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Plantar reconstruction is often challenging for plastic surgeons because of the peculiar anatomical features of this region. A large variety of reconstructive techniques for the plantar aspect of the foot have been described previously, including skin grafts, local flaps, fasciocutaneous flaps, perforator flaps, cross-limb flaps, and free flaps. This article presents a case of a 64-year-old patient with insulin-dependent diabetes who was involved in a traffic accident that resulted in a large plantar tissue defect (9x4 cm) extending to the base of the toes. After debridement of the wound, a subcutaneous flap was raised from the medial aspect of the lower leg in a sovrafascial plane. The flap was based on a double vascularization given by the great saphenous vein and by the perforator vessels from the posterior tibial artery, located anteriorly and inferiorly to the medial malleolus. The flap showed excellent vitality and long-term result with reduced donor site morbidity. We believe this flap represents a reliable surgical option in superficial plantar defects due to easy harvesting, short operative time, and minimal donor site morbidity. The subcutaneous flap of the distal medial fourth of the leg is a safe technique because of the vascular components of the pedicle. It provides durable coverage, mechanical resistance to pressure and shear stresses and, in selected cases (superficial defects, thin patients), is an interesting option to avoid major free flap procedures., (Copyright 2010, SLACK Incorporated.)

Aims/hypothesis: Skin and soft tissue infections (SSTIs) cause substantial morbidity in persons with diabetes. There are few data on pathogens or risk factors associated with important outcomes in diabetic patients hospitalised with SSTIs., Methods: Using a clinical research database from CareFusion, we identified 3,030 hospitalised diabetic patients with positive culture isolates and a diagnosis of SSTI in 97 US hospitals between 2003 and 2007. We classified the culture isolates and analysed their association with the anatomic location of infection, mortality, length of stay and hospital costs., Results: The only culture isolate with a significantly increased prevalence was methicillin-resistant Staphylococcus aureus (MRSA); prevalence for infection of the foot was increased from 11.6 to 21.9% (p < 0.0001) and for non-foot locations from 14.0% to 24.6% (p = 0.006). Patients with non-foot (vs foot) infections were more severely ill at presentation and had higher mortality rates (2.2% vs 1.0%, p < 0.05). Significant independent risk factors associated with higher mortality rates included having a polymicrobial culture with Pseudomonas aeruginosa (OR 3.1), a monomicrobial culture with other gram-negatives (OR 8.9), greater illness severity (OR 1.9) and being transferred from another hospital (OR 5.1). These factors and need for major surgery were also independently associated with longer length of stay and higher costs., Conclusions/interpretation: Among diabetic patients hospitalised with SSTI from 2003 to 2007, only MRSA increased in prevalence. Patients with non-foot (vs foot) infections were more severely ill. Independent risk factors for increased mortality rates, length of stay and costs included more severe illness, transfer from another hospital and wound cultures with Pseudomonas or other gram-negatives.

Background: Glycogen storage disease type 1b is a rare disorder caused by 6-glucose-phosphatase transport deficiency. It is characterised primarily by metabolic disorders combined with hypoglycaemia and hyperlactacidaemia and a predisposition to staphylococcal infections associated with polynuclear neutrophil abnormality. Herein, we report the case of a patient with glycogen storage disease type 1b who developed ulcers of the lower limbs and we discuss the possible significance of this association which, to our knowledge, has not yet been described in the medical literature., Patients and Methods: A 38-year-old man, presenting glycogen storage disease type 1b diagnosed when he was 13 months old, was hospitalised for ulcers of the lower limbs occurring over the preceding five years. The patient had a quantitative polynuclear neutrophil deficit that was treated with filgrastim. The various ulcers all developed according to the same pattern, namely pustules progressing towards necrosis followed by painful ulceration. No fever or collection of pus was observed. A number of samples of pustules proved sterile while others contained Staphylococcus aureus, sensitive to numerous antibiotics. Histopathological examination proved relatively inconclusive and laboratory tests showed no vascular cause of the ulcers., Discussion: Hypothetical diagnoses of staphylococcal ecthyma suggested by the neutrophil deficiency and of pyoderma gangrenosum were proposed but could not be confirmed with certainty. Involvement of other predisposing factors independent of the patient's glycogen storage disease cannot be ruled out. This combination, not previously reported, nevertheless deserves to be singled out, despite its as yet unclear significance., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: Deep brain stimulation (DBS) has been recognized as an efficacious treatment for movement disorders. Its beneficial effects however may be lost due to skin complications such as erosions or infections over the implanted foreign material. We sought to document skin complications in the entire Parkinson's disease patient population who received a DBS system at the Marburg/Kassel implantation centre since the start of our DBS program in January 2002 to analyze frequency, time course, and possible risk factors., Methods: We investigated 85 consecutive patients with Parkinson's disease (PD) from a single center/single surgeon DBS series for the occurrence of skin complications and analyzed localization, time course, and possible risk factors. Mean follow-up was 3 years (range 1-7 years)., Results: In total, 21/85 patients (24.7%) suffered a total of 30 single skin complications. Sixty percent of all incidents occurred within the first post-operative year. Forty percent of all incidents occurred later than the first year following primary implantation. Complications involved the burr hole cap in 37%, the course of the cables in 33%, and the impulse generator (IPG) site in 30%. Six of 21 patients suffered recurring skin complications. Eight patients permanently lost their DBS system. Factor analysis for age, gender, disease duration, disease severity, the incidence of hypertension or diabetes as well as a 2-day period with externalized electrodes for continuous test stimulation did not have any statistically significant impact on skin complications., Conclusions: We conclude that (1) PD patients have a risk for skin complications after DBS as long as the system remains in situ and (2) there are at present no identifiable risk factors for skin complications after DBS, other than PD itself.

