Nasal Vestibulitis and Vestibular Furunculosis: a systematic review about two common nasal infections and considerations about correct diagnosis and management.

Background: Nasal vestibulitis (NV) and nasal vestibular furunculosis (NVF) are two infectious processes of the nasal vestibule, sharing common etiology, the same risk of complications, and similar treatment while remaining two different pathological entities. Methods: We performed a comprehensive literature research on NV and NVF in PubMed, Cochrane, and Google Scholar databases, with the aim to review the evidence on these two conditions and discuss the therapeutic approaches. Results: We identified a total of 248 records; according to our inclusion/exclusion criteria, 27 of them, published over a period of 59 years (1962-2021), were included in this review. Conclusion: NV and NVF are reported to be common conditions, with well-known etiological agents and risk factors. The diagnosis is clinical and topical antibiotics are the mainstay of treatment. Complications appear to be infrequent. Further studies are necessary to clarify the pathogenetic mechanisms and the exact prevalence of both conditions.

Phage Cocktail Development against Aeromonas salmonicida subsp. salmonicida Strains Is Compromised by a Prophage.

Aquaculture is a rapidly growing food production sector. Fish farmers are experiencing increasing problems with antibiotic resistance when fighting against pathogenic bacteria such as Aeromonas salmonicida subsp. salmonicida, the causative agent of furunculosis. Phage therapy may provide an alternative, but effective use must be determined. Here, we studied the inhibition of A. salmonicida subsp. salmonicida strains by five phages (HER98 [44RR2.8t.2], HER110 [65.2], SW69-9, L9-6 and Riv-10) used individually or as combinations of two to five phages. A particular combination of four phages (HER98 [44RR2.8t.2], SW69-9, Riv-10, and HER110 [65.2]) was found to be the most effective when used at an initial multiplicity of infection (MOI) of 1 against the A. salmonicida subsp. salmonicida strain 01-B526. The same phage cocktail is effective against other strains except those bearing a prophage (named Prophage 3), which is present in 2/3 of the strains from the province of Quebec. To confirm the impact of this prophage, we tested the effectiveness of the same cocktail on strains that were either cured or lysogenized with Prophage 3. While the parental strains were sensitive to the phage cocktail, the lysogenized ones were much less sensitive. These data indicate that the prophage content of A. salmonicida subsp. salmonicida can affect the efficacy of a cocktail of virulent phages for phage therapy purposes.

Self-Reported Pain Alleviating Methods in Patients with Hidradenitis Suppurativa. / Métodos referidos por los pacientes para aliviar el dolor asociado a la hidradenitis supurativa.

BACKGROUND: Pain is a common, important symptom negatively affecting the well-being and quality of life of patients with hidradenitis suppurativa (HS). The aim of this study was to examine self-reported pain alleviating methods among outpatients attending a tertiary referral center. METHODS: Consecutive patients with HS were invited to complete a questionnaire regarding their self-reported pain alleviating methods for HS associated pain. Additionally, the patients filled out the Dermatology Life Quality Index questionnaire and a visual analog scale for overall distress related to HS and for boil-associated pain in the past month. Information on disease severity and onset was obtained by interview and clinical examination. RESULTS: A total of 134 patients with a mean age of 38.3 years (SD 12.8) participated; 32% (n=43) had Hurley stage i, 52% (n=70) had Hurley stage ii, and 16% (n=21) had Hurley stage iii. Overall, to achieve pain relief, 82% (n=110) of the patients had previously drained pus from the lesions by manual pressure. Compared to patients who did not alleviate pain, patients who attempted to alleviate pain had a higher mean overall disease related distress score (7.43 [SD 2.81] vs. 5.47 [SD 3.37], P<.003), and a higher boil-associated pain score in the past month (6.56 [SD 3.07] vs. 4.39 [SD 3.88], P=.007). CONCLUSION: This study demonstrates that a large proportion of HS patients attempt to alleviate pain through various alternative and homespun methods. These results may reflect a major role of pain in HS and its potential insufficient management by dermatologists.

