Minor Skin Trauma Research Articles

Sporotrichosis: Spectrum and Complications

Sporotrichosis, a fungal infection caused by the Sporothrix genus, predominantly presents as cutaneous disease following inoculation through minor skin trauma. Environmental exposure, often linked to soil, plants, or infected animals, is a common source of acquisition. The spectrum of the disease ranges from localized skin lesions to severe disseminated forms, with manifestations including osteoarticular involvement and rare occurrences of meningitis. Prompt diagnosis, typically achieved through culture, is vital for effective management. Treatment, primarily employing antifungal agents like amphotericin B and itraconazole, is essential, as spontaneous resolution is rare. The prognosis varies, with localized infections responding well to treatment, while extracutaneous forms, especially in immunocompromised individuals, may lead to complications and poorer outcomes. Meningitis poses a significant challenge due to limited therapeutic options and diagnostic complexities.

Hypertrophic Keloid Formation in a Type 2 Diabetes Mellitus Patient (A Case Report)

Keloids are scars that extend beyond the original area of skin damage. They can develop after minor skin trauma in predisposed individuals. Many factors play a role in keloid scar formation, with certain systemic diseases being a risk factor for their development. Diabetes mellitus is a disease that affects a variety of organ systems including the skin. Multiple skin conditions have been implicated directly and indirectly with diabetes mellitus and their presence would often be a sign of insulin resistance or poor glycemic control. Here we present a case of hypertrophic keloid developing in a patient with Type 2 Diabetes Mellitus. The patient had no prior skin trauma, nor did she develop the lesions at the sites of insulin injection. This raises the question of whether hypertrophic keloids might be associated with diabetes mellitus and whether recommendations for DM screening and guidance on use of insulin injections in those patients should be put in place. Key words: Keloids, Hypertrophic, Diabetes, Insulin resistance

Intestinal inflammation alters the antigen-specific immune response to a skin commensal.

SUMMARYResident microbes in skin and gut predominantly impact local immune cell function during homeostasis. However, colitis-associated neutrophilic skin disorders suggest possible breakdown of this compartmentalization with disease. Using a model wherein neonatal skin colonization by Staphylococcus epidermidis facilitates generation of commensal-specific tolerance and CD4+ regulatory T cells (Tregs), we ask whether this response is perturbed by gut inflammation. Chemically induced colitis is accompanied by intestinal expansion of S. epidermidis and reduces gut-draining lymph node (dLN) commensal-specific Tregs. It also results in reduced commensal-specific Tregs in skin and skin-dLNs and increased skin neutrophils. Increased CD4+ circulation between gut and skin dLN suggests that the altered cutaneous response is initiated in the colon, and resistance to colitis-induced effects in Cd4creIl1r1fl/fl mice implicate interleukin (IL)-1 in mediating the altered commensal-specific response. These findings provide mechanistic insight into observed connections between inflammatory skin and intestinal diseases.

Cutaneous Invasive Fungal Infections with Saksenaea Species in Immunocompetent Patients in Europe: A Systematic Review and Case Report.

Background:Invasive fungal infections from Saksenaea, a fungus belonging to the Mucorales, have been rarely reported in central European climate zones. This study aims to raise awareness of invasive cutaneous infections with Saksenaea species. The first case of a cutaneous infection was diagnosed in Switzerland in an immunocompetent 79-year-old patient. A minor skin trauma of her left lower leg led to a fulminant infection causing necrosis and extensive loss of tissue. The combination of surgical debridement and administration of antifungal agents averted a prolonged course with a possible worse outcome. A pedicled hemisoleus muscle flap was used to reconstruct the defect and treatment was continued for 63 days.Methods:A systematic review in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines was conducted to identify all European cases of infection with Saksenaea species in immunocompetent hosts. The epidemiology, clinical presentation, microbiological diagnosis, and management of cases reported in Europe were summarized and analyzed.Conclusions:The prognosis of soft tissue infections with Saksenaea species. depends on early diagnosis and appropriate antifungal and surgical treatment. Reconstruction can be successful under ongoing antifungal treatment.

