Treatment Of Bacterial Skin Infections Research Articles

Clinical experience of outpatient treatment of bacterial skin infections in children

Data regarding the role of cutaneous microbiome in physiological and pathological conditions, pharmacological properties of fusidic acid and its clinical use for the treatment of skin infections are presented in the article. Incidence of skin infections in children treated in children’s city polyclinic No. 1 of Izhevsk city through 2019–2022 are analyzed. Outcomes of the treatment of these patients with topical fusidic acid preparations are presented. Due to high activity against typical cutaneous bacterial pathogens including MRSA strains of Staphylococcus aureus, favorable safety profile and pharmacokinetic profile when topically applied along with low resistance of the key pathogens fusidic acid preparations are the first line treatment of primary and secondary pyodermas.

Azithromycin-loaded liposomes and niosomes for the treatment of skin infections: Influence of excipients and preparative methods on the functional properties

The aim of this study was to develop azithromycin (AZT)-loaded liposomes (LP) and niosomes (NS) useful for the treatment of bacterial skin infections and acne. LP based on phosphatidylcholine from egg yolk (EPC) or from soybean lecithin (SPC), and NS composed of sorbitan monopalmitate (Span 40) or sorbitan monostearate (Span 60) were prepared through the thin film hydration (TFH) and the ethanol injection (EI) methods. The formulations were subsequently characterized for their physico-chemical and functional properties. Vesicles prepared through TFH showed higher average sizes than the corresponding formulations obtained by EI. All the vesicles presented adequate encapsulation efficiency and a negative ζ potential, which assured good stability during the storage period (except for LP-SPC). Formulations prepared with TFH showed a more prolonged AZT release than those prepared through EI, due to their lower surface area and multilamellar structure, as confirmed by atomic force microscopy nanomechanical characterization. Finally, among all the formulations, NS-Span 40-TFH and LP-EPC-TFH allowed the highest drug accumulation in the skin, retained the antimicrobial activity and did not alter fibroblast metabolism and viability. Overall, they could ensure to minimize the dosing and the administration frequency, thus representing promising candidates for the treatment of bacterial skin infections and acne.

Experimental and in silico evaluation of Carthamus tinctorius L. oil emulgel: a promising treatment for bacterial skin infections.

The current study aimed to develop a topical herbal emulgel containing Carthamus tinctorius L. (CT) oil extract, which has been scientifically proven for its antibacterial and antioxidant activities for the ailment of bacterial skin infections. The CT emulgel was formulated by response surface methodology (RSM) and was evaluated by various parameters like extrudability, spreadability, pH, viscosity, and antibacterial and antioxidant activities. Molecular docking was also performed using AutoDock. Among all formulated CT emulgels, F9 and F8 were optimized. Optimized formulations had shown good spreadability and extrudability characteristics. Sample F8 had % inhibition of 42.131 ± 0.335, 56.720 ± 0.222, and 72.440 ± 0.335 at different concentrations. Sample F9 had % inhibition of 26.312 ± 0.280, 32.461 ± 0.328, and 42.762 ± 0.398 at concentrations of 250 µg/ml, 500 µg/ml, and 1,000 µg/ml, respectively, which shows that both samples F8 and F9 have significant antioxidant potential. Optimized CT emulgels F8 and F9 had significant antibacterial activity against Staphylococcus aureus and Escherichia coli at p-value = 0.00, the Emulgel-F8 shows zone of inhibition of 24 mm for E-coli and 19 mm for S-aureus. Emulgel-F9 shows zone of inhibition of 22 mm for E-coli and 15 mm for S-aureus while pure CT- Oil extract shows zone of inhibition of 25 mm for E-coli and 20 mm for S-aureus and ciprofloxacin used as standard shows 36mm zone of inhibition against both E-coli and S-aureus. The comparative investigation through molecular docking binding affinities and interactions of ligands with various target proteins provides insights into the molecular processes behind ligand binding and may have significance for drug discovery and design for the current study. The current study suggests that C. tinctorius L.-based emulgel has good antioxidant and antibacterial activities against E. coli for the treatment of bacterial skin infections.

