Association between atopic dermatitis and extracutaneous bacterial and mycobacterial infections: A systematic review and meta-analysis.

BACKGROUND: Atopic dermatitis (AD) is associated with increased bacterial colonization and infection of skin and multiple risk factors for extracutaneous infections. However, previous studies found conflicting results about whether AD is associated with increased extracutaneous infections. OBJECTIVE: To determine whether extracutaneous bacterial and mycobacterial infections are increased in AD. METHODS: A systematic review was performed of all published observational studies with controls in MEDLINE, EMBASE, Global Resource of EczemA Trials, Cochrane, and Web of Science that assessed extracutaneous infections in AD. Pooled meta-analysis was performed by using random-effects weighting. RESULTS: Overall, 7 studies met inclusion criteria. All 7 studies found an increased odds for at least 1 extracutaneous infection, including endocarditis, meningitis, encephalitis, bone and joint infections, and sepsis, in AD patients. In pooled meta-analysis, AD in children and adults was associated with a higher odds of ear infection (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.16-1.43), strep throat (OR 2.31, 95% CI 1.66-3.22), and urinary tract infection (OR 2.31, 95% CI 1.66-3.22) but not pneumonia (OR 1.72, 95% CI 0.75-3.98). No publication bias was detected. LIMITATIONS: Individual-level data were not available. CONCLUSION: AD patients have higher odds of extracutaneous infections. Future studies are needed to confirm these associations and determine their mechanisms.

Immediate Results of the Use of Split-Thickness Skin Autografts With and Without Acellular Dermal Matrix in Patients with Burns: A Comparative Study in a Colombian Population.

Dermal substitutes have become fundamental tools for covering skin defects, most recently with biological subtypes such as glycerolized acellular dermal matrix (GADM). However, literature regarding this matter is scarce in Latin America and Colombia. In this descriptive observational study, we compared the use of partial skin autografts (PSA) combined with GADM and autografts without GADM. Patients were selected from the burn unit of a hospital in northeastern Colombia between 2021 and 2022. Two study groups were defined: one receiving GADM plus PSA and the other control receiving only a partial split-thickness autograft. A total of 29 patients with 68 body areas were included, with an average age of 20 years. Most cases involved third-degree burns caused by flame. Hospitalization time was the same for both groups (41 days). The percentage of grafts taken was similar in both groups; in the GADM with autografts group, it was 94.7% compared with 96% in the control group. The presence of complications was similar in both groups. GADM produced in local tissue banks is a cost-effective alternative. It can be used in a single surgical procedure without increasing complications, providing a postsurgical course similar to autografts alone. Granting the potential long-term benefits that dermal matrices give for healing in these patients, which should be evaluated in subsequent studies.

African American race is a risk factor for severe hidradenitis suppurativa.

BACKGROUND: African Americans face a disproportionate incidence and prevalence of hidradenitis suppurativa (HS) in the United States, but HS severity and outcomes across racial and ethnic groups have not been well-established while controlling for potentially confounding factors. In this retrospective cohort study, we investigated the associations of race and ethnicity with HS severity, emergency department (ED) visits, hospitalizations, and surgeries for HS while controlling for age, sex, body mass index (BMI), tobacco use, and insurance type. METHODS: We reviewed 1190 patients seen at the Medical College of Wisconsin with ≥3 encounters for HS between 1/1/2002 and 3/19/2019, excluding those without race data or an encounter in which HS was treated. RESULTS: A total of 953 patients were included; 470 patients were Black or African American non-Hispanic (49%), 39 Hispanic (4%), 418 White non-Hispanic (44%), and 26 other race or ethnicity (3%). Controlling for age, sex, BMI, tobacco use, and insurance type, Black patients had 2.8 times the odds of having Hurley stage III disease (95% CI 1.76-4.45, P < 0.001), 2.86 times the risk for experiencing an ED visit for HS (95% CI 2.12-3.88, P < 0.001), 2.25 times the risk for experiencing a hospitalization for HS (95% CI 1.42-3.56, P < 0.001), and 1.61 times the risk for experiencing a surgical encounter for HS (95% CI 1.34-1.95, P < 0.001) when compared to White patients. CONCLUSIONS: African Americans face significant disparities in HS severity, ED visits, hospitalizations, and surgeries. The causes of these disparities must be further investigated and addressed.

Racial disparities of delay in diagnosis and dermatologic care for hidradenitis suppurativa.

