Cutaneous Bacterial Infections Research Articles

Systemic therapy for psoriasis and the risk of cutaneous infections.

Systemic treatments are important for patients with moderate-to-severe psoriasis; however, they may occasionally cause adverse infectious events. Although the risk of severe infections with psoriatic treatments is well established, little is known about cutaneous infections. Therefore, we studied the frequency of cutaneous infections in patients with psoriasis who underwent biologic treatment. A total of 878 patients (237 females and 641 males) were analyzed in this follow-up survey conducted in 2020 and based on the Western Japan Psoriasis Registry. The observed skin phenotypes were psoriasis vulgaris (83.3%), pustular psoriasis (7.5%), and psoriatic arthritis (28.9%). The most frequently prescribed systemic drug was apremilast (11.3%), followed by ixekizumab (11.0%), risankizumab (10.9%), and secukinumab (10.4%). The incidence of cutaneous bacterial infections was 12 (1.37% of the total patients), with cellulitis being the most common (8/12, 67%). The incidence of viral infections was 11 (1.25%) including the most common, herpes zoster (9/11, 82%); and that of fungal infections was 45 (5.13%) including 33 (73%) and seven (16%) patients with trichophytosis and oral candidiasis, respectively. Multivariate analysis revealed that cutaneous bacterial infections were frequently observed in patients receiving tumor necrosis factor-α (odds raio [OR] 9.917, 95% confidence interval [CI] 2.069-47.572, p = 0.004) and interleukin (IL)-17 (OR 10.798, 95% CI 2.35-49.616, p = 0.002) inhibitor treatments. A history of otitis media and treatment with oral medications (OR 4.50, 95% CI 1.281-15.804, p = 0.019 and OR 3.80, 95% CI 1.141-12.679, p = 0.03 respectively) were associated with a higher ORs for cutaneous viral infections. Furthermore, age and use of IL-17 inhibitors were associated with elevated ORs for fungal infections. In conclusion, our study reveals that systemic therapies may increase the risk of cutaneous viral infections. Therefore, dermatologists should exercise caution in this regard.

Blue-Light-Activated Water-Soluble Sn(IV)-Porphyrins for Antibacterial Photodynamic Therapy (aPDT) against Drug-Resistant Bacterial Pathogens.

Antimicrobial resistance has emerged as a global threat to the treatment of infectious diseases. Antibacterial photodynamic therapy (aPDT) is a promising alternative approach and is highly suitable for the treatment of cutaneous bacterial infections through topical applications. aPDT relies on light-responsive compounds called photosensitizer (PS) dyes, which generate reactive oxygen species (ROS) when induced by light, thereby killing bacterial cells. Despite several previous studies in this area, the molecular details of targeting and cell death mediated by PS dyes are poorly understood. In this study, we further investigate the antibacterial properties of two water-soluble Sn(IV) tetrapyridylporphyrins that were quaternized with methyl and hexyl groups (1 and 2). In this follow-up study, we demonstrate that Sn(IV)-porphyrins can be photoexcited by blue light (a 427 nm LED) and exhibit various levels of bactericidal activity against both Gram-(+) and Gram-(-) strains of bacteria. Using localization studies through fluorescence microscopy, we show that 2 targets the bacterial membrane more effectively than 1 and exhibits comparatively higher aPDT activity. Using multiple fluorescence reporters, we demonstrate that photoactivation of 1 and 2 results in extensive collateral damage to the bacterial cells including DNA cleavage, membrane damage, and delocalization of central systems necessary for bacterial growth and division. In summary, this investigation provides deep insights into the mechanism of bacterial killing mediated by the Sn(IV)-porphyrins. Moreover, our approach offers a new method for evaluating the activity of PS, which may inspire the discovery of new PS with enhanced aPDT activity.