Antimicrobial, antioxidant, and sun protection potential of the isolated compounds from Spermacoce princeae (K. Schum)

BackgroundSpermacoce princeae (K. Schum) has been used in the treatment of bacterial skin infections in Uganda. Pharmacological studies revealed that extracts of S. princeae exhibited antibacterial, antioxidant, and sun protection potential. This study aimed at isolating and identifying pure compounds from the extracts based on comprehensive analytical characterization by multiple analytical techniques.MethodsThe plant samples were extracted by sequential maceration using n-hexane, ethyl acetate, methanol, and distilled water. The compounds were isolated using a combination of chromatographic techniques and their structures were elucidated by multiple spectroscopic techniques. The antibacterial and antifungal activity determination of the isolated compounds was carried out using an agar well diffusion and potato dextrose assay against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Candida albicans, and Aspergillus flavus while the antioxidant activity was screened with the 2,2-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The sun protection factor was determined using a Shimadzu Ultra Violet-visible (UV–VIS) double beam spectrophotometer between 290 to 320 nm.ResultsEleven compounds; quercetin (1), kaempferol-3-O-rutinoside (2), rutin (3, 12), myo-inositol (4), asperulosidic acid (5), hexadecanoic acid (6), β-sitosterol (7), stigmasterol (8), campesterol (9), ursolic acid (10), and β-sitosterol glucoside (11) were identified in the S. princeae extracts. Compound 2 had good antifungal activity against C. albicans (zone of inhibition, 23.0 ± 0.1 mm). Compound 10 showed antibacterial and antifungal activity against S. aureus, P. aeruginosa, C. albicans, and A. flavus. Compound 2 had a good percentage radical scavenging effect (IC50 = 64.81 µg/ml) and a good sun protection factor (SPF = 26.83).ConclusionThis study reports the first-time isolation and identification of compounds 1 to 11 from S. princeae, which contribute to its antimicrobial, antioxidant, and sun protection potential.

Evaluation of the antimicrobial activity of propolis ointment against Staphylococcus aureus

Background: This study was carried out to determine the antimicrobial effect of propolis ointment formulations against Staphylococcus aureus.Methods: Propolis was extracted with 70 ml Ethanol (99 %) and the ointment was prepared by incorporating the extract into emulsifying ointment BP. Formulations were evaluated against Staphylococcus aureus using agar diffusion test. Physicochemical properties of the formulation (pH, viscosity and spreadability) were determined using a pH meter, and viscometer. Homogeneity and texture were also determined. Differences in means were evaluated by the independent student t-test at p-value < 0.05.Results: The ointment was dark brown, greasy with a smooth texture. The viscosity of the propolis emulsifying ointment and simple ointment was 11133 ± 1229 and 11800 ± 1100 cP with spreadability of 6.32 ± 1.33 and 6.00 ± 2.40 mm2/g respectively. The pH of the simple and emulsifying ointment was 7.10 ± 0.05 and 7.22 ± 0.06 respectively. There was however reduced pH, spreadability and viscosity of the formulation over a period of 90 days (3 months) resulting in more acidic preparations less than 6 (5.65) in batch F2. Depth of penetration of the simple ointment was between 6.00 ± 0.8 mm to 7.55 ± 0.8 mm and 6.75 ± 0.5 mm to 9.20 ± 1.10 mm for the emulsifying ointment over a period of 14 days. The minimum inhibitory concentration of the propolis extract against Staphylococcus aureus was 300 mg/ml. Inhibition zone diameter of the simple and emulsifying ointment were 16.5 ± 1.3 mm and 17.0 ± 1.2 mm respectively.Conclusion: Propolis can be formulated as an ointment for the treatment of bacterial skin infections. The physicochemical properties of the formulation were stable with gradual decline over a period of 3 months. The propolis ointment exhibited antimicrobial activity against Staphylococcus aureus.

