A serious flaw mars the study by Phillips and coworkers1 that appeared in the July 1993 issue of the Archives. Winter,2in 1962, showed that superficial experimental wounds in pigs healed more rapidly under an occlusive dressing compared with those exposed to air. Hinman and Maibach3 confirmed these findings in humans in 1963, and since then there has been an extensive literature describing improved healing when superficial skin wounds are not allowed to desiccate. We know why; dry wounds form a crust that acts as a barrier to the movement of epithelial cells to cover the wound bed. Modern dressings try to prevent wound desiccation and subsequent crust formation.
Unfortunately, Phillips and coworkers in their study deliberately produced a crust by the use of Monsel's solution or Drysol solution. Monsel's solution contains ferric iron, a powerful protein precipitant while Drysol contains aluminum chloride, which is also an
Epstein E. Comparing Dressings on Crusted Wounds Yields Flawed Information. Arch Dermatol. 1994;130(3):389. doi:10.1001/archderm.1994.01690030125024