Hidradenitis suppurativa is a chronic, debilitating skin disease that disproportionately affects African Americans, and care-related factors may contribute to this disparity. In this study, we investigated delay in diagnosis and dermatologic care for HS at an urban Midwestern Academic Center. A retrospective chart review of 1,190 patients with 3 or more encounters for HS between 1/1/2002 and 3/19/2019 was conducted. A total of 953 patients were included in statistical analysis. A mean (standard deviation) delay in diagnosis was 4.1 ± 7.0 years. For white patients the delay in diagnosis was 3.2 ± 6.3 years, for Black patients 4.8 ± 7.0 years, for Hispanic patients 4.7 ± 5.8 years, and for other races 4.9 ± 7.4 years (p <0.001). Among the 932 patients with known specialist visit types, 500 (53.6%) had seen dermatology including 222 (47.8%) of Black patients, 242 (59.5%) of white patients, 24 (64.9%) of Hispanic patients, and 12 (50%) patients of other races (p=0.003).White patients and Hispanic patients saw a dermatologist an average of 3.0 years after first presentation of HS and Black patients saw a dermatologist on average 5.0 years after first presentation (p=0.004). Of the patients who did see dermatology, 44.9% of Black patients, 31.6% of white patients, 23.1% of Hispanic patients, and 30.8% of other races saw surgery before dermatology (p<.001). Our results indicate that non-white patients have a longer delay in diagnosis than their white counterparts and that Black patients do not see dermatology as early in their disease course as other racial groups. Black patients also see surgery more often than white patients before seeing dermatology, which could suggest greater disease severity at presentation and diagnosis or difficult access to dermatology.

A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging.

Injection of platelet concentrates for the treatment of aging skin has gained popularity. The objective was to systematically assess the evidence regarding the safety and effectiveness of platelet-rich plasma (PRP) for reducing the visible signs of aging. Cochrane Library, MEDLINE (PubMed), EMBASE, and Scopus were searched from inception to March 2019 for prospective trials and case series assessing PRP for skin aging in 10 or more patients. Twenty-four studies, including 8 randomized controlled trials (RCTs), representing 480 total patients receiving PRP, were included. Based on physician global assessment, injection PRP monotherapy was shown to at least temporarily induce modest improvement in facial skin appearance, texture, and lines. Periorbital fine lines and pigmentation may also benefit. Adjuvant PRP accelerated healing after fractional laser resurfacing. Although the degree of improvement was typically less than 50%, patients generally reported high satisfaction. It was limited by heterogeneity in PRP preparation and administration, and lack of standardization in outcome measures. PRP injections are safe and may be modestly beneficial for aging skin. The evidence is most convincing for improvement of facial skin texture. The persistence of these effects is not known. More high-quality trials with sufficient follow-up are needed to optimize treatment regimens.

Risankizumab in moderate-to-severe plaque psoriasis.

Psoriasis is a chronic inflammatory disease affecting multiple organ systems affecting approximately 2% of the population worldwide. The etiology is multifactorial etiology with multiple co-morbidities complicating the disease. Therapeutic options for patients with moderate-to-severe psoriasis have made tremendous strides since the turn of the century and biologic agents are now generally considered to be safe, efficacious and common options for these patients. However, some patients remain recalcitrant to the current treatment options. Risankizumab is a newly US FDA-approved biologic therapy that inhibits IL-23p19 subunit, which is specific to IL-23. Risankizumab has proven rapid onset, safety and efficacy in moderate-to-severe psoriasis and is currently being studied in other diseases utilizing the IL-23 pathway.

Pruritus in Cutaneous T-Cell Lymphoma and Its Management.

Pruritus is a common symptom in cutaneous T-cell lymphoma (CTCL) and critically affects the quality of life of patients. Understanding the pruritogenesis has led to development of new therapeutic agents with promising outcomes in management of this recalcitrant symptom. Clinical assessments are warranted to aid in evaluation of treatment response or disease recurrence. Severe pruritus scores may require further investigation of emotional distress for a better patient approach. Dermatologists play a key role in the treatment of CTCL-pruritus by guiding the patient in the importance of preserving the integrity of the skin barrier.

Hemophagocytic Lymphohistiocytosis in Cutaneous T-Cell Lymphoma.

