Escharotic – Keratolytic
Action And Clinical Pharmacology: Dichloroacetic acid rapidly penetrates and cauterizes skin, keratin and other tissues. Its cauterizing effect is comparable to that obtained with such methods as electrocautery or freezing.
Indications And Clinical Uses: For all types of verrucae; calluses; hard and soft corns; xanthoma palpebrarum; seborrheic keratoses; ingrown nails; cysts and benign erosion of the cervix including endocervicitis; epistaxis.
Contra-Indications: Should not be used for the treatment of malignant or premalignant lesions.
Manufacturers’ Warnings In Clinical States: Dichloroacetic acid is an extremely powerful keratolytic and cauterant. It should be restricted to those areas where these effects are desired.
Precautions And Adverse Reactions: Before treating cervical lesions a careful diagnosis and possibly a biopsy may be required to rule out malignancy. Treatment is contraindicated in the event of positive findings.
Topical chemical cauterant-keratolytics should be applied only to the lesion being treated. To prevent them from spreading onto normal skin, petrolatum is painted around the area to be treated. If any acid is accidentally spilled on normal tissue or if too much acid is accidentally applied, it should be immediately wiped up with a cotton pledget and washed with water. Sodium bicarbonate may be applied as a local antidote.
Prior to treatment with dichloroacetic acid the surfaces or cervical lesions must be well dried. If these surfaces have not been well dried or if too much acid is used, a fine trickle may be observed as a line of white moving downward on the cervix. If this occurs or if the vaginal wall is inadvertently touched with the applicator swab, immediately touch the affected area with a dry cotton swab following at once with a swab well moistened with water.
Symptoms And Treatment Of Overdose: Symptoms and Treatment: Skin Contact: Immediately remove contaminated clothing and wash affected area thoroughly with soap and water. In the event of massive exposure get immediate medical help.
Inhalation: Remove individual to fresh air. Get immediate medical help.
Eye Contact: Flush thoroughly with water for 15 minutes. Get immediate medical help.
Ingestion: If person is conscious, immediately give water or milk to dilute stomach contents (dilution of a least 100 mL/mL ingested). Do not induce vomiting. If breathing has stopped administer artificial respiration. Get immediate medical help.
Note: Contact lenses should not be worn when working with this chemical.
Dosage And Administration: The amount of dichloroacetic acid which should be applied varies with the nature of the lesion. Dense horny lesions such as corns, warts, calluses, plantar warts, etc. require repeated intensive treatment. Lesions of light density such as pedunculated warts, xanthoma palpebrarum, soft corns, seborrheic keratoses, condyloma acuminata, etc. should receive lighter applications.
Similarly, the technique for application will vary depending on the type of lesion being treated. Dense growths are treated by rubbing dichloroacetic acid into the lesion with a pointed wooden applicator or a cotton tipped applicator. Three or 4 office visits may be necessary before the desired result is achieved. Lesions of light density should receive a lighter application at each visit. Usually 1 or 2 such treatments is sufficient.
Administration is facilitated by use of the Treatment Kit (see Supplied) which contains in addition to the acid, petrolatum, pointed wooden applicators, 2 acid receptacles of differing capacity and a micro-dropper and holder. Both sealed-stem acid receptacles have flared funnel-shaped tops to simplify transfer of the acid from the bottle using the micro-dropper. Most kinds of lesions can be satisfactorily treated using the small-stemmed receptacle and 1 of the sharpened applicators. The large-stemmed receptacle is for use with cotton tipped applicators in the treatment of calluses or with gauze swabs in cauterization of the cervix uteri.
Typical Use: First a thin layer of petrolatum is applied to the normal tissue surrounding the lesion.
Next, the micro-dropper is used to transfer some dichloroacetic acid to the small-stemmed acid receptacle. The acid should not contact the neoprene bulb of the micro-dropper. Use the micro-dropper upright filling it no more than half way. Between uses store the micro-dropper in its holder.
A sharpened applicator stick is then moistened in the acid in the receptacle and drawn over the flared lip to remove any excess. There should never be a large excess drop of the liquid on the applicator.
Where it is desired to apply very small amounts, the applicator stick is held level or with the point up. By controlling the angle of application, a tiny fraction of one drop can be transferred to small lesions. Cauterization progress is followed by observing the change in color of the treated area to gray-white, using a loupe if necessary.
It is sometimes advantageous to apply the liquid by rolling the applicator over the surface of the lesion, using the point only at the edges.
When each treatment has been completed, rinse the receptacle with water, dry and return it to the Kit. To avoid contamination with foreign material, do not return any remaining acid from the receptacle to the bottle. Keep the bottle tightly capped except when removing acid. Applicators should be discarded after use.
Verrucae: Verrucae vulgaris will respond more quickly if surgically pared down before treatment with dichloroacetic acid. These warts require heavy treatments. After protecting the surrounding area with petrolatum, coat the entire lesion, including the sides, with acid. With the sharpened applicator work the acid into the center of the wart. Instruct the patient to return in 7 to 10 days. If any warty tissue remains, it will facilitate treatment to pare off the hard tissue with a scalpel. Try to avoid drawing blood. Repeat the application of dichloroacetic acid as outlined above. The results are permanent if all verrucous tissue has been destroyed.