To reduce pruritus and colonization with Staphylococcus aureus, textiles containing silver are increasingly used as therapeutic option for patients with atopic dermatitis (AD). While wearing such textiles, the contained silver is in close contact with the patient's skin. The silver serves two purposes: to reduce bacterial colonization of the skin, and to prevent contamination of the textile with ensuing growth of microorganisms. It is unknown whether the silver impregnation is able to reduce bacterial contamination of the textile during wearing and to prevent bacterial growth within the textile. The aim of this study was to investigate the bacterial contamination in textiles containing silver versus placebo worn by patients with AD and to determine the efficacy of processing worn textiles by manual and machine-based washing. Additionally, the effect of silver textiles on S. aureus and total bacterial counts colonizing the skin of AD patients was analyzed. The reduction factor of silver textile compared to placebo was 0.5 log steps against S. aureus and 0.4 log steps against total bacteria. Silver textiles exhibited significantly less S. aureus as well as total bacterial colonization after 2 days of wearing without washing, as compared with a placebo textile. On placebo textiles 385.6 +/- 63.5 CFU total bacteria and 236.5 +/- 49.9 CFU S. aureus, and on silver textiles 279.9 +/- 78.7 CFU total bacteria and 119.3 +/- 39.4 CFU S. aureus were found on the inner side of the textiles facing the neurodermitis lesions. However, the unexpectedly high residual contamination despite the silver exposure represents a potential risk as recontamination source of S. aureus that could maintain the proinflammatory process in AD. This contamination is nearly completely eliminated by machine-based washing at 60 degrees C using conventional washing powder. AD patients wearing silver textiles should change their used clothes at least daily and wash them in a washing machine at 60 degrees C., ((c) 2009 S. Karger AG, Basel.)

Background and Objective: Methicillin-resistant Staphylococcus aureus (MRSA) skin infections are now known to be a common and important problem in the Unites States. The objective of this study was to investigate the efficacy of photodynamic therapy (PDT) for the treatment of MRSA infection in skin abrasion wounds using a mouse model., Study Design/materials and Methods: A mouse model of skin abrasion wound infected with MRSA was developed. Bioluminescent strain of MRSA, a derivative of ATCC 33591, was used to allow the real-time monitoring of the extent of infection in mouse wounds. PDT was performed with the combination of a polyethylenimine (PEI)-ce6 photosensitizer (PS) and non-coherent red light. In vivo fluorescence imaging was carried out to evaluate the effect of photobleaching of PS during PDT., Results: In vivo fluorescence imaging of conjugate PEI-ce6 applied in mice indicated the photobleaching effect of the PS during PDT. PDT induced on average 2.7 log(10) of inactivation of MRSA as judged by loss of bioluminescence in mouse skin abrasion wounds and accelerated the wound healing on average by 8.6 days in comparison to the untreated infected wounds. Photobleaching of PS in the wound was overcome by adding the PS solution in aliquots., Conclusion: PDT may represent an alternative approach for the treatment of MRSA skin infections.

