ABSTRACT
Silver has been in medicine for hundreds of years and has proven antimicrobial properties. It was widely used until the Second World War, when antibiotics emerged. Silver nitrate (SN) sticks (75% silver nitrate and 25% potassium nitrate) are currently employed as a topical haemostatic agent for various cutaneous surgical procedures. In the initial phase of the COVID-19 pandemic, faced with a limited supply of personal protective equipment, we used SN stick haemostasis for several skin surgical procedures (including excisions). COVID-19-related guidance from the Trust recommended the avoidance of electrocautery owing to the generation of surgical plume;hence, SN stick haemostasis seemed a pragmatic option. Four female patients with a mean age of 67 years (range 48-75) presented with swelling, erythema and pain at the surgical site within a week of the procedure. Three had ellipse excisions for suspected melanoma and squamous cell carcinomas, and one had a shave excision for possible seborrhoeic keratosis. Postsurgical wound infection was suspected, but repeated microbiological swabs did not grow any pathogens. All patients failed to respond to broad-spectrum oral antibiotics, even after two courses. The inflammatory changes took up to 4 weeks to settle, with topical corticosteroids used for wound healing. On contact with moisture, SN sticks deliver free silver ions that form an eschar as they bind to the tissue and occlude vessels. The longer the tip contacts the tissue, the greater the degree of the resultant caustic action. It is widely used in clinical practice, especially wound care (overgranulation, epibole and delayed healing). A 2020 review found an increased incidence of postoperative pain along with pigmentary changes in surgical wounds treated with SN sticks vs. aluminium chloride hexahydrate and ferric subsulfate. In skin surgery, SN is used to cauterize superficial wounds after curettage and shave excision. It does not generate aerosol and, in a pandemic setting, this particular feature can be valuable. However, the potential to cause aseptic skin inflammation that mimics postoperative infection is noteworthy. There are no evidence-based guidelines for its use in dermatology. We believe that the SN is an effective haemostatic agent but can induce significant tissue inflammation in some patients, particularly if it is used in excisions when the cauterized tissue is closed. If SN-induced haemostasis for excision was to be adopted in clinical practice, our experience suggests that larger studies and guidelines are recommended.
ABSTRACT
In the age of 'influencers', social media is exerting an ever-increasing impact in dermatology. More than half the world's population use social media and its popularity continues to grow. However, studies have confirmed that content is not always evidence based. Owing to its accessibility, social media is frequently used as an information resource for patients on managing their own skin condition. The influence that it has on parents and guardians in paediatric dermatology is less well described. A 10-point questionnaire was designed to assess social media use in parents and guardians with regard to their child's skin condition. Data were collected on parent or guardian age, sex, online platforms used and changes in management as a direct result of social media-sourced information. Children's demographics, diagnosis and disease duration were also noted. Questionnaires were anonymously distributed in a general paediatric dermatology outpatient clinic waiting room over 3 months. A chi2-test of independence was used to examine the relationship between social media use and parent or guardian age, sex and child's disease duration. In total, 116 parents and guardians participated in the survey. Average child age was 9.9 years (range 0-18), male-to-female ratio 1 : 1. Diagnoses included eczema (n = 35;30%), naevi or other skin lesions (n = 27;23%), acne (n = 18;15%) and psoriasis (n = 4;3%). Ninety-three (80%) of the dermatoses had a duration of > 1 year. Over 40% (n = 48) of parents and guardians used social media on at least one occasion as an educational resource for their child's skin condition across eight online platforms, most commonly Facebook (n = 21;44%), Google (n = 15;31%) and YouTube (n = 8;16%). There was no significant relationship between social media use and parent or guardian age (P = 0.89), sex (P = 0.10) or disease duration (P = 0.77). Of the 48 social media users, 26 (54%) parents and guardians changed their use of over-the-counter products, and a further 14 (29%) altered use of physician-prescribed treatments as a result of social media-derived information. Our findings suggest that a significant number of parents and guardians use social media to understand their child's dermatosis and some change the management based on it. Following the COVID-19 pandemic, a shift to virtual platforms for human interactions has fuelled the use of social media. With its growing popularity, it is likely that dermatologicalrelated content will also increase and therefore this should be addressed in both adult and paediatric clinics.