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Phenazopyridine is an azo dye, which exerts local anesthetic or analgesic action on urinary tract mucosa through an unknown mechanism. Besides its common complications including orange discoloration of the urine and gastrointestinal problems, it may have rare side effects like hemolytic anaemia, methemoglobinemia, renal failure, and skin changes. We reported a paraplegic man with skin ulcers on scretom and right foot after about 3 days of phenazopyridine use A 62-year-old man presented with flesh shaped deep ulcers in lower parts of the body. He declared that at first a bluish discoloration was developed in the lower extremities and scrotum skin after use of eight phenazopyridine tablets (200 mg) and then these lesions turned to blisters and ulcers and they were prurient. The patient underwent sonography and CT-angiography; however, no pathologic findings were found. He just received losartan for many years as past drug history. According to the history, a delayed drug hypersensitivity reaction was suspected and the patient wounds healed after using special type of dressings and antibiotic therapy regarding positive wound cultures. Phenazopyridine severe skin changes are hardly reported. We described a case who experienced severe skin reactions and ulcers following phenazopyridine use not related to other complications including renal dysfunction, methemoglobinemia, and hemolytic anemia. [ABSTRACT FROM AUTHOR]

Baccharis genus Asteraceae is widely used in traditional treatment against fever, headache, hepatobiliary disorders, skin ulcers, diabetes, and rheumatism, as well as an antispasmodic and diuretic. Its phytochemistry mainly shows the presence of flavonoids and terpenoids such as monoterpenes, sesquiterpenes, diterpenes, and triterpenes. Some of them have been evaluated for biological activities presenting allelopathic, antimicrobial, cytotoxic, and anti-inflammatory properties. In this paper, our research group reported the isolation, characterization, and antifungal evaluation of several molecules isolated from the dichloromethane extract from Baccharis prunifolia, Baccharis trinervis, and Baccharis zumbadorensis against the phytopathogen fungus Botrytis cinerea. The isolated compounds have not previously been tested against Botrytis, revealing an important source of antifungals in the genus Baccharis. Six known flavones were isolated from B. prunifolia. The dichloromethane extracts of B. trinervis and B. zumbadorensis were subjected to a bio-guided isolation, obtaining three known flavones, an α-hydroxidihydrochalcone mixture, one labdane, one triterpene, and two norbisabolenes from the most active fractions. The compounds 4′-methoxy-α-hydroxydihydrochalcone (7A), 3β,15-dihydroxylabdan-7-en-17-al (8), and 13-nor-11,12-dihydroxybisabol-2-enone (11) are novel. The most active compounds were the Salvigenin (5) and 1,2-dihydrosenedigital-2-one (10) with an IC50 of 13.5 and 3.1 μg/mL, respectively. [ABSTRACT FROM AUTHOR]

A case study presents a challenging diagnosis involving a 45-year-old male with a non-healing penile ulcer initially suspected as donovanosis but later identified as squamous cell carcinoma (SCC). Despite initial therapy, lack of response prompted deeper evaluation, revealing dermoscopy clues leading to a confirmed diagnosis of SCC, emphasizing the diagnostic complexity between donovanosis and SCC in genital ulcers.

Introduction: Buruli Ulcer (BU) is caused due to mycobacteria, namely Mycobacterium ulcerans. Buruli ulcer is caused by the mycolactones that are secreted by the Mycobacterium ulcerans which results into the tissue necrosis. Metagenomics is a branch of genomics that deals with the study of uncultured microbial genomes present in natural samples like human body parts, environmental samples, food and dairy, disease conditions. Metagenomics branch has enabled us to explore and elucidate the importance of microbial genomes in healthy and infected samples. Aim: To evaluate metagenomic and microbial analysis of buruli and non buruli ulcer skin wound samples along with structural and functional analysis of MUL_3720 protein. Materials and Methods: The present analytical study was conducted from May 2021 to January 2022 at Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India. European Nucleotide Archive (ENA) database was used to retrieve metagenome data of BU and non BU skin lesions with the project id PRJEB14948. Galaxy server was used for the metagenomics analysis from quality control to identification and classification of microbial community in the samples. Different tools from the Galaxy like FASTQC, Trim Galore, KRAKEN2, convert kraken, Krona pie chart tools were used for metagenomic analysis and for taxonomic classification of microbes. Finally, Krona pie chart was generated that gives an elaborate understanding of the different microbes and their percentage in the BU. Complete annotation like protein structure prediction, domain analysis of MUL_3720 protein of Mycobacterium ulcerans was also done as potential drug target against BU. Statistical analysis was done using Krona pie chart generation and prediction. Results: Metagenomic analysis shows that there is difference in microbiome of BU and non BU samples. Differential microbes identified were Mycobacteriacae 1-2%, Sporomusa species 18-22% and Desulfovibrio halophillus 24-25%. Bacteria which were present in both the samples are Actiniidae, Desulfovibrio halophillus, Sphingomonas, and Mycobacteriacae. Structural and functional annotation of MUL_3720 protein of Mycobacterium ulcerans shows that MUL_3720 protein can be potential drug target for drug discovery. Conclusion: This study highlights the metagenome of Buruli Ulcer skin wound and can be used to identify potential drug targets for Buruli Ulcer. Metagenomic analysis of BU and non BU skin wound shows that there is difference in microbial community hence this information can be used in proper diagnostic and medication to combat Buruli Ulcer disease. [ABSTRACT FROM AUTHOR]

Introduction: the nasal bridle (NB) is one of the strategies to avoid the displacement of tubes for enteral nutrition (EN) used during a nutritional intervention. Objectives: to review the efficacy and safety of NB placement in a patient population requiring EN by tube feeding. To analyze their clinical characteristics and identify complications related to this procedure. Methods: a retrospective observational study in usual clinical practice including patients admitted to a second-level hospital with EN catheters who required the use of a commercial NB—CORGRIP NG/NI TFEEDING TUBE RETENTION SYSTEM. Results: 51 patients with a mean age of 73 years (37-96) were analyzed; 64.7 % were men. Oropharyngeal dysphagia (OPD) was the funda)mental indication for placement of an EN tube (54.9 %) followed by refusal to ingest (17.6 %), and orotracheal intubation (7.8 %), among others. NB was withdrawn in 7.8 % of cases due to change in digestive access (gastrostomy), in 21.6 % because of transition to the oral route, and in 9.8 % due to ignorance on how to use it. We found significant differences between accidental removal and self-withdrawal of probes before and after BN placement (2.59 ± 1.512 vs 0.24 ± 0.596; p < 0.05). No related complications were recorded except for only one case of skin ulcer. Conclusions: NB is a safe and effective retention system for the prevention of probe displacement and withdrawal in patients with a wide variety of pathologies. Training health professionals is essential for proper use. [ABSTRACT FROM AUTHOR]

