182 JOURNAL OF COSMETIC SCIENCE ointment decreased TEWL, severity of dermatitis, and bacterial colonization of axillary skin in premature infants treated twice daily (53). Studies by Glatz et al. (54) showed that early daily use of a petroleum-based emollient led to a more beneficial skin microbiome in high-risk newborns. Microbial diversity increased and more closely mirrored non-AD sites in both adults and infants with AD after emollient treatment (55). Numerous studies have shown that moisturization is useful in prevention and treatment of AD in infants and children through improvement in barrier properties and through modulation of skin microbiome. However, petrolatum and petrolatum-containing products have an additional benefit in accelerating barrier recovery and stimulating the innate immune response. WOUND HEALING Although commonly used for minor wounds or burns, topical antibiotic dressings do not offer any advantages over PJ alone and may cause irritation due to cross-sensitization or allergic contact dermatitis. They also present a risk for antibiotic resistance (56–59). Petrolatum is routinely used postoperatively as an alternative to antibiotic ointments to promote wound healing and prevent infections. In a large, randomized, controlled clinical study, no significant differences in infection rates and healing characteristics were found between petrolatum and bacitracin for skin healing post-procedurally (56). Bacitracin was shown to induce allergic contact dermatitis in up to 13% of patients, whereas allergic reactions to petrolatum are rare. Bacitracin has reportedly caused contact anaphylaxis in several cases, while there have been no documented cases for VPJ (60–63). Smack and colleagues concluded that “white petrolatum is an effective, safe wound care ointment for ambulatory surgery” and furthered stated that PJ is highly cost-effective compared to antibiotic ointments. PJ was the highest (69.4%) recommended emollient post-surgically by more than 850 members of the American College of Mohs Surgery (64). In a small comparative study of patients who had undergone Mohs surgery, the authors found that the surgical wounds treated with PJ resulted in significantly less erythema (12%) than did those treated with Aquaphor® (Beiersdorf Inc., Wilton, Connecticut) healing ointment (52%). This was presumably due to differences in formulation where other allergens may have been present (65). More recently, Saco and colleagues performed a meta-analysis and found no significant difference in postoperative wound infection rates between topical antibiotics and petrolatum/paraffin (66). PJ is also indicated for treatment of partial thickness burns. In one clinical study, it was as effective as silver sulfadiazine as measured by time to reepithelialization and incidence of infection and contact dermatitis, and it was significantly better than silver sulfadiazine gauze dressing for wound adherence and ease of use (65,67). The authors concluded that PJ was a cost-effective alternative for minor superficial partial thickness burns. In patients with extensive burn wounds, application of a petrolatum-based moisture dressing for microskin autografting on granular tissue showed improvement in cosmetic appearance, with less blood loss, shorter surgical duration, and lower cost of surgery (68). Treatment for toxic epidermal necrolysis wounds by gauze infused with PJ was found to be a good alternative for disease management, decreasing pain without impacting wound healing time as compared with more expensive treatments (69). Petrolatum was equally effective in prevention of postoperative auricular suppurative chondritis as gentamicin. Campbell et al. concluded it was cost-effective and potentially less irritating (58).

183 Efficacy of Petrolatum VPJ has been found useful in multiple skin-healing applications. PJ is considered a moisturizer with therapeutic attributes because it creates a highly occlusive, semipermeable barrier that allows for exchange of water and oxygen. This contrasts with the application of higher occlusion products, such as certain polymers, that likely impair barrier function (25,15). These examples establish petrolatum as a safe and effective wound care agent, with a similarly low infection rate and minimal risk for inducing allergies. OTHER APPLICATIONS PF is not just restricted to leave-on care applications. It has also been tested in cleansing formulations for mildness benefits. In a clinical trial involving subjects with moderate xerotic eczema, those using a petrolatum-delivering bodywash demonstrated enhanced clinical benefits over conventional cleansing systems (70). Furthermore, in a study involving subjects with moderately dry legs, use of a petrolatum-containing bodywash had positive benefits on stratum corneum health, such as hydration and biomarkers including improved cohesion as measured by tape stripping (71). Petrolatum has also been used as an emollient in hair care to coat the hair fibers, thus repelling water loss and maintaining style integrity. Additionally, pomades consisting of petrolatum are applied directly to the scalp, typically before harsher treatments—such as chemical hair straighteners—to mitigate irritation (72). CONCLUSION Petrolatum has been shown to be safe and effective for topical use and by ingestion. Its long history of use and extensive testing have demonstrated that it is nonirritating, is hypoallergenic, and has no systemic toxicity. Petrolatum is also highly efficacious in the treatment of barrier impairment and wound healing. Multiple studies have compared petrolatum’s therapeutic potential to a wide assortment of other ointments, moisturizers, and oils, including those containing antibiotics or other drugs. In many of these comparisons, petrolatum was found to be comparable or superior to the other ointments and oils. Furthermore, petrolatum is highly cost-effective when compared to steroid-, calcineurin-, and antibiotic-containing ointments. Petrolatum may have some unique advantages compared with other moisturizers, because it has been shown to accelerate the skin’s own barrier repair mechanisms and to stimulate aspects of the innate immune response, such as production of AMPs. Robert Chesebrough’s description of PJ as a “wonder jelly” still rings true to this day. REFERENCES (1) R.A. Cheseborough, Improvement in products from petroleum. US patent 127,568. June 4, 1872. (2) Unilever Vaseline, The Healing Power of Vaseline®, accessed May 16, 2022, http://www.vaseline.co.uk/ article/vaselinestory.html. (3) P. Homan, Vaseline: from trad mark to noun, Pharm. J. (2008). (4) K.M. Al Aboud and A. Khachemoune, Vaseline: a historical perspective, Dermatol. Nurs., 21, 143–144 (2009). (5) B.W. Barry and A.J. Grace, Structural, rheological and textural properties of soft paraffins, J. Texture Stud., 2, 259–279 (1971).