RESUMEN
In Part I of our CME we reviewed the skin microbiome in healthy individuals. Part II reviews the evolving understanding of alterations in the skin microbiome in specific human diseases. We also discuss how the skin microbiome can change with environmental exposures and medications such as antibiotics as well as ongoing research on microbiome-based interventions.
RESUMEN
Human skin is home to a myriad of microorganisms, including bacteria, viruses, fungi, and mites, many of which are considered commensal microbes that aid in maintaining the overall homeostasis or steady-state condition of the skin and contribute to skin health. Our understanding of the complexities of the skin's interaction with its microorganisms is evolving. This knowledge is based primarily on in vitro and animal studies, and more work is needed to understand how this knowledge relates to humans. Here, we introduce the concept of the skin microbiome and discuss skin microbial ecology, some intrinsic factors with potential influence on the human skin microbiome, and possible microbiome-host interactions. The second article of this two-part CME series describes how microbiome alterations may be associated with skin disease, how medications can affect the microbiome, and what microbiome-based therapies are under investigation.
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BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that generates multiple cytokines. Here, we present an example of the cytokines forming a cytokine storm and its effects on the patient. CASE PRESENTATION: We report the case of a 55-year-old man who had severe but stable HS. Serum samples were collected from the patient and extraordinarily elevated cytokine concentrations were identified in the patient's serum. Conclusion: Cytokine storms may be a condition associated with HS posing additional risk to patient survival. J Drugs Dermatol. 2024;23(5):e134-e136. doi:10.36849/JDD.7860R1e.
Asunto(s)
Síndrome de Liberación de Citoquinas , Hidradenitis Supurativa , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Liberación de Citoquinas/inmunología , Síndrome de Liberación de Citoquinas/diagnóstico , Síndrome de Liberación de Citoquinas/etiología , Síndrome de Liberación de Citoquinas/sangre , Citocinas/sangre , Hidradenitis Supurativa/sangre , Hidradenitis Supurativa/complicaciones , Hidradenitis Supurativa/diagnóstico , Hidradenitis Supurativa/inmunología , Índice de Severidad de la EnfermedadRESUMEN
Melanomas affecting acral and mucosal sites have distinct features and are associated with poorer prognosis. Patients of color may be disproportionately affected. Herein we discuss six ethnically diverse cases of acral and mucosal melanoma (AMM). More data on clinical, genetic, and environmental features of AMM are needed, but thorough physical examination can reduce the burden of disease now. J Drugs Dermatol. 2024;23(8):683-685. doi:10.36849/JDD.8311.
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Melanoma , Membrana Mucosa , Neoplasias Cutáneas , Humanos , Melanoma/patología , Melanoma/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Membrana Mucosa/patología , Anciano , AdultoRESUMEN
Bullous pemphigoid is often difficult to treat with the limited therapies available. Here, we describe clinical outcomes among 30 adults with bullous pemphigoid patients treated with dupilumab. We performed a multicenter, retrospective case series between March 2020 to August 2022. Patients received a loading dose of dupilumab 600 mg, followed by 300 mg maintenance dose with varying administration frequency tailored to individual patient response. All patients experienced at least some improvement in blister formation and pruritus, with 23 (76.7%) of patients demonstrating either complete clearance of blistering or marked response. Complete clearance of pruritus or marked response was noted in 25 (83.3%) of patients. Eight patients were effectively maintained solely on dupilumab. One (3.3%) patient reported an injection site reaction. Thirty patients represent a small sample, however, to our knowledge, this is the second largest group of BP treated with dupilumab. Furthermore, we provide an understandable framework for clinicians outside of academics to follow and assess treatment responses in their BP patients treated with dupilumab. Dupilumab should be considered as a therapeutic option in patients with bullous pemphigoid given its ability to induce sustained blistering and pruritus response in both typical and refractory cases while maintaining a favorable safety profile. J Drugs Dermatol. 2024;23(6):e144-e148. doi:10.36849/JDD.8258e.
