Potassium permanganate: a 'desert island drug' in dermatology.

Potassium permanganate (KMnO4 ) is an astringent with oxidizing and antiseptic properties, which dates from the 17th century and has been in medical use since the early 1800s. It is available as an over-the-counter preparation and is often used as compresses and baths for various exudative dermatoses. Its advantages include lower cost, good healing rate and reduced allergenic potential. However, it can stain skin (as well as clothing and ceramics), and more serious adverse effects include chemical burns and systemic toxicity. Owing to its easy availability, there is a risk of accidental or deliberate ingestion of this drug. The focus of this article is to increase awareness among dermatologists about the clinical use and adverse effects of KMnO4 , as well as the signs and management of systemic toxicity.

Topical potassium permanganate solution use in dermatology: comparison of guidelines and clinical practice.

In this small study we wish to highlight the difference that exists between the nationally recommended dilution of 0.01% (1 in 10 000) with the dilution used in our routine patient care 0.00125% (1 in 80 000) when preparing potassium permanganate soaks. We suggest that patient and clinician education should emphasize the importance of visual assessment rather than formulaic calculations in the safe preparation of potassium permanganate solution.

What is the evidence for the use of potassium permanganate for wound care?

Topics for Drug and Therapeutics Bulletin (DTB) review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.

[Curative effect of ozone hydrotherapy for pemphigus].

OBJECTIVE: To determine clinical curative effects of ozone therapy for pemphigus vulgaris.
 Methods: Ozone hydrotherapy was used as an aid treatment for 32 patients with pemphigus vulgaris. The hydropathic compression of potassium permanganate solution for 34 patients with pemphigus vulgaris served as a control. The main treatment for both groups were glucocorticoids and immune inhibitors. The lesions of patients, bacterial infection, usage of antibiotics, patient's satisfaction, and clinical curative effect were evaluated in the 2 groups.
 Results: There was no significant difference in the curative effect and the average length of staying at hospital between the 2 groups (P>0.05). But rate for the usage of antibiotics was significantly reduced in the group of ozone hydrotherapy (P=0.039). The patients were more satisfied in using ozone hydrotherapy than the potassium permanganate solution after 7-day therapy (P>0.05).
 Conclusion: Ozone hydrotherapy is a safe and effective aid method for pemphigus vulgaris. It can reduce the usage of antibiotics.

Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

[Generalized cutaneous candidiasis in newborn at term]. / Candidiasis cutánea generalizada en recién nacido a término.

INTRODUCTION: Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. OBJECTIVE: A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth. MATERIALS AND METHODS: A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. RESULTS: Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. CONCLUSIONS: The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.

"Too good to be true": the controversy over the use of permanganate of potash as an antidote to snake poison and the circulation of Brazilian physiology in the nineteenth century.

This article examines an international controversy over the most visible scientific event of Brazilian physiology in the nineteenth century. In 1881, Brazilian scientist João Baptista Lacerda stated that he had found an efficient antidote to the poison of Brazilian snakes: permanganate of potash (nowadays, potassium permanganate). His findings were given great publicity in Brazil and traveled rapidly around the world. Scientists, especially in France, contradicted Lacerda's claims. They argued that permanganate of potash could not be a genuine antidote to snake bites since it could not neutralize snake venom when diffused in the body. Lacerda turned down such criticism, claiming that clinical observation provided solid evidence for the drug's local action, on the spot surrounding the bite. The controversy over the use of permanganate of potash as an antidote to snake bite illustrates different regimes of proof that could be mobilized in favor of a physiological discovery.

Assessment of Aquaflor(®) , copper sulphate and potassium permanganate for control of Aeromonas hydrophila and Flavobacterium columnare infection in sunshine bass, Morone chrysops female × Morone saxatilis male.

Two experiments were conducted to test the effectiveness of different therapeutants against a mixed infection of Aeromonas hydrophila and Flavobacterium columnare in sunshine bass. Experiment 1 evaluated copper sulphate, florfenicol-medicated feed and potassium permanganate (KMnO(4) ) against a natural mixed infection. Experiment 2 further evaluated copper sulphate as a treatment to control an experimental mixed infection. In experiment 1, naturally infected untreated fish had the lowest final survival per cent, at 71%, while florfenicol-medicated feed at 15mgkg(-1) body weight for 10days or copper sulphate at 2.1mgL(-1) (1% of the total alkalinity) for 24h produced the highest final survivals, at 90% and 88%, respectively. The final survival of the naturally infected fish administered florfenicol-medicated feed was significantly different (P<0.1) from the untreated fish. The survival curves for the florfenicol and the copper sulphate at 2.1mgL(-1) were significantly improved from the untreated fish. In experiment 2, fish were challenged by waterborne exposure to A. hydrophila and F. columnare and either not treated or treated with copper sulphate at 2.1mgL(-1) . At the end of experiment 2, the per cent survival of the challenged fish treated with copper sulphate (99%) was significantly higher (P<0.05) than the non-treated (61%). The results illustrate clear benefit of florfenicol and copper sulphate against a mixed infection of A. hydrophila and F. columnare.

