time, repetitive cooking cycles, and multiple types of tomato sauces for their effects on nickel and chromium leaching. Trials included three types of stainless steels and a stainless steel saucepan; cooking times of 2 to 20 hours, ten consecutive cooking cycles, and four commercial tomato sauces. After a simulated cooking process, samples were analyzed by ICP-MS for Ni and Cr. After six hours of cooking, Ni and Cr concentrations in tomato sauce increased up to 26- and 7-fold respectively, depending on the grade of stainless steel. Longer cooking durations resulted in additional increases in metal leaching, where Ni concentrations increased 34 fold and Cr increased approximately 35 fold from sauces cooked without stainless steel. Cooking with new stainless steel resulted in the largest increases. Metal leaching decreases with sequential cooking cycles and stabilized after the sixth cooking cycle, though significant metal contributions to foods were still observed. The tenth cooking cycle, resulted in an average of 88 µg of Ni and 86 µg of Cr leached per 126 g serving of tomato sauce. Stainless steel cookware can be an overlooked significant source of nickel and chromium, where the contribution is dependent on stainless steel grade, cooking time, and cookware usage.
Article
Kurozu (Japanese black vinegar), a traditional product made from unpolished rice, contains beneficial organic materials and minerals. Improved manufacturing processes yielded a new vinegar, Izumi, that contains large amounts of these constituents. Because the antioxidative effects of Kurozu are well understood, we examined Izumi for its anticancer activity against the human squamous cell carcinoma (SCC) cell line HSC-5. HSC-5 cells were treated with Izumi or ordinary grain vinegar adjusted to 4.2% acidicity. MTT assay and the trypan blue dye exclusion test showed that Izumi significantly inhibited the proliferation of HSC-5 cells compared to ordinary grain vinegar. Propidium iodide (PI) flow cytometry and annexin V/PI staining revealed that among cells treated or untreated with Izumi or ordinary grain vinegar there was no difference in the number of apoptotic cells. A new form of necrosis, programmed necrosis or necroptosis, has been proposed. It is mediated by receptor-interacting serine-threonine kinase 3 (RIPK3), key signaling molecule, and results in the release of cellular danger-associated molecular patterns (DAMPs). When HSC-5 cells were treated with Izumi, the cellular level of RIPK3 protein and the amount of high-mobility group protein B1, one of the DAMPs, released into culture media were remarkably increased. These findings indicate that Izumi inhibits the proliferation of human SCC cells via programmed necrosis (necroptosis).
Article
Notwithstanding the above advantages, the major concern is low specificity (a high false-positive rate), which means that many subjects must be recalled for colposcopy. The frequency of referral after VIA ranged from 3.1% to 38.7% in reported studies.11-16 It seems that the objectivity of the test can further be improved with adequate training of the providers and possibly by magnification. We believe that the low proportion of acetowhite cases in our study was due to 1) the prolonged training of our workers, 2) including colposcopy sessions in the training, and 3) scoring only those with distinct acetowhite areas on the cervix as positive and not including those with faint and suspicious whitish appearances. However, another explanation for the low proportion of acetopositivity is that the subjects in this study more or less resembled the general population as opposed to selected diseased populations attending the clinic-based studies. The proportion of acetopositive subjects was approximately 12-13% in 2 other studies,11, 14 indicating that the proportion recalled for further investigations and false-positives may be considerably reduced by technical refinements and in general populations. Despite this, it does seem likely that a higher proportion of subjects will require follow-up after VIA than with good quality cervical cytology. However, because the result of VIA is immediately available, colposcopy and treatment of preinvasive lesions could be performed during the same visit, which will certainly have favorable implications for the costs of screening. Alternatively, because treatment (cauterization or cryotherapy) may have a low risk of morbidity, treatment of a large number of false-positives may be judged as an acceptable price to pay for the effective control of cervical carcinoma.