Skin Erosion Research Articles

To determine the differences in complications between buried versus unburied-k-wire fixation for pediatric lateral condyle fracture

Introduction: Operatively treated pediatric lateral humeral condyle fractures require longer period of in-situ k -wire fixation depending upon age, fracture configuration and mode of reduction. After fixation of lateral condyle fracture k-wires can be kept beneath or outside the skin. Aim: To determine the differences in complications between buried versus unburied K-wire fixation in pediatric lateral condyle humeral fractures. Patients and Methods: This prospective study was done in our centre on 50 operatively treated pediatric lateral condyle humeral fractures between January 2017 to Feb 2020. Results: This study included 50 patients among which 35 were males and 15 were females with average age of 7.5 (range 2-15 years). All patients were treated by ORIF and k-wire fixation. In buried group K-wire was kept for 7-12 weeks with average of 8 weeks and in unburied group K-wire was kept 5-9 weeks with average of 7 weeks. Complications like infection, scaring, nonunion, damage of physis due to infection and stiffness was more common in unburied group. Skin erosion, K-wire prominence and requirement of anesthesia was more in buried group. Conclusion: Our study found better results in operatively treated pediatric lateral condyle humerus fractures where k-wires kept beneath skin.

The Importance of Skincare for Neonates and Infants: An Algorithm.

The skin of neonates and infants undergoes a maturation process from birth and is susceptible to barrier disruption. The current algorithm follows a US-based consensus paper on skincare approaches using gentle cleansers and moisturizers in neonatal and healthy infant skin. This summary provides clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating neonates and infants. The project used a modified Delphi process comprising virtual discussions followed by an online follow-up replacing the use of a questionnaire. During the virtual meeting, the systematic literature review results and a draft algorithm addressing over-the-counter skincare for neonates and infants with healthy skin were discussed and adopted using evidence coupled with the expert opinion and experience of the panel. The algorithm addresses three clinical signs: xerosis, erythema, and erosion/bulla. A growing body of evidence recognizes the benefits of ongoing daily use of non-alkaline cleansers and ceramides containing moisturizers to reduce inflammation and maintain a healthy skin barrier function. Diaper rash is common in infants presenting as erythema or, in more severe cases, skin erosion. Skin protection with a barrier cream and frequent diaper changes using disposable diapers resolves most cases; however, if the rash continuous despite appropriate care, rule out a candida infection. The current algorithm focuses on neonatal and infant healthy skin that can benefit from skincare. When applied from birth onwards, gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier. J Drugs Dermatol. 2021;20(11):1195-1205. doi:10.36849/JDD.6219.

034 Dysfunctional Collagen XVII provokes skin inflammation

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering skin disease where autoantibodies are developed against BP180 (also known as collagen XVII, colXVII). Our group has previously developed a transgenic mouse line, ΔNC14A mice, in which deletion of exon 18 in Col17a1 results in the absence of NC14A domain, corresponding to human NC16A domain, the main autoantigen in BP. ColXVII levels in skin are decreased and during aging ΔNC14A mice develop severe itch, blisters, and skin erosion similarly to BP patients.

324 Improvement of epidermal covering on AEC patients with severe skin erosions by PRIMA-1MET

P63 is a major transcription factor regulating skin development and homeostasis : cell proliferation, adhesion, and early differentiation. P63 is mutated in several rare syndromes called p63-related ectodermal dysplasia syndromes (ED). One of the main form, called AEC syndrome, associates ankyloblepharon, clef/lip palate, ED, and severe skin erosions that not always heal. P63 belongs to the p53 gene family. We found that ED-iPSC epidermal commitment can be rescued by a p53-reactivating compounds called PRIMA-1MET currently used in anticancer clinical trials.

Novel missense mutation of the TP63 gene in a newborn with Hay-Wells/Ankyloblepharon-Ectodermal defects-Cleft lip/palate (AEC) syndrome: clinical report and follow-up

