These authors point out that propionibacterium acnes is a commonly recovered from failed shoulder surgery and that standard surgical preparation does not eradicate P acnes from the skin.
They sought to determine whether topical application of benzoyl peroxide (BPO) gel could decrease the presence of P acnes compared with today’s standard treatment with chlorhexidine soap (CHS). They also investigated and compared the recolonization of the skin after surgical preparation and draping between the BPO- and CHS-treated groups.
24 men and 16 women age 20 to 66 years were randomized to preoperative topical treatment at home with either 5% BPO or 4% CHS on the left shoulder at the area of a deltopectoral approach.
The BPO group started their treatment 48 hours before the trial day. After showering, the participants
applied a 5-cm strip of 5% BPO on dry skin on the left shoulder twice that day. They repeated the application the following morning and evening. The fifth, and last, application occurred in the morning on the trial day. (2) According to the local routine protocol, the CHS group underwent preparation with 4% CHS on the left shoulder, starting the day before the trial day with 2 showers, with a minimum of 2 hours between them, using 2 sponges each, and on the trial day, with 1 shower in the morning, using 2 more sponges.
Four skin swabs from the area were taken in a standardized manner at different times: before and after topical treatment, after surgical skin preparation and sterile draping, and 120 minutes after draping.
Topical treatment with BPO significantly reduced the presence of P acnes measured as the number of colony-forming units on the skin after surgical preparation. P acnes was found in 1 of 20 subjects in the BPO group and 7 of 20 in the CHS group (P = .044). The results remained after 2 hours (P = .048).
Comment: This is an interesting report indicating that at present no skin preparation can effectively remove Propionibacterium from the skin.
This study shows a marginally statistically significant effectiveness of BPO in reducing the amount of Propionibacterium recovered from the skin surface. It would be of interest to see a larger study in which the effect of BPO was controlled for patient age and sex.
24 men and 16 women age 20 to 66 years were randomized to preoperative topical treatment at home with either 5% BPO or 4% CHS on the left shoulder at the area of a deltopectoral approach.
The BPO group started their treatment 48 hours before the trial day. After showering, the participants
applied a 5-cm strip of 5% BPO on dry skin on the left shoulder twice that day. They repeated the application the following morning and evening. The fifth, and last, application occurred in the morning on the trial day. (2) According to the local routine protocol, the CHS group underwent preparation with 4% CHS on the left shoulder, starting the day before the trial day with 2 showers, with a minimum of 2 hours between them, using 2 sponges each, and on the trial day, with 1 shower in the morning, using 2 more sponges.
Four skin swabs from the area were taken in a standardized manner at different times: before and after topical treatment, after surgical skin preparation and sterile draping, and 120 minutes after draping.
Topical treatment with BPO significantly reduced the presence of P acnes measured as the number of colony-forming units on the skin after surgical preparation. P acnes was found in 1 of 20 subjects in the BPO group and 7 of 20 in the CHS group (P = .044). The results remained after 2 hours (P = .048).
Comment: This is an interesting report indicating that at present no skin preparation can effectively remove Propionibacterium from the skin.
This study shows a marginally statistically significant effectiveness of BPO in reducing the amount of Propionibacterium recovered from the skin surface. It would be of interest to see a larger study in which the effect of BPO was controlled for patient age and sex.
Benzoyl peroxide commonly causes initial dryness and sometimes irritation. A small percentage of people are much more sensitive to it and may develop burning, itching and crusting.
Finally, it is unclear whether reducing the amount of Propionibacterium on the skin might make the shoulder more susceptible to infection with other organisms, such as Streptococcus and Staphylococcus.
Finally, it is unclear whether reducing the amount of Propionibacterium on the skin might make the shoulder more susceptible to infection with other organisms, such as Streptococcus and Staphylococcus.
In our view, more research is necessary before BPO can be recommended for Propionibacterium prophylaxis in routine cases of shoulder surgery.
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