Commentary
TO COMPRESS OR NOT TO COMPRESS—THAT IS THE QUESTION
JOSEPH A. WITKOWSKI, M.D. AND LAWRENCE CHARLES PARISH, M.D.
From the Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Are dermatologists in training overlooking a valuable therapeutic modality? Perhaps the virtues of compresses have not been adequately extolled. Possibly we have not instructed the residents in their use. Maybe they just do not want to take the time to teach their patients how to apply a wet dressing. Prescription of a steroid cream alone, no matter how effective, often will not do it all. Even parenteral drugs cannot effect a cure. The lack of compresses is often responsible for the therapeutic failures of the generalist. As a matter of fact, such dry therapy characterizes treatment prescribed by the nondermatologist. "If it's wet, wet it. If it's dry, dry it," is often cited, when indications for compress therapy are sought by the trainee. Although this is a catchy phrase, easily remembered by all, the directions fall short of the mark. Both wet and dry should be compressed. In addition to combating inflammation, that is, erythema, edema and vesiculation, compresses also help to remove crusts, encourage drainage, and reduce pruritus. Best of all, wetting the skin surface enhances absorption of topically applied cortiosteroids. Only man's ingenuity, or lack of, limits what can be used as a compress. Although
aluminum subacetate is most often prescribed, weak tea, regular or camomile, milk, saline, boric acid and even water can be used effectively. Such eponyms as Burow and Dalibour can frighten away even the most diligent. Often relatively messy preparations such as permanganate, silver nitrate and tars are therapeutically useful. For most dermatologic conditions, compresses must be cool, not occluded with plastic or some other impermeable wrap, and their application should be intermittent, 20 to 30 minutes at the most. Longer periods of wetting will often cause maceration and the dermatitis to worsen. For large areas of the body surface, applications may take the form of a pad made up of several layers of cotton cloth. Wetting a cotton glove or sock is often useful for compressing a hand or foot. If these directions are followed, often the most recalcitrant dermatologic problem will succumb to simple therapy. Hear ye now, future dermatologists!
OOn-9059/79/0500/0291/$00.55 © International Society of Tropical Dermatology, Inc.
291
TO COMPRESS OR NOT TO COMPRESS—THAT IS THE QUESTION
JOSEPH A. WITKOWSKI, M.D. AND LAWRENCE CHARLES PARISH, M.D.
From the Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Are dermatologists in training overlooking a valuable therapeutic modality? Perhaps the virtues of compresses have not been adequately extolled. Possibly we have not instructed the residents in their use. Maybe they just do not want to take the time to teach their patients how to apply a wet dressing. Prescription of a steroid cream alone, no matter how effective, often will not do it all. Even parenteral drugs cannot effect a cure. The lack of compresses is often responsible for the therapeutic failures of the generalist. As a matter of fact, such dry therapy characterizes treatment prescribed by the nondermatologist. "If it's wet, wet it. If it's dry, dry it," is often cited, when indications for compress therapy are sought by the trainee. Although this is a catchy phrase, easily remembered by all, the directions fall short of the mark. Both wet and dry should be compressed. In addition to combating inflammation, that is, erythema, edema and vesiculation, compresses also help to remove crusts, encourage drainage, and reduce pruritus. Best of all, wetting the skin surface enhances absorption of topically applied cortiosteroids. Only man's ingenuity, or lack of, limits what can be used as a compress. Although
aluminum subacetate is most often prescribed, weak tea, regular or camomile, milk, saline, boric acid and even water can be used effectively. Such eponyms as Burow and Dalibour can frighten away even the most diligent. Often relatively messy preparations such as permanganate, silver nitrate and tars are therapeutically useful. For most dermatologic conditions, compresses must be cool, not occluded with plastic or some other impermeable wrap, and their application should be intermittent, 20 to 30 minutes at the most. Longer periods of wetting will often cause maceration and the dermatitis to worsen. For large areas of the body surface, applications may take the form of a pad made up of several layers of cotton cloth. Wetting a cotton glove or sock is often useful for compressing a hand or foot. If these directions are followed, often the most recalcitrant dermatologic problem will succumb to simple therapy. Hear ye now, future dermatologists!
OOn-9059/79/0500/0291/$00.55 © International Society of Tropical Dermatology, Inc.
291
