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Background: Herpes zoster is a disease caused by varicella-zoster virus infection, which is characterized by dense clusters of vesicles distributed along unilateral bands of nerves and accompanied by neuralgia. Although the disease is self-limited, some patients may develop neurological, ocular, skin, or visceral complications.Case Presentation: We report a 65-year-old Chinese man with ulceration secondary to cutaneous blister rupture on the left lumbar abdomen, who was diagnosed with herpes zoster and did not respond to conventional treatment. Dermatological examination showed diffuse dark erythema with clear boundaries on his left waist and abdomen. Deep ulcers of different sizes were densely distributed with steep edges and relatively dry base, while yellow secretions and black scabs could be seen. Fungal microscopy showed a few pseudohyphae and clusters of spores. Meanwhile, the fungal culture of the secretions showed Candida albicans growth. Skin biopsy of the affected skin from the ulcer of the left abdomen revealed epidermal absence and clusters of spores in the superficial dermis. PAS staining was positive. The patient was diagnosed with gangrenous herpes zoster complicated with Candida albicans infection. After antifungal treatment based on the results of drug sensitivity, the patient's condition was improved.Conclusion: This case reveals the co-existence of herpes zoster and Candida albicans infection, expands our understanding of overlapping diseases, and provides value for clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Aims: Most diabetic foot ulcers are caused by tissue stress from being ambulatory in people without protective sensation. These ulcers are suggested to be preceded by local skin temperature increase due to inflammation of the underlying tissue, a so‐called hotspot. Evidence to support this mechanism of ulcer development is meagre at best. We investigated if foot ulcers are preceded by increased skin temperature in people with diabetes and foot ulcer history. Material and Methods: Participants measured temperature at 6–8 plantar foot locations each day for 18 months and identified a hotspot with a temperature difference >2.2°C between corresponding foot locations for two consecutive days. Results: Twenty‐nine of 151 participants developed a non‐traumatic ulcer while adhering to temperature measurements. In the 2 months prior to ulceration, 8 (28%) had a true hotspot (i.e. at/adjacent to the ulcer location) and the hotspot was on average no longer present 9 days before ulceration. Seven (24%) participants had a false hotspot (i.e. at another location) and 14 (48%) had no hotspot. Conclusions: The skin of the majority of the ulcers does not heat up before it breaks down or, when it does, not directly before breakdown, questioning the foot temperature increase—uslcer association. [ABSTRACT FROM AUTHOR]

Digital hypoperfusion ischaemic syndrome (DHIS), also known as steal syndrome, is a well recognised serious complication of haemodialysis (HD) access creation. The clinical presentation varies from cyanosis to tissue loss due to necrosis or gangrene. In this article, we present a case of painless digital ulceration due to DHIS and provide a review of the literature. A 40-year-old-female presented with multiple painless digital ulcerations of the left hand. Her medical profile included atherosclerotic disease, hypertension, hyperparathyroidism and type I diabetes causing retinopathy, peripheral neuropathy, gastroparesis and end-stage renal disease (ESRD). Her ESRD required HD with the construction of a left-arm basilic vein transposition arteriovenous fistula (AVF). A year later, she developed intermittent, painless ulcerations of the left hand. A Doppler ultrasound confirmed the diagnosis of DHIS. The patient was treated with AVF ligation surgery. At six months postoperatively, she had near complete re-epithelialisation of her ulcers. This case is unique in that the patient did not have preceding pain, likely due to her underlying diabetic neuropathy. While DHIS in haemodialysis patients with AVF is well documented in literature, digital ulceration in this context is an advanced form of this condition. Early recognition of digital ulceration as a complication of DHIS may enable early intervention and prevent permanent damage. [ABSTRACT FROM AUTHOR]

Objective: To explore hierarchical condition categories (HCC) risk score variation among Florida Fee for Service (FFS) Medicare beneficiaries between 2016 and 2018. Data Sources: This study analyzed HCC risk score variation using Medicare claims data for Florida beneficiaries enrolled in Parts A & B between 2016 and 2018. Study Design: The CMS methodology analyzed HCC risk score variation using annual mean county- and beneficiary-level risk score changes. The association between variation and beneficiary characteristics, diagnoses, and geographic location was characterized using mixed-effects negative binomial regression models. Data Collection: Not applicable. Principal Findings: Counties in the Northeast [marginal effect (ME)=− 0.003], Central (ME=− 0.021), and Southwest (ME=− 0.009) Florida have relatively lower mean risk scores. A higher number of lifetime (ME=0.246) and treatable (ME=0.288) conditions were associated with higher county-level risk scores, while more preventable conditions (ME=− 0.249) were associated with lower risk scores. Counties with older beneficiaries (ME=0.015) and more Blacks (ME=0.070) have higher risk scores, while having female beneficiaries reduced risk scores (ME=− 0.005). Individual risk scores did not vary by age (ME=0.000), but Blacks (ME=0.001) had higher rates of variation relative to Whites, while other races had comparatively lower variation (ME=− 0.003). In addition, individuals diagnosed with more lifetime (ME=0.129), treatable (ME=0.235), and preventable (ME=0.001) conditions had higher risk score variation. Most condition-specific indicators showed small associations with risk score changes; however, metastatic cancer/acute leukemia, respirator dependence/tracheostomy, and pressure ulcers of the skin were significantly associated with both types of HCC risk score variation. Conclusion: Results showed demographics, HCC condition classifications (ie, lifetime, preventable, and treatable), and some specific conditions were associated with higher variation in mean county-level and individual risk scores. Results suggest consistent coding and reductions in the prevalence of certain treatable or preventable conditions could reduce the county and individual HCC risk score year-to-year change. [ABSTRACT FROM AUTHOR]

The outbreak of monkeypox virus (MPXV) in non-endemic countries is an international public health emergency, and the diversity in manifestations poses challenges for early diagnosis and isolation. We describe an atypical case of monkeypox (MPX) in a 46-year-old homosexual male living with HIV. He reported 1-day duration fever, a lesion on his chin that, over a period of 18 days, had gradually enlarged and ulcerated. Biopsy examination performed at an external centre revealed pyoderma gangrenosum, unconfirmed at a subsequent biopsy. When he reported to our hospital outpatients' clinic the chin lesion had a diameter of 5 × 5 cm, necrotic margins and ulcerated base and signs of superinfection. He was admitted for further investigations. Three swabs collected from pharynx, skin and chin lesion resulted positive for MPXV. He had a favourable clinical course and was discharged soon after. Pending the achievement of optimal vaccination coverage in at-risk groups, early identification and isolation of infectious patients represent the cornerstones of the containment strategy. Atypical cases of MPX manifestations are not uncommon, particularly in patients with HIV infection. A high level of suspicion should be maintained to identify infectious cases at an early stage and avoid further spread of the infection. [ABSTRACT FROM AUTHOR]

