Home' Australian Pharmacist : March 2011 Contents Vol. 30 -- March #03
Sulphacetamide -- from eyes
to fingers and toes?
By Dr Lisa Nissen
old drug new indication
Skin and nail conditions are common
occurrences in everyday pharmacy
practice, ranging from simple cut and
scratches to allergic reactions and
infections. One of the most common
hand infections is paronychia, an
infection of the perionychium (the skin
that hangs over the side of the nail).
Paronychia is generally categorised as
either acute or chronic depending on
the amount of time the infection has
Paronychia is a condition frequently
occurring in children because of
nail biting and finger sucking.
However, it is also commonly seen
in adults where people have their
hands repeatedly exposed to moist
environments or in those who have
prolonged and repeated contact with
irritants such as mild acids, mild
alkalis, or other chemicals.
Both acute and chronic paronychia
starts with a break in the epidermis.
An acute infection is usually
associated with trauma to the skin,
for example ingrown nails or nail
biting. The most common bacteria
responsible being Staphylococcus
aureus, while other bacteria
such as Streptococcus species
and Pseudomonas species are
Acute infections start as a red, warm,
painful swelling of the skin around the
nail which may lead to the formation
of pus that separated the skin from
the nail. The infection generally
develops over a few hours. However,
it will usually clear completely in a few
days and rarely recurs.
Chronic paronychia is associated with
repeated irritation such as exposure
to detergents and water and is most
Dr Lisa Nissen is Associate Professor (QUM),
at the School of Pharmacy, University of
Queensland and Deputy-Director, Centre for
Safe and Effective Prescribing (CSEP).
commonly caused by Candida albicans
or other fungi, often mixed with
bacteria. In chronic paronychia the
redness and tenderness we see in
acute forms of the condition are less
noticeable. Each affected nail fold is
swollen and lifted off the nail plate.
The nail plate becomes distorted and
ridged as it grows. It may become
yellow or green and brittle. After
recovery from the infection it may take
up to a year for the nail to grow back
The relief of pain and inflammation
and treatment of the bacterial
infection with oral antibiotics
(e.g. cephlexin) is the mainstay
of treatment of acute infections.
However, chronic paronychia may
involve a course of oral antifungal
agents (e.g. itraconazole) and topical
antiseptics or antifungal lotions, for
example thymol, miconazole and
Sulphacetamide is a sulfonamide
antibiotic, which are synthetic
bacteriostatic antibiotics with a wide
spectrum against most gram-positive
and many gram-negative organisms.
Sulfonamides inhibit multiplication
of bacteria by acting as competitive
inhibitors of p-aminobenzoic acid
in the folic acid metabolism cycle.
Topically applied sulfonamides
are considered active against
susceptible strains of: Escherichia coli,
Staphylococcus aureus, Streptococcus
pneumoniae, Streptococcus (viridans
group), Haemophilus influenzae,
Klebsiella sp. and Enterobacter sp.
Sulphacetamide is the primary
ingredient in over-the-counter
preparations used to treat
conjunctivitis and other superficial
ocular infections. One of the
commonly used preparations is Bleph-
10 which contains sulphacetamide
10%. Although this product is licensed
for use in the eyes, the mixed etiology
of chronic paronychia (bacterial
and fungal) has led to its use by
dermatologists and other specialists
as a topical solution of sulphacetamide
for treatment of the skin condition
with good effect.
While the clinical data used to support
the topical use of sulphacetamide
for skin infections goes back into the
early 1900s its benefit is still being
seen today in patients around the
world. Topical preparations such as the
10% eye drop solution provide a mean
of accessing this useful antibacterial
agent and may be something
pharmacists will see recommended
for patients under their care. In this
case sulphacetamide is definitely and
old drug with a modern indication.
1--2 drops into the
sac of the
every 2--3 hours.
Apply topically to
the affected area
2--3 times a day
• Stone S. Unusual, innovative,
and long-forgotten remedies.
Dermatologic Clinics, 2000;
• RJ Hay. The management of
superficial candidiasis. Journal
of the American Academy of
Dermatology, 1999;40(6 supp):
• PR Cohen, RK Scher. Geriatric nail
disorders: diagnosis and treatment.
Journal of the American Academy of
• RK Scher. Toenail disorders. Clinics
in Dermatology, 1983;1(1): 114--24.
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