Importance: Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. Objectives: To examine the characteristics of CTCL associated with HLH and analyze the presenting signs and symptoms, therapeutic options, and outcome. Design, Setting, and Participants: In this case series, patients diagnosed with CTCL and HLH who were treated at a single institution from January 1, 2014, through December 31, 2017, were studied. Exposures: The HLH-2004 trial criteria, HScore, and various clinical and histopathologic variables were applied to and analyzed in the cohort. Main Outcomes and Measures: Subtype of CTCL, treatment administered for HLH, and patient outcome were assessed. Results: Seven patients (4 men and 3 women; median age, 50 years; range, 34-77 years) were identified from the database and included in the study. Cytotoxic subtypes of CTCL that involve the deep dermis and subcutaneous tissue were most commonly associated with HLH. Four patients met 5 or more HLH-2004 trial criteria, and 5 had an HScore probability greater than 85% at presentation. Common presenting HLH symptoms were fever and malaise. Cyclosporine, polychemotherapy, and systemic corticosteroids were the most common treatments. Patients receiving allogeneic stem cell transplants had the best outcomes, with all 3 of these patients alive and in complete remission. Conclusions and Relevance: Hemophagocytic lymphohistiocytosis is a life-threatening complication of CTCL associated with rare cytotoxic CTCL subtypes that primarily involve the subcutaneous tissue. Because these cases may resemble a granulomatous or infectious condition, the diagnosis and appropriate management are often delayed. The results of this study demonstrate the need for high awareness of HLH in patients with panniculitic lymphomas and indicate that allogeneic stem cell transplantation may be the best option for a sustained remission.

Vigencia de los bancos de tejidos laminares / Validity of tissue Banks

INTRODUCCIÓN Y OBJETIVO: En las unidades de quemados de Colombia, como en las del resto del mundo, se ha vivido la necesidad de dar cobertura cutánea transitoria y definitiva a los pacientes con quemaduras. El objetivo del presente trabajo es revisar brevemente la historia de las coberturas cutáneas, la creación de los bancos de piel, principalmente en Latinoamérica y Colombia, su importancia y su futuro. Material y Método. Realizamos una revisión bibliográfica de las coberturas cutáneas, de la creación y actual existencia de los bancos de tejidos en el mundo y realizamos una encuesta para recabar datos sobre el tema a los directores de los bancos de tejidos laminares de América Latina. RESULTADOS: La necesidad de cobertura cutánea para las heridas por trauma ha existido desde la antigüedad, con diferentes alternativas autólogas y heterólogas. Con el surgimiento de enfermedades infecciosas como el SIDA, se creó la necesidad de ofrecer tejidos de calidad y seguros, lo que desencadenó la creación de bancos de teji¬dos que produjeron apósitos biológicos transitorios. El incremento de la supervivencia de los pacientes con quemaduras extensas y profundas creó el reto de ofrecer coberturas definitivas para disminuir las secuelas del paciente quemado. Hasta el momento, no existen publicaciones que demuestren cuáles son las mejores alternativas. CONCLUSIÓNES: Los bancos de tejidos siguen vigentes puesto que se requieren tanto los tejidos biológicos transitorios como los sustitutos dérmicos que se están investigando y produciendo. No existe aún evidencia de un producto que cumpla todos los requisitos del sustituto dérmico ideal. Son necesarios estudios multicéntricos pros¬pectivos que comparen los existentes para determinar sus ventajas y desventajas

BACKGROUND AND OBJECTIVE: Burn units in Colombia, as in the rest of the world, have been a need to provide temporary and definitive skin coverage to burn patients. Our aim is to get a brief review about the history of skin coverage, the creation of skin banks, mainly in Latinamerica and Colombia, their importance and their future. METHODS: We conduct a bibliographic review of skin coverings, creation and current existence of tissue banks in the world and sent a survey to get knowledge about the theme to the directors of Latinamerican laminar tissue banks. RESULTS: Need of skin coverage for trauma injuries has always existed, with different autologous and heterologous alternatives. With the emergence of infectious diseases such as AIDS, the need to offer quality and safe tissues was born, and this triggered the creation of tissue banks that produced the transitory biological dressings. Increase in the survival of patients with extensive and deep burns created the challenge of offering definitive coverage to reduce the scars and sequels of the burned patient. So far, there is no evidence pointing out which are the best alternatives. CONCLUSIONS: Tissue banks continue to be valid due to the usefulness of their transient biological products and permanent dermal substitutes that are constantly improving. There is no evidence yet of a product fulfilling all requirements and tissue banks research is still a work in progress. Multicenter studies are required to compare existing ones in order to determine the advantages and disadvantages of each new developed tissue

Cicatriz hipertrófica y queloide: rompiendo paradigmas con el uso de Z-plastias / Hypertrophic scar and keloid: breaking paradigms with the use of Z-plasties

