Management of Paraffin Vacuoles
Primary Treatment Approach
For paraffin vacuoles affecting the skin, apply white soft paraffin (50% white soft paraffin and 50% liquid paraffin) to the affected areas to support barrier function, reduce transcutaneous water loss, and encourage re-epithelialization. 1
This recommendation is based on the British Association of Dermatologists' guidelines for managing skin erosions and barrier dysfunction. The application should be:
- Applied liberally to affected areas to create a protective barrier and maintain skin hydration 1
- Reapplied frequently throughout the day, particularly after washing or bathing 1
- Used as a bland emollient without additional active ingredients that might cause irritation 1
Critical Context and Warnings
Historical Misuse of Paraffin Products
It is essential to distinguish between therapeutic topical application of paraffin-based emollients versus the obsolete and dangerous practice of paraffin injection:
- Never inject paraffin oil or liquid paraffin into tissues - this is an obsolete procedure from 1899 that causes severe complications including paraffinomas (hard nodules), sterile abscesses, skin inflammation, diffuse lymphangitis, and tissue destruction 2, 3, 4
- Inadvertent intravenous administration of liquid paraffin can cause life-threatening pulmonary complications including bilateral pulmonary infiltrates, hemoptysis, and systemic inflammation 5
- Intramuscular or subcutaneous paraffin injection leads to irreversible tissue damage that is extremely difficult to treat surgically 2, 3
Appropriate Clinical Applications
Topical paraffin-based emollients are safe and recommended for:
- Skin erosions and barrier dysfunction in conditions like pemphigus vulgaris 1
- Eroded skin around the nose and mouth in children 6
- Oral mucosal injuries when applied as white soft paraffin ointment 6, 7
Wound Care Considerations
If paraffin vacuoles are associated with skin erosions or blistering:
- Gently cleanse the area with antimicrobial solution using an aseptic technique 1
- Do not deroof intact blisters - pierce at the base to drain fluid while leaving the blister roof as a biological dressing 1
- Apply nonadherent dressings if necessary to protect the area 1
- Monitor vigilantly for infection as this is a major complication risk - look for increased erythema, purulent discharge, or systemic signs 1
Infection Prevention
- Daily washing with antibacterial products can decrease colonization in patients with extensive erosions 1
- Use topical antimicrobials for short periods only if clinical signs of infection are present 1
- Systemic antibiotics are indicated if there are local or systemic signs of infection or extending skin infection 1
- Barrier nursing should be implemented for patients with extensive erosions 1
Common Pitfalls to Avoid
- Never confuse topical paraffin emollients with injectable paraffin products - only topical application is safe and therapeutic 5, 2, 3
- Do not use occlusive paraffin ointments if active infection is present as this may worsen the infection 6
- Avoid adhesive dressings on fragile or eroded skin as removal causes additional trauma 6
- Do not delay treatment of infected erosions as the rich vascularity can lead to rapid spread 7