Thermoresponsive Hydrogel-Enabled Thermostatic Photothermal Therapy for Enhanced Healing of Bacteria-Infected Wounds.

Photothermal therapy (PTT) has emerged as an attractive technique for the treatment of bacterial infections. However, the uncontrolled heat generation in conventional PTT inevitably causes thermal damages to healthy tissues and/or organs. It is thus essential to develop a smart and universal strategy to regulate the photothermal equilibrium temperature to a preset safe threshold. Herein, a thermoresponsive hydrogel-enabled thermostatic PTT system for enhanced healing of bacteria-infected wounds is reported. In this system, the near-infrared (NIR)-triggered heat generation by photothermal nanomaterials is spontaneously transferred to a thermoresponsive hydrogel with a lower critical solution temperature (LCST), leading to its rapid phase transition by forming considerable light-scattering centers to block NIR penetration. Such a dynamic and reversible process automatically regulates the photothermal equilibrium temperature to the phase-transition point of the LCST-type hydrogel. In contrast to temperature-uncontrolled conventional PTT with severe thermal damages, the thermoresponsive hydrogel-enabled thermostatic PTT provides effective protection on healthy tissues and/or organs, which remarkably accelerates wound healing by efficient bacterial eradication. This study establishes a smart, simple and universal PTT platform, holding great promise in the safe and efficient treatment of bacterial skin infections.

Design of Quercetin-Loaded Natural Oil-Based Nanostructured Lipid Carriers for the Treatment of Bacterial Skin Infections.

The biological activity of natural plant-oil-based nanostructured lipid carriers (NPO-NLCs) can be enhanced by the encapsulation of bioactive compounds, and they in turn can improve topical delivery of the drugs. Quercetin (QR), a vital plant flavonoid, expresses antibacterial properties, and we recently showed that empty NPO-NLCs also have antimicrobial activity. The main objective of this study was to evaluate the synergetic effect of loading natural plant-oil-based nanostructured lipid carriers with quercetin (QR-NPO-NLCs) as a topical delivery system for the treatment of bacterial skin infections. Five nanostructured lipid carrier systems containing different oils (sunflower, olive, corn, coconut, and castor) were engineered. The particles’ stability, structural properties, bioavailability, and antimicrobial activity were studied. NLCs with an average size of <200 nm and Z-potential of −40 mV were developed. Stable QR-NPO-NLCs were obtained with high encapsulation efficiency (>99%). The encapsulation of QR decreased cytotoxicity and increased the antioxidant effect of nanocarriers. An increase in antibacterial activity of the systems containing QR was demonstrated against Staphylococcus aureus. QR-NPO-NLCs could transport QR to an intranuclear location within HaCaT cells, indicating that QR-NPO-NLCs are promising candidates for controlled topical drug delivery.

Multidisciplinary panel opinion on the management of bacterial skin infections

AbstractEight hot topics regarding the diagnosis and management of bacterial skin infections were selected and reviewed by five experts from different European countries, chosen based on their expertise in microbiology, infectious diseases, and dermatology. As noninfectious skin diseases/conditions such as atopic dermatitis can be complicated by infections, including Acute Bacterial Skin and Skin Structure Infections (ABSSSI), a collaboration between dermatologists and infectious disease specialists can promote a rational approach to diagnosis and a more functional treatment approach, especially for complicated infections. In addition, an important role would be played by microbiologists as they are crucial for the isolation and classification of the bacterial pathogen to guide clinicians toward the most effective antibiotic therapy. Although there are many therapeutic options for the treatment of bacterial skin infections, including those due to methicillin‐resistant Staphylococcus aureus, these drugs often require multiple daily administrations leading to patient noncompliance and are associated with gastrointestinal adverse events and drug resistance. With their characteristics of being long‐acting, safety and single‐dose regimens, long‐acting antibiotics, such as dalbavancin and oritavancin, represent an effective alternative that could change the management of these infections with a considerable reduction of hospitalisation costs and risks.