IntroductionAnkyloblepharon-ectodermal defects-cleft lip/palate (AEC) syndrome, also known as Hay-Wells syndrome, is a rare genetic syndrome with ectodermal dysplasia. About 100 patients have been reported to date. It is associated to a heterozygous mutation of the tumor protein p63 (TP63) gene, located on chromosome 3q28. Typical clinical manifestations include: filiform ankyloblepharon adnatum (congenital adherence of the eyelids), ectodermal abnormalities (sparse and frizzy hair, skin defects, nail alterations, dental changes and hypohidrosis), and cleft lip/palate. Diagnostic suspicion is based on clinical signs and confirmed by genetic testing.Patient’s presentationWe hereby report on a female newborn with erythroderma, thin lamellar desquamations, extensive skin erosions, sparse and wiry hair, filiform ankyloblepharon adnatum, agenesis of the lachrymal puncta, cleft palate and nail dysplasia. Her phenotype was compatible with AEC syndrome. Then, based on the clinical suspicion, sequencing analysis of the TP63 gene was performed, and revealed a de novo novel missense mutation. Eyelids adherence and cleft palate underwent surgical correction, while skin erosions were treated with topical antibiotics/antifungals and emollient/re-epithelizing creams. A surgical reconstruction is presently planned for the agenesis of the lachrymal puncta. The infant currently is 17 months of age and is included in a multidisciplinary follow-up. At present shows growth impairment and mild developmental delay, and typical signs of ectodermal dysplasia with small areas of dermatitis lesions on the scalp, without further abnormalities.ConclusionsOur report underlines the relevance of an early and careful clinical evaluation in neonates with ankyloblefaron, facial dysmorphism, and signs of ectodermal dysplasia. In these cases, the suspicion of AEC syndrome must be promptly raised, and sequencing analysis of TP63 early performed as well. An individualized, multidisciplinary and long-term follow-up should be guaranteed to affected subjects and their families, also to identify associated morbidities and prevent possible serious complications and adverse outcomes.

Diffuse Geometric Erosions on the Skin of a Premature Infant, Fraternal Twin Unaffected

Diffuse Geometric Erosions on the Skin of a Premature Infant, Fraternal Twin Unaffected

Long-term vascular access for infants with moderate to severe osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a genetic disorder that causes skeletal fragility. For the most fragile infants and young children with OI, intravenous (IV) bisphosphonate administration is essential, but IV access attempts often cause fractures. Port-a-caths help prevent these events, but some surgeons are hesitant to insert these devices in these infants due to lack of data on their safety. Retrospective study of pediatric patients with OI who underwent port-a-cath placement from 1999 to 2018; incidence of complications such as infection and thrombosis and need for reoperation or replacement are described. Port-a-caths were placed in 17 patients with OI (median age, 8 mos [5-23 mos]; median weight, 5.8kg [3.96-9.08kg]) and remained in place for a median of 53.5 mos (10-127 mos). One port-a-cath was replaced because of thrombosis. Two port-a-caths were removed because of malfunction, one for skin erosion, and one for infection. In these five cases, replacement was not needed because patients could safely tolerate IV access. Two patients have their port-a-cath in place and the remaining ten patients had theirs removed electively as it was no longer needed. Port-a-cath placement in pediatric patients with OI is safe and efficacious for durable central access, enabling reliable IV bisphosphonate delivery and reducing iatrogenic trauma.

Evaluation of safety and performance of the self balancing walking system Atalante in patients with complete motor spinal cord injury.

Prospective, open label, observational. To present results of the first clinical study on a newly developed robotic exoskeleton (Atalante®, Wandercraft, Paris, France) that enables individuals with spinal cord injury (SCI) to perform ambulatory functions without technical aids. Two sites specialized in SCI rehabilitation, France. Inclusion criteria were presence of chronic complete SCI (AIS A) ranging from T5 to T12. The study protocol included 12 one-hour training sessions during 3 weeks. Patients walked on floor with robotic assistance and wore a harness connected to a mobile suspension system (without weight-bearing) to prevent from falling. Main outcome was the ability to walk 10 meters unassisted, secondary outcomes were assessment of other ambulatory functions, bladder and bowel functions, pain and spasticity. Twelve patients were enrolled, and 11 completed the protocol, mean age 33,9 years. Six patients had T6 levels of lesion or above. Seven patients passed the 10mWT at the 12th session unassisted (mean walking speed 0.13 m/s) while four required some human help. All patients succeeded at the other ambulatory tests (stand-up, sit-down, balance, turn). There were no significant change for bladder (Qualiveen) or bowel (NBD) functions, neuropathic pain (NPSI, NPRS), yet five patients reported a subjective improvement of their bowel function. Impact on spasticity was variable depending on the muscle examined (Ashworth). Ischial skin erosion was seen in one patient that needed local dressing. The Atalante system is safe and enables to perform ambulatory functions in patients with complete SCI.