INTRODUCCIÓN Y OBJETIVO: La cicatriz queloide es uno de los problemas clínicos más frustrantes en la curación de heridas y un gran desafío para los médicos. Los diversos tratamientos (escisión parcial o total), inyección de drogas intralesionales, radioterapia, láser, silicona, prendas de lycra, entre otros, tienen un alto riesgo de recurrencia (10-45%). Los desafíos que enfrenta la comunidad dedicada a la rehabilitación incluyen la investigación del proceso de curación, los efectos de los diferentes factores involucrados en la cicatrización de heridas y el desarrollo de cicatrices, y la mejor combinación de intervenciones quirúrgicas, farmacológicas y terapéuticas para maximizar el resultado. La cirugía se puede realizar para tratar los queloides de dos maneras: primero, resección radical de los queloides y, en segundo lugar, reducción de la masa queloide. El objetivo que proponemos es mejorar las cicatrices hipertróficas y queloides mediante múltiples zetaplastias o con resección parcial más múltiples zetaplastias. MATERIAL Y MÉTODO: Realizamos un estudio prospectivo sobre un total de 335 cicatrices clasificadas según la escala de Vancouver entre febrero de 2013 y julio de 2018. Se intervinieron cicatrices lineales con zetaplastia múltiple teniendo en cuenta las líneas de menor tensión, tanto en cicatrices hipertróficas como en queloides extensos; si el tejido vecino lo permitía, la cicatriz se resecó parcialmente y se hizo zetaplastia múltiple; si el tejido vecino no permitía la resección, se seleccionaron algunas áreas para realizar la primera sesión de zetaplastia y en intervenciones posteriores se realizaron otras para poder intervenir en toda el área en función de las fuerzas de tensión. RESULTADOS: Revisamos un total de 335 cicatrices, 188 (56.1%) hipertróficas y 147 (43.9%) queloides, en pacientes entre 1 y 56 años, durante un promedio de 13 años. Cara y cuello 123 (37%), extremidades superiores 85 (25,3%), extremidades inferiores 63 (18,8%), tórax 53 (15,8%) y oreja 11 (3,3%) fueron las principales áreas tratadas. De las 123 fotografías intraopoeratorias revisadas, 4 (3%) tenían solo 1 zetaplastia, 3 (2.4%) tenían 2, 27 (21.9%) tenían 3 y 89 (72.3%) más de 4 zetaplastias múltiples (promedio de 6). Con los buenos resultados obtenidos, la cirugía también se realizó en cicatrices durante el proceso de maduración, 3 o 4 meses después de la qemadura. Setenta y ocho pacientes (23.2%) con seguimiento de 5 años no presentan recurrencia, ni 35 (10.4%) a los 4 años. CONCLUSIONES: La zetaplastia múltiple, con o sin resección parcial de cicatriz hipertófica o queloidea, puede realizarse en cicatrices activas inmaduras, rompiendo el paradigma de esperar hasta que la cicatriz esté madura o incluso cuando los tratamientos terapéuticos hayan fallado. La sutura continua con monofilamento es una contribución técnica que permite reducir el tiempo quirúrgico y facilita la extracción

BACKGROUND AND OBJECTIVE: The keloid scar is one of the most frustrating clinical problems in wound healing and a great challenge for doctors. The various treatments (partial or total excision), intralesional drug injection, radiotherapy, laser, silicone, lycra garments, among others, have a high risk of recurrence (10-45%). The challenges facing the rehabilitation community include the investigation of the healing process, the effects of the different factors involved in wound healing and the development of scars, and the best combination of surgical, pharmacological and therapeutic interventions to maximize the result. Surgery can be performed to treat keloids in two ways: first, radical resection of keloids and, secondly, reduction of keloid mass. Our general objective is to improve hypertrophic and keloid scars with multiple zetaplasties or with partial resection plus multiple zetaplasties. METHODS: A prospective study was conducted on 335 scars classified based on the Vancouver scale between February 2013 and July 2018. Linear scars were intervened with multiple zetaplasty taking into account the lines of least tension; in hypertrophic scars or extensive keoids, if the neighboring tissue allowed it, the scar was partially resected, and perform multiple zetaplasty; if the neighboring tissue did not allow resection, some areas were selected to perform the first zetaplasty session and in subsequent interventions the others were performed to be able to intervene the entire area based on the tension forces. RESULTS: A total of 335 scars, 188 (56.1%) hypetrophic and 147 (43.9%) keloyds, were treated in patients between 1 and 56 years, for an average of 13 years. Face and neck 123 (37%), upper extremities 85 (25.3%), lower extremities 63 (18.8%), thorax 53 (15.8%) and ear 11 (3.3%) were the main areas treated. Of 123 intraopoeratory photographs reviewed, 4 (3%) had only one zetaplasty, 3 (2.4%) had 2 zetaplasties, 27 (21.9%) had 3 zetaplasties and 89 (72.3%) had more than 4 multiple zetaplasties (with one average of 6). With the good results obtained, surgery was also performed on patients with scars during the maturation process as soon as 3 or 4 months post burn. Seventy eight patients (23.2%) who have 5-year follow-up do not present recurrence nor 35 (10.4%) at 4 years. CONCLUSIONS: Multiple zetaplasty, with or without partial resection of hypertorphic scar o keloyd, can be performed on immature active scars, breaking the paradigm of waiting until the scar is mature or even when therapeutic treatments have failed. The continuous suture with monofilament is a technical contribution that allows to reduce surgical time and facilitates the removal of the stitches