Development and Characterization of Azithromycin-Loaded Microemulsions: A Promising Tool for the Treatment of Bacterial Skin Infections.

In recent years, the treatment of bacterial skin infections has been considered a major healthcare issue due to the growing emergence of antibiotic-resistant strains of Staphylococcus aureus. The incorporation of antibiotics in appropriate nanosystems could represent a promising strategy, able to overcome several drawbacks of the topical treatment of infections, including poor drug retention within the skin. The present work aims to develop microemulsions containing azithromycin (AZT), a broad-spectrum macrolide antibiotic. Firstly, AZT solubility in various oils, surfactants and co-surfactants was assessed to select the main components. Subsequently, microemulsions composed of vitamin E acetate, Labrasol® and Transcutol® P were prepared and characterized for their pH, viscosity, droplet size, zeta potential and ability to release the drug and to promote its retention inside porcine skin. Antimicrobial activity against S. aureus methicillin-resistant strains (MRSA) and the biocompatibility of microemulsions were evaluated. Microemulsions showed an acceptable pH and were characterized by different droplet sizes and viscosities depending on their composition. Interestingly, they provided a prolonged release of AZT and promoted its accumulation inside the skin. Finally, microemulsions retained AZT efficacy on MRSA and were not cytotoxic. Hence, the developed AZT-loaded microemulsions could be considered as useful nanocarriers for the treatment of antibiotic-resistant infections of the skin.

In Vitro Growth-Inhibitory Synergistic Effect of Zinc Pyrithione in Combination with Gentamicin against Bacterial Skin Pathogens of Livestock.

Bacterial skin diseases of livestock could be a serious global threat, especially in association with overcoming bacterial resistance. Combinatory action of antimicrobial agents proves to be an effective strategy to overcome the problem of increasing antibiotic resistance of microorganisms. In this study, the in vitro combined effect of zinc pyrithione with gentamicin against bacterial skin pathogens of livestock (Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus dysgalactiae) was evaluated according to the sum of fractional inhibitory concentration indices (FICI) obtained by checkerboard method. The results showed that a combination of zinc pyrithione with gentamicin produced a strong synergistic effect (p < 0.001) against all tested streptococcal strains (with FICI values ranging from 0.20 to 0.42). Compared to that, only three out of eight S. aureus strains were highly susceptible to the combination of antimicrobial agents at single concentration (0.25 µg/mL) of zinc pyrithione with range of FICI 0.35–0.43. These findings suggest that interference between agents tested in this study can be used for the development of future veterinary pharmaceutical preparations for the treatment of bacterial skin infections of livestock.

Antibacterial, antioxidant, and sun protection potential of selected ethno medicinal plants used for skin infections in Uganda

BackgroundRural populations in Uganda rely heavily on medicinal plants for the treatment of bacterial skin infections. However, the efficacy of these medicinal plants for their pharmacological action is not known. The study aimed at evaluating the antibacterial, antioxidant, and sun protection potential of Spermacoce princeae, Psorospermum febrifugum, Plectranthus caespitosus, and Erlangea tomentosa extracts.MethodsThe plant samples were extracted by maceration sequentially using hexane, dichloromethane, ethyl acetate, methanol, and distilled water. Antibacterial activity of each extract was carried out using an agar well diffusion assay against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella pneumonie, Streptococcus pyogenes, and Salmonella typhi. Acute dermal toxicity of the aqueous extract of S. princeae and P. febrifugum, and E. tomentosa was assessed in young adult healthy Wistar albino rats at a dose of 8000 and 10,000 mg/kg body weight. The antioxidant activity of each extract was carried out using a 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The sun protection factor was determined using Shimadzu UltraViolet-Visible double beam spectrophotometer between 290 and 320 nm.ResultsThe plant extracts showed good antibacterial activity against the tested bacterial strains with minimum inhibitory concentration (MIC) ranging between 3.12 and 12.5 mg/ml. There was no significant change in the levels of creatinine, alanine aminotransferase, and aspartate aminotransferase in the rats even at a higher dose of 10,000 mg/kg, which was related to the results of biochemical analysis of the blood samples from the treated and control groups. The aqueous and methanol extracts of S. princeae showed potential antioxidant properties, with half maximal inhibitory concentration (IC50) values of 59.82 and 61.20 μg/ml respectively. The organic and aqueous extracts of P. caespitosus showed high levels of protection against Ultraviolet light with sun protection potential values ranging between 30.67 and 37.84.ConclusionsThe study demonstrated that the selected medicinal plants possessed good antibacterial, antioxidant, and sun protection properties. Therefore, the plants are alternative sources of antibacterial, antioxidant, and sun protection agents in managing bacterial skin infections.