Wireless Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Trigeminal Pain: A Single Center Experience

Subcutaneous trigeminal nerve field stimulation (sTNFS) is a neuromodulatory treatment for neuropathic trigeminal pain with the ability to reduce the intensity and frequency of pain attacks. However, hardware issues including lead migration, skin erosion, infection, so-called pocket pain at the site of the implanted neurostimulator are reported. Implantable wireless neurostimulation technology promises not only an even less invasive sTNFS treatment and thinner and more flexible electrodes better suited for facial implants, but also provides further advantages such as lack of an implantable neurostimulator and 3T magnetic resonance imaging compatibility. All patients who had received trial stimulation with a partially implantable sTNFS system were analyzed for ICHD-3 (3rd edition of the International Classification of Headache Disorders) diagnosis, success of trial stimulation, pre- and postoperative pain intensity, frequency of attacks, complications, and side-effects of sTNFS. All patients (N=3) responded to sTNFS (≥50% pain reduction) during the trial period. According to ICHD-3, N=2 of the patients were classified with trigeminal neuralgia (TN) with concomitant persistent facial pain and N=1 patient with multiple sclerosis associated TN. The time of the test period was 44 ± 31.24 days (mean ± SD). The average daily duration of stimulation per patient amounted 2.5 ± 2.2hours (range 1-5). The pain intensity (defined on a visual analog scale) was reduced by 80% ± 17% (mean ± SD). Reduction or cessation in pain medication was observed in all patients. No surgical complications occurred in the long-term follow-up period of 18.84 ± 6 (mean ± SD)months. The partially implantable sTNFS device seems to be safe, effective, and reliable. Compared to conventional devices, the equipment is not limited to the length of trial stimulation. Furthermore, the daily stimulation duration was much shorter compared to previous reports.

Skin erosion in deep brain stimulation procedures: Using the temporalis muscle to treat this complication - A technical note.

Background: Skin erosion is a common complication after deep brain stimulator procedures. Despite being a relatively common event, there is no standard surgical technique or a widely accepted guideline for managing this kind of complication.Methods: We describe a case of cutaneous erosion in the connector’s site of deep brain stimulation case, surgically managed with anterior displacement of the connectors and overlapping and wrapping the connections within the temporal muscle.Results: Postoperatively, the patient did well and achieved complete resolution of the skin erosion, with no signs of infection or new skin lesions.Conclusion: This technique demonstrated to be effective in this case in the long-term follow-up.

Lamotrigine induced Steven Johnson syndrome: A case report in Al Batool teaching hospital in Diyala governorate

Background: Steven Johnson syndrome (SJS) is a rare disease that is characterized by acute cutaneous manifestation represented by eruptions of the skin and the mucosal membranes. SJS is an immune-mediated disease, a hypersensitive reaction, characterized by hyperpigmentation of the mucous membranes, rash on the skin and multiple bullae and erosions scattered all over the body especially the face, trunk, and the extremities. Many studies reported that the incidence rate of the SJS was about 1.2 – 6 cases/ million each year and it is more common among males while the toxic epidermal necrolysis (TEN) is more common among females. In addition to the cutaneous manifestations.SJS might show multiple systemic manifestations including the liver, lungs and kidneys. In this case we reported the development of Steven Johnson syndrome in relation to the use of lamotrigine antiepileptic drug.

Congenital self-healing reticulohistiocytosis in a newborn: unusual oral and cutaneous manifestations

BackgroundCongenital self-healing reticulohistiocytosis (CSHRH), also called Hashimoto-Pritzker disease, is a rare and benign variant of Langerhans cell histiocytosis, characterized by cutaneous lesions without extracutaneous involvement.Case presentationWe present a case of CSHRH with diffuse skin lesions and erosions in the oral mucosa, present since birth and lasting for 2 months, and we perform a review of the literature on Pubmed in the last 10 years.ConclusionsOur case confirm that lesions on oral mucosa, actually underestimated, may be present in patients with CSHRH. Patients affected by CSHRH require a close follow-up until the first years of life, due to the unpredictable course of Langerhans cell histiocytosis, in order to avoid missing diagnosis of more aggressive types of this disorder.

