Aesthetics explores the use of a new skin disinfectant for aesthetic procedures
As an aesthetic practitioner, limiting the risk of infection in patients should be a fundamental focus of delivering treatment. Employing an aseptic technique with the use of an effective topical sterilising agent is one way to support this.1,2
Common skin disinfectants used in aesthetics include aqueous chlorhexidine and 70% isopropyl alcohol solutions,1-3 however, according to surgeon and cosmetic doctor, Miss Sherina Balaratnam, there are potential side effects to these.4,5
Miss Balaratnam explains, “Whilst I know that I am getting great skin disinfection when using something like isopropyl ethanol, what you can expect as a side effect is irritated skin, especially with inflamed or sensitive skin.” She adds, “When it comes to skin disinfection, practitioners are trying to find the best product that will efficiently disinfect and cleanse the skin before any procedure, while, at the same time, not causing irritation.”
Clinisept+, launched by distributor AestheticSource in June 2017, is a product that contains a stabilised version of hypochlorous acid (HOCI), which has displayed positive results for disinfection.6-9 Professor J Lorrain Smith et al. first publicised the benefits of HOCI in the British Medical Journal in 1915, stating that ‘the fundamental practical difficulty in the use of hypochlorous is that, in solution, they rapidly lose their strength by decomposition’.6
Due to the challenge of maintaining storage of HOCI in its natural form, it has not previously been commercially available.7 However, the UK manufacturer of Clinisept+, Clinical Health Technologies Ltd, has managed to create a stabilised, high purity version that gives a shelf life of two years, whilst retaining an optimum pH of 5.2-5.8 for ideal skin compatibility.
It does not contain alcohol, is non-irritant, non-cytotoxic and is not susceptible to causing resisitance.7,10
Miss Balaratnam, who is on the Clinisept+ advisory board and has been using it since February, explains, “What you have is a widely researched hypochlorous solution that is bactericidal, virucidal, sporicidal, and has anti-inflammatory effects. Furthermore, it allows wound healing to occur more quickly, reduces facial redness in sensitised skin and is non-cytotoxic. This is important for me in my clinic as I see and treat a large number of facial injectable patients who struggle with facial redness, sensitised skin and rosacea, which will become irritated and inflamed following skin disinfection using alcohol-based skin preparation solutions.”
Although no clinical studies have been conducted on Clinisept+ in the aesthetics specialty to date, according to the manufacturer, the technology has been used for several years in the piercing sector, where more than four million procedures have been conducted without post-treatment infection.11
There are also several studies that demonstrate the disinfecting and dermatological benefits of HOCI.6-9,12,13
In 2007, a paper by Wang et al. studied stabilised HOCI in the form of a physiologically-balanced solution in 0.9% saline at a pH of 3.5-4.0.7 Results suggested that stablised HOCI exerts rapid, concentration-dependent activity against gram-negative and gram-positive bacteria, yeast, and fungal pathogens, as long as the pH range is maintained. There was no evidence of ocular irritation following single installation of HOCI in rabbits and no reports of dermal sensitisation or reaction in guinea pigs.7
Part two of this study by Martin et al. used a standard rodent model of a chronically infected granulating wound to test various preparations of a stabilised form of HOCI.8 Results suggested that 0.01% of the stabilised HOCI with a pH of 3.5-4.0 was an effective topical antimicrobial.
Compared to other antimicrobials investigated in this animal model, HOCI was shown to control the tissue bacterial bioburden without inhibiting the wound healing process. It was also associated with improved wound closure.8
In a 2006 study looking at the effects of HOCI on the healing of leg ulcers, Selkon et al. observed 30 patients receiving compression treatment.9 After three weeks, 10 patients achieved a 44% ulcer reduction. The remaining 20 patients were given HOCI washes for a further 12 weeks; of this, 45% healed and 25% reduced in size by 60%, with all patients reporting to be pain free. The authors concluded that HOCI washes, as an adjacent therapy, increases healing and rapidly relieves pain.9
According to Clinical Health Technologies, Clinisept+ has been accepted by independent laboratory testing to approved British Standard European Norm (BS EN) standards, where it passed tests to denote its suitably as a skin disinfectant.14 Its safety has also been demonstrated in several papers.15
There are two products within the Clinisept+ range, Clinisept+ Prep & Procedure and Clinisept+ Aftercare. Miss Balaratnam explains that in her clinic she uses Clinisept+ across all stages of her patient journey, “This includes skin preparation for pre-skin imaging to remove make up and oil without causing irritation to sensitised or inflamed skin, compared to standard skin wipes.
It is essential to prepare skin for injectable dermal filler treatment to reduce the risk of bacterial infection and potential biofilm formation. I also use it pre-laser and skin resurfacing procedures to disinfect the skin pre-treatment as well as post-treatment to encourage a faster wound healing, to speed up recovery time and minimise post-treatment erythema,” she says.
In addition, Miss Balaratnam recommends applying Prep & Procedure after the treatment, “When I finish a procedure, I apply Clinisept+ across the face with a swab, and this not only cleanses the skin immediately post-procedure, but also reduces the redness that comes following any post-injection trauma and the redness post-lasers, which is very beneficial. For post-laser and skin resurfacing procedures, in my experience, the solution has shown to reduce post-treatment erythema and reduce microbial activity without slowing down the wound healing process.”
Miss Balaratnam says that the Aftercare cleanser also helps to achieve this, “I give patients a sample of the cleanser and I advise them to use it for up to 48 hours post treatment.”
As well as skin cleansing and disinfecting, Miss Balaratnam has also been trialling Clinisept+ to treat skin concerns such as resistant pustular rosacea. “As part of a small in-clinic trial, we took six patients off their existing skincare and put them on Clinisept+ Aftercare twice a day, morning and night, followed by a broad spectrum SPF,” she explains, adding, “After just seven days we can see excellent results with the skin imaging system, showing an improvement in pustular rosacea, facial redness and an overall improvement in patient satisfaction.”
Miss Balaratnam says that skin disinfection is an integral part of all aesthetic pre-procedure care, and praises the fact that Clinisept+ can support this. She concludes, “I would definitely advise all colleagues to place focus on preparing skin for cosmetic procedures. You want to use the best product that is going to deliver the best results, with the best recovery time, in order to minimise the risk of infection, transmission of infection. This product represents an evolution and is a game changer to skin disinfection here in the UK.”