Cutaneous Mucormycosis in an Immunocompetent Child following a Minor Skin Trauma

Cutaneous mucormycosis is a rare infection by the Zygomycetes class of fungi, which carries significant morbidity and mortality. While typically associated in patients with underlying immunocompromise (especially in the current era of COVID-19), it may also be seen in immunocompetent patients. We report a case of a healthy 4-year-old girl with acute right leg cellulitis and abscess formation, who required surgical debridement following poor response to antibiotic therapy and initial incision and drainage. Tissue histopathology returned cutaneous zygomycosis despite negative tissue cultures. At four-week follow-up, her wound was healed well. Clinicians should maintain a high degree of clinical suspicion for cutaneous mucormycosis given its potential for rapidly progressive and disseminated disease. Currently, the mainstay of diagnostic investigations is tissue histopathology, with a growing role for tissue fungal PCR. Treatment involves multidisciplinary management between surgeons and Infectious Diseases team to guide the role for surgical debridement and antifungal therapy.

Preliminary investigation of an idiopathic muscle disease in farmed burbot Lota lota.

The rearing of less established fish species in recirculating aquaculture systems (RASs) is increasing, but may require adaptations of the rearing facilities if health impairments occur. We observed several health issues in burbot Lota lota reared for up to 2 yr in a RAS and used microbiological, histological and molecular-biological methods to identify the causative agents. Minor skin trauma led to the development of ulcers. In addition, several fillets of burbot showed pronounced granulomatous inflammation and calcification with signs of muscle fiber degeneration which resembled a condition called 'sandy flesh disease' in North American walleye. Several infectious agents were able to be excluded as a cause for the disease. Carnobacterium maltaromaticum was isolated in high numbers in some of the affected muscle tissue. However, the role of this bacterium or other causative agents or husbandry conditions remains to be elucidated.

A comparative study of foot infections in diabetic and non-diabetic patients with reference to etiopathogenesis, clinical features and outcome

Background: Infections in the foot are more common with significant proportion of world’s population remaining bare foot, minor skin trauma is a frequent cause of local infection. The present study was conducted with an aim to study various foot infections and compare the findings in diabetic and non diabetic patients with reference to etiopathogenesis, clinical features, management, duration of hospital stay and outcome.Methods: The present study was conducted in Mamata General Hospital, Khammam, Telangana state from October 2016 to September 2018. A total of 50 cases were divided into 2 groups, Group A included 25 patients with diabetic foot infection and Group B included 25 patients with non diabetic foot infections.Results: In diabetics 6th decade and in non-diabetics 4th-6th decade was the most common age group presenting with foot infections. Cellulitis of the foot was the most common in both diabetics (40%) and non-diabetics (52%). Wagner’s grade 4 lesions were more common in diabetics (28%) than in non-diabetics (8%). The most common site of lesion in diabetics was dorsum (40%) and in non-diabetics was toes (40%). The incidence of neuropathy was significantly higher in diabetics (72%) than in non-diabetics (20%). Rate of amputation was high in diabetics (12%) compared to non-diabetics (8%). The average number days in a hospital stay in diabetics was 42.27 days and in non-diabetics it was 28.96 days.Conclusion: Diabetic patients have increased severity of infections, delayed healing process, need more active interventions. As compared to the non-diabetic patients, they do show high risk of amputations and prolonged hospital stay.

Impetigo/Staphylococcal Scalded Skin Disease.

1. Lorena C. Dollani, MD*,†,‡ 2. Kalyani S. Marathe, MD* 1. *Children’s National Medical Center, Washington, DC 2. †Washington Hospital Center, Washington, DC 3. ‡Georgetown University Hospital, Washington, DC Bacterial skin infections are among the most common skin diseases in children. These encompass a range of cutaneous manifestations from localized (bullous impetigo) to systemic (staphylococcal scalded skin disease [SSSS]). The most common pathogen in both nonbullous and bullous impetigo is Staphylococcus aureus . Another important pathogen causing nonbullous impetigo is group A β-hemolytic Streptococcus. SSSS specifically refers to a spectrum of skin diseases induced by the exfoliative toxins of S aureus. The most common pathogen implicated in their pathophysiology is S aureus, which is a gram-positive coccus and can commonly colonize the nose, perineum, eyes, axillae, umbilicus, and wound sites. Impetigo frequently involves children younger than 6 years, accounting for approximately 10% of skin problems observed in pediatric clinics. SSSS is a rare blistering manifestation affecting mainly neonates and young children. Impetigo is an extremely contagious infection that can spread quickly via direct person-to-person contact or through fomites, and its peak incidence is in the summer months. Primary impetigo can result from direct bacterial involvement of the previously normal skin, whereas secondary impetigo is caused by a disruption in the skin barrier that allows the bacteria to adhere, invade, and establish an infection. Causes of secondary impetigo include minor skin trauma secondary to abrasions, cuts, or insect bites or skin infections due to herpes simplex virus or varicella zoster virus. Colonization of the nasopharynx, axillae, and perineal skin with S aureus increases the risk of developing staphylococcal infections. Impetigo is classified as nonbullous or bullous. Whereas nonbullous impetigo …