Insulin injection site abscesses have been attributed to pyogenic streptococci and Staphylococcus aureus. In this report, the authors describe a patient in whom Mycobacterium abscessus was isolated from one of multiple insulin injection sites. The article reviews six additional cases of rapidly growing Mycobacteria identified as the causative agent of skin infections at insulin injection sites. In most cases, precise identification of the source of infection was not successful. Possibly, inadequate skin preparation prior to injection or a contaminated insulin ampoule resulted in these infections.

Background: Foot infections are a common reason for hospitalization and a cause of complications in patients with diabetes. The aim of this study was to determine the prevalence of microorganisms found on culture in complicated diabetic foot infections in hospitalized patients, and the sensitivity of the causative microorganisms to antimicrobial agents., Methods: Between December 2001 and December 2005 in our department, 84 samples in 62 diabetic patients with moderate/severe infection were collected for microbiological study., Results: At least one microorganism was isolated in 88% of samples. The most frequently isolated germ group was gram-positive bacteria (55% of the samples), with Staphylococcus aureus (33%) in the first position, followed by Pseudomonas aeruginosa (12%), Enterococcus spp. (9%), and Escherichia coli (8%). Culture for anaerobic microorganisms was only performed in half the samples; 25% were positive, and Peptostreptococcus spp. predominated. Among the multiresistant microorganisms, methicillin-resistant staphylococci aureus (MRSA) were the most common, accounting for 38% of the isolated strains of S. aureus, ie, 12% of all samples. As to the gram-negative microorganisms, nearly 30% of E. coli strains were resistant to amoxicillin/clavulanic acid and ciprofloxacin., Conclusion: Most of the cultures in our study were monomicrobial, with S. aureus being the most prevalent microorganism, followed by enterobacteria and P. aeruginosa. The main resistant microorganism in diabetic foot infections requiring hospitalization was methicillin-resistant golden staphylococcus, which was found in 12% of the series.

Background: Bacterial infections are a common complication of cutaneous T-cell lymphoma (CTCL). The most common pathogen of cutaneous infections in CTCL patients is Staphylococcus aureus., Objective: The purpose of this study was to assess S aureus colonization rates among CTCL subjects compared to control subjects., Methods: Fifty subjects with CTCL, 25 psoriasis control subjects, and 25 healthy control subjects were included in this study. Culture swabs were obtained from nares and lesional skin or normal skin in the healthy controls., Results: S aureus colonization rates were 44% in CTCL subjects, 48% in psoriasis subjects, and 28% in healthy control subjects (P = .29)., Limitations: The sample size was small, and the exclusion criteria resulted in an underestimation of the colonization rate., Conclusion: There was a trend for higher methicillin-sensitive S aureus colonization in the CTCL group compared with healthy control subjects. S aureus colonization may be directly related to body surface area of CTCL.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is currently a problem of epidemic proportion. Athletes represent a specific group of individuals who are at increased risk to develop CAMRSA skin infections. In this article, the previously published reports of cutaneous CAMRSA infections in athletes are categorized by sport and summarized. General treatment guidelines for the management of cutaneous CAMRSA infection and its associated lesions in athletes are discussed. Also, recommendations for the prevention of CAMRSA skin infection in sports participants are reviewed.

This 1-year multicentre prospective study in northern France sought to evaluate the incidence of secondary bacterial skin complications related to varicella, describe these superinfections, and analyse risk factors for their onset. The study included every child admitted to a district paediatric unit with a varicella infection. Patients with varicella infection, with and without secondary bacterial skin complication, were compared. The study included 159 children, 43 of whom had a secondary bacterial skin complication on admission, 21 of them had a severe secondary bacterial skin complication (respective incidence: 7.5 and 3.7/100,000 children younger than 16 years old). Persistence or recurrence of fever > or =38.5 degrees C for > or =3 days after the beginning of varicella infection (adjusted odds ratio (aOR)=8.1; 95% confidence interval (CI): 2.3-28.4) and the use of non-steroidal anti-inflammatory drugs (aOR=4.8; 95% CI: 1.6-14.4) were independent factors associated with severe secondary bacterial skin complication.

