Atopic Dermatitis: Diagnosis and Treatment.

Atopic dermatitis (atopic eczema) is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime. Atopic dermatitis is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupts the epidermis causing intensely pruritic skin lesions. Repeated scratching triggers a self-perpetuating itch-scratch cycle, which can have a significant impact on the patient's quality of life. The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings. Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers. Use of topical corticosteroids is the first-line treatment for atopic dermatitis flare-ups. Pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment. Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate. Antistaphylococcal antibiotics are effective in treating secondary skin infections. Oral antihistamines are not recommended because they do not reduce pruritus. Evidence is lacking to support the use of integrative medicine in the treatment of atopic dermatitis. Newer medications approved by the U.S Food and Drug Administration, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost prohibitive for most patients.

Safety of Acupuncture and Pharmacopuncture in 80,523 Musculoskeletal Disorder Patients: A Retrospective Review of Internal Safety Inspection and Electronic Medical Records.

We investigated the range and frequency of significant adverse events (AEs) in use of pharmacopuncture and acupuncture using large-scale, single-center safety data as evidence supporting safety of acupuncture with pharmacopuncture, used extensively in Asia, is scarce. Status reports (nurse records in ambulatory and inpatient care units, and administrative event records) as a part of an internal audit at a Korean Medicine hospital specializing in the treatment of musculoskeletal disorders, patient complaints filed through the hospital website, and medical records of patients visiting from December, 2010 (inception of internal audit) to October, 2014 were retrospectively reviewed. A total 80,523 patients (5966 inpatients and 74,557 outpatients) visited during this period. Inpatients received an average 31.9 ±â€Š20.7 acupuncture, 23.0 ±â€Š15.6 pharmacopuncture, and 15.4 ±â€Š11.3 bee venom pharmacopuncture sessions, and outpatients were administered 8.2 ±â€Š12.2 acupuncture, 7.8 ±â€Š11.5 pharmacopuncture, and 10.0 ±â€Š12.3 bee venom sessions, respectively. AEs associated with acupuncture/pharmacopuncture were forgotten needle (n = 47), hypersensitivity to bee venom (n = 37), presyncopic episode (n = 4), pneumothorax (n = 4), and infection (n = 2). Most cases were mild requiring little or no additional intervention and leaving no sequelae. Although serious AEs including infection (n = 2) and anaphylaxis associated with bee venom treatment (n = 3) were also reported, incidence was rare at 0.002% in infection and 0.019% in anaphylaxis. Incidence of AEs associated with acupuncture/pharmacopuncture treatment was low, and most cases were not serious. Still, however rare, avoidable AEs can and should be prevented through education and corrective action. Further prospective studies on the effect of error reduction strategies on incidence of adverse effects are warranted.

Laser and energy-based devices' complications in dermatology.

Laser dermatology is an ever-expanding part of the specialty used extensively for both aesthetic and medical conditions. Advances in laser technology have led to an expansion in the number of devices available, with as a consequence an increase in the total number of complications. Fortunately, the current technology has improved greatly which adds to the safety profile of such devices; nevertheless, thorough knowledge of laser complications and how to avoid them is paramount for any practitioner who uses such technology.

Adverse events associated with acupuncture: a clinicopathologic review.

BACKGROUND: Acupuncture is one of the most popular modalities used to treat various diseases in traditional Korean and Oriental medicine. However, its risk of adverse events can be easily overlooked. OBJECTIVE: We investigated dermatological adverse events associated with acupuncture to draw attention to the risk of such adverse events. METHODS: We evaluated the types of acupuncture, clinicopathologic diagnoses, treatments, and prognoses in patients with a causal relationship between acupuncture and dermatoses. RESULTS: The study population comprised 25 patients (mean age, 52 years) with a history of acupuncture. Bee venom acupuncture was performed the most frequently (13 of 25 patients), and most patients received acupuncture to control pain (19 of 25 patients). The most common adverse event was infectious skin disease such as atypical mycobacterial infection or pyoderma/abscess, followed by hypersensitivity reactions, localized lipoatrophy, and hypertrophic scar. Acupuncture-related dermatoses required a relatively long treatment period (average, 8.6 weeks). CONCLUSION: Various dermatoses may occur following acupuncture. To minimize the risk of these dermatoses, proper training and medical knowledge in acupuncture practice are necessary for medical personnel. Dermatologists, oriental medical practitioners, and patients should pay attention to the potential adverse events of acupuncture.

[Antibiotic susceptibility of bacteria isolated from diabetic foot infections and prospects for empiric antibiotic therapy in Ouagadougou (Burkina Faso)]. / Étude de la sensibilité aux antibiotiques des bactéries isolées lors de l'infection du pied diabétique et perspectives d'antibiothérapie à Ouagadougou (Burkina Faso).