Idiopathic neonatal necrotising fasciitis caused by community-acquired MSSA encoding Panton Valentine Leukocidin genes

Neonatal necrotising fasciitis is very rare in comparison to the adult presentation of the disease and a Plastic Surgeon may only encounter one such case during his or her career. Often this is initially misdiagnosed and managed as simple cellulitis. It generally affects previously healthy babies, the site is often the lower back area and a history of minor skin trauma may be elicited. The causative organism is usually Streptococcus or polymicrobial, as is the case in the adult population. We present the case of a previously healthy 11-day-old infant with idiopathic, rapidly progressive necrotising fasciitis of the back, cause by Methicillin sensitive Staphylococcus aureus (MSSA) infection. The strain was isolated and found to encode the Panton-Valentine Leukocidin genes, which have been associated with particularly severe necrotising infections in other sites, with high mortality. These strains are the subject of specific treatment and eradication guidance in the UK but awareness of this and the importance of obtaining detailed culture typing is likely to be low amongst Plastic Surgeons.

Impetigo in children: a clinical guide and treatment options

AbstractImpetigo is a contagious, superficial bacterial infection of the skin, most frequently encountered in children. Causative organisms are almost always Staphylococcus aureus or streptococci, or a combination of the two. Predisposing factors are nasal and perineal colonisation, overcrowding, poor personal hygiene, minor skin trauma and pre-existing skin diseases with disrupted skin barrier function, like eczema. Infection is mainly acquired through contact with sufferers or nasal carriers. Treatment should be given to avoid spread of the disease, and to minimise the risk of infecting others. Although the majority of cases of impetigo are self-limiting, under certain circumstances complications like toxic shock syndrome, staphylococcal osteomyelitis, septic arthritis and pneumonia can occur. Furthermore, certain strains of group A β-haemolytic streptococci causing impetigo may result in poststreptococcal glomerulonephritis, just like streptococcal throat infections can result in rheumatic fever in chi...

Playing with fire and getting burnt—a retrospective analysis of injuries presenting to the emergency department during ‘firework season’

During firework season in the UK (October–January), many patients present to emergency departments across the country with firework-related injuries. These seasonal injuries can vary from minor skin trauma to major burns, inhalation injuries and even death in some cases. Governments have tried to improve public awareness and safety with education using multi-million pound national safety campaigns as well as clamping down on fireworks both from within and outside of the EU which fail to meet safety standards. Despite these measures, firework-related injuries are increasing (2005 census Royal Society of Prevention of Accidents (RoSPA)). Reasons for this have been cited as new variations in firework design, antisocial behaviour and readily available cheap fireworks. The author conducted a retrospective study in the emergency department in Exeter from October 2006 to January 2007 highlighting 18 firework-related injuries. Of those, four patients needed referral to local burns centres and five needed admission for supportive treatment and specialty management. Prevention of firework injuries to the hand is of the utmost importance. It is hoped that an increase in public awareness will concentrate attention on precautionary measures to prevent these avoidable ‘recreational’ accidents. If and when accidents do occur, hand surgeons and therapists attempt to provide patients with the best possible return of hand function with a minimum disability and disfigurement. Further research together with national awareness is suggested to reduce these injuries, all for a tradition which can cost millions in healthcare and loss of earnings, but ultimately, it can cost peoples’ lives.