Candidiasis cutánea generalizada en recién nacido a término / Generalized cutaneous candidiasis in newborn at term

Introducción. La candidiasis cutánea es una enfermedad que afecta tanto a población infantil como adulta. Las forma de presentación puede ser localizada o sistémica y el agente etiológico múltiple, siendo las especies infecciosas de Candida albicans más prevalentes en niños. Objetivo. Presentar un caso de candidiasis cutánea congénita cuya causa aparente fue la transmisión vertical durante el parto. Material y metodología. Se describe el caso de un recién nacido a término expuesto a una candidiasis vaginal subclínica, que desarrolló una candidiasis cutánea congénita por C. albicans asociada a sepsis y dificultad respiratoria en las primeras 24 horas de vida. Se practicaron hemocultivos, biopsia cutánea de las lesiones pápulopústulo-vesiculosas, análisis de sangre y punción lumbar. Resultados. En la bioquímica y el hemograma se encontró una proteína C reactiva de 5,7 mg/dl, leucocitosis con desviación a la izquierda y anemia leve. A las 24 horas, en el control se encontró una proteína C reactiva (7,82 mg/dl) que fue en aumento progresivo durante tres días, por lo que se practicó punción lumbar. El hemocultivo fue positivo para Staphylococcus aureus. La biopsia cutánea dio como resultado histológico la candidiasis cutánea. Conclusiones. El diagnóstico precoz es fundamental para prevenir complicaciones derivadas del cuadro producido por C. albicans en neonatos.

Introduction. Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. Objective. A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth. Materials and methods. A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. Results. Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. Conclusions. The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.

Gastric ventilation: a new approach to metal phosphide fumigant ingestion.

INTRODUCTION: Phosphine is absorbed rapidly across mucous membranes causing systemic poisoning including functional cellular hypoxia. Following ingestion of metal phosphides, continuous absorption of phosphine could contribute to the intractable systemic manifestations. CASE REPORT: A 16-year-old male was admitted to hospital 1-hour post-ingestion of two fresh 3 g tablets of aluminum phosphide 56%. He complained of abdominal discomfort and burning pain, thirst, nausea, and foul-odor vomitus. The silver nitrate test was positive by exhaled breath and gastric content, confirming exposure to phosphine. Initial therapy included intravenous fluids and gastric lavage with sodium bicarbonate and potassium permanganate. Hypotension, severe agitation and tachypnea prompted endotracheal intubation and treatment with gastric ventilation. This procedure involves insertion of a nasogastric tube to insufflate air into the distal part of the stomach. An orogastric tube is inserted near the gastro-esophageal junction as an inflow air tract. Ventilation was provided by blowing fresh air using an air-pump into the naso-gastric tube and phosphine contaminated air escaped via the wide-bore orogastric tube; the treatment continued for several hours. Although there was some evidence of progression of poisoning, including metabolic acidosis, arterial fibrillation, and mild gastrointestinal bleeding, the patient subsequently recovered and was discharged 6 days later with no persisting complications. This case report discusses probable benefit, availability, and simplicity of this treatment. We suggest that further clinical trials are required to confirm that this treatment improves outcomes in this highly toxic poisoning.

A clinical trial comparing parenteral oxytetracyline and enrofloxacin on time to recovery in sheep lame with acute or chronic footrot in Kashmir, India.

BACKGROUND: No clinical trials have been conducted in India on the efficacy of parenteral antibacterials to treat footrot in sheep. In addition, there are no studies worldwide on the efficacy of parenteral antibacterials to treat chronic footrot. Sixty two sheep with acute footrot and 30 sheep with chronic footrot from 7 villages in Kashmir, India were recruited into two separate trials. Sheep with acute footrot were allocated to one of three treatments using stratified random sampling: long acting parenteral oxytetracycline, long acting parenteral enrofloxacin and topical application of potassium permanganate solution (a traditional treatment used by sheep farmers in India). In a quasi pre-post intervention design, sheep with chronic footrot that had not responded to treatment with potassium permanaganate were randomly allocated to treatment with one of the two parenteral antibacterials mentioned above. Sheep with acute footrot were treated on day 0 and those with chronic footrot on days 0, 3, 6 and 9. Sheep were monitored for up to 28 days after treatment. Time to recovery from lameness and initial healing of lesions was assessed using Kaplan-Meier survival curves, nonparametric log-rank and Wilcoxon sign-rank tests. RESULTS: There was significant correlation in recovery from lameness and presence of healing lesions in sheep with acute (r = 0.94) or chronic (r = 0.98) footrot. Sheep with acute footrot which were treated with parenteral antibacterials had a significantly more rapid recovery from lameness and had healing lesions (median = 7 days) compared with those treated with topical potassium permanganate solution (less than 50% recovered in 28 days). The median time to recovery in sheep with chronic footrot treated with either antibacterial was 17 days; this was significantly lower than the median of 75 days lame before treatment with antibacterials. The median time to recovery for both acute and chronic footrot increased as the severity of lesions increased. There was no difference in time to recovery by age, body condition score, duration lame, or presence of pus in the foot within acute and chronically affected sheep. CONCLUSIONS: We conclude that use of parenteral antibacterials to treat sheep lame with either acute or chronic footrot in India is highly effective. This is likely to improve welfare and give economic benefits to the farmers.

