potassium hydroxide

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po·tas·si·um hy·drox·ide (KOH),

KOH; a strong, penetrating caustic.
Synonym(s): caustic potash

potassium hydroxide (KOH)

a white, soluble, highly caustic compound. Occasionally used in solution as an escharotic for bites of rabid animals, KOH has many laboratory uses as an alkalinizing agent, including the preparation of clinical specimens for examination for fungi under the microscope.

po·tas·si·um hy·drox·ide

(KOH) (pŏ-tasē-ŭm hī-droksīd)
Strong, penetrating caustic.

potassium hydroxide

; KOH topical, strongly alkaline, caustic and keratolytic chemical, liberating hydroxyl (OH-) ions on dissolution in sweat; OH- ions react with and break down side salt linkages of keratin molecules; formulated as 85% pellets; used to achieve local destruction of tissue (e.g. nail matrix) or lesions (e.g. verrucae); see Table 1
Table 1: Caustic agents used in podiatric practice to achieve local tissue destruction
AgentActionSpecial precautionsContraindications
Monochloroacetic acid (crystals or saturated solution) e.g. single VPKeratolytic; hydrolysing agent
Non-self-limiting
Deep penetration
Painful
Do not use mask if applying solution
Use a mask if applying crystals
Review in 5-7 days
Neutralize with foot bath ± NaHCO3 or NaCl
Soft-tissue atrophy
Peripheral vascular disease
Sensory neuropathy
Salicylic acid paste (40-70%) e.g. single VP; plantar hard cornKeratolytic; hydrolysing agentMacerates tissues
Review in 7-14 days
May be used in conjunction with monochloroacetic acid crystals
Neutralize with foot bath ± NaHCO3 or NaCl
Soft-tissue atrophy
Peripheral vascular disease
Sensory neuropathy
Pyrogallic acid e.g. single VPKeratolytic; oxidizing agentDeep penetration
Review in 3-5 days
Prolonged caustic action
Do not apply more than 3 times sequentially
Stains skin black/brown
Use with great care: may cause deep tissue breakdown
Soft-tissue atrophy
Peripheral vascular disease
Sensory neuropathy
Trichloroacetic acid (saturated solution; 10% solution) e.g. mosaic VPMild keratolytic
Protein precipitant
Shallow penetration
Neutralize with foot bath ± NaHCO3 or NaCl
Review in 3 weeks
Peripheral vascular disease
Sensory neuropathy
Silver nitrate (70% solution; 75-95% stick) e.g. mosaic VP; as a protective skin application below a maskProtein precipitant
Self-limiting
Stains skin black/brown
Maximum effect occurs within 24 hours
Some patients show hypersensitivity to silver nitrate (or experience acute pain)
Neutralize with NaCl foot bath
May be applied in alternate layers with trichloroacetic acid
Peripheral vascular disease
Known sensitivity
Potassium hydroxide (KOH; 85% pellets)Strong keratolyticPotentially deep penetration
Action of KOH stopped by application of 5% acetic acid after macerated coagulum has been removed
Single treatment
Soft-tissue atrophy
Peripheral vascular disease
Sensory neuropathy
Phenol (80% solution or 100% crystal)Protein precipitateAction retarded by flooding with industrial methylated spirit
Skin overspill flooded with glycerine
Review as per postoperative protocol
Peripheral vascular disease (phenol suppresses inflammatory response)

VP, verruca pedis.

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