Formaldehyde as an alternative to antibiotics for treatment of refractory impetigo and other infectious skin diseases

ABSTRACT

Introduction: Antibiotic-resistant strains of bacteria are an increasing problem in hospitals and in the community. This has resulted in bacterial infections such as impetigo becoming difficult to treat. Alternative treatment options are needed.

Areas covered: In this paper, a past study that assessed the health burden of scabies in North Queensland is described and from it, the potential for formaldehyde as an alternative antimicrobial treatment is discussed. In doing so, antibiotic resistance, impetigo, permethrin, and formaldehyde are introduced and the current understanding and limitations of the effects of formaldehyde on humans are outlined. The limited cases of formaldehyde resistance in bacteria are also discussed.

Expert opinion: Formaldehyde is currently used as a preservative in cosmetics and medicinal creams due to its antibacterial activity. It, therefore, has the potential to be used as an alternative antibacterial treatment for infections with antibiotic-resistant bacteria. The harmful side effects of airborne formaldehyde and exposure in allergic individuals have been extensively studied. Significantly less research has been conducted on formaldehyde skin contact in healthy individuals. If formaldehyde is safe for topical use in humans, it has the potential to assist with combating antibiotic resistance.

KEYWORDS:

• Antibiotic resistance
• formaldehyde
• impetigo
• methicillin resistance
• permethrin
• Staphylococcus aureus

Article highlights

• The increasing incidence of antibiotic-resistant strains of Staphylococcus aureus has increased the need for alternative treatment options.

• Past work by Whitehall et al. [5] implicated treatment with a 5% permethrin cream as capable of curing infections with flucloxacillin resistant S. aureus.

• Permethrin is a synthetic pyrethroid that is used in the treatment of scabies infections but has been found to have no antibacterial effect, implicating the formaldehyde preservative of the cream in Whitehall et al. [5] as being responsible for the observed antibacterial activity.

• Formaldehyde is used in a wide variety of industries making it a ubiquitous indoor air pollutant that can cause a variety of harmful effects in humans including sensory irritation, carcinogenic effects in the respiratory system, allergic contact dermatitis and potentially increasing the rate of allergies and asthma in children.

• Despite the wealth of research on the effects of airborne formaldehyde and dermally applied formaldehyde in allergic individuals, there is significantly less available information on the effect of dermally applied formaldehyde in non-allergic individuals which is a major oversight in the literature.

• If formaldehyde can be confirmed to be minimally harmful to humans as a topically applied cream, it represents an alternative to traditional antibiotics for treating antibiotic-resistant bacterial infections such as impetigo.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.