Bacterial infections of the skin in the context of climate change and migration

In the context of climate change and migration, both common and previously less common pathogens are gaining importance as cutaneous bacterial infections. To inform medical professionals about challenges to dermatology posed by climate change and migration. Review of the current literature on emerging antimicrobial resistance and emerging pathogens in general and on the epidemiological situation in Germany in particular. Climate change has adirect impact on microbiological ecosystems in Germany's warming coastal waters leading to an increase of marine V.vulnificus counts and human infections. Secondary to global warming, transmitting vectors of, for example, Lyme disease, rickettsioses and tularemia are also increasing. In addition, infectious diseases like cutaneous diphtheria and mycobacteriosis have been diagnosed in migrants, mostly likely acquired before migration or on the migration route and first diagnosed in Germany. In this context, antimicrobial resistance (e.g. methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant gram-negative bacteria) is gaining importance. Due to progressive changes in global climate and ongoing migration, the aforementioned pathogens of infectious skin diseases and changes in antimicrobial resistance patterns have to be expected. Physicians should be aware of these developments in order to offer appropriate diagnostics and treatment. Epidemiological and biogeographic monitoring will be indispensable for managing emerging changes.

Formulation and Characterization of Hesperidin-Loaded Transethosomal Gel for Dermal Delivery to Enhance Antibacterial Activity: Comprehension of In Vitro, Ex Vivo, and Dermatokinetic Analysis.

In this study, hesperidin was loaded into a transethosome and was developed employing the rotary evaporator method. The formulation was optimized using the Box-Behnken design (BBD). The optimized HSD-TE formulation has a spherical shape, vesicle size, polydispersity index, entrapment efficiency, and zeta potential within the range of 178.98 nm; the PDI was 0.259 with a zeta potential of -31.14 mV and % EE of 89.51%, respectively. The in vitro drug release shows that HSD-TE exhibited the release of 81.124 ± 3.45% in comparison to HSD suspension. The ex vivo skin permeation showed a 2-fold increase in HSD-TE gel permeation. The antioxidant activity of HSD-TE was found to be 79.20 ± 1.77% higher than that of the HSD solution. The formulation showed 2-fold deeper HSD-TE penetration across excised rat skin membranes in confocal laser microscopy scanning, indicating promising in vivo prospects. In a dermatokinetic study, HSD-TE gel was compared to HSD conventional gel where TE significantly boosted HSD transport in the epidermis and dermal layers. The formulation showed greater efficacy than free HSD in the inhibition of microbial growth, as evidenced by antibacterial activity on the Gram-negative and positive bacteria. These investigations found that the HSD-TE formulation could enhance the topical application in the management of cutaneous bacterial infections.

IMPETIGO, DESCRIPTION, ETIOLOGY, EPIDEMIOLOGY, PATHOPHYSIOLOGY, EVALUATION, DIFFERENTIAL DIAGNOSIS, TREATMENT, PROGNOSIS AND COMPLICATIONS

Introduction: Impetigo is a common infection of the superficial layers of the epidermis that is highly contagious and usually originated by gram-positive bacteria, this disease manifests with the presence of erythematous plaques with a yellow crust, which may become itchy or painful. Diagnosis is usually based on signs and symptoms alone. Treatment involves topical and oral antibiotics and symptomatic care. Objective: to detail current information related to impetigo, description, etiology, epidemiology, pathophysiology, evaluation, differential diagnosis, treatment, prognosis and complications. Methodology: a total of 37 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 28 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: impetigo, cutaneous bacterial infection, S. aureus, streptococcal, bullous impetigo. Results: Impetigo accounts for approximately 10% of skin complaints in the pediatric population and the main pathogens involved include Staphylococcus aureus and Streptococcus pyogenes. There are two common variants of impetigo: non-blistering (70%) and blistering (30%)Streptococcus pyogenes (group A streptococcus) is one of the most important bacterial causes of skin and soft tissue infections (STBI) worldwide. Impetigo is a non-life-threatening infection, but can lead to acute post-streptococcal glomerulonephritis. Conclusions: Impetigo is a common disease in early life, especially in warm and humid climates. The infection can be blistering or non-blistering and is usually caused by Staphylococcus aureus and Streptococcus pyogenes. The infection usually affects the face, but can occur anywhere else on the body with a laceration, abrasion, insect bite, or other trauma. History and physical examination are paramount for diagnosis, which is usually based on symptoms and clinical manifestations alone. Treatment strategies for impetigo differ, depending on whether the condition is localized or generalized, as well as resistance patterns to the causative agents and current guidelines. Topical antibiotics alone or in combination with systemic antibiotics are most frequently used for treatment. The prognosis is usually good and complications are rare. KEY WORDS: impetigo, S. aureus, blistering, cutaneous, skin.