Cutaneous leishmaniasis (CL) is a notifiable disease in Sri Lanka with increasing case numbers reported from every part of the country. In addition to disease treatment and vector control measures, knowledge and perceptions in a community are key contributors to a successful intervention program. An island-wide survey was carried out to assess the knowledge and perceptions regarding CL across the island, with 252 confirmed CL cases and 2,608 controls. Data was collected by trained personnel, using a pre-tested Case Reporting Form (CRF). Although the percentage who referred to CL by its correct name was low (1.4%), majority stated that it is a fly induced skin disease (79.1%). Knowledge on the symptoms, curability and the name of the vector was high in these communities, but specific knowledge on vector breeding places, biting times and preventive methods were poor. The patients were more knowledgeable when compared to the controls. Differences in the level of knowledge could be identified according to the level of education of the participants as well as across the different areas of the country. The main source of information was through the healthcare system, but the involvement of media in educating the communities on the disease was minimal. While this study population was unaccustomed to the use of repellants or sprays, the use of bed nets was high (77.7% of the participants) in this study population. Although misconceptions and incorrect practices are rare in Sri Lankan communities, promoting health education programs which may improve disease awareness and knowledge on vector and its control will further strengthen the control and prevention strategies. Author summary: Cutaneous leishmaniasis (CL) is a disease which causes skin ulcers and spread by the sand fly. In recent years, the number of CL patients reported from all parts Sri Lanka increased notably, indicating that the spread of the disease should be controlled. The general publics' knowledge on the disease and its control methods, is very important to implement a successful control program. Thus, this study was conducted to assess the level of knowledge of the local community on CL, its vector and control methods. The required information was collected by interviewing CL patients as well as healthy persons. More than 50% of both groups gave correct answers to more general questions about the disease such as the disease name, symptoms and spread, indicating that the awareness of CL among the public is satisfactory. However, the study also indicated that the patients were more knowledgeable when compared to the healthy persons. Furthermore, it was evident that knowledge on more detailed information such as vector breeding places, vector biting times is poor in both groups and the healthcare system has been the primary source of information. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study to evaluate the outcome of varicose vein surgery with and without venous stripping. Material and methods: This research covered 100 varicose vein operations across all surgical units. This research included all varicose vein patients between the ages of 18 and 70 who also had incompetent perforators and the saphenofemoral valve. The research excluded individuals with age extremes between 18 to 70, deep vein thrombosis, concomitant short saphenous vein varicosity, venous ulcer or other skin abnormalities, and recurring varicosity. Results: The left leg was more commonly involved than the right side. The left limb was involved in 64% and the right limb was involved in 36% of patients in group 1 and 70% and 30% in group 2. 30% of patients who had venous stripping experienced hematoma development in the thigh, compared to 6% of patients who received the Trendelenburg operation alone without venous stripping. 18% of patients had haemorrhage. Due to the tissue stress that occurs during venous stripping, there is an increased risk of hematoma development in the thigh in individuals who undergo stripping. The ineffective perforators in the legs of both groups were accessed by making a transverse incision at the preoperatively indicated spot under Doppler guidance. In the days after the operation, these wounds were checked. In each group, 6% of patients had slower wound healing. On the first post-operative day, when patients were urged to walk, 70% of those who had had stripping and 90% of those who had undergone ligation alone were able to do so comfortably. It was discovered that there was increased discomfort, tissue stress, hematoma development, and bruising in the case of venous stripping. Conclusion: There is no noticeable difference between the two processes with regards to wound healing, hospital stay, or pain treatment. It would seem that the Trendelen burg technique with incompetent perforator's ligation without venous stripping is preferable to the Trendelenburg method with incompetent perforator's ligation with venous stripping, based on the observed characteristics. [ABSTRACT FROM AUTHOR]

Objective: As a global health challenge, especially in Iran, cutaneous leishmaniasis is one of the major health and medical problems in Sistan and Baluchestan Province and plays a significant role in the inhibition of socioeconomic growth of this deprived province. The aim of our study was molecular identification of cutaneous leishmaniasis species using kinetoplast DNA (kDNA) gene in in a small part (Mirjaveh and Reg-e Malek) of Sistan and Baluchestan region of Iran. Methods: This descriptive cross-sectional study was carried out on patients suspected of cutaneous leishmaniasis with epidemiologics information. Samples of the skin lesions and ulcers suspected of cutaneous leishmaniasis were collected from patients with active ulcers, and the collected samples were diagnosed by of parasitologic (direct smears of the lesions and staining them using Giemsa Staining Method) and molecular methods. The specific Polymerase Chain Reaction (PCR) method was applied to the kinetoplast DNA's isolated from the direct smears to identify the genus and species of Leishmania. Finally, the resulting information was analyzed in SPSS software. Results: The microscopic test results of 43 (57.9%) patients of the 76 patients suspected of cutaneous leishmaniasis were positive. In a PCR assay, the Leishmania kDNA fragment was identified in 50 patients (65.8%). Besides, 44 samples were diagnosed with Leishmania major and 6 samples were diagnosed with Leishmania tropica using species-specific primers. The agreement between the results of the molecular method and the parasitology method in the samples in Mirjaveh and Reg-e Malek was (Kappa=0.8) compelling agreement. There was a significant difference between the results of molecular with the parasitologic results obtained in the samples of cutaneous leishmaniasis in the city of Mirjaveh and the Reg-e Malek (Pv=0.05). Conclusion: According to the present research, cutaneous leishmaniasis prevalance caused by Leishmania major in Mirjaveh City in Sistan and Baluchestan Province in Iran was high. Our findings also confirmed the necessity of carrying out direct molecular tests (including direct smears) on the clinical samples of patients for negative results and species identification. [ABSTRACT FROM AUTHOR]

Hand disease severity in people with systemic sclerosis (SSc) arises from connective tissue and vascular changes causing functional limitations, pain, and disability. Fatigue is not well-understood in SSc and reported to be highly distressing. It is not known how fatigue relates to these disease changes. The objective of this study was to identify which elements of hand disease severity contribute to fatigue in individuals with SSc. Five online databases and Google Scholar were searched to identify publications through 2021 presenting data related to hand disease severity and fatigue. Five articles met the inclusion criteria. The samples were 72–91% female, and 35–100% with diffuse SSc. Measures of disease severity included skin thickening (modified Rodnan score), joint involvement (mobility, tenderness, swelling), and digital ulcers. Fatigue was measured by various self-report. Joint involvement was strongly associated with fatigue. Skin thickening weakly associated with fatigue. The perceived interference of digital ulcers in daily activities was related to fatigue. Few studies have examined how fatigue relates to hand disease severity. While joint involvement was associated with fatigue over time and in cross-sectional studies, digital ulcers may be associated with fatigue indirectly. A conceptual model is proposed with implications for future research. Structural disease changes that manifest in the hands, is often associated with pain, disability, and fatigue in SSc. Fatigue is one of the most distressing symptoms of SSc and reported by 61–90% of individuals with SSc, but is not well characterized. Of measures of hand disease severity, joint involvement (contractures, swollen and tender joints) is most associated with fatigue in individuals with SSc and more so if pain is involved. A better understanding of the physiological features of disease and fatigue could provide insight into development of fatigue management interventions and help rheumatology providers work with patients to manage their fatigue. Rehabilitation assessments and interventions for hand disability need to be considered as important elements in improving all elements of quality of life for individuals with systemic sclerosis. [ABSTRACT FROM AUTHOR]

Joint exposure with an extensive skin defect following soft tissue tumor resection might cause a refractory ulcer. Although a vascularized tissue transplant is ideal for ulcer treatment, it is a highly invasive procedure and usually unsuitable for older patients with general prostration. One-stage perifascial areolar tissue (PAT) and skin grafting combined with negative pressure wound therapy (NPWT) is less invasive and effective procedure for refractory wounds with exposed bones and tendons. This is the first case where this procedure was used to treat a wound that involved an exposed elbow joint with an extensive skin defect. An 80-year-old woman underwent wide excision to remove a leiomyosarcoma on the olecranon with reconstruction using an ipsilateral pedicled latissimus dorsi musculocutaneous flap. The distal three-quarter of the flap was necrosed owing to insufficient blood supply. Furthermore, an articular capsule deficit of 1.5 × 1.0 cm2 was found during necrotomy. The PAT was harvested from the lower abdomen as a non-vascularized tissue, and the articular capsule deficit was covered by overlapping on the granulation tissue around the deficit. Simultaneous split-thickness skin grafting combined with NPWT was applied on the PAT and residual skin defect. Wound healing was achieved in 4 weeks postoperatively without synovial fluid leakage. Elbow joint motion ranging from 0 to 120° was maintained 18 months postoperatively. This procedure helped achieve better wound healing and sufficient functional outcome. Furthermore, this can help decrease patients' burden by preventing invasive resections associated with severe functional impairments or long-term rehabilitation requirements. [ABSTRACT FROM AUTHOR]

