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1.
Pediatr Dermatol ; 38(5): 1111-1117, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34338362

RESUMO

BACKGROUND: Despite the large burden of impetigo in childhood and high frequency of pediatric emergency department (ED) visits for skin conditions, limited information exists on the use of EDs for impetigo among US children. OBJECTIVE: Our study aimed to generate national estimates of ED utilization and to identify sociodemographic predictors of impetigo-related ED visits. METHODS: This was a retrospective, cross-sectional study of children ages 1-17 presenting to EDs with a primary diagnosis of impetigo using years 2013-2015 of the Nationwide Emergency Department Sample. RESULTS: Impetigo accounted for 163 909 of the 71 488, 511 pediatric ED visits and was the fourth most common presenting skin diagnosis. Controlling for sociodemographic factors, patients presenting to the ED with impetigo were most likely to be 6-11 years old, male, and from lower-income quartiles. Patients were most likely to be uninsured and most likely to present on weekends in the summer. CONCLUSION: This study provided national-level estimates of ED use for impetigo among US children. Ultimately, the identification of factors associated with increased ED utilization may help in developing targeted interventions to reduce the use of emergency care for impetigo.


Assuntos
Impetigo , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico , Impetigo/epidemiologia , Lactente , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia
3.
Med Clin North Am ; 105(4): 783-797, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059250

RESUMO

This evidence-based review highlights cutaneous infections of bacterial, viral, and fungal origin that are frequently encountered by clinicians in all fields of practice. With a focus on treatment options and management, the scope of this article is to serve as a reference for physicians, regardless of field of specialty, as they encounter these pathogens in clinical practice.


Assuntos
Infecções Bacterianas/patologia , Infecções por Herpesviridae/patologia , Micoses/patologia , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/patologia , Adolescente , Adulto , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Ectima/diagnóstico , Ectima/tratamento farmacológico , Erisipela/diagnóstico , Erisipela/tratamento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/tratamento farmacológico , Foliculite/diagnóstico , Foliculite/tratamento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Herpes Labial/diagnóstico , Herpes Labial/tratamento farmacológico , Infecções por Herpesviridae/complicações , Infecções por Herpesviridae/virologia , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico , Erupção Variceliforme de Kaposi/diagnóstico , Erupção Variceliforme de Kaposi/tratamento farmacológico , Pessoa de Meia-Idade , Micoses/complicações , Micoses/microbiologia , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Dermatopatias Infecciosas/microbiologia , Dermatopatias Infecciosas/virologia , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Adulto Jovem
4.
Int J Infect Dis ; 108: 333-339, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34022330

RESUMO

BACKGROUND: Invasive Staphylococcus aureus (iSA) and group A Streptococcus (iGAS) impose significant health burdens globally. Both bacteria commonly cause skin and soft tissue infections (SSTIs), which can result in invasive disease. Understanding of the incidence of iSA and iGAS remains limited in settings with a high SSTI burden. METHODS: Prospective surveillance for admissions with iSA or iGAS was conducted at the referral hospital in Fiji's Northern Division over 48 weeks between July 2018 and June 2019. RESULTS: There were 55 admissions for iSA and 15 admissions for iGAS (incidence 45.2 and 12.3 per 100,000 person-years, respectively). The highest incidence was found in patients aged ≥65 years (59.6 per 100,000 person-years for iSA and iGAS). The incidence of iSA was higher in indigenous Fijians (iTaukei) (71.1 per 100,000 person-years) compared with other ethnicities (incidence rate ratio 9.7, 95% confidence interval 3.5-36.9). SSTIs were found in the majority of cases of iSA (75%) and iGAS (53.3%). Thirteen of the 14 iGAS strains isolated belonged to emm cluster D (n = 5) or E (n = 8). The case fatality rate was high for both iSA (10.9%) and iGAS (33.3%). CONCLUSIONS: The incidence of iSA and iGAS in Fiji is very high. SSTIs are common clinical foci for both iSA and iGAS. Both iSA and iGAS carry a substantial risk of death. Improved control strategies are needed to reduce the burden of iSA and iGAS in Fiji.