Vitamin K3 (Menadione) is a multifunctional microbicide acting as a photosensitizer and synergizing with blue light to kill drug-resistant bacteria in biofilms.

Cutaneous bacterial wound infections typically involve gram-positive cocci such as Staphylococcus aureus (SA) and usually become biofilm infections. Bacteria in biofilms may be 100-1000-fold more resistant to an antibiotic than the clinical laboratory minimal inhibitory concentration (MIC) for that antibiotic, contributing to antimicrobial resistance (AMR). AMR is a growing global threat to humanity. One pathogen-antibiotic resistant combination, methicillin-resistant SA (MRSA) caused more deaths globally than any other such combination in a recent worldwide statistical review. Many wound infections are accessible to light. Antimicrobial phototherapy, and particularly antimicrobial blue light therapy (aBL) is an innovative non-antibiotic approach often overlooked as a possible alternative or adjunctive therapy to reduce antibiotic use. We therefore focused on aBL treatment of biofilm infections, especially MRSA, focusing on in vitro and ex vivo porcine skin models of bacterial biofilm infections. Since aBL is microbicidal through the generation of reactive oxygen species (ROS), we hypothesized that menadione (Vitamin K3), a multifunctional ROS generator, might enhance aBL. Our studies suggest that menadione can synergize with aBL to increase both ROS and microbicidal effects, acting as a photosensitizer as well as an ROS recycler in the treatment of biofilm infections. Vitamin K3/menadione has been given orally and intravenously worldwide to thousands of patients. We conclude that menadione/Vitamin K3 can be used as an adjunct to antimicrobial blue light therapy, increasing the effectiveness of this modality in the treatment of biofilm infections, thereby presenting a potential alternative to antibiotic therapy, to which biofilm infections are so resistant.

Common superficial and deep cutaneous bacterial infections in domestic animals: A review.

The skin covers the external surface of animals, and it is constantly exposed to and inhabited by different microorganisms, including bacteria. Alterations in the skin barrier allow commensal and/or pathogenic bacteria to proliferate and penetrate deep into the lower layers of the skin. Being the first barrier to the external environment, the skin is prone to injuries, allowing the penetration of microorganisms that may lead to severe deep infections. Companion animals, especially dogs, are prone to bacterial infections, often secondary to allergic dermatitis. When environmental conditions are unfavorable, horses, cattle, sheep, and goats can develop superficial infections, such as those caused by Dermatophilus congolensis. Deep inflammation is commonly caused by Mycobacterium spp., which results in granulomatous to pyogranulomatous dermatitis and panniculitis. Likewise, bacteria such as Nocardia spp. and Actinomyces spp. can cause deep pyogranulomatous inflammation. Bacteria that lead to deep necrotizing lesions (eg, necrotizing fasciitis/flesh-eating bacteria) can be severe and even result in death. This review includes an overview of the most common cutaneous bacterial infections of domestic animals, highlighting the main features and histologic morphology of the bacteria, cutaneous structures involved, and the type of inflammatory infiltrates.

Profile of Cutaneous Bacterial Flora in Pemphigus Patients.