Edwardsiella tarda is a severe fish pathogenic bacteria circulating in both cultured and wild fish species, with a broad host range and geographical distribution. The experimental infection of Nile tilapia with Edwardsiella tarda was conducted to determine its Median Lethal Dose (LD50). Fifty (50) live fish of 75 gram body weight were acclimatized and divided into 5 equal groups of 10 fish. Each group was randomly assigned to treatments of 106, 107, 108, 109 cfu/ml dilutions or control (PBS). Previously isolated laboratory stock of Edwardsiella tarda KOCT4', was intraperitoneally injected into each fish in the test groups respectively, while PBS was used for the control group. The calculated LD50 value was 1.6x108 and the infected fish showed hemorrhages, skin ulcers, swollen abdomen, vertical hanging and loss of pigment. Results from this study will be very useful for further pathogenicity studies and facilitation of vaccine development. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis described for the first time by Brunsting et al. in 1930. It is not often encountered in childhood, representing only 4% of PG. In children, predominate pustules that subsequently get ulcerated, with the most common presentation being multiple and disseminated ulcerative lesions that mainly involve lower extremities. It is typically associated with systemic diseases such as inflammatory bowel disease (IBD), rheumatoid arthritis, and hematological discrasias; however, there are cases not associated with illness. The diagnosis is based on clinical results and the course of the disease, in addition to ruling out other pathologies, mostly infections. Histologic findings may be nonspecific, but the presence of subcorneal pustules, neutrophilic inflammatory infiltrate, fibrosis, ulceration, and necrosis help in the diagnosis. [ABSTRACT FROM AUTHOR]

Drug induced erythema multiforme (EM) is a rare clinical entity which majorly involves the oral cavity. It commonly occurs due to intake of drugs such as NSAID'S, certain antibiotics, and anticonvulsants. It is characterized by rapidly rupturing vesicles leading to ill-defined erosions in the oral cavity and encrusted lip lesions. These lesions are usually difficult to differentiate from other vesiculo bullous and ulcerative lesions which would have a similar presentation and the absence of skin lesions can sometimes lead to misdiagnosis. Drug induced EM has an acute onset and is a selflimiting inflammatory hypersensitivity reaction that causes blistering and ulcerations of the skin and mucous membrane. The lesions heal following the discontinuation of the causative medications. This case report describes a case of drug induced erythema multiforme of the oral cavity that occurred consequent to the intake of Tab. Diclofenac Sodium and Tab. Cephelexin. The patient developed painful, bleeding, burning ulcerations with severe crustations on the upper, and lower lip, lateral and ventral surface of tongue, hard palate and retro molar regions. The case was managed with corticosteroids. [ABSTRACT FROM AUTHOR]

Background: Lipoid proteinosis (LP) or Hyalinosis Cutis et Mucosae or Urbach–Wiethe disease is a rare autosomal recessive genodermatosis characterized by an amorphous hyaline material deposition in the skin mucosa and viscera. The clinical symptoms of this disease often begin in childhood, which persist throughout life. Skin manifestations include inflammation, scaling, acne, and eventually ulceration, and hyaline amorphous deposits in these areas of the wound cause a waxy and thick appearance on the skin. In addition, wounds leave atrophic scars like chickenpox. Aim: Herein, we present the first case of LP in the north of Iran; although LP is a sporadic disease, it occurs all around the world, with about 400 cases worldwide having been reported thus far. Patient: We report the case of a 28‐year‐old female patient with a history of skin lesions on her face, scalp, extremities, and buttock, as well as hoarse cry, respiratory problems, dysphagia, and migraine since childhood. There was no evidence of other clinical presentations. A biopsy was taken from the lesions, and the patient was diagnosed with LP. A laryngeal laser was performed for the patient, and peeling creams were used for her skin lesions. Result: According to previous findings, there has been no case report of LP with systemic symptoms in the north of Iran. [ABSTRACT FROM AUTHOR]

Solid organ transplant (SOT) recipients are at increased risk of opportunistic infections, as they are on immunosuppressive drugs. The risk increases if the cumulative immunosuppression is high, especially when the patient is treated for acute rejection episodes. Multiple opportunistic infections in the same patient are reported in SOT recipients. We report a 43-year-old man, renal allograft recipient, 15 years posttransplant, on dual immunosuppression who presented with fever, generalized skin rashes, and altered sensorium. He was recently treated with pulse methylprednisolone injections for acute graft rejection episode. He had multiple pustules all over the body, predominantly over the face, eyelids, chest, and lower limbs. Pus from the facial lesion grew Nocardia, and tissue culture of skin ulcer from the leg grew nontuberculous mycobacteria. Combined infection with these organisms posed diagnostic challenge as both can present with cutaneous manifestation, both organisms are acid-fast bacilli, and both organisms were detected and grown from the sample taken from one of the large skin ulcers. It was important to identify both the organisms from the skin ulcer as the treatment options are different. [ABSTRACT FROM AUTHOR]

Bullous dermatoses is a heterogeneous group of blistering skin disorders that can either be inherited or acquired. Subepidermal blisters may result in ulceration and scarring following their rupture. Wegener's granulomatosis (WG) is a granulomatous necrotizing vasculitis affecting small- to medium-sized blood vessels. It is associated with anti-neutrophil cytoplasmic antibodies (ANCA) and can be manifested cutaneously as multiple bullous and ulcers. A case of WG was reported in an 18-year-old man presented with multiple skin bullous and ulcers. The patient was diagnosed with WG based on the findings from nasopharyngoscopy examination that revealed crusts in his nasal cavity; necrotizing granulomatous appearance on chest radiograph; hematuria on urinalysis; and positive ANCA blood test. This patient received a combination of methylprednisolone and methotrexate, resulting in improvement within four weeks of therapy. His multiple skin ulcers were treated with a combination of dialkyl carbamoyl chloride, hydrocolloid, and hydrogel dressings. This patient was in complete remission state after six months of treatment, which later followed by a relapse episode that occurred within one year. WG with multiple skin bullous and ulcers can mimic other diseases. Various examinations such as histopathology, direct immunofluorescence, and ANCA blood test may aid in determining the etiology of skin bullous and ulcers. [ABSTRACT FROM AUTHOR]

Objective: Hard-to-heal wounds are a global health challenge, and effective treatments are still lacking. Moist exposed burn ointment (MEBO) and maggots are traditional treatments for promoting wound healing. This study was a preliminary exploration of combined maggot therapy and MEBO in the treatment of hard-to-heal wounds. Method: A coexistence experiment was conducted to determine the survival rates of maggots in MEBO. The maggots were placed in two different existence conditions: one set in MEBO (MEBO group), and another set as the control group (no MEBO) to compare survival rates. Case reports describe the use of the combined application of MEBO and maggots in the treatment of patients with hard-to-heal wounds. Results: The coexistence experiment indicated that maggots in the MEBO group had a higher survival rate. From the therapeutic effect of the clinical cases (n=7), the combined application was safe and effective, with all the reported wounds eventually healing. Conclusion: Based on the findings of this study, we believe the combined application of MEBO and maggots is a promising way of promoting wound healing. Further studies and clinical trials are needed to elucidate the mechanism of the combined application in promoting wound healing and to more persuasively clarify the therapeutic effect. [ABSTRACT FROM AUTHOR]