Background: Radiation dermatitis occurs to some degree in most patients receiving radiotherapy, with or without chemotherapy. Patients with squamous cell carcinoma of the head and neck (SCCHN) who receive radiotherapy in combination with epidermal growth factor receptor (EGFR) inhibitors, such as cetuximab, may develop a characteristic acne-like rash in addition to dermatitis., Design: An advisory board of 11 experienced radiation oncologists, medical oncologists and dermatologists discussed the management options for skin reactions in patients receiving EGFR inhibitors and radiotherapy for SCCHN. Skin toxicity was categorised according to the National Cancer Institute-Common Terminology Criteria for Adverse Events (version 3) grading., Results: Both general and grade-specific approaches for the management of dermatitis in this patient group are presented. It was concluded that where EGFR inhibitor-related acne-like rash and dermatitis coexist within irradiated fields, management should be based on the grade of dermatitis: for grade 1 (or no dermatitis), treatment recommendations for EGFR-related acne-like rash outside irradiated fields should be followed; for grades 2 and above, treatment recommendations for dermatitis were proposed., Conclusions: This paper presents comprehensive consensus guidelines for the treatment of dermatitis in patients with SCCHN receiving EGFR inhibitors in combination with radiotherapy.

Some patients with community-associated methicillin-resistant Staphylococcus aureus skin and skin structure infections have experienced frequent recurrences. We performed a retrospective study and determined that the presence of nasal colonization did not affect recurrence and nasal mupirocin treatment marginally decreased recurrence.

Retapamulin is a semisynthetic pleuromutilin compound with in vitroactivity against Gram-positive bacteria, no cross-resistance to other classes of antimicrobial agents in current use and a low potential for development of resistance. A 1% ointment formulation has been developed for clinical use, and a placebo-controlled trial of impetigo in 210 patients produced significantly higher rates of clinical and microbiological success compared with placebo - 85.6 versus 52.1% and 91.2 versus 50.9%, respectively. Additional comparative studies in over 1900 patients showed noninferiority to topical fusidic acid and oral cephalexin and a low frequency of adverse events. In 2007, retapamulin was approved in the USA for topical treatment of impetigo caused by Streptococcus pyogenes and methicillin-susceptible Staphylococcus aureus, and in the EU for topical treatment of impetigo and infected wounds caused by S. pyogenes and S. aureus, with approvals including adults and children over 9 months of age.

Methicillin-resistant Staphylococcus aureus (MRSA) is a disease-causing organism that has been present in hospital settings since the 1960s. However, a genetically distinct strain of MRSA, called community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), has emerged in recent years in community settings among healthy individuals. While this organism has been found to be less resistant to antibiotics, it is also more virulent and capable of causing a spectrum of illnesses. School nurses must be aware of the risk factors for this infection and understand its signs, symptoms, diagnostic testing, and management. With this knowledge, school nurses can help protect students, staff, and community members from this increasingly prevalent pathogen.

Patients with human immunodeficiency virus (HIV) may present with a variety of dermatologic complaints, including reactions to medications, physiologic manifestations of their disease, numerous infectious conditions, and unusual or severe presentations of common dermatologic diseases. Botryomycosis is an uncommon infectious disorder with rare visceral involvement. The cutaneous manifestations of botryomycosis are variable and have not been well-described. We report a case of botryomycosis in an HIV-positive woman who presented with pruritic papules on her neck, trunk, and extremities.

Background: Actinic keratoses (AKs) are a common premalignant tumor of the skin. Several treatment modalities exist for broad-area therapy. Photodynamic therapy (PDT) is one such treatment modality. Disruption of squamous epithelium locally compromises the normal physical barrier of the skin, potentially allowing bacteria penetration into the dermis. This may occur subsequent to PDT, resulting in cellulitis and its sequelae. Undiagnosed and untreated this can prolong recovery times and increase patient discomfort., Objective: We report 4 cases of cellulitis that developed after treatment of AKs with PDT. These cases developed 1 to 4 days after PDT., Methods: Standard short-contact 2-hour incubation is performed on patients receiving treatment on the face or scalp. Patients are contacted by telephone on day 1 and day 3 postprocedure. Patients are asked to call immediately if they experience no resolution of discomfort or an abrupt increase in pain in the days following treatment. Those patients reporting an increase in pain and discomfort on either of these days are asked to come to the office for examination. A culture and sensitivity is performed on those presenting with cellulitis clinically and empiric antibiotic therapy is initiated. Antibiotic therapy is adjusted, if necessary, based on the culture and sensitivity report., Results: All cases of cellulitis presented with an increase in pain and burning as the primary symptom between day 1 and 4 following PDT. The appearance of impetiginized areas or pustules was clearly evident in 2 out of the 4 patients. A culture and sensitivity confirmed the growth of staphylococcus aureus in all 4 patients., Conclusion: Cellulitis should be considered as a possible complication in patients reporting an abrupt increase in pain or those who do not experience a gradual resolution of pain and discomfort following PDT.