Assuntos
Impetigo , Escabiose , Infecções Estreptocócicas , Humanos , Impetigo/epidemiologia , Estudos Prospectivos , Staphylococcus aureus , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes
6.
Clin Ther ; 43(6): 986-1006, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34053699

RESUMO

PURPOSE: Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings. METHODS: We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias. FINDINGS: We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings. IMPLICATIONS: This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.


Assuntos
Impetigo , Antibacterianos/uso terapêutico , Criança , Humanos , Impetigo/tratamento farmacológico , Impetigo/epidemiologia , Pomadas , Resultado do Tratamento
8.
PLoS Negl Trop Dis ; 15(4): e0009330, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33861741

RESUMO

BACKGROUND: Scabies is often endemic in tribal communities and difficult to control. We assessed the efficacy of a community-based intervention using mass screening and treatment with oral ivermectin in controlling scabies. METHODS/ FINDINGS: In this cluster randomised controlled trial, 12 villages were randomly selected from a cluster of 42 tribal villages in Gadchiroli district. In these villages, trained community health workers (CHWs) conducted mass screening for scabies. The diagnosis was confirmed by a physician. Six villages each were randomly allocated to the intervention and usual care arm (control arm). In the intervention arm (population 1184) CHWs provided directly observed oral ivermectin to scabies cases and their household contacts. In the usual care arm (population 1567) scabies cases were referred to the nearest clinic for topical treatment as per the standard practice. The primary outcome was prevalence of scabies two months after the treatment. Secondary outcomes were prevalence of scabies after twelve months of treatment and prevalence of impetigo after two and twelve months of treatment. Outcomes were measured by the team in a similar way as the baseline. The trial was registered with the clinical trial registry of India, number CTRI/2017/01/007704. In the baseline, 2 months and 12 months assessments 92.4%, 96% and 94% of the eligible individuals were screened in intervention villages and 91.4%, 91.3% and 95% in the usual care villages. The prevalence of scabies in the intervention and usual care arm was 8.4% vs 8.1% at the baseline, 2.8% vs 8.8% at two months [adjusted relative risk (ARR) 0.21, 95% CI 0.11-0.38] and 7.3% vs 14.1% (ARR 0.49, 95% CI 0.25-0.98) at twelve months The prevalence of impetigo in the intervention and usual care arm was 1.7% vs 0.6% at baseline, 0.6% vs 1% at two months (ARR 0.55, 95% CI 0.22-1.37) and 0.3% vs 0.7% at 12 months (ARR 0.42, 95% CI 0.06-2.74). Adverse effects due to ivermectin occurred in 12.1% of patients and were mild. CONCLUSIONS: Mass screening and treatment in the community with oral ivermectin delivered by the CHWs is superior to mass screening followed by usual care involving referral to clinic for topical treatment in controlling scabies in this tribal community in Gadchiroli.


Assuntos
Anti-Infecciosos/administração & dosagem , Impetigo/tratamento farmacológico , Ivermectina/administração & dosagem , Administração Massiva de Medicamentos , Escabiose/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Anti-Infecciosos/efeitos adversos , Criança , Pré-Escolar , Serviços de Saúde Comunitária , Feminino , Humanos , Impetigo/epidemiologia , Índia/epidemiologia , Ivermectina/efeitos adversos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Escabiose/epidemiologia , Resultado do Tratamento , Adulto Jovem
10.
J Drugs Dermatol ; 20(4): 366-372, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33852242

RESUMO

BACKGROUND: Impetigo is a contagious bacterial infection that affects the superficial skin layers. Increasing worldwide antimicrobial resistance (AMR) to existing topical agents commonly prescribed to treat impetigo is central to treatment failure. The Worldwide Health Organization developed a global action plan on AMR, but omitted information about AMR stewardship programs for topical antibiotics. OBJECTIVES: The review aims to provide information to clinicians and stakeholders regarding AMR and antimicrobial stewardship on topical antimicrobial drugs for impetigo treatment. METHODS: The literature searches reviewed the status of AMR to current topical antibiotics in impetigo, current therapeutic behavior, and concordance with antimicrobial stewardship principles. Two international panels convened to discuss the output of the searches, and the results of the panel discussions were used in the development of the manuscript. RESULTS: The literature search included clinical trials, research studies, clinical guidelines, consensus papers, and reviews (if they provided original data), published between January 2008 and May 2019. The articles were selected based on clinical relevancy of impetigo management, clinical efficacy, and safety of the treatment and antimicrobial resistance. The searches resulted in one-hundred and ninety-eight articles. After applying the eligibility criteria, nineteen articles met inclusion criteria and were considered in the present review. CONCLUSIONS: While published antimicrobial stewardship guidelines have focused on systemic antibiotics, few studies have attempted to evaluate topical antibiotic prescribing practices for impetigo treatment. Many of the topical impetigo treatments currently in use have developed resistance. The appropriate use of topical ozenoxacin can help eradicate impetigo while minimizing AMR.J Drugs Dermatol. 20(4):366-372. doi:10.36849/JDD.5795.