Case: A 53-year-old male patient presented to the dermatology clinics with a three-week history of painful necrotic patches coalescent of the lateral malleolus of the right and left ankles. History goes back to when the patient reported developing pruritic papules two weeks after receiving his second shot of the Pfizer BioNTech COVID-19 vaccine (BNT162b2). Punch biopsy was consistent with leukocytoclastic vasculitis. He was prescribed a four-week course of systemic corticosteroids and antibiotics as per cultures. Vascular assessment confirmed normal peripheral arterial and venous system. Two months later, the patient re-presented with fever and worsening of his lower extremity ulcers. He underwent debridement of his wounds. Intra-operative cultures revealed multidrug resistant bacteria. He required an additional debridement session a few days later and a 14-day course of Piperacillin-Tazobactam. The patient was subsequently discharged on corticosteroids and Azathioprine and followed up in the vascular surgery and rheumatology clinics. At four months follow-up, the patient's wounds were almost completely healed., Conclusion: This article highlights a case of severe new-onset COVID-19 vaccine-associated leukocytoclastic vasculitis complicated with infected ulcers that required debridement twice in addition to a prolonged course of antibiotics and immunosuppression therapy. To our knowledge, none of the cases reported in the literature were this severe in nature. In this post-pandemic era, it must remain high on the differential list, and healthcare specialists should maintain a high index of suspicion when evaluating sudden new-onset skin lesions that do not have an immediately apparent etiology., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Wound management represents a substantial clinical challenge due to the growing incidence of chronic skin wounds resulting from venous insufficiency, diabetes, and obesity, along with acute injuries and surgical wounds. The risk of infection, a key impediment to healing and a driver of increased morbidity and mortality, is a primary concern in wound care. Recently, antimicrobial dressings have emerged as a promising approach for bioburden control and wound healing. The selection of a suitable antimicrobial dressing depends on various parameters, including cost, wound type, local microbial burden and the location and condition of the wound. This review covers the different types of antimicrobial dressings, their modes of action, advantages, and drawbacks, thereby providing clinicians with the knowledge to optimize wound management.

This letter to the editor discusses a case of scurvy in a 77-year-old woman with multiple chronic medical conditions. The patient presented with symptoms such as fever, confusion, hypotension, and respiratory distress, as well as necrotic skin ulcers and a necrotic lower left leg. The article highlights the importance of considering vitamin deficiencies, including vitamin C and thiamin deficiency, in patients with unclear symptoms. The authors emphasize the need for timely diagnosis and treatment of vitamin deficiencies, as they can contribute to poor outcomes in acute illness. The case prompted increased testing for vitamin C levels at the hospital, revealing a high prevalence of vitamin C and/or thiamin deficiency in the rural setting. [Extracted from the article]

This article discusses a case of Papillon-Lefèvre syndrome (PLS), an inherited disorder characterized by palmoplantar keratoderma (PPK) and periodontal disease. The patient in this case presented with recalcitrant pyoderma gangrenosum (PG)-like ulcers, which is an unusual manifestation of PLS. The article provides a detailed description of the patient's symptoms, examination findings, and genetic testing results. It also compares PLS to other genetic disorders that present with recurrent nonhealing ulcers. The authors emphasize the importance of considering PLS as a diagnosis in patients with persistent, treatment-resistant skin ulcers. [Extracted from the article]

The article describes the case of an 80-year old man who was diagnosed with bilateral scalp ulceration or necrosis. The patient experienced bilateral blurred vision, jaw claudification and weight loss and he showed necrotic ulcerations on his scalp, bilateral pale optic discs, and occlusal of the temporal, frontal and parietal arteries bilaterally on examination. The patient's ulceration improved following prednisolone therapy.

Chronic non-healing ulcers pose significant challenges in clinical management, particularly when complicating conditions such as hypertension and dyslipidaemia are present. We present a case of a 38-year-old male with a neglected nonhealing ulcer over the dorsum of his right foot, complicated by underlying hypertension and dyslipidaemia. Despite conventional wound care measures, the ulcer failed to heal over a period of six months. Subsequently, the patient underwent successful treatment with skin grafting, resulting in complete wound closure and restoration of foot function. This case underscores the importance of considering advanced interventions like skin grafting in the management of chronic ulcers, especially in patients with comorbidities that may impair wound healing. [ABSTRACT FROM AUTHOR]

Introduction: Superficial soft tissue sarcomas are often left untreated unless they invade the skin and skin ulcers manifest. Progressive sarcomas frequently result in dismal oncological outcomes despite multidisciplinary treatment. This study aimed to identify prognostic factors for superficial soft tissue sarcomas. Materials and methods: This study retrospectively analyzed the clinicopathological data of 82 patients with superficial soft tissue sarcomas treated between August 2003 and December 2020 at our institution. A superficial soft tissue sarcoma was defined if the percentage of the area occupied by the tumor in the assessed region (skin, subcutaneous) was more than 50%. Age, sex, location, tumor size, tumor-skin invasion, tumor grade, and distant metastasis at initial diagnosis were evaluated as potential prognostic factors. Cox proportional hazards regression models were used to identify the prognostic factors. Five-year survival rates were assessed by the Kaplan-Meier method. Results: The mean follow-up time was 60.1 months. The 5-year overall survival, 5-year local recurrence-free survival, and 5-year metastasis survival rates were 76.4%, 60.6%, and 71.0%, respectively. Univariate analysis showed significant relationships between poor prognosis and tumor size ≥5 cm, distant metastasis at initial diagnosis, and tumor-skin invasion. In the multivariate analysis, only the tumor-skin invasion was associated with worse overall survival. Conclusions: Superficial soft tissue sarcomas have biologically been considered a separate category due to their better prognosis. In this study, the tumor-skin invasion was the only significant factor associated with a poor prognosis. Therefore, all superficial soft tissue sarcomas without tumor-skin invasion should be treated as early as possible. [ABSTRACT FROM AUTHOR]

Background: Non-melanoma skin cancer (NMSC) is the most common type of cancer in the world. In traditional Persian medicine (TPM), various types of temperament (Mizaj) are considered to diagnose, treat, and prevent a variety of illnesses. The present study aimed to evaluate the temperament of patients with NMSC in comparison with a control group. Methods: A case-control study was conducted in 2018 at the Dermatology Clinic of Shahid Faghihi Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 110 patients, aged ≥20 years with confirmed NMSC (case group), and 181 individuals without NMSC (control group) were enrolled in the study. The temperament of the participants in both groups was evaluated using Mojahedi's Mizaj questionnaire. The data were analyzed using SPSS software, and P<0.05 was considered statistically significant. Results: The results showed that the odds ratio of developing NMSC was 2.62 (95%CI: 1.42-4.83, P=0.002) times higher in individuals with dry temperament than other types of temperament. Moreover, the odds ratio of patients with a history of chronic skin ulcers and other types of cancer was 35.7 (95%CI: 11.9-107.15, P<0.001) and 5.22 (95%CI: 1.43-19.06, P=0.012) times higher, respectively, than the control group. Conclusion: Temperament is associated with NMSC, particularly the dry temperament type, and should be considered a risk factor. [ABSTRACT FROM AUTHOR]