MED-12-2103-02

Currently, one of the priority medical and social problems of medicine is to optimize the treatment of bacterial skin infections, in particular pyoderma associated with Streptococcus pyogenes-group A streptococcus. The traditional treatment complex, including antibacterial drugs used systemically or topically, selected taking into account individual sensitivity, the presence of pathognomonic microflora, is not always effective due to the increase in antibiotic resistance. Currently implemented methods of immunocorrection, taking into account changes in the immune status in this pathology, corresponding to the clinic of patients, are pathogenetically justified and can be effective. The use of immunomodulatory therapy requires a change in approaches to diagnosis, clarifying the role of factors of innate and adaptive immunity, intercellular mediators and the system of antioxidant protection, allowing to optimize the methods of treatment of this pathology. The use of recombinant interleukin-2 makes up for the lack of interleukin-2 in the blood serum of patients with streptoderma and contributes to the clinical recovery of patients.

The Antimicrobial Peptide Temporin G: Anti-Biofilm, Anti-Persister Activities, and Potentiator Effect of Tobramycin Efficacy Against Staphylococcus aureus.

Bacterial biofilms are a serious threat for human health, and the Gram-positive bacterium Staphylococcus aureus is one of the microorganisms that can easily switch from a planktonic to a sessile lifestyle, providing protection from a large variety of adverse environmental conditions. Dormant non-dividing cells with low metabolic activity, named persisters, are tolerant to antibiotic treatment and are the principal cause of recalcitrant and resistant infections, including skin infections. Antimicrobial peptides (AMPs) hold promise as new anti-infective agents to treat such infections. Here for the first time, we investigated the activity of the frog-skin AMP temporin G (TG) against preformed S. aureus biofilm including persisters, as well as its efficacy in combination with tobramycin, in inhibiting S. aureus growth. TG was found to provoke ~50 to 100% reduction of biofilm viability in the concentration range from 12.5 to 100 µM vs ATCC and clinical isolates and to be active against persister cells (about 70–80% killing at 50–100 µM). Notably, sub-inhibitory concentrations of TG in combination with tobramycin were able to significantly reduce S. aureus growth, potentiating the antibiotic power. No critical cytotoxicity was detected when TG was tested in vitro up to 100 µM against human keratinocytes, confirming its safety profile for the development of a new potential anti-infective drug, especially for treatment of bacterial skin infections.