Skin diseases pose a significant threat to animals. We obtained 35 adult annulated sea snakes (Hydrophis cyanocinctus) and 30 adult Shaw's sea snakes (Hydrophis curtus) collected as fishing bycatch from the coastal waters of Sanya, Hainan, South China. Nearly 2/3 of these snakes had signs of skin ulcer and were therefore assigned as sick ones. Of these sea snakes, 21 (14 sick and 7 healthy) adults of each species were used to conduct this study. Specifically, we used high-throughput 16S rRNA and ITS gene sequencing technology to characterize the skin bacteria and fungi and identify the possible pathogens responsible for skin disease by comparing the skin microbiota between the two sea snakes with versus without skin ulcer. The bacterial alpha diversity indices were higher in H. curtus than in H. cyanocinctus, and were higher in healthy snakes than in sick ones. None of fungal alpha diversity indices differed between species and between sick and healthy snakes. Skin microbial communities differed between H. curtus and H. cyanocinctus and between sick and healthy snakes. Skin ulcer was caused by combined bacterial and fungal infection, with bacteria of the genus Arcobacter being the common pathogen in both species. Bacteria of the genera Maritalea, Pseudomonas and Paracoccus formed an important pathogen group in H. curtus, and so did bacteria of the genera Tenacibaculum, Maritalea and Vibrio in H. cyanocinctus. Fungi of the genus Aspergillus were the pathogen in H. cyanocinctus, and so were fungi of the genus Verticillium in H. curtus. Future work could usefully find more information on the pathogen of skin diseases and thereby optimize treatment protocols for these diseases in sea snakes. [ABSTRACT FROM AUTHOR]

We previously demonstrated that the flagellin of intracellular Vibrio splendidus AJ01 could be specifically identified by tropomodulin (Tmod) and further mediate p53-dependent coelomocyte apoptosis in the sea cucumber Apostichopus japonicus. In higher animals, Tmod serves as a regulator in stabilizing the actin cytoskeleton. However, the mechanism on how AJ01 breaks the AjTmod-stabilized cytoskeleton for internalization remains unclear. Here, we identified a novel AJ01 Type III secretion system (T3SS) effector of leucine-rich repeat-containing serine/threonine-protein kinase (STPKLRR) with five LRR domains and a serine/threonine kinase (STYKc) domain, which could specifically interact with tropomodulin domain of AjTmod. Furthermore, we found that STPKLRR directly phosphorylated AjTmod at serine 52 (S52) to reduce the binding stability between AjTmod and actin. After AjTmod dissociated from actin, the F-actin/G-actin ratio decreased to induce cytoskeletal rearrangement, which in turn promoted the internalization of AJ01. The STPKLRR knocked out strain could not phosphorylated AjTmod and displayed lower internalization capacity and pathogenic effect compared to AJ01. Overall, we demonstrated for the first time that the T3SS effector STPKLRR with kinase activity was a novel virulence factor in Vibrio and mediated self-internalization by targeting host AjTmod phosphorylation dependent cytoskeleton rearrangement, which provided a candidate target to control AJ01 infection in practice. Author summary: Vibrio splendidus AJ01 is the major pathogen for skin ulcer syndrome (SUS) in Apostichopus japonicus, nevertheless, its pathogenic mechanism remains unknown. Eukaryotic-like factors play a crucial role in bacterial virulence by targeting hosts. Despite their significance, the eukaryotic factors in Vibrio splendidus have not been studied, and the mechanism by which they interact with the host remains unclear. In this study, we found an eukaryotic-like factor STPKLRR of V. splendidus for the first time. Furthermore, STPKLRR, selected by T3SS, can phosphorylate Tmod at S52, dissociate the Tmod/actin complex, cause cytoskeleton rearrangement and promote the internalization of V. splendidus. Our findings provide insight into the mechanisms underlying the internalization of V. splendidus and advance our knowledge of the general biology of pathogen-host interactions. [ABSTRACT FROM AUTHOR]

The adeno-associated virus (AAV) is a potent vector for in vivo gene transduction and local therapeutic applications of AAVs, such as for skin ulcers, are expected. Localization of gene expression is important for the safety and efficiency of genetic therapies. We hypothesized that gene expression could be localized by designing biomaterials using poly(ethylene glycol) (PEG) as a carrier. Here we show one of the designed PEG carriers effectively localized gene expression on the ulcer surface and reduced off-target effects in the deep skin layer and the liver, as a representative organ to assess distant off-target effects, using a mouse skin ulcer model. The dissolution dynamics resulted in localization of the AAV gene transduction. The designed PEG carrier may be useful for in vivo gene therapies using AAVs, especially for localized expression. A PEG-based carrier, named PEG slime, enables localized recombinant adeno-associated virus (rAAV) delivery to mouse skin ulcer with limited off target delivery, demonstrating a new method for highly localized gene transduction. [ABSTRACT FROM AUTHOR]

Secondary lymphedema is caused by lymphatic insufficiency (lymphatic drainage failure) following lymph node dissection during the surgical treatment or radiation therapy of breast or pelvic cancer. The clinical problems associated with lymphedema are reduced quality of life in terms of appearance and function, as well as the development of skin ulcers, recurrent pain, and infection. Currently, countermeasures against lymphedema are mainly physical therapy such as lymphatic massage, elastic stockings, and skin care, and there is no effective and fundamental treatment with a highly recommended grade. Therefore, there is a need for the development of a fundamental novel treatment for intractable lymphedema. Therapeutic lymphangiogenesis, which has been attracting attention in recent years, is a treatment concept that reconstructs the fragmented lymphatic network to recover lymphatic vessel function and is revolutionary to be a fundamental cure. This review focuses on the translational research of therapeutic lymphangiogenesis for lymphedema and outlines the current status and prospects in the development of therapeutic applications. [ABSTRACT FROM AUTHOR]

Propolis is a natural resin that is produced by bees. It has anti-inflammatory and antibiotic properties, promotes reepithelization, and stimulates skin regeneration. Propolis has great potential for the development of new therapeutic approaches to treat skin ulcers. The present study performed a systematic review and meta-analysis of published studies of the use of propolis for the regeneration of cutaneous wounds and its efficacy as a therapeutic agent. Data were collected from articles in the PubMed, SCOPUS, and Web of Science databases that were published since 1900 by searching the terms "propolis" AND "wound healing." This search yielded 633 articles, of which 43 were included in this systematic review and meta-analysis. The results showed that interest in the therapeutic efficacy of propolis has increased over the years. The studies reported that the propolis was effective for the treatment of skin ulcers by promoting a higher percentage of healing than classically employed interventions. The mode of propolis application has also evolved. An increasing number of studies combined it with other substances and materials to achieve additive or synergistic effects on the skin regeneration process. Propolis appears to be an effective therapeutic alternative for the treatment of skin ulcers. [ABSTRACT FROM AUTHOR]