Incidence of pocket infection during long- term follow- up

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac implantable electronic devices (CIEDs) are being implanted worldwide in increasing numbers, so the incidence of hospitalizations due to their infections is also increasing. Purpose The aim of this study was to analyze the incidence of pocket infection related to the CIED procedure, as well as clinical presentation, diagnostic approach and methods of treatment during long-term follow- up on large cohort of patients. Methods: This was a retrospective, observational, single-center study. We enrolled patients who underwent CIED procedure between January 2011 and December 2015. The CIED procedure included implantation and replacement of the device. Pocket infection is defined as an infection limited to the generator pocket and can be presented from redness, swelling, pain to the skin erosion with exposure of the generator and/or leads. It may also be associated with lead infections and systemic CIED infections and/or infective endocarditis. All patients with CIED infection underwent the same diagnostics: complete blood count and inflammatory markers, pocket swab, three sets of blood cultures and echocardiography. Results: During the observed period 5 969 CIED procedures were performed (anti-bradycardia pacemakers 68.6%; ICD 21.4%; CRT-P/D 10.0%; CIED replacement 26.1%). CIED infection was registered in 41 patients (0.68%), most often after the ICD procedure (59.0%). In 22 patients (53.6%) the infection occurred after primo-implantation. The average time from intervention to infection was 17 ± 7.3 months. The mean follow-up was 52.2 ± 13.4 months. The most common manifestations of infection were redness (68.1%) and swelling (56.0%), then the protrusion of the generator or electrode (41.5%). Pacemaker pocket swabs and wound swabs were positive in 61.1% of samples and coagulase negative staphylococcus was found to be the most prevalent cause of infection (64.2%). The hemoculture test was positive in 10 patients, and the isolated causative agent matched the swab finding. The valvular vegetation was found in 4 patients. Pacemaker removal and surgical wound treatment were performed in all patients. Complete removal of all leads was achieved in 32 patients. In all pacemaker dependent patients and patients with ICD implanted in the secondary prevention of sudden cardiac death, reimplantation of the new device was performed in the same hospitalization on the opposite side. The remaining patients were operated on 3 to 4 weeks after the end of treatment. Conclusions: It has been shown that the risk of pocket infection was low in a large number of patients, during long-term follow-up. The risk was higher in patients with ICD devices, and slightly higher after primo-implantation.

Dermatite necrolítica superficial canina – revisão

Canine superficial necrolytic dermatitis (SND) is a progressive debilitating skin disorder commonly associated with liver abnormalities. It is an erosive skin disease with multifocal distribution, usually in the foot pads, mucocutaneous junctions and extremities of the limbs. The pathogenesis of SND in dogs is not known, and may be related to liver disease, mycotoxicosis and use of anticonvulsant drugs. SND manifests itself insidiously, especially in adult dogs, with no breed or gender predisposition. Therapy is supportive, improving the animal’s quality of life and survival time, with most animals dying within a few months of diagnosis, regardless of the proposed treatment.

Il neonato con gli occhi socchiusi. La displasia ectodermica legata al gene TP63

An Italian female newborn presented with cleft palate, erythroderma, desquamations, skin erosions, ankyloblepharon filiforme adnatum, broad nasal root, short philtrum, thin vermillion border, maxillary hypoplasia, microstomia, microglossia, cupped ears, hypoplasia of the distal phalange of left index, widely spaced nipples and polythelia. The hallmarks of ankyloblepharon-ectodermal dysplasia-clefting syndrome (or Hay-Wells syndrome) as well as persistent scalp erosions led to exclude more frequent skin disorders like congenital ichthyosiform erythroderma or epidermolysis bullosa and to diagnose Hay-Wells syndrome by genetic analysis. Target sequencing of the tumour protein p63 (TP63) gene revealed a novel heterozygous missense mutation I576T in exon 13 (c. 1727T>C) in the sterile alpha motive domain. The paper reports the clinical features, differential diagnoses and prognosis in TP63-related ectodermal dysplasia.

Triangular Valued Fuzzy Matrix in Eczema

The field of medicine is the most fruitful and interesting area of applications of Fuzzy Matrix. In real world deals, the representation of the uncertain and in accurate knowledge of medical documentation, parameters of disease diagnosis. In this work Weight Loss or Weight Gain, Excessive Thirst, Frequent Urination, Blurry Visionary, Skin Erosion. We have used the Triangular valued fuzzy number matrices to speak to the medicinal information between the side effects/infections and Patients/Symptoms.