SIZE DEPENDENT APPLICATION OF BIOLOGICALLY SYNTHESIZED SILVER NANOPARTICLES AGAINST BACTERIAL SKIN PATHOGENS

Objective: Bacterial skin infection is one of the most common causes of childhood morbidity in India. Mostly, it is caused by Streptococcus and Staphylococcus infections. However, because of antibiotic resistance in bacterial strains, treatment of skin infections is becoming increasingly difficult. The objective of this research is to study the effect of plant extract concentration on synthesis and morphology of biological silver nanoparticles and investigation of their activity against bacterial skin pathogens.Methods: Biological silver nanoparticles were synthesized using two concentrations (5 and 10 ml) of Aegle marmelos fruit pulp extract. Ultraviolet (UV)-visible spectroscopy, field emission scanning microscopy (FESEM), and high resolution transmission electron microscopy (HRTEM) were used to analyze morphological features of nanoparticles. Antibacterial activity of synthesized silver nanoparticles was studied against the most common skin pathogens Staphylococcus aureus and Streptococcus pyogen, using a well diffusion method.Results: The silver nanoparticles synthesized from 5 ml extract showed UV-absorbance peak at 430 nm with 14-18 nm size, while silver nanoparticles synthesized from 10 ml extract was showed the absorbance at 427 nm with 4-8 nm size. FESEM and HRTEM analysis revealed that both the silver nanoparticles were spherical in shape. Both nanoparticles have shown antibacterial activity among them silver nanoparticles synthesized from 10 ml extract showed better antibacterial activity.Conclusion: This research confirms that plant extract concentration modulate the rate of synthesis, morphology, surface plasmon resonance, and activity of biological silver nanoparticles. Silver nanoparticles synthesized from 10 ml extract can be used efficiently in the treatment of bacterial skin infections.

Anti-biofilm properties of a mupirocin spray formulation against Escherichia coli wound infections

Mupirocin ointment is a widely used topical drug for the treatment of bacterial skin infections. However, ointments have some limitations which motivated the development of a film forming spray of mupirocin. Mupirocin spray (2%) was formulated with Eudragit E100 as a film forming agent and tested for its antibacterial and anti-biofilm activities against Escherichia coli, a skin pathogen causing wound and surgical site infections. Treatment with mupirocin spray resulted in significant antibacterial and anti-biofilm activities (inhibition and disruption) with single spray and sub-actual dose concentrations at par with the commercial ointment concentration. The spray formulation was found to be non-toxic to fibroblast cells and greatly resisted removal from the site of application upon washing, in contrast to the ointment which was significantly removed after a single wash. This is the first study to develop and evaluate a spray formulation for mupirocin that forms a stable thin film for sustained release of the drug.

Mie scatter spectra-based device for instant, contact-free, and specific diagnosis of bacterial skin infection

Rapid and specific diagnostic techniques are needed to expedite specific treatment of bacterial skin infections with narrow-spectrum antibiotics, rather than broad-spectrum. Through this work a device was developed to determine the presence of and species responsible for a bacterial skin infection using differences in Mie scatter spectra created by different bacterial species. A 650 nm LED at five different incident angles is used to illuminate the tissue, with Mie scatter being detected by PIN photodiodes at eight different detection angles. Mie scatter patterns are collected at all photodiode angles for each of the incident light angles, resulting in a Mie scatter spectra. Detectable differences in Mie scatter spectra were found using the device developed between commensal bacteria (no infection) and bacteria inoculated (infection) on the surface of both porcine and human cadaveric epidermis. Detectable differences were found between species of infection, specifically Escherichia coli and Staphylococcus aureus, with differences summarized through principle component analysis. Mie scatter spectra can be detected within a few seconds without skin contact. This device is the first to rapidly and specifically diagnose bacterial skin infections in a contact-less manner, allowing for initial treatment with narrow spectrum antibiotics, and helping to reduce the likelihood of resistance.

Development of a topical mupirocin spray for antibacterial and wound-healing applications

Objective: The aim of this study was to develop mupirocin topical spray using Eudragit E100 as a film-forming agent for the treatment of bacterial skin infections as well as to promote wound healing.Materials and methods: Twenty-seven of mupirocin formulations were formulated containing Eudragit E100 and other excipients. Mupirocin spray was prepared by aerosol crimping and filling machine using HFA-134a as a propellant. The formulations were evaluated for their stability and physicochemical properties. The factorial study was applied to evaluate the effects of glycerol and PEG400 on mupirocin-loaded Eudragit E100 films. The optimized formulation was assessed of drug release, antibacterial activities and in vitro cell line studies in comparison to the ointment formulation.Results and discussion: Mupirocin sprays were formulated and optimized to obtain the formulation with excellent physicochemical and mechanical properties of the dressing film. The formulation had an excellent stability up to a year with more than 80% of mupirocin content. Mupirocin was released from the film up to 90% within 2 h. The formulation had a potent antibacterial effect against S. aureus and S. epidermidis. The formulation was safe to use as a topical formulation that had no toxicity to keratinocytes, fibroblasts and monocytes. The formulation also had an antiendotoxin effect without stimulating the production of NO and inflammatory cytokines (IL-1β and TNF-α).Conclusions: Mupirocin topical spray was successful developed as a topical formulation and can be used instead of the ointment formulation. Animal experiments are warranted to further emphasize the safe use in the human skin.