Prolidase deficiency is an autosomal recessive disease that causes impaired collagen degradation. Altered collagen homeostasis results in the intracellular accumulation of imidodipeptides, which contain proline and hydroxyproline. The many clinical manifestations of prolidase deficiency include dysmorphic facial features, skeletal deformities, hepatosplenomegaly, necrotizing skin ulcers, and recurrent infections. Current clinical knowledge of this genetic disease relies upon few case reports due to its extreme rarity. Diagnosis is dependent on the detection of a pathologic gene variant. Additional diagnostic confirmation may be provided by urine amino acid quantification or reduced in vitro prolidase activity. We present a case of prolidase deficiency caused by a novel variant manifested by skeletal malformations and lifelong multisystemic infections. Genetic testing revealed a homozygous missense variant in the PEPD gene at nucleotide position 200, whereby adenine was replaced by guanine (c.200A > G). The corresponding amino acid change replaced glutamine with arginine at codon 67 (p.Gln67Arg). After boiling the urine sample for hydrolysis, quantitative urine amino acids demonstrated a markedly elevated proline level, confirming the diagnosis. We also provide a discussion of the pathophysiology, clinical manifestations, diagnostic testing, and clinical management of this disease. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is an uncommon inflammatory skin disorder typically presenting as painful skin ulcers, which may also exhibit extracutaneous findings. PG can occur at the site of trauma or surgery, which is known as the pathergic phenomenon. A 36-year-old man developed bilateral steroid-induced glaucoma after prolonged systemic immunosuppressive treatment for cutaneous pyoderma gangrenosum. After successful Ahmed glaucoma valve implantation surgery with donor scleral patch graft in the right eye, the same surgery failed repeatedly in the left eye and complicated with the prolonged conjunctival necrosis and the exposure of the donor scleral patch graft. Under the impression of ocular involvement of PG, microinvasive glaucoma surgery (MIGS) with XEN® Gel Stent was performed in the left eye; the conjunctival bleb was successfully formed without conjunctival necrosis, and intraocular pressure was well maintained. Ophthalmic surgery can be complicated in patients with PG, and the surgical option should be selected prudently to minimize surgical trauma. MIGS, as a minimally invasive surgical technique, could offer an advantage for patients with PG. [ABSTRACT FROM AUTHOR]

Background: There are three main forms of leishmaniases: visceral (the most serious form because it is almost always fatal without treatment), cutaneous (the most common, usually causing skin ulcers), and mucocutaneous (affecting mouth, nose, and throat). Leishmaniasis is caused by protozoan parasites, which are transmitted by the bite of infected female phlebotomine sandflies. The disease affects some of the world's poorest people and is associated with malnutrition, population displacement, poor housing, a weak immune system, and lack of financial resources. An estimated 700,000 to 1 million new cases occur annually. Only a small fraction of those infected by parasites causing leishmaniasis will eventually develop the disease. We report a case of exclusive lymph node involvement in leishmaniasis, presenting as localized lymphadenopathies. The diagnosis of lymphatic leishmaniasis was confirmed by the presence of Leishmania donovani bodies in fine needle aspiration cytology, and positive anti-rK39 antibodies. The bone marrow aspiration was negative for Leishmania donovani bodies. Abdominal ultrasound was done and there was no organomegaly. Furthermore, localized lymphadenopathies may provide a diagnostic challenge by clinically mimicking a lymphoma or other causes of lymphadenopathy. Due to its rarity and its tendency to pose a clinical diagnostic challenge, we decided to report a case of lymphatic leishmaniasis. Case presentation: A 12-year-old Amara male patient presented to the University of Gondar comprehensive specialized hospital, Northwestern Ethiopia, with six discrete right lateral cervical lymphadenopathies, the largest measuring 3 × 2 cm2, with no cutaneous lesion. Fine needle aspiration cytology confirmed the diagnosis of leishmaniasis in lymph node, and he was put on sodium stibogluconate (20 mg/kg body weight/day) and paromomycin (15 mg/kg body weight/day) injections, which are given intramuscularly for 17 days. Having completed his medication at the University of Gondar comprehensive specialized hospital, he had a smooth course and was discharged with appointment scheduled for follow-up after 3 months. Conclusion: In the clinical evaluation of a patient with isolated lymphadenopathies, leishmaniasis must be considered as a differential diagnosis in immunocompetent subjects in endemic areas for early diagnostic workup and management. [ABSTRACT FROM AUTHOR]

Introduction: Systemic lupus erythematosus (SLE), also known as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissues of the body. Symptoms vary among people and may be mild to severe. Common symptoms include painful and swollen joints, fever, hair loss, mouth ulcers and skin rash most commonly seen on face. Aims: To determine the clinical profile of Systemic Lupus Erythematosus patients at presentation. Materials and Methods: This is a cross sectional, observational study of 60 cases of Inpatients and outpatients fulfilling the 2015 SLICC criteria for diagnosing SLE in Vivekananda Institute of Medical sciences (VIMS), Ramakrishna Mission Seva Pratishthan (RKMSP), Kolkata, during the period of Jan 2017-Jan 2018. Result: In our study, we found that 43(71.7%) patients had acute/subacute cutaneous lupus rash. 30(50.0%) patients had discoid lupus erythematosus(dle)rash or hyertrophic lupus rash. 24(40.0%) patients had non scarring frank alopecia. 33(55.0%) patients had oral/nasal ulcer. 48(80.0%) patients had joint disease. 19(31.7%) patients had pleurisy and / or pericarditis. Conclusion: SLE is more common among young females in third decade. In our study, most common features were joint and hematological manifestations followed by skin rash, oral/nasal ulcers and frank alopecia. All patients were ANA positive. SLE patients assessed their quality of life as rather low. Increased disease activity was seen among 80% of SLE patients. Measurement of quality of life along with modified SLEDAI 2000 index will help in providing better therapeutic management to SLE patients. [ABSTRACT FROM AUTHOR]

Objective: To explore the role of peripheral lymphocyte count in phenotyping and prognosis prediction in dermatomyositis (DM) patients with anti‐MDA5 antibodies. Methods: In total, 1669 patients with idiopathic inflammatory myopathy (IIM) were retrospectively enrolled. Clinical characteristics and prognosis of patients with anti‐MDA5+ DM were analyzed in association with peripheral lymphocyte counts and clusters determined by unsupervised machine learning. Results: The peripheral lymphocyte count was significantly lower in the anti‐MDA5+ DM group (N = 421) than in the other IIM serotype groups. The anti‐MDA5+ DM patients were divided into three groups; the severe lymphopenia group had skin ulcers and rapidly progressive interstitial lung disease (RP‐ILD); patients with a normal lymphocyte count had a younger age of onset, more frequent arthritis, and normal serum ferritin levels, whereas mild lymphopenia group showed a moderate increase of serum ferritin and intermediate incidence of RP‐ILD. Survival analysis revealed that the 3‐ and 6‐month mortality rates were significantly higher in the severe lymphopenia group (29.0% and 42.1%, respectively) than in the mild lymphopenia group and normal lymphocyte count group (p value <0.001). Consistently, unsupervised machine learning identified three similar groups; the arthritis cluster shows the highest lymphocyte counts and best prognosis; the RP‐ILD cluster presents the lowest peripheral lymphocyte, high incidence of RP‐ILD, and poor prognosis; the typical DM rash cluster had a moderate peripheral lymphocyte count and an intermediate prognosis. Conclusions: Lymphopenia is a unique manifestation of anti‐MDA5+ DM. Peripheral lymphocyte count can define clinical phenotypes and predict prognosis in anti‐MDA5+ DM. [ABSTRACT FROM AUTHOR]