Assuntos
Antibacterianos/farmacologia , Gestão de Antimicrobianos/normas , Impetigo/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Administração Cutânea , Aminopiridinas/farmacologia , Aminopiridinas/normas , Aminopiridinas/uso terapêutico , Antibacterianos/normas , Antibacterianos/uso terapêutico , Prescrições de Medicamentos/normas , Farmacorresistência Bacteriana , Humanos , Testes de Sensibilidade Microbiana , Guias de Prática Clínica como Assunto , Quinolonas/farmacologia , Quinolonas/normas , Quinolonas/uso terapêutico , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
11.
Parasit Vectors ; 14(1): 156, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722285

RESUMO

BACKGROUND: Scabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA. METHODS: A cross-sectional school survey was conducted in April-May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated. RESULTS: The overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%. CONCLUSIONS: Scabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.


Assuntos
Impetigo/epidemiologia , População , Escabiose/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , População Rural , Timor-Leste/epidemiologia
12.
Expert Opin Drug Saf ; 20(6): 677-683, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33726585

RESUMO

INTRODUCTION: Impetigo is a superficial bacterial skin infection largely affecting the pediatric population. The objective of this review is to provide a comparison of mechanism of action, efficacy and safety of the available topical antibiotics for impetigo. AREAS COVERED: Randomized clinical trials that evaluated the use of topical antibiotics for treatment of impetigo were included. Two thousand eighty-nine studies were initially identified, and five randomized clinical trials met the criteria for further analysis. EXPERT OPINION: Topical antibiotics had greater resolution of impetigo in comparison to vehicle in these pivotal clinical trials. Adverse events were minimal, with the most common being pruritus at the application site. Cost or insurance coverage may be a limiting factor in choosing the best therapeutic agent, with mupirocin ointment having the lowest cost. Mupirocin has shown clinical efficacy against MRSA but a bacterial culture is recommended to rule out resistance. Ozenoxacin and retapamulin are effective alternatives but may entail higher cost. Retapamulin is indicated for lesions of impetigo that are colonized by MSSA and streptococcus S. pyogenes but not MRSA based on clinical efficacy of phase III trials. Fusidic acid, available in other countries, is a non-FDA approved medication although rising resistance rates represent a growing concern.


Assuntos
Antibacterianos/administração & dosagem , Impetigo/tratamento farmacológico , Administração Cutânea , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Criança , Custos de Medicamentos , Farmacorresistência Bacteriana , Humanos , Impetigo/microbiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
Br J Gen Pract ; 71(704): e237-e242, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33558328

RESUMO

BACKGROUND: Non-bullous impetigo is typically treated with antibiotics. However, the duration of symptoms without their use has not been established, which hampers informed decision making about antibiotic use. AIM: To determine the natural history of non-bullous impetigo. DESIGN AND SETTING: Systematic review. METHOD: The authors searched PubMed up to January 2020, as well as reference lists of articles identified in the search. Eligible studies involved participants with impetigo in either the placebo group of randomised trials, or in single-group prognostic studies that did not use antibiotics and measured time to resolution or improvement. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were percentage of participants who had either symptom resolution, symptom improvement, or failed to improve at any timepoint. Adverse event data were also extracted. RESULTS: Seven randomised trials (557 placebo group participants) were identified. At about 7 days, the percentage of participants classified as resolved ranged from 13% to 74% across the studies, whereas the percentage classified as 'failure to improve' ranged from 16% to 41%. The rate of adverse effects was low. Incomplete reporting of some details limited assessment of risk of bias. CONCLUSION: Although some uncertainty around the natural history of non-bullous impetigo remains, symptoms resolve in some patients by about 7 days without using antibiotics, with about one-quarter of patients not improving. Immediate antibiotic use may not be mandatory, and discussions with patients should include the expected course of untreated impetigo and careful consideration of the benefits and harms of antibiotic use.