Childhood skin and soft tissue infections: new discoveries and guidelines regarding the management of bacterial soft tissue infections, molluscum contagiosum, and warts.

Pediatric skin and soft tissue infections (SSTIs) constitute a significant number of office-based pediatric visits. With SSTIs on the rise, it is not only important to effectively treat the individual, but to do so appropriately and cost-consciously. In this article, we highlight new research related to the treatment of bacterial skin infections, molluscum contagiosum, and cutaneous warts, with the goal of guiding pediatricians in their practice against these common skin conditions. Recent data supports the use of topical antibiotics for noncomplicated impetigo. Systemic antibiotics covering gram-positive cocci are recommended for complicated cases of impetigo and deeper nonpurulent SSTIs. Localized purulent bacterial SSTIs can be treated with incision and drainage alone but more systemic involvement warrants treatment with systemic antibiotics covering Staphylococcus aureus species, especially community acquired methicillin-resistant S. aureus. For the treatment of molluscum contagiosum, topical cantharidin has a high satisfaction rate among patients and providers. Potassium hydroxide solution is a potentially effective and cheap form of molluscum contagiosum treatment. Imiquimod, however, has an unfavorable efficacy and safety profile as a therapy for molluscum contagiosum. Regarding warts, high-risk human papilloma virus strains have been detected in cutaneous warts in children. The high-risk human papilloma virus vaccine may play a role in treating pediatric cutaneous warts in the future, and topical squaric acid dibutylester may effectively treat recalcitrant warts. Finally, both molluscum contagiosum and warts have a high rate of resolution after an extended period of time without any intervention.

SEIP–AEPAP–SEPEAP consensus document on the aetiology, diagnosis and treatment of bacterial skin infections in out-patients

Skin infections are a common cause for dermatological consultations in the paediatric setting. A review is presented of the clinical manifestations, diagnosis and treatment of the main bacterial skin infections, as well as the diagnosis and treatment of super-infected puncture and bite wounds. The most prevalent bacteria in skin infections are Staphylococcus aureus and Streptococcus pyogenes. Treatment is usually empirical, since microbiological studies are only recommended under certain circumstances or lack of improvement with common therapies. Superficial skin infections can be treated with local antiseptics or antibiotics (mupirocin or fusidic acid). Systemic treatment is usually reserved for patients with extensive or severe disease or with other risk factors. Systemic treatment depends on the suspected infecting bacteria, with penicillin, amoxicillin, amoxicillin-clavulanic acid and first or second generation cephalosporin being the most frequently used drugs. Due to the low incidence of community-acquired methicillin-resistant infection by S. aureus in Spain, the use of clindamycin or co-trimoxazole is only recommended after severe disease, relapses or a clear epidemiological background.

Photodynamic antimicrobial chemotherapy using zinc phthalocyanine derivatives in treatment of bacterial skin infection.

Photodynamic antimicrobial chemotherapy (PACT) is an effective method for killing bacterial cells in view of the increasing problem of multiantibiotic resistance. We herein reported the PACT effect on bacteria involved in skin infections using a zinc phthalocyanine derivative, pentalysine β-carbonylphthalocyanine zinc (ZnPc-(Lys)5). Compared with its anionic ZnPc counterpart, ZnPc-(Lys)5 showed an enhanced antibacterial efficacy in vitro and in an animal model of localized infection. Meanwhile, ZnPc-(Lys)5 was observed to significantly reduce the wound skin blood flow during wound healing, indicating an anti-inflammation activity. This study provides new insight on the mechanisms of PACT in bacterial skin infection.