Introduction: Stasis dermatitis (SD), also known as venous dermatitis, is a form of inflammatory dermatitis of the lower extremities that typically occurs in older individuals and represents a cutaneous manifestation of venous hypertension. Venous hypertension (also known as sustained ambulatory venous pressure) is most often due to retrograde blood flow, which occurs due to calf muscle pump failure. This failure is most commonly secondary to incompetent venous valves, valve destruction, or obstruction of the venous system. Many of the common symptoms associated with SD are caused by inflammatory processes. Methods: This review summarizes the pathogenesis and key role of inflammation in SD by reviewing inflammatory biomarkers associated with SD. The literature was selected though a high-level PubMed search focusing on keywords relating to inflammation associated with SD. Results: Venous reflux at the lower extremities causes venous hypertension, which leads to chronic venous insufficiency. High venous pressure due to venous hypertension promotes the local accumulation and extravasation of inflammatory cells across the vascular endothelium. Leukocyte trapping in the microcirculation and perivascular space is associated with trophic skin changes. Cell adhesion molecules are linked with the perpetuated influx of activated leukocytes into inflammatory sites. Here, inflammatory cells may influence the remodeling of the extracellular matrix by inducing the secretion of proteinases such as matrix metalloproteinases (MMPs). The increased expression of MMPs is associated with the formation of venous leg ulcers and lesions. Phosphodiesterase 4 activity has also been shown to be elevated in individuals with inflammatory dermatoses compared to healthy individuals. Discussion: Because inflammation is a key driver of the signs and symptoms of SD, several of the highlighted biomarkers of inflammation represent potential opportunities to target and interrupt molecular pathways of cutaneous inflammation and, therefore, remediate the signs and symptoms of SD. Conclusion: Understanding the pathogenesis of SD may help clinicians identify drivers of inflammation to use as potential targets for the development of new treatment options. Plain Language Summary: Stasis dermatitis is a skin disease that affects the legs, most often of older people, with chronic venous insufficiency. Chronic venous insufficiency is when veins cannot return blood from the legs back to the heart. This leads to high blood pressure in veins and causes blood in those veins to flow backwards. If stasis dermatitis is left untreated, complications, including skin ulcers, can result. Other skin symptoms of stasis dermatitis include itchiness, scaling, and discoloration. Such skin symptoms can have a negative effect on a person's quality of life. Inflammation that lasts a long time is likely the main link between the skin changes seen in people with stasis dermatitis and the increased pressure in leg veins. Several molecules are associated with the inflammation observed in stasis dermatitis, including white blood cells, matrix metalloproteinases, phosphodiesterase 4, and interleukin-31. Treatment for stasis dermatitis should focus both on the underlying chronic venous insufficiency and the associated skin issues. Identifying inflammatory markers and pathways could help treat the signs and symptoms associated with stasis dermatitis, including the skin symptoms. [ABSTRACT FROM AUTHOR]

Background: Cutaneous leishmaniasis (CL) is an endemic infection in the Middle East, including Iran that is also spreading to new foci. We aimed to determine the leishmaniasis species causing CL in Alborz province. Methods: Overall, out of 55-suspected CL patients referred to health centers in Alborz Province, north central Iran in 2019, 40 patients had positive smear for CL based on optical microscopy. The internal transcribed spacer 1 (ITS1) of nuclear ribosomal DNA (rDNA) was amplified by PCR. Leishmania species were identified by PCR-restriction fragment length polymorphism (PCR-RFLP) using BshF I (Hae III) enzyme. Results: Out of the 40 positive patients with CL, 34 cases (85%) had been caused by Leishmania (L) major and six (15%) by L. tropica. Fifteen patients had no history of traveling to the disease endemic areas, of which nine were Iranians. Skin lesions and scars caused by CL were mostly observed on the hands and face. Moreover, more than two skin lesions were observed in 22 cases (55%), all of which were infected with L. major. A single skin ulcer was seen in 18 (45%) of the CL patients. Conclusion: Climate change, reduced rainfall, and demographic changes such as migration into Alborz Province and the increasing marginalization of the population and their entry to settle in new areas might have caused natural transmission of both L. tropica and L. major in this province. [ABSTRACT FROM AUTHOR]

Background: Plane warts are smooth, flesh-colored papules that might be flat or raised slightly. Lesions can range in size from 1 mm to greater than 5 mm, and can number anywhere from a handful to the hundreds. The face, hands, and lower legs are frequent places for them to manifest. Scratching, shaving, and trauma can cause them to emerge in a linear pattern. Imiquimod enhances the immune system's reaction. Injecting imiquimod into a skin wound or ulcer triggers cytokine synthesis and activation of the innate and adaptive immune systems. This makes it an accessible alternative for the treatment of a wide range of dermatologic diseases, both benign and malignant. Objective: Assessment of the possible role of imiquimod in dermatology and possible benefit on plane warts. Methods: Research on Imiquimod, Skin cancer, and Genital warts was scoured through the databases PubMed, Google Scholar, and Science Direct. The authors also analysed references from related works, but only included the latest or most comprehensive study between October 2000 and January 2021. Documents written in languages other than English have been disqualified due to a lack of translation resources. Dissertations, conference abstracts, and oral presentations were not included since they do not constitute "important scientific discoveries". Conclusion: Dermatologists have taken notice of imiquimod's recent rise to prominence as a useful immunomodulatory topical medication. However, the appropriate use and utilization of imiquimod in dermatology have been impeded by a lack of randomized controlled studies in the assessment of this potentially crucial medicine, as well as anecdotal evidence combined with varying treatment regimens. [ABSTRACT FROM AUTHOR]

Leishmaniasis is a group of diseases caused by infection with Leishmania parasites. The lesions that develop as a result of leishmaniasis can vary depending on the species of the parasite and the type of leishmaniasis. Cutaneous leishmaniasis is the most common form of the disease and it results in skin sores or ulcers. Materials with manganese oxide (Mn2O3) nanoparticles and tellurium oxide (TeO2) nanorods have been shown to have antibacterial, antifungal, and antiparasitic effects. The purpose of this study was to ascertain how Mn2O3 and TeO2 nanoparticles affected Leishmania major-caused wound healing in rats. The albino rats were separated into four groups of five once a lesion appeared on their tails. In the two treatment groups, Mn2O3 and TeO2 nanoparticles were injected every day, once a day, intra-wound in three places, and in the meglumine antimoniate group, the drug was injected intramuscularly for five weeks. The albino rats in the negative control group did not receive any medication. The size of the wounds in the group treated with Mn2O3 nanoparticles did not differ significantly from the control group that did not receive treatment, however the diameter of the wounds in the group treated with TeO2 nanorods did change significantly from the control group that did not receive treatment. It was, however, larger than the group that received meglumine antimoniate treatment. TeO2 nanorods, as opposed to Mn2O3 nanoparticles, had an in vivo anti-Leishmanial potential. [ABSTRACT FROM AUTHOR]