INTRODUCTION: The aim of this study was to study the antibiotic susceptibility of bacteria isolated from diabetic foot infections to help improve empiric antibiotic prescription in Ouagadougou, where bacteriological testing is rarely possible. METHOD: This cross-sectional study took place from July 1, 2011, to June 30, 2012, in the departments of internal medicine and general and gastrointestinal surgery in the Yalgado Ouédraogo teaching hospital. Bacteria were isolated from diabetic foot infections and their antibiotic sensitivity was tested by the qualitative method (Kirby-Bauer). RESULTS: The study included 64 patients, with a median age of 57 years (interquartile range: 48-75) and a M/F sex ratio of 1.37. Among them, 39 had received antibiotics before hospitalization. Among the 71 samples, 62 cultures (87%) were positive: 53 for a single microbe (85%) and 9 for two microbes (15%). Microorganisms were mainly aerobic and anaerobic Gram-positive cocci (76%), including Staphylococcus aureus (SA) (33%) and Streptococcus spp (18%). These Gram-positive cocci were highly sensitive to amoxicillin-clavulanic acid and oxacillin. No methicillin-resistant SA (MRSA) were isolated. Enterobacteriaceae (24 %) were highly susceptible to imipenem and ticarcillin, but not to ceftriaxone or ciprofloxacin. No extended-spectrum beta-lactamase Enterobacteriaceae (ESBL) were isolated. Pseudomonas aeruginosa was highly susceptible to ciprofloxacin and imipenem. CONCLUSION: Despite our study's limitations, our findings show that most diabetic foot infections can be successfully treated with standard antibiotics.

Atopic Dermatitis: A Common Pediatric Condition and Its Evolution in Adulthood.

Atopic dermatitis (AD) is a chronic and pruritic inflammatory skin disorder that has a relapsing course and can affect any age group. Patients with AD have higher rates of other allergic disorders, mental health disorders, and skin infections. An important feature of AD for practitioners to recognize is that the clinical presentation varies by age from infancy into adulthood. The goals of treatment and management of AD focuses on restoring and maintaining the skin barrier function, minimizing inflammation, breaking the itch-scratch cycle, and treating possible external triggers and secondary infections that may propagate AD.

[Dynamics of local expression of connexin-43 and basic fibroblast growth factor receptors in patients with skin and soft-tissue infections against the background of diabetes mellitus type II].

Clinical results of wound healing dynamics were studied in 60 patients with soft-tissue infection against the background of diabetes mellitus type II. At the same time the study considered indices of intercellular contacts protein tissue expression such as connexin 43 (Cx43) and basic fibroblast growth factor receptors (bFGFR). The basic therapy of biopsy material of wound borders was applied. The reduction of bFGFR expression and the minor growth of Cx43 expression were observed. The pain syndrome proceeded for a long time and there were signs of perifocal inflammation, retard wound healing with granulation tissue. The application of combined method of ozone therapy which included autohemotherapy with ozone and an external management of wound by ozone-oxygen mixture facilitated to considerable shortening of inflammatory phase and regeneration. It was associated with increased Cx43 expression (in 1.9 times) in comparison with initial level and bFGFR was enlarged in 1.7 times to eighth day of postoperative period.

Complications in lasers, lights, and radiofrequency devices.

Lights, lasers, and radiofrequency are unique sources of energy that are increasingly utilized for therapeutic and cosmetic purposes. As the indications for these tools continue to increase and their use expands beyond physicians to aestheticians, physician-extenders, and technicians, the incidence of complications has also risen. It is imperative that operators of these tools be as familiar with the management of potential complications as they are with their usage and indications. This article serves as a review of potential complications encountered with usage of lasers, lights, and radiofrequency devices in dermatology.

Successful strategies in atopic dermatitis management.

Successful strategies for managing atopic dermatitis require an accurate diagnosis, identification and elimination of exacerbating factors including irritants and allergens, adequate hydration of the skin, control of pruritus and infections, and appropriate use of topical anti-inflammatory and other medications. Proper patient education increases the chances of successful therapy.

Melaleuca alternifolia (Tea Tree) oil: a review of antimicrobial and other medicinal properties.

Complementary and alternative medicines such as tea tree (melaleuca) oil have become increasingly popular in recent decades. This essential oil has been used for almost 100 years in Australia but is now available worldwide both as neat oil and as an active component in an array of products. The primary uses of tea tree oil have historically capitalized on the antiseptic and anti-inflammatory actions of the oil. This review summarizes recent developments in our understanding of the antimicrobial and anti-inflammatory activities of the oil and its components, as well as clinical efficacy. Specific mechanisms of antimicrobial and anti-inflammatory action are reviewed, and the toxicity of the oil is briefly discussed.

