Clinical efficacy of dialkylcarbamoylchloride‐coated cotton acetate dressing versus combination of normal saline dressing and 2% mupirocin ointment in infected wounds of epidermolysis bullosa

Abstract

Dialkylcarbamoylchloride (DACC)‐coated cotton acetate dressing works directly through hydrophobic interaction to reduce the number of bacteria without the risk of resistance. It is easy to use and therefore expected to improve patient's compliance. This study aimed to assess the clinical efficacy of DACC‐coated cotton acetate dressing compared to a combination of normal saline dressing and 2% mupirocin ointment. A single‐blind controlled trial was conducted and included 14 infected epidermolysis bullosa (EB) wounds which were divided into two groups. Group I received DACC‐coated cotton acetate dressing, and Group II received the combination of normal saline dressing and 2% mupirocin ointment. Study results showed that the average time required for complete wound closure was 8.6 and 11.1 days in Groups I and II, respectively (p = .014), which was statistically significant. Both groups showed complete bacterial elimination on Day 3 based on negative Gram stain results and on Day 6 based on clearance of clinical manifestations (p = 1.000). This is a novel study in EB‐infected wounds, which shows that DACC‐coated cotton acetate dressing promotes faster wound closure and is as effective as the combination of normal saline dressing and 2% mupirocin ointment in eliminating bacterial infection.

Use of Dialkyl Carbamoyl Chloride in the Prevention and Treatment of Biofilm in Wounds

“…Another indication described was in cases of epidermolysis bullosa, being compared to the treatment of saline solution and 2% mupirocin correlates, demonstrating an improvement equivalent to traditional antimicrobial therapy, possibly being considered an alternative for patients who have adverse reactions to the use of mupirocin a 2%, as DACC has no known secondary reactions 18 .…”

“…Corroborating the study by Dwiyana (2019), a group of researchers, in 2012, evaluated the quantitative profile of bacterial bioburden in patients with lesions caused by epidermolysis bullosa, in which they presented a permissive narrative of the use of DACC for a long period, stating that there is attenuation of symptoms of intense colonization, such as odor, pain complaints and exudation, in addition, benefiting the prophylactic management of the wound biofilm 19 .…”

“…Use of Dialkyl Carbamoyl Chloride in the prevention and treatment of biofilm in wounds Furthermore, the use of DACC in complex lesions has been advised, since the pathogens are not destroyed, but stored, with no risk of accumulation of cellular debris in the lesion, which could lead to an exacerbation of the local inflammatory response, leading to tissue repair pain and dysfunction 5,18,19 ,and given the evidence described that coverages with DACC do not have adverse effects, they become viable options for chronic, acute and, mainly, infected injuries 12 .…”

Utilização Do Cloreto De Dialquil Carbamoil Na Prevenção E Tratamento De Biofilme Em Feridas

“…Outra indicação descrita foi em casos de epidermólise bolhosa, sendo comparado ao tratamento de solução salina e correlatos de mupirocina a 2%, demonstrando uma melhora equivalente à terapia antimicrobiana tradicional, sendo possivelmente considerada uma alternativa aos pacientes que possuem reações adversas ao uso de mupirocina a 2%, visto que o DACC não possui reações secundárias conhecidas 18 .…”

“…Outrossim, o uso de DACC em lesões complexas tem sido aconselhado, visto que os patógenos não são destruídos, mas armazenados, não havendo risco de acúmulo de detritos celulares na lesão, o que poderia levar à um exacerbamento da resposta inflamatória local, levando à dor e disfunção do reparo tissular 5,18,19 , e diante das evidências descritas das coberturas com DACC não possuírem efeitos adversos, tornam-se opções viáveis para lesões crônicas, agudas e, principalmente, infectadas 12 . Em um estudo multicêntrico conduzido na Inglaterra e Irlanda, buscou-se avaliar a evolução das lesões de pele em âmbitos de eritema, edema, dor, odor e exsudato, sendo usado em uma variedade de pacientes com lesões dicótomas, como úlceras venosas, lesões traumáticas e úlcera mista.…”