Pressure- and dose-controlled transcutaneous pneumatic injection of hypertonic glucose solution for the treatment of atrophic skin disorders.

BACKGROUND: Needleless transcutaneous pneumatic injections (TPIs) are a minimally invasive way to deliver the solution into the skin for therapeutic purposes. The suggested action mechanisms of TPI therapy include mechanical stimulation, immediate tissue shrinkage and late wound healing. METHODS: Thirteen Korean patients were treated with TPI for atrophic skin disorders, including acne scars, striae albae, post-furuncle, or carbuncle scars, and horizontal wrinkles with lipoatrophy. At each TPI treatment session, a single pass was made along with the atrophic skin lesions without overlapping. Thereafter, two dermatologists objectively evaluated the clinical improvement in the lesions in the photographs via the global aesthetic improvement scale (GAIS). RESULTS: One month after the final treatment, the overall mean GAIS score was 2.3 ± 0.8. Six of the 13 (46.2%) patients exhibited clinical improvement of grade 3, five (38.5%) patients grade 2 and two (15.4%) patients grade 1. The overall mean subjective satisfaction score with the TPI treatment was 2.3 ± 0.9. Six of the 13 (46.2%) patients achieved subjective satisfaction of grade 3, six (46.2%) patients grade 2 and one (7.7%) patient grade 0. CONCLUSIONS: The present study demonstrated that the TPI treatment is effective and safe for treating atrophic skin disorders of varying causes in Korean patients.

Boils at Frictional Locations in a Patient with Hidradenitis Suppurativa.

Dear Editor, Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease. The primary clinical presentation are painful inflamed nodules or boils of inverse areas, i.e. the axillary and anogenito-crural regions, but it can also involve the infra- and inter-mammary regions (1,2). The etiology of HS is not clearly defined. Obesity, smoking, and genetic factors are considered important risk factors. In addition, it has also been suggested that friction may contribute to the development of HS, especially in the obese, but this is based on highly anecdotal reports (3-5). We describe a case with classic HS, obesity, and HS-like lesions at the position of the bra strap, suggesting that mechanical stress was an external pathogenic factor for HS development. A 33-year old woman presented with an 18-year history of chronic, recurrent, inflammatory nodules in the axillae, the groin, the pubic region, and to a lesser extent the abdomen and buttocks. She was obese with as result of 33.2 kg/m-2 of 33.2, had a positive family history of two first grade family members with HS, and was a smoker (19 Pack years). There were no other known comorbidities. The inflamed lesions had been treated with several courses of oral antibiotics (minocycline, erythromycin, and combination therapy of clindamycin and rifampicine) and surgical treatments: lancing, deroofing, and excisions (2,6). On examination, there were nodules, folliculitis, cysts, and depressed scars in the axillae and groins, including the inner thighs (Figure 1). On the chest, corresponding to where the lower edge of the patient's bra was usually located, a superficial nodule and follicular papules were observed, exactly coinciding with the red stripe caused by mechanical stress (friction and pressure) of the bra edge. There was no skin fold present on the location of the HS lesions, and there were no lesions observed in the intermammary region or on the side of the breasts in contact with the skin of the thorax (skin to skin contact) (Figure 2). Cultures from skin swabs showed commensal skin flora and moderate mixed anaerobic bacteria, as would be expected in a HS lesion. It is well documented that HS is a disease of the obese. However, the role of friction as an environmental factor is poorly documented. Patients report that environmental factors such as tight-fitting clothing or friction could cause flares in the disease (2). Furthermore, it has been postulated that friction may contribute to the development of HS by stimulating interfollicular hyperplasia (7). HS lesions arranged in a linear pattern suggest an environmental influence and suggests an etiopathogenic role for mechanical stress. Waistline, or as in this case the chest line, distribution indicates that wearing of tight waistbands, wide belts, or bras may induce HS in predisposed individuals. To our knowledge, there is only one case report describing an obese patient with classic HS (typical lesions in predilection areas) who developed HS like lesions on the upper abdomen (waist) at the height of the waistband as well as under the lower abdominal apron (skin on skin contact) (8). Two other reports suggesting a pathogenic role for mechanical stress are flawed, however, as neither of the cases showed signs of concomitant classic HS or had a family history, bringing into question the implied association of HS (9,10). In summary, we presented a case with classic HS locations (typical lesions on typical locations, i.e. the axillae and inguino-crural regions) developing inflammatory lesions on the chest at the location closely corresponding to where the bra strap was exerting mechanical pressure and friction on the skin. The lesions were clinically and microbiologically compatible with ectopic HS lesions. The chest is an atypical HS location free of apocrine sweat glands. It is postulated that these lesions may have been induced by mechanical stress, additionally triggered by the pro-inflammatory state of the obese body. Patients are encouraged to avoid friction from environmental factors such as tight clothing.