Objectives Pemphigus, a group of autoimmune bullous diseases, can be fatal, resulting from overwhelming opportunistic infection of lesions secondary to cutaneous bacterial infections. This study aimed to look into the cutaneous bacterial infection profile of pemphigus patients as timely identification and appropriate treatment can play a major role in reducing mortality. Materials and Methods Pus samples/swabs received from patients with pemphigus over a 2-year period from July 2018 to June 2020 were subjected to standard microbiological culture techniques and susceptibility testing. The frequency of isolation and susceptibility profile of the different bacterial pathogens toward various antimicrobial agents were interpreted and analyzed as per the Clinical and Laboratory Standards Institute's guidelines. Results Samples from 315 patients were received during the study period comprising of 203 (64.4%) males and 112 (35.5%) females. Of 211 samples which were culture-positive, a total of 245 bacterial isolates were obtained, comprising of 158 Gram-positive cocci and 87 Gram-negative bacilli. Staphylococcus aureus (138, 56.3%) was the most common isolate followed by Pseudomonas aeruginosa (41, 16.7%) and Escherichia coli (16, 6.5%). Methicillin resistance was observed in 24.6% Staphylococcus aureus isolates and carbapenem resistance in 9.5 to 14.6% Gram-negative bacilli. Conclusions Study findings emphasize the need for continuous monitoring of cutaneous pemphigus lesions for appropriate choice of antimicrobial therapy.

Erythrasma: A Superficial Cutaneous Bacterial Infection Overlooked in Clinical Practice

Erythrasma is a common superficial cutaneous bacterial infection caused by Corynebacterium minutissimum, a normal inhabitant of the skin surface. Under favourable conditions, the organism invades the stratum corneum, where it multiplies and produces clinically evident lesions. Increasing age, excessive sweating, diabetes mellitus, obesity, overcrowding and immunosuppression, including HIV, are risk factors for the disease. The condition can be confused with other infectious and non-infectious skin diseases, chiefly dermatophytosis. Erythrasma clinically presents in the groin, axilla, submammary, inguinal, intergluteal cleft and web spaces between the toes. Coinfection with fungi and superinfection upon primary dermatosis are common. Erythrasma can be diagnosed with a characteristic coral-pink fluorescence with Wood‘s lamp examination. Smears, biopsy and cultures are seldom required but are useful when the Wood‘s lamp test is negative. Atypical presentations do occur and require astute clinical judgment. This condition should be distinguished from other dermatosis as treatment is different. Treatment is with topical or oral antimicrobials, depending on the site and extent of the lesions. Recurrence can occur, and methods to prevent it should be in place. Novel treatments need robust testing prior to inclusion in the therapeutic armamentarium.

Turpentine Ointment in Bacterial Skin Infections: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Background: Turpentine-containing substances are considered effective in treating cutaneous bacterial infections, but reliable clinical data are scant. Objective: We investigated the efficacy and safety of an ointment containing larch turpentine (from Larix decidua), eucalyptus oil (from Eucalyptus globulus), and turpentine oil (from Pinus pinaster) in outpatients with painful skin abscesses in a randomized, placebo-controlled, double-blind study. Intervention: 116 outpatients with skin abscesses used verum or placebo for 10 days. Sum score of the patient’s discomforts, changes in abscess size, rate of therapeutic success, and complete healing served as outcome parameters. Results: Fifty-four patients were treated with verum and 56 with placebo. According to the patient’s discomfort sum score, patients in the verum group showed a better improvement compared to the placebo group (7.3 vs. 4.7; p = 0.024), and subjective assessment by the investigators revealed a higher treatment success rate after verum (70% vs. 48%; p = 0.021). Complete healing was documented in 67% of the patients receiving verum versus 46% in the placebo group (p = 0.037). There was a positive trend toward a larger decrease in the abscess sizes in the verum group compared to the placebo group (p = 0.07). Conclusion: The ointment studied is an effective and safe option for the treatment of bacterial skin diseases.