We report a HTLV-I positive infant, whose infection was confirmed by polymerase chain reaction. The infant presented with an acute, severe, generalized eczema, exfoliation and severe erythroderma that yielded to an acute proteic malnutrition and frequent staphylococcal infections, unresponsive to treatment, since the second month of life. Immunodeficiencies from other origin and other causes of erythroderma were ruled out. The histopathology studies and clinical course yielded to the diagnosis of infective dermatitis associated to HTLV-I. A review of the literature is performed.

Objective: To determine risk factors for neonatal methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection in a well-infant nursery., Design: Case-control studies., Setting: A well-infant nursery in a nonteaching, community hospital., Methods: Case infants were newborns in the nursery who were born in the period November 2003 through June 2004 and had onset of MRSA skin and soft-tissue infection within 21 days after discharge from the nursery. Site inspections were conducted. Control infants were randomly selected male infants in the nursery during the outbreak periods. MRSA isolates were characterized with pulsed-field gel electrophoresis., Results: Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and outbreak 2 occurred from May 26 through June 5, 2004. All were full-term male infants with pustular-vesicular lesions in the groin. Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices. In outbreak 1, case infants (n=6) had a significantly higher mean length of stay than control infants (3.7 vs 2.5 days; P=.01). In outbreak 2, case infants (n=5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]). Controlling for length of stay, case infants were more likely to have been circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were indistinguishable from a community-associated MRSA strain (USA300-0114)., Conclusions: Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.

All athletes have an increased risk of cutaneous infections. In both team and individual sports the skin is exposed to a range of infectious organisms. While effective therapies exist, preventive measures can decrease outbreaks of most sports-related dermatologic infections. This article highlights common dermatologic infections of the athlete, their prevention and treatment.

Infective endocarditis, a serious infection most commonly affecting rheumatic or prosthetic valves, generally occurs after bacteremia. Atopic dermatitis, a very common disease, carries a high prevalence of skin infections, particularly with Staphylococcus aureus. While cutaneous colonization by S. aureus represents an important source of bacteremia, few cases of infective endocarditis arising from the skin lesions of atopic dermatitis have been reported. We describe a patient with recurrent S. aureus prosthetic valve endocarditis developing in this manner.

Background: New antibacterial agents with activity against pathogenic strains resistant to established antibiotics are needed to treat patients with secondarily infected dermatitis (SID)., Objective: We sought to determine the clinical safety and efficacy of topical retapamulin ointment 1% versus oral cephalexin for the treatment of SID., Methods: Patients with SID were randomly assigned to retapamulin ointment 1% (twice daily [bid]) for 5 days, or oral cephalexin (500 mg bid) for 10 days. The primary efficacy end point was clinical response at follow-up. Secondary outcomes included microbiologic response at follow-up, safety, and compliance., Results: Retapamulin was as effective as cephalexin (clinical success rates at follow-up: 85.9% and 89.7%, respectively). Microbiologic success rates at follow-up were 87.2% for retapamulin and 91.8% for cephalexin. Retapamulin was well tolerated and the topical formulation was preferred over the oral drug., Limitations: An imbalance existed in the number of patients with the clinical outcome "unable to determine" (15 retapamulin, 2 cephalexin), mainly because of their failure to attend the study visit. If those who failed to attend visits (who did not withdraw as a result of drug-related events) are removed from the analysis, the clinical success rates are 89.9% for retapamulin and 89.7% for cephalexin., Conclusions: Retapamulin ointment 1% (bid) for 5 days was as effective as oral cephalexin (bid) for 10 days in treatment of patients with SID, and was well tolerated.