Treatment of childhood eczema.

Eczema in childhood is almost always atopic eczema, a common disease with huge impact on the quality of life of the child and family. Although atopic eczema constitutes part of the atopic syndrome, avoidance of allergens is never enough for disease control. Treatment of eczema in childhood has the same components as in adults. Emollients constitute the preventive background therapy in all stages of eczema, and topical corticosteroids are still the mainstay of treatment. Infectious exacerbation may require the use of a short course of topical or systemic antimicrobials. UV phototherapy should be considered as an adjunctive treatment to assist topical corticosteroids after an acute exacerbation of the disease. Cyclosporine can also be used in the treatment of childhood eczema in severe cases. Maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house-dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, and topical coal tar are other temporarily used treatment modalities, without, however, firm evidence of efficacy from proper controlled trials. Calcineurin inhibitors constitute a new generation of drugs for both adult and childhood eczema already marketed in some countries. It is postulated that they will replace topical corticosteroids as first-line treatment of eczema.

Eficacia de la monoterapia con piperacilina/tazobactám en infecciones de piel y partes blandas / Effectiveness of monotherapy with piperacillin/tazobactam in skin and soft tissue infections

Introducción. Se evaluaron la eficacia clínica por intención de tratar y la seguridad de piperacilina/tazobactám (monoterapia) en las infecciones de piel y partes blandas, así como los efectos secundarios ocasionados por dicho fármaco. Pacientes y métodos. Se realizó un estudio multicéntrico, prospectivo, observacional, en el que se incluyeron 160 pacientes con infección de piel y partes blandas, procedentes de los 15 centros participantes. Tras estandarizar los criterios diagnósticos, los pacientes fueron sometidos al protocolo de inclusión y se administró el fármaco indicado, por vía intravenosa, a dosis de 4/0,5 g cada 8 h. Se realizó control bacteriológico al inicio y al final del tratamiento. Resultados. La edad media de los pacientes fue de 57,3 años, con un porcentaje de varones afectados del 60,7 por ciento. La mayor parte de las infecciones fueron extrahospitalarias, y la diabetes fue el factor predisponente en más de la mitad de casos. El 43,8 por ciento de los procesos fue catalogado como grave. Se aisló el microorganismo responsable de la infección en el 59,3 por ciento de los casos, siendo la mayor parte monomicrobianas. Se suspendió el protocolo en 18 casos (11,2 por ciento) y aparecieron 8 casos de reacciones adversas relacionadas con el fármaco. La evaluación clínica indicó una respuesta favorable del 88,8 por ciento a la monoterapia con piperacilina/tazobactám, y la erradicación o presunta erradicación bacteriana alcanzó el 63,8 por ciento de pacientes. Conclusiones. En nuestra experiencia, la eficacia de piperacilina/tazobactám permite utilizar este antibiótico de forma empírica en monoterapia en infecciones graves de piel y partes blandas (AU)

Possible use of Betadine in HIV-positive patients.

The results of Betadine treatment obtained in the course of a one-year period proved the usefulness of the bacteriostatic and bactericidal product as a disinfectant of the skin and mucosa in immuno-deficiency diseases, in our cases in AIDS (but supposedly in other similar diseases as well). In these diseases this new therapeutic means does supply a need. The solution was successfully used in patients in whom superficial decontamination is of high importance and whose cutaneous and mucosal infections had raised therapeutic problems for years. Side-effects were not observed. The product could be easily applied. If the germ count of the atrophying pathogen is not very high and the lesion is due supposedly to mixed infection, the product will be effective even in monotherapy. Similarly, in mild mycotic infections systemic therapy could be avoided. In cases of purulent alterations the solution is successfully applied as an adjuvant to antibacterial treatment and its continuous use prevents early recurrence. The long-term use of the product did not cause side-effects, irritation of the skin or the mucosa.

Varicella-zoster infection in adult cancer patients. A population study.

In a retrospective review of varicella-zoster (V-Z) Infections in adult cancer patients, 766 episodes of V-Z Infection were studied among 740 patients seen at a large comprehensive cancer center from 1972 to 1980. The highest risk of infection was present among patients with lymphoma and leukemia. The risk of dissemination of V-Z Infection was significantly associated with the presence of active tumor at the time of Infection. The site of the primary tumor correlated with the site of subsequent zoster Infection among patients with breast cancer, cancer of the respiratory tract, and gynecologic cancer. Pain attributable to V-Z Infection was present in a large majority of episodes. The median time from the completion of therapy to the onset of Infection was seven months for patients receiving radiotherapy and less than one month for those receiving chemotherapy. Various attributes of this study group were compared with those of previously studied cancer and noncancer populations.