Clinical features and outcomes of epidermolysis bullosa in thai children: A 20-Year review from a Tertiary Care Center

Background: Epidermolysis Bullosa (EB) is a heterogeneous genetic disorder with skin fragility. Only a few cases have been reported in Thailand. This study aims to determine the clinical characteristics, complications, and outcomes of EB stratified by subtype. Methods: A retrospective single-center study of EB patients at the Dermatology Unit, Queen Sirikit National Institute of Child Health, was reviewed from January 1, 2002, to December 31, 2021. Diagnosis is based on clinical manifestations and some skin biopsies. Results: There were 38 enrolled patients, age range from 0 to 25 years with a male-to-female ratio of 1.1:1. Family history of EB and consanguineous marriage were found in 6 cases and 2 cases, respectively. The most common type of EB was dystrophic EB (DEB) (26 cases) (68.4%), including recessive DEB in 15 cases (39.5%) and dominant DEB in 11 cases (28.9%). Other types were EB simplex in 10 cases (26.3%) and junctional EB in 2 cases (5.3%). Common complications were cutaneous bacterial infection (39.5%), anemia (31.6%), failure to thrive (18.4%), and protein energy malnutrition (15.8%). Musculoskeletal (21.1%), gastrointestinal (13.2%), and eye complications (7.9%) were exclusively found in DEB. Nineteen patients (50%) received regular follow-ups with a median duration of 9 months (range = 0.5 to 248 months). The mortality rate was 31.6% (6/19). Five cases died from bacterial sepsis, while one case died from metastatic squamous cell carcinoma. Conclusion: DEB is the most common type of EB in Thai children, and bacterial sepsis is the predominant cause of death. Further multicenter and molecular genetic studies are recommended for a definite diagnosis.

P251 Disseminated Histoplasmosis in a Ghanaian HIV Patient: Role of Urine Histoplasma Antigen Testing in Rapid Diagnosis

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMBackgroundThe inhalation of the thermally dimorphic fungus Histoplasma capsulatum, may result in a wide spectrum of clinical manifestations, ranging from asymptomatic to acute or chronic pulmonary infection to disseminated infection. Symptomatic infections usually occur with high-level exposures or in immunocompromised patients mainly people with HIV. Despite the improved access to antiretroviral therapy, HIV-associated histoplasmosis remains a significant opportunistic infection in endemic regions including Africa. Unfortunately, histoplasmosis is rarely on the diagnostic radar of clinicians in several African countries such as Ghana due to insufficient awareness, inadequate epidemiological data, and poor fungal diagnostic capacity. Herein, we present a case of disseminated histoplasmosis in an HIV/AIDS patient in a tertiary hospital in Ghana.Case PresentationClinical history: A 43-year-old female was referred to the Dermatology Clinic of the Komfo Anokye Teaching Hospital (KATH) with symptoms of fever, cough, and anorexia. She had a history of a skin rash six weeks prior, which initially began on her face and later spread to the trunk and extremities. She was a known HIV/AIDS patient on anti-retroviral drugs (EFV, TFV, 3TC) with no other chronic conditions. She was anemic with a previous hemoglobin level of 7.6 g/dl. Initial diagnostic workup for cutaneous bacterial or viral infection detected no abnormality.ExaminationShe was semi-conscious, and her nostrils were clogged with crust. The patient appeared pale, warm, and anicteric. The face, trunk, and extremities (including palms) were covered with mucocutaneous erosions, ulcers, multiple papule plaques, and nodules. Examination of the cervix revealed the presence of lymph nodes.InvestigationsA fungal diagnostic work-up was done to rule out cutaneous or disseminated mycosis particularly cryptococcosis which was previously captured as a differential diagnosis. Serum cryptococcal antigen lateral flow assay (LFA) (CrAg LFA, IMMY) and Aspergillus galactomannan (GM) (sona Aspergillus GM LFA, IMMY) tests were both negative, but urine Histoplasma GM enzyme immunoassay (EIA) (clarus Histoplasma GM EIA, IMMY) test was positive with a very high optical density indicating high fungal burden was reported. A skin biopsy was also sent for histopathology and fungal culture. Histopathology analysis revealed the presence of yeast cells with round central nuclei and cytoplasmic clearing. Special staining with Periodic acid–Schiff (PAS) confirmed the presence of yeast cells, suggestive of histoplasmosis. Fungal culture was however negative after 8 weeks of incubation. A diagnosis of disseminated histoplasmosis was made.Treatment and outcomeThe patient was administered 200 mg bid of itraconazole. Few weeks after treatment, most of her skin lesions and ulcers were healed. The patient was discharged on itraconazole after the disappearance of some of her lesions. Few weeks later, the patient was admitted but died due to complications of anemia.ConclusionDisseminated histoplasmosis in HIV may be a relatively common but largely unrecognized condition in Ghana. This case report highlights the need to improve awareness of histoplasmosis among clinicians in Ghana and enhance laboratory capacity to provide timely simple contemporary fungal tests for rapid diagnosis and prompt initiation of effective antifungal agents.