Recent trends indicate an increasing incidence of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) in the general population, which is especially worrisome for clinicians caring for patients with atopic dermatitis (AD). Patients with AD are heavily colonized with S aureus and have impaired skin integrity and abnormal immune responses, which predisposes them to more invasive cutaneous infections (eg, cellulitis, furuncles, abscesses). In this report, we describe a child with severe AD who presented with CAMRSA skin abscesses. The presence of an atypical skin infection in patients with AD, particularly those unresponsive to conventional penicillinase-resistant penicillins and cephalosporins, should alert the clinician to the possibility of MRSA as the underlying etiology, and intervention should be directed accordingly.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have emerged as a major cause of skin disease in the United States. Outbreaks of CA-MRSA have occurred among athletes, inmates at correctional facilities, and military recruits. This report summarizes investigations of six unlinked clusters of skin and soft tissue infections caused by CA-MRSA among 44 recipients of tattoos from 13 unlicensed tattooists in three states (Ohio, Kentucky, and Vermont); use of nonsterile equipment and suboptimal infection-control practices were identified as potential causes of the infections. Clinicians should consider CA-MRSA in their differential diagnosis for staphylococcus diseases, including skin infections. Clinicians can contact their local health departments to determine the prevalence of CA-MRSA in their community and whether the disease is reportable. MRSA infections should be added to education and prevention campaigns highlighting the risks of unlicensed tattooing.

This article aims at determining the bathing role in skin colonization of preterm newborn by reviewing the literature from MEDLINE database. Clinical researches have demonstrated that bathing with soap triggers pH increase interfering with the skin physiological protection and provoking changes in the cutaneous microflora composition. Preterm neonates in NICU tend to acquire nosocomial skin flora from the action of bathing with cleansing products on the epidermal barrier function with direct consequences on the skin colonization.

Background: Patients with atopic dermatitis (AD) have an increased tendency to develop bacterial skin infections. Colonization with Staphylococcus aureus is known to be a major trigger and might also play a pathophysiological role. Because of their antiseptic action, silver-coated textiles suppress S. aureus colonization and toxin formation, thus damping the inflammatory reaction., Objectives: To evaluate the clinical effectiveness and safety of a special silver textile in the treatment of patients suffering from acute AD., Methods: In a randomized phase II monocenter parallel-group comparative study 30 patients were recruited (average age 25.5 years, min. 4 years, max. 70 years) who were affected by AD in an acute phase. During the first study phase from Day 1 to Day 14, 10 patients received a silver textile (Group 1), 10 a silver-free textile (Group 2), and 10 prednicarbate ointment (Group 3). In the second phase from Day 15 to Day 28 all patients wore the silver textile, and during the follow-up period from Day 28 to Day 56 no textiles were used. Prednicarbate ointment was allowed as emergency medication, but ointment consumption was measured. The overall severity of the disease was evaluated using the SCORAD index as the primary efficacy parameter. Secondary parameters included severity of pruritus and the patients' assessment of their disease control (uncontrolled, limited, good or complete). Safety tests included hematology, blood chemistry, urinalysis for silver, and physical examination for silver deposits in the skin and mucous membranes., Results: The initial SCORAD was 61.6 (IQR 26.6, min. 30.6, max. 99.9). At the end of the Study Phase 1 the SCORAD had improved significantly in the patients of Groups 1 (74.6-29.9, p = 0.005) and 3 (57.8-24.0, p = 0.009). During Study Phase 2 healing of eczema continued in Group 1 (SCORAD 29.9-18.1, p = 0.037), was observed in Group 2 (48.2-24.1, p = 0.015), and remained at an improved level in Group 3 (SCORAD 24-23.5). Consumption of prednicarbate ointment (Phase 1, Phase 2, follow-up period, medians are given): Group 1: 135 g, 10 g, 45 g; Group 2: 13 g, 0 g, 0 g; Group 3: 145 g, 30 g, 90 g. Silver textiles reduced the severity of the pruritus (p = 0.031); silver-free textiles (n.s.) and prednicarbate (n.s.) were less effective. No undesired events were observed., Conclusion: The elastic silver textile worn directly against the skin led to an impressive improvement of AD and a reduction in the use of prednicarbate ointment.

Objective: The treatment of cutaneous leishmaniasis used in Tunisia is Glucantime. The aim of this retrospective study was to determine the adverse effects of intralesional Glucantime and to calculate the risk/benefit rate of this treatment., Results: Adverse effects were observed in 14 cases (5%). For facial lesions, we observed facial staphylococci in 2 cases, stibio-intolerance in 1 case, and a palpebral subcutaneous nodule in 1 case. In limb lesions the complications were: sporotrichoid nodules in 5 cases, vagal malaise (1 case), pyodermitis (1 case), erysipelas (1 case), necrosis (1 case), and urticaria (1 case)., Commentary: The adverse effects of intralesional Glucantime are mostly infections, mainly observed in cephalic localization, and stibio-intolerance. For this reason, intralesional injection of Glucantime must be avoided in the cephalic region.