Introduction: Skin ulcers can be difficult to manage and can become a major source of morbidity. Abdominal and thigh, localisation is rare. Necrotising panniculitis can occur anywhere, but the most common location is on areas exposed to injury and pressure. Clinical case: We present here the case of a 78-year-old female patient, known to have insulin-dependent type II diabetes mellitus, hypertension, gastroesophageal reflux disease and morbid obesity, arriving at the medical cffice/clinic for multiple giant, round-oval ulcerations covered with necrosis and fibrin purulent secretions located on the abdomen and inner thighs. The onset was insidious, in the form of raised erythematous lesions on the thighs that subsided, but with a recurrence on the abdominal area two months ago, with rapid transformation into ulcerations. The patient underwent antibiotic treatment and topical therapy applied by the outpatient surgery service, but with an unfavourable outcome and was subsequently admitted to the dermatology ward. Bacteriological examinations revealed multibacterial superinfection of the ulcers with Klebsiella pneumoniae, E. Coli, Proteus and specific antibiotic therapy was initiated. Histopathological examination revealed focal changes of lipoid necrosis in the hypodermis. The differential diagnosis included pyoderma gangrenosum, necrotising panniculitis or allergic reaction to insulin. Conclusions: Localisation of ulcerations at the abdominal level (at the site of insulin injection), but also on the thigh and in the intergluteal area is rare and poses diagnostic difficulties. Management of skin ulcers requires careful management of associated pathologies such as diabetes mellitus or hypertension, and morbid obesity in the patient. [ABSTRACT FROM AUTHOR]

A woman in her 76 s has valvular heart disease, atrial fibrillation, and myelodysplastic syndrome. Warfarin bridged with low molecular weight heparin (LMWH), was treated for anticoagulation therapy in this patient. Five days later, The patient informed the anticoagulant management personnel from the APP of abnormal coagulation, thrombocytopenia, and ulcers, as well as pain in the left forearm pinhole, by Atrial fibrillation management mobile app software "Guidance on alfalfa anticoagulation". Following the diagnosis of warfarin-induced skin ulceration, the patient received intravenous vitamin K and fresh frozen plasma (FFP) to reverse the effects of warfarin. After 3 days of effective treatment, the patient 's forearm ulceration improved and healed soon. This case highlights the importance of telemedicine in patients with anticoagulant therapy. And warfarin should be used with caution in patients with HIT, HIT antibodies detection should be requested in patients presenting with thrombocytopenia after using of heparin. We suggest that medical staff should provide the remote medical and remote drug monitoring for patients with chronic diseases and those taking high-risk drugs. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 27-year-old Japanese male with ichthyosis follicularis-atrichia-photophobia syndrome-1 (IFAP1). The patient presented with congenital atrichia, photophobia, intellectual disability, and epilepsy. The article confirms the diagnosis of IFAP1 through genetic analysis and identifies a known pathogenic variant in the MBTPS2 gene. The patient also developed eccrine syringofibroadenoma (ESFA), a rare benign adnexal tumor, which has not been previously reported in association with IFAP1. The article explores potential treatments for the patient's symptoms and suggests further investigations to understand the development of ESFA in IFAP1 cases. [Extracted from the article]

This article discusses the potential use of topical tobramycin as a treatment for severe skin chronic ulcers. Chronic ulcers, which affect about 70% of all chronic wounds and 1-2% of the general population, can be extremely painful and limit daily activities. Bacterial superinfection, particularly by the multi-drug resistant bacterium Pseudomonas aeruginosa, often occurs in these wounds. The study conducted at the Istituto Dermopatico dell'Immacolata in Rome, Italy, collected swab samples from patients with leg ulcers and found that tobramycin was effective against multi-drug resistant P. aeruginosa. The study included a case series of five patients who showed improvement in inflammation, pain, and wound healing after using tobramycin ointment topically. However, the safety and efficacy of this treatment have not been fully verified and further research is needed. [Extracted from the article]

The article discusses the association between the shield sign and carcinoma hemorrhagiectoides in cutaneous metastases. Cutaneous metastases from salivary duct carcinoma are rare, and the shield sign has not been commonly reported in this context. The shield sign refers to skin metastases predominantly located on the chest area, resembling a medieval knight's shield. Carcinoma hemorrhagiectoides is an inflammatory pattern of cutaneous metastases associated with the shield sign. The article provides a comprehensive review of different presentations of inflammatory cutaneous metastatic carcinoma, including carcinoma erysipelatoides, carcinoma telangiectoides, and carcinoma hemorrhagiectoides. [Extracted from the article]

A case study of a 63-year-old male of Nigerian ancestry with urinary symptoms and rectal discomfort initially suspected as gastrointestinal in origin, and Androgen deprivation therapy (ADT) is a common treatment for prostate cancer, but it can lead to adverse reactions. It mentions that the rare case of necrotic skin ulceration following multiple administrations of intramuscular leuprolide acetate, a synthetically derived gonadotropin-releasing hormone receptor agonist.

Background: Granulomatosis with polyangiitis (GPA) is an antineutrophil-cytoplasmic-antibody (ANCA)-associated small-vessel vasculitis characterized by necrotizing granulomatous inflammation. Symptoms of skin involvement can appear in 30–50% of patients with GPA, and may present as the initial presentation. Case Presentation: We describe two patients who presented with multiple deep, large, nonhealing skin ulcers postoperatively with purulent drainage and fever. Both patients were diagnosed with GPA after an extensive evaluation, including histopathology. Infectious, connective tissue disease and malignant etiologies were excluded. Their cANCA and PR3-ANCA levels were positive. Patient 2 was diagnosed early and recovered well after treatment with corticosteroids and rituximab; however, Patient 1 had a poor prognosis due to a long disease course. Conclusions: Diseases with multiple deep, large skin ulcers and fever can be infectious or noninfectious. Atypical manifestations may lead to missed diagnosis and misdiagnosis. GPA may initially present in a localized form before progressing to a generalized disease. The two cases we have highlighted will prompt clinicians to nevertheless call for a low threshold for diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Dermatitis herpetiformis (DH) is an autoimmune vesiculobullous disease associated with celiac enteropathy. The clinical manifestation of DH is the occurrence of a papulovesicular rash on the skin. Oral mucosal involvement in DH is very rare. This study aimed to describe the impact of COVID-19 on the acute exacerbation of oral dermatitis herpetiformis. Case Report: A 74-year-old woman was referred to the Oral Medicine Department with a chief complaint of the blisters on the skin for a week and ulcers in the oral cavity appeared two days ago. Extraoral examination revealed crusts on the neck and extremities. The lips appeared dry and desquamative. Intraoral examination revealed erosive lesions covered with a white-yellowish plaques on the right and left sides of the buccal mucosa, an ulcer with a diameter of 0.5 cm, and purpura hemorrhagic on left buccal mucosa and right lateral border of the tongue. Histopathological examination of the skin lesion revealed a subepithelial blister with eosinophils and neutrophil cells. The definitive diagnosis of dermatitis herpetiformis was made. She was given 5 mg intravenous dexamethasone, cetirizine 10 mg, and clindamycin 300 mg by the dermatologist. We gave hyaluronic acid 0.025% mouthwash for oral ulcers and petroleum jelly for the lips. The oral lesions had significant improvement after 4 weeks of treatment. Two months later, the patient experienced acute exacerbation after being infected with COVID-19 (anti-SARS-CoV-2 IgG S-RBD > 40,000 AU/mL). The oral lesions healed after a month of treatment. Conclusion: COVID-19 can trigger the acute exacerbation of dermatitis herpetiformis. SARS-CoV-2 causes an immune dysregulation and hypersensitivity reaction. [ABSTRACT FROM AUTHOR]