Cutaneous bacteriological profile and antibiotic sensitivity pattern in patients with pemphigus attending tertiary care center, Northeast India

Pemphigus is an autoimmune bullous disease. Septicemia is one of the common causes of death which is usually secondary to cutaneous bacterial infection. 1: To study the cutaneous bacteriological profile and the most common cause of bacterial skin infection in pemphigus patients; 2: To find out the antibiotic sensitivity pattern in pemphigus patients of Northeastern part of India.This was a descriptive type of cross-sectional study conducted at Dermatology, Venereology and Leprosy department of Silchar Medical College from January 2021 to December 2021. A total of 33 confirmed inpatient cases of pemphigus was selected via non probability convenient sampling method. Pus for culture was collected, to study the common cause of bacterial skin infections and antibiotic sensitivity pattern in pemphigus patients. Out of 33 patients included in the study, male patients were 22 and female patients were 11. Pemphigus vulgaris was noted in 28 patients, pemphigus foliaceous was found in 4 patients and 1 patient was of pemphigus vegetans. The mean age was found to be 35.6 years and 36.36% patients were diabetics in our study. About 45.4% patient’s pus culture report showed the growth of Staphylococcus aureus, 18.1% showed the growth of Proteus mirabilis, 6.06% showed the growth of nonfermenting gram negative bacilli, 3.03% showed the growth of Klebsiella species and Beta hemolytic streptococci, 9.09% showed the growth of skin commensals and 15.15% showed no growth. Staphylococcus aureus showed 100% sensitivity to linezolid, amikacin and tetracycline; 86.6% resistance was seen for penicillin, 80% resistance was seen for levofloxacin, 60% resistance was seen for clindamycin, 66.6% resistance for cotrimoxazole was seen and 33.3% resistance was seen for azithromycin. Proteus mirabilis showed maximal sensitivity to ciprofloxacin, amikacin, gentamicin, ceftazidime, piperacillin + tazobactam and meropenem. Staphylococcus aureus is the most common organism causing skin infections in pemphigus patients and it has maximal sensitivity to linezolid, amikacin and tetracycline

091 Bacterial microbiota in autoimmune pemphigus

The autoimmune pemphigus has high risk of cutaneous bacterial infection which may be crucial for further development and prognosis of the disease. The objective was to examine bacterial microbiota in autoimmune pemphigus.18 women aged 57.5±0.5 suffered from autoimmune pemphigus. 13 patients suffered from pemphigus vulgaris, 4 from seborrheic pemphigus, 1 from pemphigus vegetans. Every patient had more than 2 lesions. The bacteriological examination was performed in different areas of the skin. The scalp lesions in 2 patients with seborrheic pemphigus were contaminated by St.

Management of cutaneous side effects of inflammatory bowel disease therapy: A dermatologic viewpoint.