Racial/ethnic differences in health care are pervasive in the USA, but the literature is limited with regards to racial disparities in the treatment of dermatologic diseases. Data on the management of skin ulcers was analyzed from the National Ambulatory Medical Care Survey (NAMCS) from 2012 to 2018. Data distributions between Blacks and Whites, chi-squared statistics, and Fisher Exact Tests were computed to identify significant differences in demographic factors, patient encounter characteristics, and medication prescribed, as a function of race. Blacks were less likely than Whites to receive: care by a physician (p =.0389), a skin examination (p <.0001), or cryotherapy (p <.0175). Blacks were more likely to be seen by a nurse practitioner (p =.0359). Whites were 6.698 times more likely than Blacks to have a follow up visit scheduled after 2 months or more. Our data suggests that among outpatient visits for skin ulcers in the USA, racial disparities exist in the probability of seeing a physician, receiving treatment, and follow-up care. Further research must be conducted and interventions implemented in order to combat racial disparities in Black patients' access to dermatologic treatment for skin ulcers. [ABSTRACT FROM AUTHOR]

Propolis has been used since ancient times for the treatment of skin diseases and, currently, its pharmacological potential for healing and repairing various types of wounds is widely cited in the literature. The healing properties of propolis are mainly attributed to its composition which is rich in phenolic compounds, and propolis has aroused the interest of the pharmaceutical industry as a low-cost product as compared with other treatments and medications; however, most of the published data refer to its effects in vitro and in vivo and, so far, few clinical studies have been carried out proving its therapeutic efficacy. In this article, we aimed to review clinical trail data published in Portuguese, Spanish, and English, in Scielo, PubMed, Google Scholar, Medline, and Lilacs between 1990 and 2021 on the clinical use of propolis for skin ulcers. The potential of propolis as an alternative healing treatment for skin wounds such as diabetic, venous, and surgical wounds, as well as wounds caused by burns, etc., is mainly due to its evidenced properties such as antimicrobial, anti-inflammatory, analgesic, and angiogenesis promoter effects. However, there is a need to standardize the type of administration and the concentration of propolis for each type of wound. Furthermore, further clinical studies are essential to add information about propolis safety and for obtaining the best possible therapeutic benefits from its use. [ABSTRACT FROM AUTHOR]

Nowadays, cold atmospheric plasma jet (CAP-jet) shows interesting results in the dermatology sector, particularly focusing on wound healing and antimicrobial properties. The purpose of this case report is to present a nonthermal atmospheric pressure plasma treatment as a novel therapy for venous ulcers. The plasma consists of ionized helium gas that is produced by a high-voltage (4.5 kV) and high-frequency power supply (22 kHz). We here present a 65-year-old man with a slow-healing ulcer on the right lower limb. The CAP was applied to the ulcer twice a week for four consecutive weeks and the patient was followed for 6 weeks. The amount of exudate, ulcer size, and wound grading were determined weekly. The results showed that exudate from the ulcer significantly reduced in the first week after complete treatment, the wound grading of the ulcer improved by the second week, and the size of the ulcer significantly decreased after 2 weeks. The ulcer entirely healed after 4 weeks without any signs of infection. This case study demonstrates that applying CAP-jet can decrease the bacterial load on the ulcer site and stimulate tissue regeneration concurrently. This increases the speed of the healing process. [ABSTRACT FROM AUTHOR]

Abietic acid (AA) is a main constituent from pine resin, which has definite therapeutical effects for treating skin ulcers and tumor. Here, we explored the metabolome changes in skin tissues of mice with UVC-induced skin injury treated with AA by a HPLC-QTOF-MS/MS method. Model mice were induced with UVC irradiation. Skin histopathological changes were examined by routine HE staining. Metabolomic analysis technology and pattern recognition statistical method were applied to analyze the metabolites in the skin tissues of mice to study the therapeutic effect of AA on UVC-induced skin injury in mice. Ceramides, sphingosines, glycyl-L-glutamine, dihydroorotic acid, adenosine, dCMP and lysophosphatidylcholines can be used as biomarkers of UVC-induced skin injury. AA can improve the pathological tissue from the pathway of skin lipid and purine pyrimidine metabolism to achieve the therapeutic effect. AA can effectively treat UVCinduced skin injury in mice. [ABSTRACT FROM AUTHOR]

BACKGROUND Polidocanol is an FDA-approved treatment of incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, but numerous other off-label dermatological applications have been reported. OBJECTIVE To describe the various off-label dermatological clinical uses of polidocanol, as well as efficacy and adverse effects. METHODS The review of studies searchable on PubMed from 2004 to 2021 describing clinical uses of polidocanol to determine efficacy and adverse effects associated with various dermatologic applications. RESULTS Polidocanol has shown efficacy in the treatment of mucocele of minor salivary gland, hemangioma, upper extremity veins, reticular veins of the chest, facial veins, pyogenic granuloma, lymphangioma circumscriptum, digital mucous cyst, mixed skin ulcers, cutaneous focal mucinosis, seromas, glomuvenous malformations, acne cysts, lymphocele, and dissecting cellulitis. Commonly reported side effects include pain, erythema, swelling, ecchymosis, and ulceration. Most sources were case reports and small prospective studies, as such the strength of data supporting many uses is limited by small sample sizes and lack of controls. CONCLUSION Although polidocanol is currently only FDA approved for incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, the use of polidocanol has been selected for a variety of off-label clinical applications. [ABSTRACT FROM AUTHOR]

Since May 2022, more than 6,900 cases of monkeypox virus infection have been reported in 52 countries. The World Health Organization is planning to rename the virus and its clades to reduce stigma. As of July 5, 2022, 556 cases have been reported in 33 U.S. states and the District of Columbia. The initial cases were travel-associated; however, person-to-person transmission is now occurring domestically. Close, sustained skin-to-skin contact, including during sexual activity, appears to be the primary mode of transmission. The risk of widespread community transmission remains low; however, rapid identification of monkeypox virus infection and isolation of affected individuals is critical to prevent further transmission. Most but not all cases have occurred in males; some infections have started with anogenital lesions and can be mistaken for common sexually transmitted infections. To facilitate rapid, accurate diagnosis of monkeypox virus infection, obstetrician-gynecologists (ob-gyns) in the United States should ask about recent travel history and new ulcers or lesions and perform a thorough visual inspection of skin and mucosal sites (oral, genital, perianal area) in patients presenting with new rash. Obstetrician-gynecologists should become familiar with the appearance of monkeypox lesions and know whom to call to report a suspected case, how and when to test for monkeypox virus, and how to counsel patients. In the event of a suspected case, ob-gyns should follow infection-control guidelines to prevent transmission and make recommendations to prevent further community spread. This article outlines the diagnosis, prevention, and treatment of monkeypox virus infection, monkeypox virus infection during pregnancy, and implications for practicing ob-gyns in the United States. [ABSTRACT FROM AUTHOR]

