A&D Ointment for Large Skin Tears in Elderly Patients
Plain white petrolatum ointment is the appropriate first-line treatment for large skin tears in elderly patients, applied directly to the clean wound and covered with a nonadherent dressing changed regularly until healing is complete. 1
Why Plain Petrolatum is Preferred
Petrolatum-based ointments without antibiotics provide equivalent wound healing efficacy while avoiding unnecessary risks. 2 The evidence demonstrates several key advantages:
Plain petrolatum promotes barrier repair by upregulating antimicrobial peptides (S100A8, S100A9, human β-defensin 2) and innate immune genes (IL6, IL8, IL1B), while simultaneously increasing epidermal differentiation markers like filaggrin and loricrin 3
Petrolatum creates a moist wound environment that reduces friction and promotes healing without causing irritation 1
Studies show no difference in wound healing outcomes between plain petrolatum and antibiotic ointments for erythema, edema, epithelial confluence, crusting, or scabbing at any time point 2
The A&D Ointment Question
A&D ointment is a petrolatum-based product containing lanolin and mineral oil. While this formulation can be used, there are important considerations:
Plain white petrolatum causes less wound reactivity (12% redness) compared to petrolatum ointments with additives like lanolin (52% redness) 4
Highly purified lanolin alcohol in modern formulations shows very low rates of allergic contact dermatitis (0% in 499 subjects), but this depends on the specific purification process used 5
The lanolin component provides additional emollient properties but is not necessary for wound healing 5
Proper Application Technique
Clean the wound thoroughly with running tap water or sterile saline before applying any ointment to remove bacterial contamination and foreign matter. 1 This irrigation step is essential for preventing infection and should never be skipped.
Apply a thin layer of plain white petrolatum to the entire wound surface 1
Cover with a clean nonadherent dressing 1
Change dressings regularly to monitor for signs of infection 1
Critical Safety Considerations
Reserve topical antibiotics only for wounds showing clinical signs of infection (increasing redness, swelling, foul-smelling drainage, increased pain, or fever). 1, 6 Prophylactic antibiotic use is not recommended because:
Antibiotic ointments significantly increase the risk of allergic contact dermatitis 2
Unnecessary antibiotic use contributes to antibiotic resistance 1
One study documented allergic contact dermatitis after antibiotic ointment treatment, while none occurred with plain petrolatum 2
Antibiotic ointments caused significantly more burning at week 1 compared to plain petrolatum 2
Monitoring and Follow-Up
Inspect the wound daily for signs of infection or delayed healing. 1 Elderly patients with skin tears require careful monitoring because:
Age-related skin fragility increases vulnerability to complications 1
The warm, moist environment of covered wounds can increase infection risk if not properly monitored 1
Worsening pain, increased erythema, or purulent discharge indicates the need for antibiotic therapy 6
When to Escalate Care
Refer to wound care specialists or dermatology for extensive skin tears, deep tissue involvement, or signs of infection despite appropriate topical management. 1 Large skin tears in elderly patients may require:
Assessment for underlying causes (medication review, nutritional status, skin fragility) 1
Consideration of advanced wound dressings if healing is delayed beyond expected timeframes 1
Evaluation for systemic factors impairing wound healing 1
Common Pitfalls to Avoid
Do not use antibiotic ointments prophylactically – they provide no healing advantage and increase adverse event risk 2
Do not apply antiseptics like povidone-iodine for routine cleansing – simple irrigation with water or saline is equally effective and less irritating 1
Do not use ointments with multiple additives when plain petrolatum suffices – simpler formulations cause less wound reactivity 4