Medications used in the treatment of inflammatory bowel disease cause a wide range of dermatologic side effects, and minimal guidance exists on how to manage them. The intention of this review article is to summarize common dermatologic adverse reactions related to inflammatory bowel disease therapy and to provide evidence-based guidance on management. We conducted a scoping review using PubMed and Google Scholar to identify studies reporting clinical information on dermatologic side effects of medications used in the treatment of inflammatory bowel disease. The most commonly reported dermatological adverse effects from inflammatory bowel disease therapy were cutaneous malignancy and cutaneous infections. Thiopurines, methotrexate, tumor necrosis factor (TNF) inhibitors, interleukin (IL)-12/23 inhibitors, and integrin inhibitors can be continued if nonmelanoma skin cancer arises during therapy and the malignancy should be surgically excised. TNF inhibitors and IL-12/23 inhibitors can be continued in the setting of stage I surgically resectable melanoma but should be discontinued in advanced melanoma. For complicated cutaneous bacterial infections, methotrexate and TNF inhibitors should be halted, and IV antibiotics should be administered. Complicated herpes zoster infection warrants discontinuation of TNF inhibitors, whereas IL-12/23 and JAK inhibitors can be continued. Inflammatory bowel disease therapies are associated with several dermatological adverse effects, and management options vary by agent. Certain agents may require discontinuation in the setting of nonmelanoma skin cancer, melanoma, and cutaneous infections. Many other dermatological adverse effects from inflammatory bowel disease therapy require specialized management or referral to dermatology.

Role of Cathelicidin (Ll-37) and Human Β-Defensin In Atopic Dermatitis And Psoriasis

The Human epithelium, including the epidermis produces antimicrobial peptide (AMP)as part of innate immunity. Cathelicidin and human β-defensins are the most AMPfound on the skin. This antimicrobial peptide has a role in the response of the naturalimmune system by becoming the front line of the defense system against infection. Thediscussion of this literature review will focus on cathelicidin and human β-defensin-1which are the main AMPs that affect atopic dermatitis and psoriasis. Antimicrobialpeptides are excessively produced in lesional psoriatic scales or rosacea in contrast tothe atopic skin that shows lower AMP levels when compared with psoriasis. Despitethe impaired skin barrier which facilitates potentially pathogenic microbes to colonizethe epidermis, patients with psoriasis surprisingly present a low frequency of skininfections, whereas patients with atopic dermatitis are predominantly susceptible toparticular cutaneous bacterial, fungal and viral infections. One possible explanation ofthe fact is the difference in the expression of AMPs. DA patients have fewer AMPexpression characteristics, especially cathelicidins LL-37 and HBD-2. Research onantimicrobial use can help reduce pathogen colonization so that clinical improvementof AD occurs. In the case of psoriasis, AMP expression increases, especially LL-37 andHBD-2, showing synergistic antimicrobial activity that is effective in eradicatingmicrobial colonization, so there is no strong evidence to support antibiotic use intreating psoriasis or in preventing disease.

Skin lesion of hidradenitis suppurativa mimicking lymphogranuloma venereum: a case report

Background: Hidradenitis suppurativa clinical appearance is painful, deep-seated inflamed lesions, most commonly found on axillary, inguinal, anogenital regions. It should be differentiated with primary cutaneous bacterial infection (abscesses, carbuncles, or furunculosis) and rare conditions such as lymphogranuloma venereum.Case: we report a 50-year-old male presenting with an unusual clinical presentation of hidradenitis suppurativa located in suprapubic such as bilateral fluctuant and suppurative nodules resembling lymphadenitis, led to an initial diagnosis of lymphogranuloma. We excluded lymphogranuloma diagnosis based on the serology test of Chlamydia trachomatis, bacterial cultures, and sensitivity tests. The results were non-reactive for the Chlamydia trachomatis serology test, and Staphylococcus aureus was found in bacterial culture.Conclusion: clinicians must be aware of diagnosis precisely, prevent the recurrent, and improve the prognosis.