Background: Genital and anorectal Chlamydia trachomatis (CT) frequently present together in sexually transmitted infection (STI) clinics. Aim: To investigate the prevalence of co-occurrent genital and anorectal chlamydia infection, and to study whether sexual behaviour is associated with anorectal infection. Design & setting: A cross-sectional study in general practices in the north of the Netherlands. Method: Women attending general practice with an indication for genital chlamydia testing were included and asked to complete a structured questionnaire on sexual behaviour. Anorectal infection prevalence was compared according to testing indications: standard versus experimental (based on questionnaire answers). Variables associated with anorectal chlamydia were analysed by univariate and multivariate logistic regression analyses. Results: Data could be analysed for 497 of 515 women included. Overall, 17.8% (n = 87/490) were positive for CT; of these, 72.4% (n = 63/87) had co-occurrent genital and anorectal infection, 13.8% (n = 12/87) had genital infection only, and 12.6% (n = 11/87) had anorectal infection only. Rectal infection was missed in 69.3% of cases using the standard indication alone, while adding the sexual history still missed 20.0%. Age was the only variable significantly associated with anorectal infection. Conclusion: The prevalence of anorectal disease is high among women who visit their GP with an indication for genital CT testing. Many anorectal infections are missed despite taking comprehensive sexual histories, meaning that standard treatment of genital infection with azithromycin may result in rectal persistence. Performing anorectal testing in all women with an indication for genital CT testing is, therefore, recommended. [ABSTRACT FROM AUTHOR]

Background and Aims: Diabetic foot ulcers (DFUs) add billions of dollars to the direct annual costs associated with diabetes. Despite various treatments, many DFUs do not heal and become infected. Both skin‐associated microbial communities and glycemic control are believed to be important in nonhealing DFUs. Recent studies have linked serum Vitamin C levels with glycemic control and DFUs. This cross‐sectional study assessed skin microbiome in DFUs, intact diabetic skin, and nondiabetic skin to identify correlations between hemoglobin A1c (HbA1c), Vitamin C, and microbial community structure. Correlations between Vitamin C, HbA1c, wound size, and ulcer duration were also determined. Methods: Participants had their DFUs or intact skin culture swabbed. HbA1c was obtained via point‐of‐care fingerstick testing and serum Vitamin C was obtained via venipuncture. All participants completed a dietary questionnaire. Participants with ulcers were stratified into the controlled (≤8.0%) or uncontrolled (>8.0%) HbA1c group. Analysis of microbial communities was performed via 16S ribosomal RNA (rRNA) gene amplicon sequencing and bacterial load was measured by the domain‐level quantitative polymerase chain reaction of the 16S rRNA gene. Results: Forty‐two patients were recruited over 6 months. Bacteria from the genera Staphylococcus and Stenotrophomonas were present in all samples and often dominant, but a shift towards anaerobic pathogenic taxa was observed in ulcers. No global significant differences were observed for HbA1c and Vitamin C levels in the microbial community structure (R < 0.013/p > 0.375). Bacterial loads were 4–5 orders of magnitude higher in ulcers than in intact skin samples. Bacterial load was not significantly higher in the uncontrolled HbA1c group (p = 0.67). Larger wound sizes (p = 0.46) were observed in the uncontrolled HbA1c group compared to the control. Lower Vitamin C levels (p = 0.002) were observed in the uncontrolled HbA1c group compared to nondiabetic controls. Conclusion: Understanding the link between Vitamin C and HbA1c and DFU microbiome may aid in new therapies. [ABSTRACT FROM AUTHOR]

Background. Granulomatosis with polyangiitis (GPA) is a small vessel vasculitis characterized by lung and kidney involvement. It is typically a disease of white females and has a poor prognosis with the average life expectancy of 5 months for a patient without treatment. Oral and skin ulcers are considered to be rare presentations. Case. A 39-year-old black male presented to the hospital with oral and skin ulcers and was diagnosed with GPA based on the biopsies of both cutaneous lesions and kidney. He was started on rituximab with minimal improvement. Later he was admitted to the ICU and had plasmapheresis, and he gradually improved and was discharged home 8 days after admission. Conclusion. GPA is an aggressive vascular disorder resulting in possible organ system damage and failure. The role of the sickle cell trait in this patient is undefined, but this combination of gender, race, and presenting symptoms in GPA is extremely unusual. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical features and prognoses of dermatomyositis (DM) associated with a double-positive anti-MDA5 and anti-aminoacyl-tRNA synthetase (anti-ARS) antibody presentation. Methods: We retrospectively analyzed 1280 consecutive patients with idiopathic inflammatory myopathy (IIM). Individuals with anti-MDA5 and anti-ARS antibodies (anti-MDA5+/ARS+) were compared to anti-MDA5-/ARS+ and anti-MDA5+/ARS- control individuals based on clinical, pulmonary radiological characteristics, treatment, and follow-up information. Results: Six individuals (0.47%) presented with anti-MDA5+/ARS+; of these, 2 (33.3%) were anti-PL-12+, 2 (33.3%) were anti-Jo-1+, 1 (16.7%) was anti-EJ+, and 1 (16.7%) was anti-PL-7+. Hallmark cutaneous manifestations, including Gottron's sign (100%), heliotrope rash (50%), mechanic's hand (66.7%), and skin ulcers (16.7%) were common. Anti-MDA5+/ARS+ patients tended to have higher ferritin levels (p = 0.038) than anti-MDA5-/ARS+ group, and higher CD4+ T-cell counts (p = 0.032) compared to the anti-MDA5+/ARS- group. Radiologically, NSIP with OP overlap was predominant (60%). Consolidation (60%), ground-glass attenuation (GGA) (80%), traction bronchiectasis (80%), and intralobular reticulation (100%) were common in anti-MDA5+/ARS+ individuals. All were diagnosed with ILD and 50% were categorized as RPILD. All patients received glucocorticoids combined with one or more immunosuppressants. Most (83.3%) had a good prognosis following treatment, but there was no difference in the survival rate between the three subgroups. Conclusion: Presentation with anti-MDA5+/ARS+ DM was rare. The clinical and radiological characteristics of anti-MDA5+/ARS+ DM combined the features of anti-MDA5+ and anti-ARS+ individuals. Individuals with anti- MDA5+/ARS+ antibodies may respond well to glucocorticoid therapy; glucocorticoids combined with one or more immunosuppressants may be considered a basic treatment approach. [ABSTRACT FROM AUTHOR]

Buruli ulcer is a chronic skin disease caused by a toxic lipid mycolactone produced by Mycobacterium ulcerans, which induces local skin tissue destruction and analgesia. However, the cytotoxicity pathway induced by mycolactone remains largely unknown. Here we investigated the mycolactone-induced cell death pathway by screening host factors using a genome-scale lenti-CRISPR mutagenesis assay in human premonocytic THP-1 cells. As a result, 884 genes were identified as candidates causing mycolactone-induced cell death, among which SEC61A1, the α-subunit of the Sec61 translocon complex, was the highest scoring. CRISPR/Cas9 genome editing of SEC61A1 in THP-1 cells suppressed mycolactone-induced endoplasmic reticulum stress, especially eIF2α phosphorylation, and caspase-dependent apoptosis. Although previous studies have reported that mycolactone targets SEC61A1 based on mutation screening and structural analysis in several cell lines, we have reconfirmed that SEC61A1 is a mycolactone target by genome-wide screening in THP-1 cells. These results shed light on the cytotoxicity of mycolactone and suggest that the inhibition of mycolactone activity or SEC61A1 downstream cascades will be a novel therapeutic modality to eliminate the harmful effects of mycolactone in addition to the 8-week antibiotic regimen of rifampicin and clarithromycin. Author summary: Buruli ulcer is a chronic skin disease caused by the bacterium Mycobacterium ulcerans. The disease mainly affects children in West Africa, and the skin ulcers are induced by mycolactone, a toxin produced by the bacteria. The mycolactone diffuses through the skin, killing cells, creating irreversible ulceration, and weakening host immune defenses. However, the cytotoxic pathway induced by mycolactone remains largely unknown. We evaluated the mycolactone-induced cell death pathway by screening host factors using a genome-scale knockout assay in human premonocytic THP-1 cells. We identified 884 genes that are potentially involved in mycolactone-induced cell death, of which SEC61A1, the α-subunit of the Sec61 translocon complex, was the highest ranking. Knockout of SEC61A1 in THP-1 cells resulted in suppression of endoplasmic reticulum stress and caspase-dependent apoptosis induced by mycolactone. These results suggest that SEC61A1 is an essential mediator of mycolactone-induced cell death. [ABSTRACT FROM AUTHOR]