Objective To develop and validate the prognostic prediction model DU-VASC to assist the clinicians in decision-making regarding the use of platelet inhibitors (PIs) for the management of digital ulcers in patients with systemic sclerosis. Secondly, to assess the incremental value of PIs as predictor. Methods We analysed patient data from the European Scleroderma Trials and Research group registry (one time point assessed). Three sets of derivation/validation cohorts were obtained from the original cohort. Using logistic regression, we developed a model for prediction of digital ulcers (DUs). C -Statistics and calibration plots were calculated to evaluate the prediction performance. Variable importance plots and the decrease in C -statistics were used to address the importance of the predictors. Results Of 3710 patients in the original cohort, 487 had DUs and 90 were exposed to PIs. For the DU-VASC model, which includes 27 predictors, we observed good calibration and discrimination in all cohorts (C -statistic = 81.1% [95% CI: 78.9%, 83.4%] for the derivation and 82.3% [95% CI: 779.3%, 85.3%] for the independent temporal validation cohort). Exposure to PIs was associated with absence of DUs and was the most important therapeutic predictor. Further important factors associated with absence of DUs were lower modified Rodnan skin score, anti-Scl-70 negativity and normal CRP. Conversely, the exposure to phosphodiesterase-5 inhibitor, prostacyclin analogues or endothelin receptor antagonists seemed to be associated with the occurrence of DUs. Nonetheless, previous DUs remains the most impactful predictor of DUs. Conclusion The DU-VASC model, with good calibration and discrimination ability, revealed that PI treatment was the most important therapy-related predictor associated with reduced DU occurrence. [ABSTRACT FROM AUTHOR]

Introduction: Neurogenic patients performing clean-intermittent self-catheterization (CIC) may develop an urethral erosion, resulting in ischial-urethral fistulas (I-UF). In this work we present our single-center experience in dealing with this peculiar complication. Methods: In this work we included all neurogenic patients performing CIC treated at out Institution for I-UF. All patients had a spinal cord injury or myelomeningocele. We extracted from the patients' medical records the surgical management and postoperative clinical data. We defined failure the persistence of the fistula at X-ray contrast fistulography, retrograde urethrography, or uretrocystoscopy. Results: We treated 11 patients (8 spinal cord injury, 3 myelomeningocele). Four patients have been treated with the placement of a new generation urethral stent (Uventa) after surgical toilette of the skin ulcer and placement of a temporary suprapubic catheter. All patients demonstrated a complete healing of the urethral lesion at stent removal and continued CIC without any difficulty. Four patients have been treated with perineal urethroplasty, requiring a buccal mucosal graft in two cases. In two patients a suprapubic permanent catheter was placed for a simpler bladder management due to the patients' comorbidities. In one case the incidental finding of an high grade muscle invasive urothelial bladder cancer, made it mandatory to perform an uretheroileocutaneostomy. Conclusions: This work represent a unique series of I-UF in neurogenic patients performing CIC. Surgical urethral reconstruction, often with the use of buccal mucosa in large lesions, may be a difficult solution in neurogenic patients, new generation stents (Uventa) represent a minimally invasive, effective, and safe alternative. [ABSTRACT FROM AUTHOR]

Perifascial areolar tissue (PAT) is a thin membranous tissue with rich horizontal vascular plexus that is located on the deep fascia and is usually harvested from the deep fascia of the thigh and fascia of the external oblique muscle of the abdomen. We successfully treated lateral malleolar ulcers that were refractory to drug preparations and wound dressings for several years with PAT grafts using the Integra® Meshed Dermal Regeneration Template (Integra, Integra Life Sciences, Princeton, NJ). The subjects were two patients of elderly or many underlying illnesses with lateral malleolar ulcers caused by ischemia and chronic venous insufficiency that had remained uncured despite ongoing treatment with ointments, bFGF (Fiblast® Spray; Kaken Pharmaceutical Co. Ltd., Tokyo, Japan) and wound dressings. We performed surgery with debridement of the ulcer site and PAT graft placement on the defect, with Integra placed over the PAT. The PAT survived, and good dermal regeneration was achieved with Integra. On postoperative day 18, split-thickness skin graft was performed. Completely elastic and flexible skin was formed, resulting in reduced ulcer recurrence. One year postoperatively, the patients reported improved quality of life without recurrence. In elderly patients, surgeries involving free flap procedures are highly invasive and pose risks. Thus, we believe that PAT grafting and Integra, for which engraftment is achieved with the blood supply received through wide contact with the healthy tissue surrounding the wound, is a useful option for refractory ulcers as it is a minimally invasive method that causes little postoperative pain. [ABSTRACT FROM AUTHOR]

Introduction: Beta-blockers are proven to be safe and cost-effective agents in treating multiple dermatological conditions, which is why they are considered as an interesting and good alternative therapeutic agent by dermatologists. To our knowledge, there has been no comprehensive systematic review to date summarizing the role of both systemic and topical beta-blockers in dermatology. Methods: In this systematic review, we aim to review recent and relevant published literature in order to provide a comprehensive evidence-based summary to inform dermatologists. Results: An electronic-based literature search was carried out during October–December 2021 in the databases PubMed (MEDLINE), SCOPUS (EMBASE), and Cochrane Library. Furthermore, bibliographic sources were also reviewed for the selected articles. We followed The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA) guidelines. We reviewed published literature about the role of beta-blockers in dermatology for the time period (January 2016 to December 2021). Conclusions: A total of 126 publications were retrieved from different databases, of which 59 studies were finally included in our review after excluding non-eligible literature in accordance with our inclusion and exclusion criteria. The included articles consisted of meta-analyses, systematic reviews, clinical trials, retrospective and prospective cohort studies, case–control studies, case series, and case reports. In general, data in reviewed literature showed that both systemic and topical beta-blockers were reliable and safe therapeutic options in treating different dermatoses. Their effect has been studied as a mono-therapy, also as an adjuvant therapy combined with other current disease-specific therapeutic modalities such as lasers, radiation, chemotherapy, corticosteroids, or other beta-blockers options. Local and systemic adverse effects were mainly minor and non-significant. [ABSTRACT FROM AUTHOR]

Burn severity is determined by total body surface area affected, temperature of source, and duration of exposure. Patients with impaired mobility are less capable of avoiding hazards and escaping traumatic injuries. Additionally, patients with impaired mobility frequently suffer from other comorbid conditions and have specialized needs, which can complicate their acute treatment. This study was a retrospective electronic medical records review of all adult patients, aged 18 years and older with a preexisting mobility impairment, admitted as inpatients to a single burn center for treatment of burn-related injuries from January 1, 2009, to December 31, 2019. The 10-year review of 1520 adult burn admissions meeting the initial criteria of inpatient admission and burn injury revealed 174 patients with documentation supporting preexisting functional mobility impairment (11%). Surprisingly, patients' overall lengths of stays were consistent with all burn populations at 0.81 days per % TBSA, with the average length of stay being 6.7 days. The demographic data were consistent with national burn registry data as male, Caucasian, and older, with mean age of 61.1 years. Demographic data and details of hospital course focusing on treatment, complications, and outcomes were extracted and analyzed. There is a paucity of literature describing the needs of this unique burn population. Burn-injured patients with preexisting mobility impairments suffer from similar mechanisms of injury. By identifying attributes unique to this population, we hope to develop specialized prevention education and treatment protocols. [ABSTRACT FROM AUTHOR]

