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To the Editor:—
Although I am not a dermatologist, I believe there is some fuzzy thinking in the clinical note entitled "Topical Use of Chymar Ointment" in the August, 1960 issue:
The authors postulate that chymotrypsin improves circulation "probably by digesting the tiny fibrin clots blockading the blood vessels surrounding the wound." I do not see how the chymotrypsin could get at those intravascular clots without digesting the blood vessel wall first. This should produce more bleeding. Of course such a phenomenon is not observed, but I also doubt that chymotrypsin transudes through a vessel wall to digest fibrin.
The authors report on the various dermatologic conditions that were improved by chymar ointment such as atopic eczema, dermatitis venenata, dermatitis medicamentosa, etc. Several of these conditions would be benefited by plain hydrocortisone ointment or cream. There is no proof that the chymotrypsin really helps. This type of therapy, therefore, is akin to saying that you can buy a 10-cent cup of coffee for a dime and a piece of old shoe leather. Every coffeeshop owner would be glad to