Background: The Sheng-ji Hua-yu (SJHY) formula is a quite effective Traditional Chinese Medicines (TCM) in the treatment of delayed diabetic wounds. Previous research has shown that the SJHY formula has significant anti-inflammatory and wound-healing effects, but the precise mechanism remains unknown. The purpose of this study was to evaluate the effects of rhein, a compound extracted from SJHY formula, in keratinocytes and to investigate the underlying mechanisms. Methods: Microscale thermophoresis (MST) technology was used to confirm that rhein binds directly to oestrogen receptors (ERs). Rhein was then used to treat keratinocytes in vitro. Cell cycle and proliferation analysis, Real-time polymerase chain reaction (RT-PCR) and Western-blot were conducted. Results: Rhein increased the proportion of cells in the S phase of the cell cycle and promoted keratinocyte proliferation. ICI 182,780, an ER inhibitor, was also used to treat keratinocytes. The expression of c-myc mRNA and protein induced by rhein was antagonized by ICI 182,780, indicating that this induction is ER dependent. Intervention with ICI 182,780 had no effect on the upregulation of FosB and JunD, indicating that activator protein 1 (AP-1) members (FosB and JunD) are involved in rhein-induced c-myc mRNA and protein expression but does not require the ER. Conclusion: The present study found that rhein stimulates keratinocyte proliferation by activating the oestrogen signalling pathway via the oestrogen receptor, which induces the expression of c-myc in collaboration with FosB and JunD, thereby accelerating the process of re-epithelialization. [ABSTRACT FROM AUTHOR]

Leishmaniasis is a global illness that is endemic in many countries, including Iraq. The characteristic of cutaneous leishmaniasis (CL) is the development of skin ulcers that are controlled by the immune system. Tumor necrosis factor-alpha (TNFα), a cytokine generated by the innate immune response to CL infection, can influence disease clearance in the human host. The effect of this pro-inflammatory cytokine in CL ulcer development during the infection is not well established. In this study TNF-α level was detected in the patients who suffered from cutaneous leishmaniasis. This level was also assessed in the newly diagnosed patients and others who were undergoing different stages of pentostam treatment. Notably the results revealed a significant increment in TNF-α serum levels in the test groups of newly infected patients, as well as, in the patients enduring second and third trials of pentostam treatment, which was (1125.49, 838.75, 1264.26) ng/ml accordingly, in comparison with healthy control group which was 235.35 ng/ml. Furthermore, there was no significant observation in TNF-α among the three patient groups. The perceived rise of TNF-α serum levels may give insights into this pro-inflammatory cytokine as a biomarker in the prognosis and tracking the disease progression. [ABSTRACT FROM AUTHOR]

Pressure ulcers are a skin condition caused by friction, shear, and long-term pressure on the skin and can result in considerable discomfort for patients. We developed a novel monitoring device for the early diagnosis of pressure ulcers. We designed and fabricated the diagnosis, transmission, and recording units of the system based on an optimal design. The skin-injury monitoring system has a user-friendly interface with a high-speed real-time wireless transmission function. We developed a stable platform firmware and sensible operational software program for the system as well. Furthermore, we fabricated a portable skin-injury monitoring device package via 3D printing. We performed primary experiments in the laboratory using a biological skin-injury model. The developed pressure ulcer sensing system can determine indicators of pressure ulcers and is suitable for the early diagnosis of pressure ulcers and the prevention of skin injury and lesions. [ABSTRACT FROM AUTHOR]

Introduction. Marjolin's ulcer is a skin malignancy that occurs on a scar or chronic wound. It most commonly occurs on a burn scar. Squamous cell carcinoma is the most common type of this tumor in more than 90% of cases. The rate of this rare malignant transformation is 1-2%. Marjolin's ulcer is more aggressive than other skin cancers. Wide excision is the treatment of choice. Recurrences are common. We present a large exophytic carcinoma of the lower leg as a rare form of this tumor according to the size and type together with reconstruction results. Case report. A 52-year-old man was presented with a large exophytic tumor on the left lower leg. The tumor was located at the site of the previous gunshot injury. The latent period w as 2 2 y ears. T umor s ize w as 14 × 12 cm. Wide excision was performed (2-cm surgical margin), including the deep fascia, and the defect was closed by a split-thickness skin graft from the opposite thigh. Histology showed well-differentiated squamous cell carcinoma. There were no regional or distant metastases. One year after surgery, there was no recurrence of the tumor. Conclusion. Early diagnosis of Marjolin's ulcer and wide excision are mandatory. Surgical margins for excision should be 2 cm, and excision should include deep fascia. Multiple and repeated biopsies of chronic wounds are advised. There is no consensus on the staging of Marjolin's ulcer and lymph node dissection. [ABSTRACT FROM AUTHOR]

Background: Substance use has turned out to be one of the growing social problems of the present society cutting across all sorts of boundaries of the world with Kashmir Valley being no exception to this growing pathological phenomenon. Aims and Objectives: To find the prevalence and pattern of dermatological manifestations among substance users across Kashmir Valley. Materials and Methods: Cross-sectional study where patients of all age-groups, irrespective of gender, were enrolled in the three largest districts of Kashmir Valley over a span of 18 months. Results: Sample size was 710 with a male/female ratio of 12.4:1. The mean age of the cases was 25.2 ± 7.05 years. Heroin, one of the opioids, was the most common substance used (n = 515), followed by cannabis (n = 334). Pruritus was found to be the most common dermatological manifestation overall and statistically significant among heroin users. Stigmata of injection drug use (IDU) with the presence of track marks and sooting tattoos (93.1%), atrophic scars secondary to skin popping (30.7%), active skin ulcers (18.8%), and puffy hand syndrome (8.7%) were specifically seen among injection drug users. Oral involvement was seen in 48.5%, including periodontal disease, oral thrush, and stomatitis nicotinica. Hyperhidrosis was present in 30%, and hesitation cuts over arms in 16.3% of all substance users. Conclusion: Dermatological manifestations are quite prevalent among substance users in the population of Kashmir. Pruritus with temporal relation to substance use, stigmata of injectable drug use including track marks and sooting tattoos, atrophic scars at injection sites, active skin ulcers, and skin and soft tissue infections, and hyperhidrosis are among important dermatological clues for detecting substance use. Recognition of such cutaneous signs is important in these cases for more effective diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objectives JDM is an inflammatory myopathy characterized by prominent vasculopathy. AECAs are frequently detected in inflammatory and autoimmune diseases. We sought to determine whether AECAs correlate with clinical features of JDM, and thus serve as biomarkers to guide therapy or predict outcome. Methods Plasma samples from 63 patients with JDM, 49 patients with polyarticular JIA and 40 juvenile healthy controls were used to detect anti-heat shock cognate 71 kDa protein (HSC70) autoantibodies, a newly identified AECA, in ELISA assays. Clinical features were compared between JDM patients with and without anti-HSC70 autoantibodies. Results Anti-HSC70 autoantibodies were detected in 35% of patients with JDM, in 0% of patients with JIA (P  < 0.0001) and in 0% of healthy donors (P  < 0.0001). Both the presence of cutaneous ulcers (59% vs 17%, P  < 0.002) and the use of wheelchairs and/or assistive devices (64% vs 27%, P  < 0.007) were strongly associated with anti-HSC70 autoantibodies in JDM. High scores on the severity of myositis damage measures at the time of measurement of anti-HSC70 autoantibodies and an increased number of hospitalizations were also associated with anti-HSC70 autoantibodies. Intravenous immunoglobulin therapy was used more often in anti-HSC70 autoantibody-positive patients. Conclusion Anti-HCS70 autoantibodies are detected frequently in children with JDM and are novel myositis-associated autoantibodies correlating with disease severity. [ABSTRACT FROM AUTHOR]