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Anticuerpos Monoclonales Humanizados , Penfigoide Ampolloso , Prurito , Humanos , Penfigoide Ampolloso/tratamiento farmacológico , Penfigoide Ampolloso/diagnóstico , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Estudios Retrospectivos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Anciano de 80 o más Años , Prurito/tratamiento farmacológico , Prurito/etiología , Prurito/diagnóstico , Adulto , Reacción en el Punto de Inyección/etiología , Reacción en el Punto de Inyección/diagnósticoRESUMEN
The various presentations of many dermatologic conditions among various skin types are slowly being elucidated throughout the recent years. These differences present as an issue as it leads to delayed diagnosis, treatment, and poorer quality of life. Herein, we present the characteristics of leukemia cutis in a skin of color patient with diagnosed chronic myelomonocytic leukemia. Adjei S, Temiz LA, Miller AC, et al. Leukemia cutis in skin of color. J Drugs Dermatol. 2023;22(7):687-689. doi:10.36849/JDD.7020.
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Leucemia , Neoplasias Cutáneas , Humanos , Leucemia/diagnóstico , Calidad de Vida , Piel , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/etnología , Neoplasias Cutáneas/terapia , Pigmentación de la PielRESUMEN
Virtually any antibiotic can be used in dermatology given the broad range of conditions treated. With the widespread use of antibiotics and the rapid emergence of resistant organisms, it is important to understand how dermatologists can combat this issue.
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Acné Vulgar , Fenómenos Bioquímicos , Dermatología , Humanos , Farmacorresistencia Microbiana , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Acné Vulgar/tratamiento farmacológicoRESUMEN
Virtually any antibiotic can be used in dermatology given the broad range of conditions treated. With the widespread use of antibiotics and the rapid emergence of resistant organisms, it is important to understand the mechanisms at play that contribute to resistance.
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Dermatología , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia MicrobianaRESUMEN
Empedobacter brevis (E. brevis) is a gram-negative, nonmotile, aerobic bacteria that is part of the Flavobacteriaceae family. It is mostly found in water sources, plants, soils, and more recently, hospital environments. There have been emerging cases of human infections, although still rare.
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Flavobacteriaceae , Celulitis (Flemón) , Flavobacterium , Humanos , TetraciclinasRESUMEN
Tetracycline-class drugs have been used for first-line treatment of moderate-to-severe acne and rosacea for decades. Recently, a new third generation tetracycline, sarecycline, was US FDA-approved for the treatment of moderate-to-severe acne. This narrow-spectrum tetracycline-derived antibiotic has been shown to be effective with an improved safety profile.
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Acné Vulgar , Antibacterianos , Acné Vulgar/tratamiento farmacológico , Antibacterianos/efectos adversos , Humanos , Inhibidores de la Síntesis de la Proteína/uso terapéutico , Tetraciclina/uso terapéutico , Tetraciclinas/uso terapéuticoRESUMEN
Actinic keratosis (AK) is a common precancerous condition found on chronically sun-damaged skin, particularly on the face, scalp, arms, and legs. Early and effective treatment of AKs is important to prevent progression to squamous cell carcinoma. Many topical treatments for AKs are often limited because of poor tolerability, prolonged treatment duration, and reduced adherence. Tirbanibulin 1% ointment, a new topical field therapy for AKs, reduces these issues. It requires a consecutive 5-day application period and is effective, demonstrating complete (100%) clearance of AK lesions in 49% of patients, partial (>75%) clearance in 72%, and a median reduction in lesion count of 87.5% while exhibiting a favorable safety profile, mild adverse events, improved tolerability, and long-term results.
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Queratosis Actínica , Acetamidas , Administración Tópica , Humanos , Queratosis Actínica/tratamiento farmacológico , Queratosis Actínica/patología , Morfolinas , Piridinas , Cuero Cabelludo/patología , Resultado del TratamientoRESUMEN
Herpes simplex virus (HSV) is one of the most prevalent infections worldwide. It consists of two types: HSV1 and HSV2 that primarily cause orofacial and genital disease. However, both types can infect any site. Rarely, HSV infection of the hand occurs and is often documented as herpetic whitlow. Herpetic whitlow is primarily recognized as an HSV infection of the digits and thus HSV infection of the hand is largely associated with infection of the fingers. This is problematic, as HSV is often left off the differential diagnosis of non-digit hand pathology. We present two cases of non-digit HSV infection of the hand that were misdiagnosed as bacterial infections. As our cases and others demonstrate, the lack of knowledge that HSV infections can occur on the hand leads to confusion and delayed diagnosis among a myriad of providers. Therefore, we seek to introduce the term "herpes manuum" to increase awareness that HSV can appear on the hand in locations aside from the digits and thus differentiate it from herpetic whitlow. By doing so, we hope to encourage more timely diagnosis of HSV hand infections to decrease associated morbidity.
