How is liquid paraffin used in the management of skin lesions?

Use of Liquid Paraffin in Skin Lesions Management

Liquid paraffin is primarily used in skin lesions as part of a 50% white soft paraffin and 50% liquid paraffin emollient formulation to support barrier function, reduce transcutaneous water loss, and encourage re-epithelialization of affected areas. 1

Primary Applications

Wound and Blister Management

• For skin lesions with blisters:
  • Pierce blisters at the base with a sterile needle (bevel facing up)
  • Do not remove the blister roof (leave as biological dressing)
  • Apply 50% white soft paraffin/50% liquid paraffin emollient to affected areas 1, 2
  • This emollient combination helps maintain skin hydration and promotes healing

Barrier Function Support

• Liquid paraffin in combination with white soft paraffin:
  • Supports compromised skin barrier function
  • Reduces water loss from damaged skin
  • Provides a protective layer over erosions and lesions 1
  • Helps prevent infection by maintaining skin integrity

Application Protocol

• Apply emollient liberally to affected areas
• Recommended usage: 200-400g per week for an adult (with twice daily application) 1
• Can be used as part of regular dressing changes for skin lesions
• Apply after gentle cleansing with antimicrobial solution 2

Evidence of Effectiveness

In Burn Wounds

• Liquid paraffin as adjuvant therapy in residual burn wounds has shown:
  • Higher effective treatment rates (79% vs 38% in control group by day 21)
  • Better infection control (100% vs 69% by day 21)
  • Shorter wound healing time (15 days vs 22 days) 3

In Specific Skin Conditions

• In pemphigus vulgaris management, liquid paraffin combined with white soft paraffin is recommended to support barrier function and encourage re-epithelialization 1
• For patients with psoriasis, a cream containing glycerol, vaseline, and liquid paraffin showed improved skin hydration and reduction in erythema, flaking, and lichenification 4

Advantages and Limitations

Advantages

• Readily available and cost-effective
• Creates an occlusive barrier that prevents water loss
• Non-irritating to damaged skin
• Compatible with most topical medications

Limitations

• Simple paraffin-based emollients without humectants (like urea or glycerol) may not improve skin barrier function as effectively as more complex formulations 5
• May feel greasy and uncomfortable in hot weather
• Not suitable as primary treatment for infected lesions (requires concurrent antimicrobial therapy if infection is present)

Clinical Pearls

• Always ensure the skin is clean before applying liquid paraffin preparations
• For optimal results, apply immediately after bathing while skin is still slightly damp
• When managing blisters, the combination of proper blister care technique and emollient application yields better outcomes 1, 2
• Liquid paraffin preparations can be used alongside topical medications, but apply medications first and allow absorption before applying the emollient

Cautions

• Avoid using near open flames due to flammability risk
• May stain clothing and bedding
• Should not be the sole treatment for infected lesions
• Paraffin accumulation on bedding and clothing can increase fire risk, especially with regular use

Liquid paraffin remains a valuable component in skin lesion management, particularly when combined with white soft paraffin in a 50:50 ratio as recommended by dermatology guidelines 1.