Análise combinada de casos homeopáticos de alta qualidade / Combined analysis of high-quality homeopathic cases

Um protocolo para Relato de Casos Clínicos Homeopáticos de Alta Qualidade (RCCHAQ) foi desenvolvido por C.N. Cámpora, tendo coerência interna como critério principal, além de categorizar a documentação clínico-patológica que fundamenta o diagnóstico e a pretensão de sucesso terapêutico. A análise conjunta de 4 estudos, no presente trabalho, permitiu elucidar como RCCHAQs podem ser utilizados para avaliar os efeitos da homeopatia hahnemanniana clássica em doenças crônicas de longa evolução. Todos os casos foram tratados de acordo com o método desenvolvido por Cámpora, denominado Fórmula Homeopática de Diagnóstico do Simillimum (FHDS). A duração média das queixas antes d tratamento homeopático foi de 5,4 anos e os casos foram acompanhados por 3 anos em média. Os casos estão completamente documentados em vídeo, atestados assinados, registros de testemunhas, resultados laboratoriais e escalas de dor e qualidade de vida. Todas as pacientes relataram mudanças substanciais, definidas como cura (melhora de mais de 90%) dos sintomas locais, gerais e mentais acompanhando uma profunda transformação de sua atitude vital, descrita como uma sensação de paz, liberdade ou felicidade, segundo a definição do Banco de Relato e Estudo de Casos Homeopáticos de Argentina (BRECHA]. Em todos os casos a medicação convencional prévia foi suspensa num período de 1 a 3 meses. Os resultados mostram que RCCHAQs contribuem a tornar os relatos de cais um recurso confiável no contexto da moderna medicina baseada em evidências, assim como podem ajudar a melhorar o desenho de estudos homeopáticos prospectivos, incluindo ensaios clínicos placebo-controlados.

A High Quality Homeopathic Clinical Case Report (HHQCR) Protocol exhaustively including requisites to constitute a reliable documented clinical report was developed by C.N. Cámpora. The protocol requires measuring homeopathic internal coherence and categorizes clinicalpathological backing documentation. Through joint analysis of 4 cases the present study elucidates how HHQCRs can be used to assess the effects of classical Hahnemannian homeopathy on longstanding chronic diseases. The mean duration of complaints before homeopathic treatment was 5.4 years and the duration of follow up 3 years on average. Cases are fully documented with complete video-recordings of consultations, signed certifications, third party recorded statements, laboratory results and pre-post treatment pain and quality-of-life scales. All the patients reported substantial change, defined as cure (>90% improvement) of local, general and mental symptoms accompanying a deep transformation their life attitude described as a feeling of peace, freedom or happiness. Also all of them were able to discontinue previous conventional treatment within the first 1 to 3 months of homeopathic treatment. The results show that HHQCRs contributes to make case reports a reliable resource within the context of modern evidence-based medicine and might help improving the design of prospective homeopathic studies, including randomized placebo-controlled trials.