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Dermatitis , Dermatosis de la Mano , Herpes Simple , Enfermedades Cutáneas Infecciosas , Humanos , Herpes Simple/diagnóstico , Herpesvirus Humano 2 , Dedos , Dermatitis/complicaciones , Dermatosis de la Mano/diagnósticoRESUMEN
Dermatologic conditions frequently portrayed in visual art forms are of considerable significance due its influence on public perception of the field. Skin conditions are utilized in television and film to quickly portray character traits to the audience. Most often, these conditions carry negative connotations when attached to characters, being used as visual cues to symbolize immorality, evilness, and unattractiveness. The misrepresentation of dermatologic conditions in film can cause trivialization of skin disease in society. Affected patients, as well as the general public, can suffer as a result of this misinformation. Key words: Dermatology; media; movie; television; film; society.
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We present a case of erythema multiforme (EM) associated with a third (booster) dose of COVID-19 vaccination in a patient who had no cutaneous reactions to previous doses. To our knowledge, this is the first documented case of vaccine-associated EM occurring after a third/booster vaccination. Furthermore, our case emphasizes the need to remain vigilant for vaccine-associated EM in any patient recently vaccinated, regardless of whether previous vaccinations were administered without cutaneous reactions.
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Poromas or poroid tumors are a group of rare, benign cutaneous neoplasms derived from the terminal eccrine or apocrine sweat gland duct. There are four poroma variants with overlapping features: dermal duct tumor (DDT), eccrine poroma, hidroacanthoma simplex, and poroid hidradenoma, of which DDT is the least common. Clinically, the variants have a nonspecific appearance and present as solitary dome-shaped papules, plaques, or nodules. They can be indistinguishable from each other and a multitude of differential diagnoses, necessitating a better understanding of the characteristics that make the diagnosis of poroid neoplasms. However, there remains a paucity of information on these lesions, especially DDTs, given their infrequent occurrence. Herein, we review the literature on DDTs with an emphasis on epidemiology, pathogenesis, clinical features, diagnosis, and management.
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PURPOSE: The aim of this paper is to concisely summarize what is currently known about OAG among persons of LAD in the United States for the purpose of improving individualized care and highlighting areas requiring further study. MATERIALS AND METHODS: Review of relevant literature was performed through PubMed and Google Scholar from October 1978 through November 11, 2019. RESULTS: As the Latin American population grows within the United States, it is predicted that by 2050, men of LAD will make up the largest demographic group with OAG. Persons of LAD experience a greater increase in OAG prevalence per decade of life compared with persons of African descent and may have unique risk factors. In particular, those with African ancestry and hypertension are at greater risk of elevated intraocular pressure (IOP). Maximum IOP, variability in IOP, and diabetes are also important considerations. Unique anatomic and physiological characteristics such as scleral tensile strain, longer axial length, thin corneas, and corneal hysteresis may play a role in this population's unique risk for the development and progression of OAG. CONCLUSIONS: OAG represents a growing concern among persons of LAD in the United States; however, information on specific risk factors in this population currently remains limited. Studies should be designed to investigate the LAD population and their respective structural, vascular, and social risk factors for the development and progression of OAG to assist clinicians in improving outcomes for this growing population.
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Glaucoma de Ángulo Abierto/etnología , Hispánicos o Latinos , Adulto , Anciano , Femenino , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Presión Intraocular/fisiología , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
Abnormalities of the retinal blood supply have been widely implicated in primary open-angle glaucoma (POAG). Impaired blood supply to the retina and optic nerve head (ONH) may be a primary pathophysiologic mechanism contributing to POAG ('vascular hypothesis'). However, the decreased metabolic activity of atrophic tissue is itself known to induce both vascular changes and decreased blood flow due to reduced oxygen demand. Therefore, primary nonvascular factors could potentially induce glaucomatous atrophy, with subsequent secondary vascular pathology ('mechanical hypothesis'). Retinal oximetry holds great promise in the investigation of glaucoma pathogenesis, as it can provide useful data on retinal metabolic oxygen demand, especially when combined with measurements of retinal blood flow. This review surveys the research on retinal metabolism in POAG using spectroscopic retinal oximetry. The use of mathematical models in combination with oximetric data to investigate the role of retinal metabolism and oxygen supply in POAG is also discussed.