Genetics of keloid scarring

Keloid scarring, also known as keloid disease (KD), is a common, abnormally raised fibroproliferative cutaneous lesion that can occur following even minor skin trauma. The aetiopathogenesis of KD has remained an enigma todate compounded by an ill-defined clinical management. There is strong evidence suggesting a genetic susceptibility in individuals affected by KD, including familial heritability, common occurrence in twins and high prevalence in certain ethnic populations. This review aims to address the genetic aspects of KD that have been described in present literature that include inheritance patterns, linkage studies, case-control association studies, whole genome gene expression microarray studies and gene pathways that were significant in KD. In addition to our clinical and scientific background in KD, we used search engines, Scopus, Scirus and PubMed, which searched for key terms covering various genetic aspects of KD. Additionally, genes reported in seven whole genome gene expression microarray studies were separately compared in detail. Our findings indicate a varied inheritance pattern in KD (predominantly autosomal dominant), linkage loci (chromosomes 2q23 and 7p11), several human leukocyte antigen (HLA) alleles (HLA-DRB1*15, HLA-DQA1*0104, DQ-B1*0501 and DQB1*0503), negative candidate gene case-control association studies and at least 25 dysregulated genes reported in multiple microarray studies. The major pathways reportedly proposed to be involved in KD include apoptosis, mitogen-activated protein kinase, transforming growth factor-beta, interleukin-6 and plasminogen activator inhibitor-1. In summary, involvement of more than one gene is likely to be responsible for susceptibility to KD. A better understanding of the genes involved in KD may potentially lead to the development of more effective diagnostic, therapeutic and prognostic measures.

Methicillin-resistant Staphylococcus aureus (MRSA) in the Athlete

Although once considered only a nosocomial pathogen, methicillin-resistant Staphylococcus aureus (MRSA) is a rapidly emerging, problematic infection in the community. Community acquired MRSA (CA-MRSA) is notably becoming more prevalent in athletic environments and unfortunately, can be easily transmitted via superficial abrasions and minor skin trauma. CA-MRSA infections are highly contagious and are associated with significant morbidity, with published reports of up to 70% of infected team members requiring hospitalization and intravenous antibiotics . Risk factors for athletic related environments include contact sports with repeated close physical contact with other competitors, open abrasions, and sharing of personal equipment. Failure to correctly diagnose and appropriately treat skin and soft tissue lesions infected with CA-MRSA may contribute to large scale MRSA infections in athletic environments. The purpose of this review article is to help sports medicine physicians prevent, identify, and treat MRSA skin and superficial soft tissue infections in athletic environments.

Fascitis necrosante palpebral y shock tóxico por Streptococcus pyogenes

Necrotizing fasciitis (NF) is a serious infection that compromises subcutaneous tissue, fascia, and adipose tissue, with high mortality rate and sequelae. Extremities, trunk and pelvis are the most common body sites affected. Periorbital celullitis with necrotizing fasciitis of the eyelid is rare. We report the case of a three years oíd child with bilateral NF of the eyelids and toxic shock syndrome secondary to Streptococcus pyogenes infection occurring after a minor skin trauma. Early recognition leading to intensive care treatment and prompt surgical debridement were critical in the favourable outcome of the child.

Topical triple-antibiotic ointment as a novel therapeutic choice in wound management and infection prevention: a practical perspective

Triple-antibiotic ointment (TAO) is a safe and effective topical agent for preventing infections in minor skin trauma. The formulation contains neomycin, polymyxin B and bacitracin in a petrolatum base. TAO is active against the most common disease-causing pathogens found in wounds and on the skin and may be an attractive alternative to oral therapy in select circumstances. Resistance to TAO does not develop readily, and safety studies have shown that the risk of allergic sensitivity to TAO is low. Susceptibility profiles of TAO have remained relatively unchanged since its discovery. Prophylaxis or treatment with TAO should be considered as resistant organisms continue to emerge in the community and hospital setting.

High viscosity of newborn extracellular matrix is the etiology of erythema toxicum neonatorum: Neonatal jaundice?: Hyaline membrane disease?