Background: Cutaneous manifestations associated with Hodgkin's Disease (HD) have not been well described. Most existing studies of the cutaneous manifestations of HD are individual case reports or literature reviews. The goal of this study was to define the spectrum of cutaneous manifestations of HD, as observed by the consulting dermatologist at a cancer center., Methods: The tumor registry database maintained by the Department of Medical Informatics and the M.D. Anderson Visits database over a 5-year period was searched to identify patients with a diagnosis of HD and an appointment with Dermatology. The medical records were reviewed to determine frequency and presentation of cutaneous findings in HD., Results: The search identified a total of 1049 registered patients with HD, of which 88 were seen at the Dermatology Clinic. Of these 88 patients evaluated by dermatology, 47 patients had either paraneoplastic cutaneous manifestations associated with HD (n = 45) or cutaneous HD (n = 3). The most common paraneoplastic skin manifestations were eczema (n = 18) and pruritus (n = 17), mycosis fungoides (n = 11), and erythema nodosum (n = 3). Mycosis fungoides, observed in 1% of the patients with HD at MDACC, was more than 290 times more common in patients with HD than in the general population., Conclusion: Although pruritus is the most commonly recognized presenting symptom of Hodgkin's lymphoma, new onset of eczema should also be considered as a possible warning sign deserving further investigation. Patients with adult-onset pruritus or eczema should be evaluated for possible HD with full lymph-node exam, CBC with differential, and chest X-ray. Erythema nodosum and mycosis fungoides should also be considered as cutaneous manifestations of HD.

Background: Increased skin Staphylococcus aureus colonization is frequently found in atopic patients. The reduction of local overinfection decreases skin inflammation and improves the flares., Objective: To evaluate the effectiveness of the antimicrobial activity of a silk fabric (MICROAIR DermaSilk) coated with alkoxysilane quaternary ammonium with durable antimicrobial properties (AEGIS AEM 5572/5) in children affected by atopic dermatitis (AD)., Methods: Sixteen children, 12 affected by AD with symmetric eczematous lesions on the antecubital areas and 4 without any cutaneous disease, used, for 7 days, tubular arm covers made of this special silk fabric but only one of each pair was coated with AEGIS AEM 5572/5. Microbiological examinations were done with standard cultural swabs and by means of quantification of bacterial agents using agar plates at baseline, after 1 h and after 7 days., Results: After 7 days a significant improvement in the mean value of the 'local SCORAD' index was observed in both the covered areas compared to the values obtained at baseline. The reduction in the mean number of colony forming units per square centimetre was similar in both areas., Conclusions: Although this special silk fabric seems to be able to improve skin lesions in AD, we were unable to demonstrate that such silk fabrics coated with AEGIS AEM 5572/5 have an antibacterial activity in vivo, as shown in vitro.

Background: Atopic dermatitis (AD) is aggravated by mechanical irritation and bacterial colonization., Objective: This study compared the efficacy of an antimicrobial silk fabric (DermaSilk) with that of a topical corticosteroid in the treatment of AD., Methods: Fifteen children were enrolled and wore a dress, where the left side was made of DermaSilk and the right side was made of cotton. The right arm and leg were treated daily with the corticosteroid mometasone for 7 days. The treatment efficacy was measured with a modified EASI (Eczema Area and Severity Index) and with an assessment by the patients/parents and by a physician. All patients were evaluated at baseline, as well as 7 and 21 days after the initial examination., Results: All parameters showed that, irrespective of the treatment, there was a significant decrease of eczema after 7 days. No significant difference between DermaSilk-treated and corticosteroid-treated skin could be observed., Conclusion: DermaSilk showed potential to become an effective treatment of AD.

We investigated community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections among HIV-positive men who have sex with men. We performed a matched case-control study of 35 case patients and 76 control subjects. CA-MRSA skin infections were associated with high-risk sex and drug-using behaviors and with environmental exposures but not with immune status.

We present a rare case of necrotizing fasciitis in an 5-year-old infant with preexisting varicella infection. Initially, the patient showed acute pain and swelling of the left thorax with high inflammatory parameters and varicella-specific skin affections. MRT presented diffuse soft tissue swelling of the left chest consistent with necrotizing fasciitis. After aggressive surgical debridement of necrotic tissue and extirpation of axillary lymph nodes, the clinical course improved under appropriate parenteral antimicrobial therapy using penicillin and clindamycin. In conclusion, necrotizing fasciitis should be suspected in any child with a history of varicella infection and increasing complaints of pain and swelling in an extremity or other body area associated with increasing fever, erythema, lethargy, and irritability. Shock, multiorgan failure, and death will ensue if the diagnosis is not promptly recognized.