Análise combinada de casos homeopáticos de alta qualidade / Combined analysis of high-quality homeopathic cases

Um protocolo para Relato de Casos Clínicos Homeopáticos de Alta Qualidade (RCCHAQ) foi desenvolvido por C.N. Cámpora, tendo coerência interna como critério principal, além de categorizar a documentação clínico-patológica que fundamenta o diagnóstico e a pretensão de sucesso terapêutico. A análise conjunta de 4 estudos, no presente trabalho, permitiu elucidar como RCCHAQs podem ser utilizados para avaliar os efeitos da homeopatia hahnemanniana clássica em doenças crônicas de longa evolução. Todos os casos foram tratados de acordo com o método desenvolvido por Cámpora, denominado Fórmula Homeopática de Diagnóstico do Simillimum (FHDS). A duração média das queixas antes d tratamento homeopático foi de 5,4 anos e os casos foram acompanhados por 3 anos em média. Os casos estão completamente documentados em vídeo, atestados assinados, registros de testemunhas, resultados laboratoriais e escalas de dor e qualidade de vida. Todas as pacientes relataram mudanças substanciais, definidas como cura (melhora de mais de 90%) dos sintomas locais, gerais e mentais acompanhando uma profunda transformação de sua atitude vital, descrita como uma sensação de paz, liberdade ou felicidade, segundo a definição do Banco de Relato e Estudo de Casos Homeopáticos de Argentina (BRECHA]. Em todos os casos a medicação convencional prévia foi suspensa num período de 1 a 3 meses. Os resultados mostram que RCCHAQs contribuem a tornar os relatos de cais um recurso confiável no contexto da moderna medicina baseada em evidências, assim como podem ajudar a melhorar o desenho de estudos homeopáticos prospectivos, incluindo ensaios clínicos placebo-controlados. (AU)

A High Quality Homeopathic Clinical Case Report (HHQCR) Protocol exhaustively including requisites to constitute a reliable documented clinical report was developed by C.N. Cámpora. The protocol requires measuring homeopathic internal coherence and categorizes clinicalpathological backing documentation.Through joint analysis of 4 cases the present study elucidates how HHQCRs can be used to assess the effects of classical Hahnemannian homeopathy on longstanding chronic diseases. The mean duration of complaints before homeopathic treatment was 5.4 years and the duration of follow up 3 years on average. Cases are fully documented with complete video-recordings of consultations, signed certifications, third party recorded statements, laboratory results and pre-post treatment pain and quality-of-life scales. All the patients reported substantial change, defined as cure (>90% improvement) of local, general and mental symptoms accompanying a deep transformation their life attitude described as a feeling of peace, freedom or happiness. Also all of them were able to discontinue previous conventional treatment within the first 1 to 3 months of homeopathic treatment. The results show that HHQCRs contributes to make case reports a reliable resource within the context of modern evidence-based medicine and might help improving the design of prospective homeopathic studies, including randomized placebo-controlled trials. (AU)

Incidence and recurrence of boils and abscesses within the first year: a cohort study in UK primary care.

BACKGROUND: Boils and abscesses are common in primary care but the burden of recurrent infection is unknown. AIM: To investigate the incidence of and risk factors for recurrence of boil or abscess for individuals consulting primary care. DESIGN AND SETTING: Cohort study using electronic health records from primary care in the UK. METHOD: The Health Improvement Network (THIN) database was used to identify patients who had consulted their GP for a boil or abscess. Poisson regression was used to examine the relationship between age, sex, social deprivation, and consultation and to calculate the incidence of, and risk factors for, repeat consultation for a boil or abscess. RESULTS: Overall, 164 461 individuals were identified who consulted their GP for a boil or abscess between 1995 and 2010. The incidence of first consultation for a boil or abscess was 512 (95% CI = 509 to 515) per 100 000 person-years in females and 387 (95% CI = 385 to 390) per 100 000 person-years in males. First consultations were most frequent in younger age groups (16-34 years) and those with the greatest levels of social deprivation. The rate of repeat consultation for a new infection during follow up was 107.5 (95% confidence interval [CI] = 105.6 to 109.4) per 1000 person-years. Obesity (relative risk [RR] 1.3, 95% CI = 1.2 to 1.3), diabetes (RR 1.3, 95% CI = 1.2 to 1.3), smoking (RR 1.3, 95% CI = 1.2 to 1.4), age <30 years (RR 1.2, 95% CI = 1.2 to 1.3), and prior antibiotic use (RR 1.4, 95% CI = 1.3-1.4) were all associated with repeat consultation for a boil or abscess. CONCLUSION: Ten percent of patients with a boil or abscess develop a repeat boil or abscess within 12 months. Obesity, diabetes, young age, smoking, and prescription of an antibiotic in the 6 months before initial presentation were independently associated with recurrent infection, and may represent options for prevention.