Manejo de quemaduras faciales de segundo grado con membrana amniótica preservada en glicerol 85% / Managing of second-degree facial burns with amniotic membrane preserved en 85% glycerol

Introducción y Objetivo: El 70% de los grandes quemados presentan compromiso de la cara y su tratamiento quirúrgico depende de la profundidad de la quemadura; generalmente, en las de espesor profundo se indica escisión tangencial temprana y cobertura inmediata una vez el paciente se encuentre reanimado; en las de espesor parcial se indica dermoabrasión y cobertura con diferentes agentes tópicos, apósitos sintéticos o biológicos. Sin embargo, las curaciones con agentes tópicos son dolorosas y frecuentes, y muchos de los apósitos sintéticos y biológicos son costosos y poco accesibles para algunos sistemas de salud. El objetivo de este estudio es evaluar el uso de membrana amniótica preservada en glicerol como apósito biológico temporal en el tratamiento de quemaduras faciales de segundo grado, superficial y profundo. Material y Método: Estudio descriptivo observacional prospectivo mediante serie de 53 casos consecutivos. Empleamos como cobertura temporal membrana amniótica preservada en glicerol al 85% procedente del Banco de Tejidos del Instituto Distrital de Ciencia, Biotecnología e Innovación en Salud (IDCBIS) de la Secretaría de Salud de Bogotá (Colombia), en forma expuesta, inmediatamente después de dermoabrasión mecánica en pacientes con quemaduras faciales de espesor parcial superficial y profundo. Resultados: Con una sola aplicación, sin necesidad de ningún tipo de tópicos y vendajes secundarios, los pacientes epitelizaron entre el 5 y el 10° día sin graves secuelas cicatriciales; algunos tuvieron un periodo de hospitalización superior a 10 días debido a mayor extensión con compromiso de otras áreas corporales; ningún paciente presentó infección y todos manifestaron ausencia de dolor postoperatorio. Conclusiones: El uso de membrana amniótica como apósito biológico temporal en el tratamiento de las quemaduras faciales de espesor parcial superficial y profundo es un recurso económico, efectivo y accesible en países que cuentan con disponibilidad del banco de piel. Su aplicación tras dermoabrasión evitó la realización de curaciones diarias, controló el dolor y promovió la epitelización de la zona quemada

Background and Objective: Seventy percent of the major burn patients have face burns and their surgical management depends on the depth of the burn; usually full thickness burns have to undergo early tangential excision with immediate coverage once the patient is stable and in the partial thickness facial burns the surgical management is dermoabrasion and coverage with topical agents, synthetic dressings or biological dressings. However, the dressing changes with topical agents are painful and frequent procedures and many of the synthetic and biological dressings are expensive and not available for some health systems. The aim of this study was to evaluate the use of amniotic membrane glicerol preserved 85%, as a transient biological dressing in the management of partial and total thickness facial burns. Methods: We developed an observational descriptive prospective study case series of 52 consecutive patients. We used exposed 85% glycerol preserved amniotic membrane as a transient biological coverage provided by the Science, Biotechnology and Innovation District Institute of Health (IDCBIS) of the Health Secretary of Bogotá (Colombia), without secondary dressings, immediately after mechanic dermoabrasion in patients with partial and total thickness facial burns. Results: All the patients epithelialized between the 5th and 10th day with only one application of the amniotic membrane without secondary dressings or topical agents; also the patients did not show wound healing alterations. Some patients stayed in the hospital longer than 10 days because they presented major burns. None of them presented infection and all referred absence of pain during the postoperative period. Conclusions: The use of amniotic membrane as a transient biological dressing for the treatment of partial and total thickness facial burns is an economic, effective and available tool in countries with skin banks. The use of the amniotic membrane after the dermoabrasion avoids daily wound dressing changes, decreases and controls the pain and promotes wound healing and epithelization

Comentario al artículo “Quemaduras Químicas por Agresión: Características e Incidencia Recogidas en El Hospital Simón Bolívar, Bogotá, Colombia” / No disponible

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