Catastrophic mass mortalities caused by Photobacterium damselae affecting farmed marine fish from Deeba Triangle, Egypt

Farmed marine fish constitute 20% of the total farmed fish production in Egypt, and the Deeba Triangle produces a relatively large portion of this percentage. Last year, several private fish farms in the Deeba Triangle have suffered severe economic losses due to acute fish mass kills. This study aimed to investigate the hidden aetiologies behind these colossal mass fish kills and to propose an emergency control strategy. Several tons of dead farmed fish were remarkably scattered throughout affected ponds and at the vicinity of impacted fish farms. Moribund farmed European seabass (Dicentrarchus labrax), thin-lipped grey mullet (Liza ramada) and gilthead seabream (Sparus aurata) have exhibited skin darkness, emaciation, congested gills and fins, ascites, skin erosions and ulcerations. Internally, moribund fish emitted unpleasant odour upon opening the abdomen together with severe congestion and haemorrhages in kidneys and brain. Mottled atrophied spleens were the most prominent findings, while the gastrointestinal tracts were filled with whitish caseous material. The liver was pale with multiple whitish nodules. Photobacterium damselae was the most retrievable bacterial pathogen from most infected fish and trash fish. Photobacterium damselae subspecies piscicida and Photobacterium damselae subspecies damselae were definitively identified from examined moribund fish using both conventional morpho-chemical and molecular assays. Data analysis has revealed that the poor water quality was profoundly incriminated in triggering the bacterial infections with a fate of mass mortalities. Conclusively, adopting various strict biosecurity strategies will be the key factors in prevention of future episodes of mass kills.

486 Systemic collagen VII protein therapy for treatment of advanced RDEB

Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic skin blistering disease associated with progressive multi-organ fibrosis. RDEB is caused by biallelic COL7A1 mutations leading to reduced production or functionality of the extracellular matrix protein, collagen VII (C7), which is necessary for epidermal-dermal adherence. C7 is not simply a structural protein but also has multiple functions, including regulation of TGFβ bioavailability and the inhibition of skin scarring after wounding. The multi-organ involvement of RDEB calls for systemic treatment. Intriguingly, intravenous (IV) administration of recombinant C7 (rC7) improves the clinical phenotype of newborn C7 deficient mice and rescues them from neonatal lethality. The effect on established RDEB in adult animals has not been determined. Here, we used small and large adult RDEB animal models to investigate the disease-modulating abilities of rC7 on established RDEB. In adult RDEB mice, IV-injected rC7 accumulated dose-dependently at the dermal-epidermal junction of wounded skin and oral mucosa. Bi-weekly IV injections of rC7 for 7 weeks in adult RDEB mice reduced new skin blisters and effectively reduced progression of the fibrotic mitten deformities of their paws. The inhibition of fibrosis was mediated through reduction of TGFβ signaling. IV infusion of rC7 in adult dogs with RDEB also improved disease by promoting the healing of blister-induced skin erosions without excessive scarring. In both models, IV C7 was well tolerated. These preclinical studies suggest that repeated IV administration of rC7 is an efficacious systemic treatment for established adult RDEB.

Fat grafting: A novel technique for difficult ostomy management

The creation of fecal or urinary stomas are common surgical procedures. However, even when the operation is done technically well, a spectrum of morbidities can result from contour deformities of the peristomal skin. These often result in poor appliance fitting with leakage, skin erosion, pain, discomfort, and embarrassment. Irregularities in parastomal skin contour can be secondary to scarring, wound contraction, and change in body habitus.

Subcutaneous implantable cardioverter defibrillator in children and adolescents: results from the S-ICD "Monaldi care" registry.

Implantable cardioverter defibrillators (ICD) are widely accepted therapy in children and adolescents who are survivors of cardiac arrest or for high-risk patients with inheritable channelopathies, cardiomyopathies, or congenital heart disease. Initial experience with subcutaneous ICD (S-ICD) systems has shown a high efficacy in adults. However, the use of S-ICD in children and adolescents implies some specific considerations, as the safety for these patients is unknown and recommendations among physicians may vary widely. We reviewed the data and studied the indications for S-ICD in children and adolescents and discuss the preliminary clinical experience. From a cohort of 297 patients enrolled in the S-ICD "Monaldi care" registry that encompass all the patients implanted in the Monaldi Hospital of Naples, we considered 21 consecutive children and adolescents (mean age 13.9 years, range 8-18 years, mean body weight 59.3 kg, range 38-100 kg) who underwent S-ICD implant from April 2014 to June 2020. Mean follow-up was 41.9±21.9 months. Only one patient presented, 6 weeks after implantation, skin erosion at the inferior parasternal incision that resolved after antibiotic therapy, without the necessity of any system revision. Two patients experienced appropriate shocks and four inappropriate shocks, due to T wave oversensing or atrial arrhythmia. Only one patient, with arrhythmogenic right ventricular dysplasia, required a system revision after 36 months of the first implantation and then a reintervention with a replacement of the S-ICD by a conventional ICD system. Our experience suggests that the S-ICD device can be used in some children over the age of 8 as well as adults, with a similar rate of unwanted side effects, and early evidence of apparent efficacy.