Furúnculo, furunculosis y ántrax: abordaje y tratamiento / Management of furuncle, furunculosis and anthrax

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[Skin and soft tissue infections in children: consensus on diagnosis and treatment]. / Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento.

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectiologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento: Parte 1 / Skin and soft tissue infections in children: consensus on diagnosis and treatment

Las infecciones de piel y partes blandas son una causa frecuente de consulta en los centros de atención primaria de la salud. Los datos de la epidemiología local de estas infecciones son escasos; el Staphylococcus aureus y el Streptococcus pyogenes son los principales agentes etiológicos. La emergencia, en los últimos años, de cepas de S. aureus meticilino resistentes provenientes de la comunidad y S. pyogenes resistentes a eritromicina plantea controversias en la elección del tratamiento empírico inicial. Este consenso nacional está dirigido a médicos pediatras, de familia, dermatólogos, infectólogos y otros profesionales de la salud. Trata el manejo clínico, especialmente el diagnóstico y tratamiento, de las infecciones de piel y partes blandas de origen bacteriano provenientes de la comunidad en pacientes inmunocompetentes menores de 19 años de edad.

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of commu-nity-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

Lancing of a boil leading to severe invasive methicillin-sensitive Staphylococcus aureus infection in an adolescent.

A 10-year-old boy presented to the emergency department with chief symptoms of fever and right leg pain for 3 days. Also of note, he reported that he had a boil on his neck 2 weeks prior to admission. This lesion was lanced by his mother with a hot needle. An X-ray, CT scan and MRI of the right knee showed no evidence of osteomyelitis. He was placed on intravenous vancomycin for empiric treatment. Blood culture grew methicillin-susceptible Staphylococcus aureus (MSSA), susceptible to vancomycin and clindamycin. He continued to spike fever with the development of erythema, and swelling of the distal thigh. Repeat MRI of the right knee showed osteomyelitis and subperiosteal abscess in the distal femur shaft with surrounding intramuscular abscesses and pyomyositis. He was taken to the operating room where 50 mL of fluid was drained from the periosteal abscess and a bone biopsy was obtained. Bone marrow culture also grew MSSA, susceptible to clindamycin.

Forúnculo de la nariz / Furuncle of the nose

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[Treatment of recurrent furunculosis]. / Behandeling van recidiverende furunculose.

The management of recurrent furunculosis is difficult, and often disappointing. We present the case of a 23-year-old female patient suffering from recurrent furunculosis. The furunculosis persisted after treatment with mupirocin nasal ointment, chlorhexidine soap and instructions for washing clothes, towels and bed sheets for a period of 7 days. Treatment with low-dose clindamycin for three months ultimately proved successful. We propose a structural approach for recurrent furunculosis in which extensive history-taking is followed by appropriate tests. Before prescribing an oral antibiotic (preferably low-dose clindamycin or a macrolide for 3 months), the patient should use an antimicrobial nasal ointment and soap and follow hygienic instructions as mentioned above. Members of the household who also have signs of the infection should be treated. Hygienic education is an essential component of treatment. We believe that this approach will lead to a treatment that is more effective and efficient.