Plantar warts are treated similarly to other warts but treatment will usually be of longer duration.
Venereal warts are best destroyed when the product is applied in light applications which should be repeated until the warts disappear.
Calluses: These dense lesions should first be surgically pared and the surrounding normal tissue protected with a thin layer of petrolatum. Dichloroacetic acid is then transferred to the large-stemmed acid receptacle. Dip a cotton tipped applicator into the acid in the receptacle and remove it permitting it to drain against the flared lip. Rub the acid into the callus lightly. In less than a week the patient will be able to remove the dead skin by soaking his feet in warm water, then rubbing the treated areas with a soft cloth. If complete removal is not obtained, make another application to the thickened areas and soak as before. Very thick dense calluses require further surgical paring before application of the acid.
Cervical Cauterization: First, the micro-dropper is used to transfer dichloroacetic acid to the large-stemmed acid receptacle. Two fairly large cotton or gauze swabs and a tightly-wound swab small enough to slip into the acid receptacle will also be needed (these swabs are not supplied in the Kit).
Next, use one of the large cotton swabs to wipe mucus or purulent material away from the cervical canal and from the eroded area.
Dip the small tightly-wound swab into the dichloroacetic acid in the receptacle then raise it and permit it to drain against the receptacle wall.
While the areas to be treated are still free of mucus, use the small well-drained swab to apply the product to all eroded areas. The swab may be rotated within the cervical canal if endocervicitis is found. The swab may be redipped in the acid or a fresh swab may be used if the first application does not cover the diseased area.
After a minute or two use the second large cotton swab to gently touch all the areas to which dichloroacetic acid has been applied. A slow rotating motion increases the efficiency of the swab in drying and removing any remaining acid.
Cauterization with dichloroacetic acid will often be followed for 5 to 10 days by a vaginal discharge, usually not profuse or foul smelling. In most cases the cervix will have completely healed after 10 days. If needed, additional courses of therapy with the acid may follow at 10 day intervals.
Nabothian cysts are usually destroyed concurrently with treatment of the areas of erosion. These cysts may be destroyed by puncturing them with a sharpened wooden applicator moistened with dichloroacetic acid.
In cases where electro-cautery has been used without satisfactory results, dichloroacetic acid may be used as a follow-up treatment. Properly used, dichloroacetic acid cauterization if far less drastic than electro-cauterization or conization.
Corns, Hard: With a scalpel or burr, surgically pare the corn as thoroughly as possible without drawing blood. Any slight bleeding which may occur will be stopped by application of the acid.
Apply dichloroacetic acid to all thickened areas and especially to the core. In a few minutes the acid will be absorbed. Make several more applications and instruct the patient to return in 4 or 5 days. At this second visit remove all hard, horny tissue with the scalpel or burr. If necessary, make several more applications of acid and pare off the hard tissue again after 5 days. The lesion will not recur if properly fitted shoes are worn.
Corns, Soft: Surgically pare down the corn and apply dichloroacetic acid. After 7 days remove the dead skin with a scalpel. Another application of the acid can then be made to the center of the corn and to the whitened skin. This is usually sufficient. A pad to separate the toes is helpful. Properly fitted shoes prevent recurrences.
Xanthoma Palpebrarum: Paint petrolatum around the xanthoma then carefully apply dichloroacetic acid with a sharpened applicator stick. In 7 to 10 days the crust falls off. Repeat application of the acid every 7 to 10 days until the xanthoma disappears. Very little scarring results.
Seborrheic Keratoses: These lesions yield very easily to dichloroacetic acid. Paint petrolatum around the abnormal tissue and apply the liquid until it whitens the lesion. A second treatment may be made in 7 to 10 days if needed. Very little scarring will result.
Ingrown Nails: Treat ingrown nails by applying dichloroacetic acid lightly to the granulation tissue associated with the lesion.
Epistaxis: The bleeding point is located, usually in Kiesselbach’s area, and is lightly touched with dichloroacetic acid using a fine wooden applicator with cotton twisted on the end. Only the very tip of the applicator should be moistened with the acid. Cauterization is almost immediate.
Caution: Cauterize only the bleeding point.
Availability And Storage: Treatment Kit: Each permanent, white plastic container contains: dichloroacetic acid 10 mL, petrolatum 16 g, approximately 100 applicators and directions. Also contains 2 sealed-stem acid receptacles of differing capacity, a micro-dropper and holder.
Replenishment Unit: Each unit contains: dichloroacetic acid 10 mL with approximately 100 pointed 7.5 cm applicators and directions.
Restocking Unit: Each unit contains: dichloroacetic acid 75 mL with approximately 200 pointed 7.5 cm applicators and directions.
BICHLORACETIC ACID® Glenwood Dichloroacetic Acid Escharotic – Keratolytic