At the time of birth, the fetal ground substance is under the influence of maternal and placental hormones. Hormones are known to exert significant effect on ground substance. The ground substance viscosity that is ideal for intrauterine life is too viscous for the newborn. Sites of minor skin trauma develop swelling, inflammation and pustules. Dilution of tissue fluids causes formation of some of the mediators of inflammation including those responsible for intraepidermal pustule formation. The newborn responds to inflammation with eosinophilic granulocyte. The clinical lesions referred to as erythema toxicum neonatorum are known to localize at pressure sites. The skin lesions correct as maternal and placental hormone influence weakens. The entity occurs in 31 to 72% of white infants. The hormone induced viscosity changes may aid in better understanding some aspects of neonatal physiology; such as jaundice of the neonatal period, the eosinophilic granulocyte inflammatory response of the neonatal period and hyaline membrane disease.

Streptococcal Myositis-Reply

The patient described by Grau and colleagues appears to represent an additional case of streptococcal myositis. This case demonstrates the extremely rapid and fatal course of patients with this disease. The patient involved had minor skin trauma, which was seen in one of the patients that we described. Underlying systemic illnesses, such as Hodgkin's disease, are not usually the accompaniments of streptococcal myositis. Since the pathogenesis is unknown, however, an underlying cellular defect cannot be excluded.

Impaired microvascular hyperaemic response to minor skin trauma in type I diabetes.

The microvascular response of foot skin to minor thermal injury and the skin of the anterior abdominal wall to injury from a needle was assessed by laser Doppler flowmetry in 23 patients with type I diabetes and 21 healthy control subjects. After minor thermal injury mean (SD) maximum skin blood flow was significantly lower in the diabetic group than the control group (0.53 (0.11) v 0.72 (0.10) V, in arbitrary units of flow, respectively, p less than 0.001) and was negatively correlated with the duration of diabetes (r = -0.60; p less than 0.01). After needle injury a similar pattern of impairment was seen, the peak flow value recorded being significantly lower in the diabetic group than the control group (0.28 (0.10) v 0.41 (0.09) V, respectively; p less than 0.001) and also negatively correlated with the duration of diabetes (r = -0.61; p less than 0.01). There was a significant relation between the response obtained at the two sites of injury in the diabetic group (r = +0.72, p less than 0.001) but not in the control group. The impairment in response was not related to diabetic control and was not explicable in terms of a reduction in superficial skin capillary density. The inability of the diabetic skin microvasculature to respond normally to injury may be an important factor in the development of foot ulceration that often follows minor trauma.

The natural history of streptococcal skin infection: Prevention with topical antibiotics

An investigation on the natural history of streptococcal skin infection was done in fifty-nine children in a rural day care setting. A double-blind study for prevention of streptococcal pyoderma was done during the peak season for skin infection. Triple antibiotic ointment, containing bacitracin, polysporin, and neomycin, was compared to placebo ointment. Ointments were applied thrice daily for minor skin trauma; mosquito bites and abrasions were predominant. Cultures of normal skin surfaces were taken for group A streptococci each week of the 15-week study period. Skin lesions were cultured whenever present. Eighty-one percent of the fifty-nine patients had positive normal skin cultures on one or more occasions. Nineteen children (32%) developed streptococcal pyoderma. Infection occurred significantly more often in children using placebo ointment than in those using topical antibiotic (47% vs 15%; p = 0.01). The infecting strain was first recovered from normal skin surfaces in 67% of placebo patients and in two of the four patients using antibiotic ointment. This study further confirms the importance of skin carriage of group A streptococci as a precursor to pyoderma and demonstrates the importance of minor skin trauma as a predisposing factor. Topical antibiotics may be useful in preventing streptococcal pyoderma, especially in children known to be at increased risk for such infection.

Cutaneous Streptococcal Infections in Vietnam

Tropical bacterial pyodermas have been a leading cause of disability among American soldiers in Vietnam. The predominant lesions were ecthymatous ulcers of the lower extremities, 90% of which yielded group A β-hemolytic streptococci on culture. Combat-related exposure to environmental sources of minor skin trauma appeared to account for the greater than threefold difference between combat and support troops in prevalence of pyoderma involving the foot and ankle. Pyodermas were more than 21/2 times as prevalent in whites as in those with darker skins, a difference which existed independent of environmental exposure. Systemic addition of penicillin to standard topical treatment significantly reduced healing time. Coagulase-positive staphylococci were commonly isolated from pyodermas, but evidence is adduced that they were secondary wound colonizers rather than primary pathogens.