Assuntos
Impetigo , Antibacterianos/uso terapêutico , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico
15.
PLoS Negl Trop Dis ; 15(2): e0009142, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33617544

RESUMO

Pacific Island countries have a high burden of scabies and impetigo. Understanding of the epidemiology of these diseases is needed to target public health interventions such as mass drug administration (MDA). The aim of this study is to determine the prevalence of scabies and impetigo in Solomon Islands as well as the relationship between them and their distribution. We conducted a prevalence study in 20 villages in Western Province in Solomon Islands. All residents of the village were eligible to participate. Nurses conducted clinical assessments including history features and skin examination. Diagnosis of scabies was made using the 2020 International Alliance for the Control of Scabies diagnostic criteria. Assessments were completed on 5239 participants across 20 villages. Overall scabies prevalence was 15.0% (95%CI 11.8-19.1). There was considerable variation by village with a range of 3.3% to 42.6%. There was a higher prevalence of scabies in males (16.7%) than females (13.5%, adjusted relative risk 1.2, 95%CI 1.1-1.4). Children aged under two years had the highest prevalence (27%). Overall impetigo prevalence was 5.6% (95%CI 4.2-7.3), ranging from 1.4% to 19% by village. The population attributable risk of impetigo associated with scabies was 16.1% (95% CI 9.8-22.4). The prevalence of scabies in our study is comparable to previous studies in Solomon Islands, highlighting a persistent high burden of disease in the country, and the need for public health strategies for disease control.


Assuntos
Impetigo/epidemiologia , Escabiose/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Impetigo/diagnóstico , Lactente , Masculino , Melanesia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Escabiose/diagnóstico , Fatores Sexuais
16.
J Drugs Dermatol ; 20(2): 134-142, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33538559

RESUMO

BACKGROUND: Impetigo, a highly contagious bacterial skin infection commonly occurring in young children, but adults may also be affected. The superficial skin infection is mainly caused by Staphylococcus aureus (S. aureus) and less frequently by Streptococcus pyogenes (S. pyogenes). Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients. An evidence-based impetigo treatment algorithm was developed to address the treatment of impetigo for pediatric and adult populations. METHODS: An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidence-based, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics. RESULTS: The algorithm includes education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up and distinguishes between localized and widespread or epidemic outbreaks of impetigo. The panel adopted the definition of localized impetigo of fewer than ten lesions and smaller than 36 cm2 area affected in patients of two months and up with no compromised immune status. Resistance to oral and topical antibiotics prescribed for the treatment of impetigo such as mupirocin, retapamulin, fusidic acid, have been widely reported. CONCLUSIONS: When prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo.J Drugs Dermatol. 2021;20(2):134-142. doi:10.36849/JDD.5475 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.


Assuntos
Antibacterianos/uso terapêutico , Procedimentos Clínicos/normas , Impetigo/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Streptococcus pyogenes/efeitos dos fármacos , Aminopiridinas/farmacologia , Aminopiridinas/uso terapêutico , Antibacterianos/farmacologia , Gestão de Antimicrobianos/normas , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , Técnica Delfos , Diterpenos/farmacologia , Diterpenos/uso terapêutico , Farmacorresistência Bacteriana , Medicina Baseada em Evidências/normas , Ácido Fusídico/farmacologia , Ácido Fusídico/uso terapêutico , Humanos , Impetigo/diagnóstico , Impetigo/microbiologia , Testes de Sensibilidade Microbiana/normas , Mupirocina/farmacologia , Mupirocina/uso terapêutico , Guias de Prática Clínica como Assunto , Quinolonas/farmacologia , Quinolonas/uso terapêutico , Creme para a Pele/farmacologia , Creme para a Pele/uso terapêutico , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação , Revisões Sistemáticas como Assunto
17.
J Dermatol ; 48(5): 699-702, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33599999