Objectives Vascular disease in SSc is associated with significant morbidity and mortality. Preliminary data may lead to the suggestion of a modifiable unified-vascular endophenotype. Our aim was to determine whether the prevalence, mortality and severity of SSc-vascular disease have changed over time. Methods We performed a systematic review and meta-analysis of the literature in PubMed 1950–2019 related to SSc-digital ulcers (DUs), pulmonary artery hypertension (PAH) and scleroderma renal crisis (SRC). We included full-text articles and extracted study characteristics and assessed risk of bias/quality. We examined the prevalence, mortality and surrogate measures of SSc-associated vascular disease severity. Results We included 55 studies in our meta-analysis. The pooled prevalence of DUs (41.0%), PAH (9.5%) and SRC (4.9%) remained largely stable over time. There was significant improvement in PAH 1-year (P  = 0.001) and SRC mortality (P  < 0.001), but not PAH 3-year (P  = 0.312) or 5-year (P  = 0.686) mortality. The prevalence of DU healing did not significantly change (P  = 0.265). There was a trend (all P  = ∼0.1) towards improvement in PAH surrogates: mean pulmonary artery pressure, pulmonary vascular resistance and right atrial pressure. For SRC, there was evidence that the overall frequency of dialysis (66.7%, P  = 0.297) and permanent dialysis (35.4%, P  = 0.036) increased over time. Conclusion Despite the heterogeneity and scarcity of the disease, there have been major improvements obtained in the various vascular complications in SSc leading to benefit in survival. This is supported by a trend towards improvement in several surrogate markers and demonstrates that progress in vascular management translates into major patient benefit. [ABSTRACT FROM AUTHOR]

Background: Methotrexate cutaneous ulceration is a rare methotrexate complication, and has only been described in case reports and case series. Objective: To document patient characteristics, morphologic features, and mortality risk factors for methotrexate cutaneous ulceration. Methods: A systematic literature review of PubMed and Embase (last date 1 November 2021) was performed with data collected from case reports and case series. This study was limited to cases of cutaneous ulceration; presence of oral ulceration was collected from within these cases. Results: 114 cases (men = 57.9%, mean age = 61 years) of methotrexate cutaneous ulceration met inclusion criteria. Psoriasis (69.3%), rheumatoid arthritis (18.4%), and mycosis fungoides (6.1%) were the most common indications for methotrexate use. Morphologies included erosions localized to psoriatic plaques (33.3%), epidermal necrosis/necrolysis (35.1%), localized ulceration (16.7%), and skin-fold erosions (5.3%). Methotrexate dose preceding toxicity varied greatly; median 20 mg/week, interquartile range 15–40 mg/week, range 5–150 mg/week. Most patients had risk factors for serum toxicity (baseline renal dysfunction = 37.8%, concurrent NSAID use = 28.1%, inadequate folic acid use = 89.1%). Thirty percent of cases involved mistakenly high methotrexate doses. Fourteen patients (12%) died. Absence of folic acid use (69% vs. 100%, p value < 0.001), pancytopenia (33% vs. 86%, p value < 0.001), and renal dysfunction at presentation (47% vs. 92%, p value < 0.001) were associated with increased mortality. Limitations: Selection bias present due to abstraction from case reports and case series. Conclusion: Methotrexate cutaneous ulceration is commonly preceded by dosage mistakes, absence of folic acid supplementation, and concurrent use of nephrotoxic medications. Renal impairment, pancytopenia, and absence of folic acid supplementation are key risk factors for mortality from this adverse medication reaction. Providers should regularly monitor methotrexate dosing adherence, drug–drug interactions, and perform routine laboratory evaluation. Index of suspicion for this toxicity should remain high given the varied clinical presentation and high mortality. [ABSTRACT FROM AUTHOR]

Background: Delusional parasitosis (DP) is a false, unshakable belief that pathogens have infested one’s own skin or body. Objective: The objective was to record all patients with DP, a rare presentation of monosymptomatic delusion, in Iraq. Patients and Methods: This was a descriptive study of 21 cases diagnosed with DP in Medical City Teaching Hospital in Baghdad, Iraq, between 2013 and 2021. A detailed history and clinical examination were conducted to exclude actual organic disease. Results: All patients were females with a mean age of 65 years. They believed strongly to have pathogens in their skin or scalp, carrying containers with samples of skin debris, fibers, dead insects, hair waste, and small stones as proofs of their infestation. Careful psychiatric assessment ruled out schizophrenia, substance use disorders, and dementia, and proved the psychiatric diagnosis of monosymptomatic delusion. The patients described their symptoms as something crawling, stinging, and biting sensations. On examination, we often saw shaved scalp hair with injured skin in the form of excoriations, ulcerations, scarring, and pyogenic infections in a localized area. Conclusion: DP is a single symptom-sign complex manifestation in a person with a well-preserved personality apart from a single tactile hallucination of some sort of pathogens infesting their skin. It is commonly a disease of the scalp of elderly females that run a chronic course and rarely remits in a short time. Proper liaison between dermatologists and psychiatrists assisted by laboratory facilities is required for diagnosis and follow-up. Empathetic rapport, psychiatric referral, and early treatment by atypical anti-psychotics significantly improve such conditions. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a rare condition characterized by the development of aseptic, non-healing skin ulcers. Any skin trauma, such as a surgical incision, can trigger an outbreak of lesions. Our case and literature review show that a physician should consider PG in every event of a non-healing, aseptic wound after surgery. The treatment of PG requires collaboration within a multidisciplinary team and immunosuppressive therapy is the first line of treatment, while surgical interventions should be avoided in the active stage of PG. [ABSTRACT FROM AUTHOR]

In the diabetic foot, loss of autonomic nerve supply can alter the vascular perfusion and nerve supply of the skin. This affects the integrity of the skin and its resistance to mechanical and chemical trauma from pressure and wound exudate (Faber et al, 1993). Maceration is a common problem, particularly in the management of chronic wounds (Thomas, 1997). Moreover, diabetic foot ulceration continues to be synonymous with delayed healing, higher infection rates and an increased risk of lower-extremity amputation (Frykberg, 1998). Several factors can affect the local wound environment in diabetic foot ulceration, such as hyperglycaemia, macrovascular and microvascular disease, polyneuropathy, and impaired host immunological defence (Kamal et al, 1996). Maceration of the wound bed and surrounding skin in diabetic foot ulceration may be one of the least well-recognised factors contributing to impaired healing (Cullum et al, 2000). The impact of maceration on skin integrity, and its traditionally poor management and frequency, make it an obvious contender for inclusion as a risk factor in wound care (Cutting and White, 2002b). However, there is little research on the possible implications of maceration in diabetic foot ulceration (Bale et al, 2001). The aims of wound management are to address patient concerns, correct intrinsic and extrinsic factors where possible, and optimise the healing environment. It is also essential to include the periwound margins as an integral part of wound assessment (Cutting and White, 2002a). [ABSTRACT FROM AUTHOR]