Background: Though ubiquitously used in orthopaedic trauma, lower extremity splints may have associated iatrogenic risk of morbidity. Although clinicians pad bony prominences to minimize skin pressure, the effect of joint position on skin pressure and, more specifically, changing joint position, is understudied. The purpose of this biomechanical study is to determine the effect of various short-leg splint application techniques on anterior ankle surface pressure in the development of iatrogenic skin pressure ulcers. Methods: Various constructs of lower extremity, short-leg splints were applied to 3 healthy subjects (6 limbs total) with an underlying pressure transducer (Tekscan I-Scan system) on the skin surface centered on the tibialis anterior tendon at the level of the ankle. All subjects underwent anterior ankle surface pressure assessment when padding was applied in maximum plantar flexion and neutral position for conventional short-leg splints application in clinically relevant patient scenarios. Percentage change from initial contact pressure centered on the tibialis anterior with cast padding were calculated. Results: The percentage change in anterior ankle contact pressure when padding was applied in maximum plantar flexion (PF) and then definitively placed in neutral was increased at least 2-fold without the addition of plaster in lower extremity short-leg splints. Removing anterior ankle padding following final splint application in neutral reduced contact forces at the anterior ankle 46% and 59% in splints applied in maximum PF and neutral ankle position, respectively. Conclusion: The present study is the first of its kind to underscore and quantify clinically relevant technical pearls that can be useful in reducing risk of iatrogenic risk of skin breakdown at the anterior ankle when placing short-leg splints, mainly, that it is imperative to apply padding in the intended final splint position and to remove anterior ankle padding following splint application when able. Level of Evidence: Level IV, biomechanical study with clear hypothesis. [ABSTRACT FROM AUTHOR]

• OMT significantly attenuated neutrophil migration, restored the mRNA expression levels of JNK, casp3, mapk14a, mapkapk2a and map2k1 damaged by zebrafish caudal fin wound model and copper sulfate injury model. • In the vitro experiment, OMT regulated the chemotaxis of primary neutrophil inflammatory response in mice, increased phagocytosis, decreased the level of oxidative stress and alleviated the level of inflammation. Sophora flavescens Ait. (SFA), an extensively utilized herb for the treatment of fevers, inflammatory disorders, ulcers and skin diseases related to bur, contains oxymatrine (OMT) as its principal active constituent. OMT exerts regulatory effects over inflammation, oxidative stress and apoptosis. Neutrophils, critical regulators of the inflammation response, have not been thoroughly elucidated regarding the protective properties and underlying mechanisms of OMT-mediated anti-inflammation. This study was aim to explore the protective effect of OMT on neutrophils under inflammatory conditions and delve into its potential mechanism. Leveraging the advantages of zebrafish, an animal model with a real-time dynamic observation system, we established an in vivo caudal fin wound model and a copper sulfate induced-inflammation model in zebrafish line Tg (mpx:GFP). The result revealed that OMT significantly attenuated neutrophil migration, upregulated the mRNA expression levels of JNK, casp3, mapk14a, mapkapk2a and map2k1 damaged by zebrafish caudal fin wound model, and downregulated mRNA expression levels of JNK, casp3, mapk14a, mapkapk2a and map2k1 in the copper sulfate injury model. In vitro experiments demonstrated that OMT modulated the chemotaxis response of primary neutrophils from mice, enhanced phagocytosis, reduced oxidative stress and alleviated inflammation level. We hypothesize that the OMT may exert its anti-inflammatory effects by regulating primary neutrophils through the MAPK signaling pathway. [ABSTRACT FROM AUTHOR]

Chronic venous insufficiency due to deep vein incompetence (DVI) is difficult to treat and is prone for failure and recurrence of venous ulcers. A variety of techniques have been tried to create valve competency but majority of them have been difficult to perform and have not shown long term results. Opie reported a technique for construction of a monocusp neo valve. We have modified this procedure and successfully corrected the deep vein reflux in a patient with primary DVI.Monocusp valve was created by folding the vein wall flap so that both sides of the valve will have intimal surface.Patient had excellent symptomatic improvement. The venous ulcer healed with skin grafting and had not recurred at 30 months follow up. Descending venogram and duplex scan showed mild reflux.Monocusp neo valve creation for primary DVI is a simple procedure with good long-term result. [ABSTRACT FROM AUTHOR]

To assess the effect of naltrexone on oral mucosal healing using a traumatic ulcer model Wistar rats (n = 112) received distilled water (control) or naltrexone (0.5, 10, or 50 mg/kg/day). Ulcers were induced on the buccal mucosa using a round skin biopsy punch (diameter 6 mm). Euthanasia was performed on days 1, 3, 7, and 14. Healing was assessed by ulcer area, histological scores, histomorphometric analysis (number of polymorphonuclears, mononuclears, and fibroblasts), and collagen percentage. Immunohistochemistry for TLR-2, TLR-4, NF-kB, and CD31 was evaluated. Nociceptive threshold was measured daily. The 50 mg/kg group showed reduced ulcer area on days 1 (p < 0.001), 3 (p < 0.05), and 14 (p < 0.01). In this group, there was, on day 14, an increase in the percentage of reepithelization (p = 0.043) and collagen (p < 0.05), an increase in connective tissue maturation (p = 0.016), and on day 7 an increase in fibroblasts (p < 0.001). The 10 mg/kg dose reduced the ulcer area on day 1 (p < 0.001). The 50 mg/kg group showed lower expression of TLR-4 (p < 0.001) on day 1, NF-kB on days 1 (p < 0.05) and 14 (p < 0.05), and CD31 on day 14 (p < 0.05). The 0.5 and 10 mg/kg doses reduced TLR-4 expression on day 1 (p < 0.05; p < 0.01, respectively). Nociceptive threshold increased in the 50 mg/kg group (p < 0.01). Naltrexone enhanced traumatic oral ulcer healing by reducing TLR-4/NF-kB signaling and promoting fibroblast proliferation and collagen deposition. Additionally, naltrexone reduced pain in rats. • Naltrexone (50 mg/kg) improved healing of traumatic oral ulcers. • Naltrexone (50 mg/kg) modulated acute inflammation through TLR4 and NF-kB downregulation. • Naltrexone (50 mg/kg) increased the number of fibroblasts and collagen percentage. • Naltrexone (50 mg/kg) increased the nociceptive threshold. [ABSTRACT FROM AUTHOR]

A correction notice to the article "Lesion on the back of the hand in a hematopoietic stem cell transplant recipient'", which appeared in the previous issue of the periodical, is presented.