"Too Good to Be True": The Controversy over the Use of Permanganate of Potash as an Antidote to Snake Poison and the Circulation of Brazilian Physiology in the Nineteenth Century

This article examines an international controversy over the most visible scientific event of Brazilian physiology in the nineteenth century. In 1881, Brazilian scientist João Baptista Lacerda stated that he had found an efficient antidote to the poison of Brazilian snakes: permanganate of potash (nowadays, potassium permanganate). His findings were given great publicity in Brazil and traveled rapidly around the world. Scientists, especially in France, contradicted Lacerda's claims. They argued that permanganate of potash could not be a genuine antidote to snake bites since it could not neutralize snake venom when diffused in the body. Lacerda turned down such criticism, claiming that clinical observation provided solid evidence for the drug's local action, on the spot surrounding the bite. The controversy over the use of permanganate of potash as an antidote to snake bite illustrates different regimes of proof that could be mobilized in favor of a physiological discovery. (AU)

Avaliação in vitro da sensibilidade da Corynebacterium pseudotuberculosis frente a diferentes tipos de antissépticos e desinfetantes e determinação de sua curva de crescimento / In vitro evaluation of the susceptibility of Corynebacterium pseudotuberculosis to different kinds of antiseptics and disinfectants, and the determination of its growth curve

O objetivo deste estudo foi avaliar o efeito in vitro de antissépticos e desinfetantes contra a Corynebacterium pseudotuberculosis e descrever a curva de crescimento deste micro-organismo em caldo de infusão de cérebro e coração adicionado de 0,1% de Tween 80 (BHI + T), ao longo de 48 horas. Foram avaliados tintura de iodo a 10%, hipoclorito de sódio a 2,5%, permanganato de potássio a 5%, sabonete líquido antisséptico Aseptol® e álcool etílico absoluto (99,8%), por meio da metodologia da disco-difusão. Um swab estéril foi imerso na suspensão bacteriana produzida e semeado em placa de ágar Mueller-Hinton. Discos estéreis foram embebidos em cada solução a ser testada e distribuídos na superfície do ágar. Os resultados foram obtidos de acordo com o diâmetro do halo produzido ao redor dos discos. Para obtenção da curva de crescimento, colônias isoladas do micro-organismo foram inoculadas em frasco contendo BHI + T. A cada quatro horas, 2 mL eram retirados para medição da massa celular em espectrofotômetro e 1 mL para realização das diluições seriadas, plaqueamento em ágar sangue e contagem de células viáveis. Observou-se que, para a obtenção de uma concentração máxima de C. pseudotuberculosis, próxima a 1.200 x 105 células viáveis/mL, deve-se manter o inóculo sob incubação adequada por um período de 28 a 40 horas. Quanto à prova de sensibilidade, verificou-se que a tintura de iodo a 10%, seguida pelo hipoclorito de sódio a 2,5% e permanganato de potássio a 5%, foram os antissépticos e desinfetantes com maior poder bactericida in vitro contra a C. pseudotuberculosis.

The aim of this study was to evaluate the in vitro effect of antiseptics and disinfectants against Corynebacterium pseudotuberculosis, and to define the growth curve of this microrganism inoculated in brain heart infusion broth plus 0.1% of Tween 80 (BHI + T), for 48 hours incubation. For the susceptibility test, evaluations were made using 10% iodine, 2.5% sodium hypochlorite, 5% potassium permanganate, Aseptol® liquid soap, and absolute ethyl alcohol (99.8%), by way of the disc-diffusion method. A sterile swab was immersed in a bacterial suspension and plated in Mueller-Hinton agar. Sterile discs were immersed in each solution to be tested and distributed on the agar surface. The results were obtained according to the inhibition circle diameter formed around the disc. For the growth curve determination, colonies were inoculated in a bottle containing BHI + T. Every 4 hours, 2 mL was withdrawn to evaluate the cell mass in a spectrophotometer, and 1 mL was taken to perform serial dilutions, blood agar base plating and counting of viable cells. It was observed that in order to reach the maximum concentration of C. pseudotuberculosis, close to 1,200 x 105 viable cells/mL, the inoculum must be maintained at appropriate incubation for a period of 28-40 hours. The sensibility test indicated.