RESUMO

Impetigo herpetiformis (IH) is a rare variant of generalized pustular psoriasis (GPP), which develops during pregnancy. GPP is associated with mutations of IL36RN, but it is still unclear whether the same is true of IH. A 20-year-old Japanese woman developed erythema and pustules on her trunk during the 27th week of her first pregnancy. Within 1 month, the skin lesions spread over her whole body, accompanied by fever. Skin biopsy revealed Kogoj's spongiform pustules in the epidermis and she was diagnosed with IH. Systemic administration of prednisolone failed to resolve the skin eruption, but it was partially improved by the addition of cyclosporin. The patient gave birth to a healthy female infant. After delivery, her erythema relapsed and the effect of granulocyte and monocyte adsorption apheresis was limited. Thus, secukinumab was administrated, and since then, she has maintained complete remission. Mutation analysis revealed a homozygous c.28C>T (p.Arg10X) mutation in IL36RN. Twelve cases of IH, including that presented here, have been reported together with the results of IL36RN genetic analyses, and 10 of the 12 cases occurred in East Asia (Japan and China) despite the fact that IL36RN mutations in GPP have been reported worldwide. Among 10 IH patients of East Asian descent, seven had IL36RN mutations, all of which were founder mutations causing GPP in East Asia: c.28C>T (p.Arg10X) or c.115+6T>C (p.Arg10ArgfsX1). Thus, East Asian founder mutations may play an important role in the pathogenesis of IH. IH patients with IL36RN mutations have a tendency to require biologics to resolve postpartum flare-ups or sustained psoriatic skin lesions. Because IL36RN mutation status may help predict postpartum flare-ups in IH patients, mutation analysis should be considered to enable preparation for biologic therapy of intractable flare-ups.


Assuntos
Impetigo , Psoríase , Adulto , China , Extremo Oriente , Feminino , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico , Impetigo/genética , Interleucinas/genética , Japão , Mutação , Gravidez , Adulto Jovem
18.
J Dermatol ; 48(2): 207-210, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33035362

RESUMO

Impetigo herpetiformis (IH) is a rare pustular dermatosis. It can be life-threatening for both the mother and fetus and often causes therapeutic problems. However, there is no specific guideline for the treatment of IH and the evidence regarding the efficacy of treatments for IH has not been established. Herein, we report two cases of IH, which were successfully treated with anti-tumor necrosis factor (TNF)-α drugs. The serum levels of the drugs in the infants and mothers were examined using enzyme-linked immunosorbent assay (ELISA). Case 1 was a 35-year-old, gravida 2, para 1, female patient in week 20 of pregnancy; she was treated with adalimumab (ADA) until delivery. Case 2 was a 26-year-old, gravida 1, para 0, female patient in week 30 of pregnancy; she was treated with certolizumab pegol (CZP) until delivery. In both cases, the skin lesions started regressing considerably after administration of the biologic agents. We examined the serum levels of the biologic agents in the mothers and infants using ELISA. In case 1, the ADA serum level in the infant was as high as that in the mother at birth; it then decreased below the lower limit of quantification at week 12 post-delivery. In case 2, the CZP serum level in the infant was below the lower limit of quantification at birth. In this report, we revealed that biologic agents could be an effective treatment for severe IH and that CZP treatment can be considered safe for the mothers and fetuses.


Assuntos
Impetigo , Psoríase , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adulto , Certolizumab Pegol/uso terapêutico , Feminino , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico , Lactente , Recém-Nascido , Gravidez
20.
Pediatr Dermatol ; 38(1): 329-331, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33247445

RESUMO

A 13-year-old female patient presented with a 3-month history of recurrent blisters, which ruptured into multiple superficial erosions with overlying crust located on the face, neck, and shoulder. Treatment for presumed bullous impetigo showed no benefit. Samples collected from the patient's home revealed the presence of numerous carpet beetles in a wool rug. Carpet beetle dermatitis resembles papular urticaria but may occasionally present as skin lesions resembling bullous impetigo.


Assuntos
Besouros , Dermatite , Impetigo , Dermatopatias Vesiculobolhosas , Urticária , Adolescente , Animais , Feminino , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico , Dermatopatias Vesiculobolhosas/diagnóstico
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