Background: Black patients receiving outpatient care for skin ulcers are less likely to see a physician and are at risk for higher stage pressure injuries. While racial/ethnic differences in outpatient treatment of skin ulcers have been described, this study aims to elucidate potential differences in the inpatient setting using publicly available data. Methods: We conducted a retrospective cohort study of the Statewide Planning and Research Cooperative System database, a de-identified, patient-level dataset for inpatient visits in New York between 2009 and 2021. Admissions were filtered by diagnosis-related group (APR-DRG) code 380 (skin ulcers). Results: Compared to non-Hispanic white patients, non-Hispanic black patients demonstrated longer mean LOS (8.15 vs. 7.48 days, p = 0.009), higher mean charges ($44,400 vs. $37,600, p < 0.001), and were more frequently discharged home without services (38.1% vs. 32.4%, p < 0.001). Black Hispanic patients had similar mean LOS (7.22 vs. 6.36 days, p = 0.133), similarly discharged home without services, and had higher mean charges ($45,800 vs. $36,700, p = 0.031). After adjusting for patient factors, non-Hispanic black patients had a longer LOS by 0.26 days (p = 0.028) with $2331 higher inpatient charges (p = 0.001) compared to non-Hispanic white patients. Conclusions: The findings suggest racial and ethnic differences in hospitalizations for skin ulcers, with black patients experiencing greater LOS and charges. The reasons for these differences merit investigation, yet could be related to delays in outpatient care, more severe disease, presence of comorbid conditions, or complications requiring intensive inpatient services. [ABSTRACT FROM AUTHOR]

Livedoid vasculopathy is a painful thrombo-occlusive vascular disorder characterized by spontaneous thrombosis in medium-size arterioles, which causes localized hypoxia and skin ulceration. As livedoid vasculopathy is rare, case reports are the primary means of expanding collective knowledge about its presentation and response to various therapies. [ABSTRACT FROM AUTHOR]

The Chembio DPP (Dual Path Platform) Syphilis Screen & Confirm kit (https://chembio.com) is a rapid serologic test that can be used to diagnose yaws. We evaluated its capacity to detect patients with ulcers that tested PCR positive for Treponema pallidum subsp. pertenue. DPP detected 84% of ulcers that were positive by PCR. [ABSTRACT FROM AUTHOR]

Background: Split-skin grafting is commonly employed by surgeons for covering skin defects in case of Skin ulcers, deep burns and following trauma. Objectives: To evaluate effectiveness of collagen dressing in healing of Split Skin Graft Donor site wound (DSW). Material and Methods: This comparative study was conducted in the Department of General surgery, Kasturba Medical College affiliated Hospitals, Mangaluru between October 2014 to September 2019 and continued in few private hospitals in Mysore from September 2021 to August 2022. Purposive Sampling technique based on inclusion and exclusion criteria was used. Results: Epithelialization with collagen as a donor site dressing material on postoperative day 12 was complete in 66.7% of cases, in around 30% of cases spotty epithelialization was noted and 3.3% of cases showed no epithelialization. Pain and burning sensation are the two most distressing symptoms patient will suffer from at the donor site wound in postoperative period. Minimal use of analgesics is observed with collagen as dressing material for donor site wound. Conclusion: Epithelialisation rate was faster with the use of collagen as a material for donor site wound in comparison with conventional Vaseline gauze dressing. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes. DFUs impede patients' quality of life and are known to be unresponsive to conventional therapy. Photobiomodulation (PBM) is a pain-free, noninvasive treatment method that has been shown to promote chronic wound healing and has been successfully used for the treatment of DFUs. Since skin tone and color can affect the way light interacts with tissue, studies should take this into consideration when determining protocols for the use of PBM. This review is aimed at critically evaluating data of existing studies conducted to evaluate the clinical effect of PBM on DFUs, taking skin color into consideration. A literature search was conducted and resulted in articles on cell studies, animal studies, and clinical trials. Only 13 clinical trials and 2 clinical case studies were adopted and used in this review. All the clinical trials adopted for this review show evidence that PBM together with conventional treatment results in an increased healing rate of DFUs; however, only one study adjusted their protocol according to skin color. There are not enough studies conducted on people of color to determine the safety and efficacy of PBM therapy in such ethnic groups. Future randomized, placebo-controlled clinical trials are necessary on PBM and DFUs and should take skin color into consideration. [ABSTRACT FROM AUTHOR]

The growing phenomenon of skin ulcers represents an important health problem; therefore, we conducted a pilot study to evaluate the ulcer healing time among adult subjects followed by the Home Nursing Service of the AUSL-IRCCS of Reggio Emilia, Northern Italy, and diagnosed with at least one skin ulcer during the period of January–August 2020. We recruited 138 subjects (45.5% men) with a mean age of 86.1 years. The subjects presented with 232 ulcers, of which 76.7% were pressure ulcers (60.1% were stage II), 18.1% were vascular ulcers, and 4.7% were diabetic foot ulcers. Ulcer management required only one weekly access for the majority of subjects, with a recovery frequency of 53.6% at the end of the observation period. The median ulcer healing time was 3.6 months and was shorter in women (2.6 months) than men (5.1 months), with an increasing trend according to the number of ulcers and the severity of pressure ulcers for vascular and diabetic foot ulcers. In conclusion, this is the first study carried out in an Italian population describing the distribution and characteristics of homecare residents with skin ulcers and highlighting the factors influencing the healing time and as consequence the duration of nursing care. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a relatively rare neutrophilic dermatosis presenting as a rapidly progressive and painful skin ulcer characterized by undermined borders and peripheral erythema. Immunosuppressive therapy is the first-line treatment for PG; however, large ulcers often take months or years to heal. Surgical treatments, such as negative pressure wound therapy (NPWT) and skin grafting, are still controversial due to the risk of inducing the pathergy phenomenon and eliciting PG development by traumatic factors. Herein, we report on four cases of PG treated with skin grafting, with or without NPWT, under the control of immunosuppressive drugs at our institution. All cases adapted well, but one case showed recurrence at the periphery of the grafted area five months postoperatively. The current patients were treated with the following doses of oral prednisolone (PSL): PSL 10 mg daily, PSL 5 mg daily + adalimumab 40 mg/week, PSL 12 mg + 6 mg of tacrolimus daily, and PSL 20 mg daily during skin grafting. No severe complications, including infections, were observed. Surgical treatments, such as skin grafting with or without NPWT, may accelerate wound healing, shorten the administration of analgesics and long-term immunosuppressive therapy, and reduce the risk of infection. [ABSTRACT FROM AUTHOR]

Anti-melanoma differentiation-associated protein 5 (anti-MDA5) antibody-positive dermatomyositis (DM) is a subtype of DM described recently. It has atypical features compared with classical DM, such as cutaneous ulcers, interstitial lung disease (ILD), arthritis, and less muscle involvement. We presented a patient diagnosed with anti-MDA5 antibody-positive DM with severe cutaneous ulcers, whose symptoms started after an electrical injury trauma. The patient was a 33-year-old man who was admitted to our department with skin rash, arthralgia, and weakness developing during the last 2 months. In his medical history, he sustained a low-voltage electrical injury 1 month ago. He was diagnosed with DM according to the physical examination, laboratory, and radiological findings and cutaneous histopathology. Treatment with oral administration of prednisolone 1 mg/kg/day and intravenous administration of immunoglobulin 2 g/kg/day was initiated. At the start of symptom improvement, the prednisolone dose was gradually tapered. At the third visit, his condition deteriorated, presenting with cutaneous and mucosal ulcers. At this point, the extended myositis panel was sent, and anti-MDA5 antibody was detected. High-resolution computed tomography revealed peripheral intralobular reticular opacities on both lungs, which indicated ILD in the early stage. Therefore, intravenous administration of cyclophosphamide 1000 mg once a month was added to steroid and intravenous immunoglobulin. His treatment continued with dramatic improvement. Anti-MDA5 antibody-positive DM has a significant risk of developing rapidly progressive ILD, therefore diagnosing timely is critical for prognosis. [ABSTRACT FROM AUTHOR]