Pulse Treatment Using Azithromycin in HIV/AIDS-Associated Solitary Tumor-Like Bacillary Angiomatosis

With the advent of the HIV/AIDS pandemic within the South Saharan region, clinicians are faced with accentuated clinical presentations of previously well-known diseases. Bacillary angiomatosis is no exception to this rule. Bacillary angiomatosis is a cutaneous and systemic bacterial infection caused by gram-negative Bartonella species. We report a case of an immunocompromised 44 years old female patient who presented with a solitary tumor-like bacillary angiomatosis that was treated successfully with azithromycin in a bi-weekly pulsed dosing regimen. This patient had a considerably large (12 x 10cm’s) single lesion of the disease. The case highlights the potential that immunosuppressed patients are not only at risk of disseminated disease, but also of developing severe localized disease. Furthermore, Azithromycin pulse treatment may offer a convenient alternative as there is still no clear consensus regarding treatment protocol for using azithromycin in the treatment of cutaneous bartonellosis.

Dermatological manifestations in diabetes mellitus

Diabetes mellitus (DM) is the common endocrine disorder, which affects all ages and socioeconomic groups. The prolonged hyperglycemia may responsible for the diabetic complications. Multiple factors contribute to the onset of cutaneous manifestations in diabetes mellitus. The present study aimed tostudy the pattern of various cutaneous manifestations associated with diabetes mellitus.The present study was conducted at Dermatology, Diabetic Clinic of a teaching tertiary care centre hospital. A total of 120 subjects were included in this study. Patients were selected on the basis of dermatological signs and/or symptoms. Detailed history and clinical examination with special emphasis on dermatological complaints and signs was done for all the study subjects. Under aseptic conditions, blood samples were collected and used for the estimation of blood glucose, bacterial infections-Gram stain and isolation of organism by culture, fungal infections- KOH (potassium hydroxide) mount, Gram stain (for Candida) and isolation of organism by culture. Skin biopsies were performed wherever necessary.In the present study, 120 subjects were included from both genders. Pruritus was the predominant symptom observed. Acrochordons, Candidial Balanoposthitis, Tinea Corporis were observed in highest number of patients. Infective dermatoses were observed in 72 (60%) patients. The non-infective dermatoses was reported in 56 (46.7%) patients. On bacterial culture, Pyogenic Ulcer was observed in 4. KOH test and culture were carried on 14 candidal infections and 17 dermatophyte infection and observed KOH mount positive were observed in 11 cases and culture positive was observed in 8 cases.In the present study results indicates pruritus was the most common symptom in diabetic subjects. Infective dermatoses were more common than the non-infective dermatoses. Tinea corporis/cruris was most common clinical entity. 21.6% patients suffered from cutaneous bacterial infections, the most frequently encountered clinical entity being furunculosis. Staphylococcus aureus The commonest non-infective clinical entity was acrochordons(skin tags). Patients with diabetes may develop cutaneous manifestations of diabetic complications. Careful dermatological examination and follow-up of diabetes mellitus patients is required to provide them adequate skin management.

Serum amyloid A exhibits pH dependent antibacterial action and contributes to host defense against Staphylococcus aureus cutaneous infection

Serum amyloid A (SAA), one of the major highly conserved acute-phase proteins in most mammals, is predominantly produced by hepatocytes and also by a variety of cells in extrahepatic tissues. It is well-known that the expression of SAA is sharply increased in bacterial infections. However, the exact physiological function of SAA during bacterial infection remains unclear. Herein, we showed that SAA expression significantly increased in abscesses of Staphylococcus aureus cutaneous infected mice, which exert direct antibacterial effects by binding to the bacterial cell surface and disrupting the cell membrane in acidic conditions. Mechanically, SAA disrupts anionic liposomes by spontaneously forming small vesicles or micelles under acidic conditions. Especially, the N-terminal region of SAA is necessary for membrane disruption and bactericidal activity. Furthermore, we found that mice deficient in SAA1/2 were more susceptible to infection by S. aureus In addition, the expression of SAA in infected skin was regulated by interleukin-6. Taken together, these findings support a key role of the SAA in host defense and may provide a novel therapeutic strategy for cutaneous bacterial infection.