Complicated skin and soft tissue infections (SSTIs) remain a common reason for hospitalisation. Optimal management of complicated SSTIs begins with a physical examination, and obtaining the complete social and medical history of the patient. Empirical intravenous antibacterial therapy is guided by expected pathogens, patient factors and diagnostic procedure reports, such as the Gram-stained smear of discharge or exudates. The majority of community-acquired SSTIs are caused by Staphylococcus aureus and beta-haemolytic streptococci. On the basis of recent surveillance data, 80-90% of these pathogens remain susceptible to cefazolin or oxacillin. Consequently, a first generation cephalosporin or an antistaphylococcal penicillin remains the first line empirical therapy for community-acquired skin and soft tissue infections. Vancomycin may be an appropriate alternative when vancomycin-resistant S. aureus is highly suspected on the basis of patient history and co-morbid conditions. With the global emergence and spread of macrolide-resistant S. aureus and beta-haemolytic streptococci, clindamycin rather than a macrolide is the recommended agent for empirical antibacterial therapy of community-acquired SSTIs in penicillin-allergic patients. Nosocomial complicated SSTIs are predominantly caused by S. aureus, Pseudomonas aeruginosa, Enterococcus spp., Escherichia coli and other Enterobacteriaceae. Piperacillin/tazobactam with or without vancomycin is the preferred agent for empirical treatment depending on local resistance statistics. The newer fluoroquinolones may have a role in the treatment of complicated SSTIs, especially in penicillin-allergic patients. More clinical studies are needed before a formal recommendation can be made. Many of the newer antimicrobial agents such as the carbapenems, oxazolidinones and streptogramins have been shown to be effective for the treatment of complicated SSTIs. However, because of their proven activity against highly resistant organisms including methicillin-resistant S. aureus and vancomycin-resistant enterococci (oxazolidinones and streptogramins), and Gram-negative bacilli producing extended spectrum beta-lactamases (carbapenems), these antibacterials should be reserved for life-threatening situations and/or when resistant pathogens are suspected. Complicated skin and soft tissue infections are often associated with exudates, ulcerations, fluid collections or abscesses. Adequate debridement of devitalized tissues and drainage of abscesses and fluid collections in addition to systemic antibacterial therapy is an integral part of appropriate management.

Background: The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users. PATIENTS Y METHODS: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a aspirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen., Results: From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases gram positive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found., Conclusions: The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.

Chemical hair relaxers are used by many women to straighten their hair. We describe a case of a deep soft tissue staphylococcal abscess that complicated an irritant contact dermatitis from a hair relaxer treatment.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) generates concern in nursing homes. Restrictive isolation precautions may be applied for indefinite periods. Adverse events driving these concerns include transmission and infection., Methods: The 721-bed Wisconsin Veterans Home in King performs approximately 645 cultures annually. The site, severity, and number of MRSA infections were determined for 69 months. Pulsed-field gel electrophoresis was performed on all initial isolates, followed by a statistical cluster analysis looking for evidence of transmission., Results: Sixty-seven MRSA infections were identified (1.6 per 100 residents per year); many were polymicrobial, and it was difficult to determine the proportionate role of MRSA in morbidity or mortality. There was an episode of rapidly fatal MRSA septicemia in which empiric antibiotic therapy was ineffective. Twenty-one genetic strains were encountered. Statistical analysis identified 13 clusters of genetically identical strains clustered in time and space (P<.05)., Conclusions: Infections with MRSA were identified at relatively low rates; however, the etiology of many serious nursing home infections is not determined, especially pneumonia. Statistical analysis revealed clustering and evidence of transmission. Nursing home practitioners should consider MRSA when applying empiric treatment to serious infections. We recommend a program including (1) judicious use of antibiotics, including topical agents, to reduce selection of resistant organisms; (2) obtaining and tracking cultures of infectious secretions to diagnose MRSA infections and focus antibiotic therapy; (3) universal standard secretion precautions because any resident could be a carrier; and (4) a detailed assessment and care plan for the carrier that maximizes containment of secretions and independence in activities. However, basic hygiene cannot be maintained in communal areas by some residents without restriction of activities of daily living.