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Risk factors associated with wounds and skin infections amongst persons who inject drugs may have changed in the era of fentanyl and now stimulant coinjection. We assessed the number of injection site wounds and skin infections and associated factors amongst 675 persons who inject drugs in a syringe services programme. Of this sample, 173 participants reported a total of 307 wounds and skin infections. Significant factors associated with increased number of wounds and skin infections were age 30 or older, female gender, ever experiencing homelessness, cocaine injection, and injecting between 5 and 10 years. Wounds and skin infections were common amongst syringe services programme clients and are associated with certain risk factors that may help to design effective interventions. Given the high prevalence of wounds in syringe services programme clients, wound care clinicians can make a significant difference and improve outcomes. We also shed light on correlates of wounds and skin infections in persons who inject drugs in order to spur further research to devise efficacious interventions for this underserved group.

The purpose of this review is to describe the standard procedures used to treat venous leg ulcers (VLUs), including endovenous laser ablation (EVLA), sclerotherapy, radiofrequency ablation, or other surgical modalities, and discuss the associated literature. Results of relevant studies, including clinical trials, prospective studies, and retrospective chart reviews, will be critically analyzed and integrated with the authors’ clinical experience. We aim to compare the different methods to help guiding clinical decision-making. It is important to consider each patient’s medical comorbidities, age, and preference in considering a surgical intervention. Studies show that EVLA and ultrasound-guided foam sclerotherapy (UGFS) enable ulcers to heal faster and lower the rates of recurrence. Minimally invasive procedures have replaced open surgical techniques as a means of treating VLUs. EVLA and UGFS appear to be safe and effective treatment options for most patients.

Sponges from the phylum Porifera exist throughout the world in marine and freshwater environments. Although many encounters with humans are benign, some may lead to local dermatologic manifestations and in rare cases can cause more severe systemic reactions. Initial decontamination is of utmost importance to diminish the severity of the reaction. As contact between humans and coastal environments increases, it is important for physicians to know how to recognize and treat sponge dermatitis.

Background: Chronic wounds remain a challenge for the clinician and healthcare system. It is therefore vital for additional therapies that target steps involved in wound recalcitrance. Recently, topical timolol has shown promising results for use in wound healing. Objective: The goal of this study was to assess timolol’s effectiveness in healing wounds of varying etiologies. Methods: This multi-center series took place from 2016¬–2019 at the wound healing centers at the University of Miami Health System and the Veterans Affairs Northern California Healthcare. We identified all wound patients who received treatment with topical timolol maleate 0.5% for at least 4 weeks after failing previous treatments. Timolol drops at a dose of 1 drop per cm2 of wound area were instilled with dressing changes twice a day, once a day, every other day, or continuous application. Once they began the study, they stopped all concurrent therapies aside from standard of care. Healing outcomes were classified into 3 categories: healed, defined as complete re-epithelialization of the wound and closure, improved, defined as decreasing wound size area (WSA), and worsening, defined as increasing WSA. Results: We identified 39 patients, 32 males and 7 females that had a total of 55 chronic wounds of varying etiologies. Thirty-four of the wounds had completely healed, 15 wounds improved in WSA, 4 wounds were unchanged in WSA, and 2 wounds worsened in WSA. Conclusions: In line with our previous experience, we found topical timolol to be a safe, cost-effective, and efficacious treatment for recalcitrant wounds of varying etiologies.

This survey study assesses the status and content of dermatology curricula in US medical schools accredited by the Liaison Committee on Medical Education.

Recalcitrant wounds pose a challenge to the dermatologist. In recent years, many skin substitutes have been developed and are broadly classified as either acellular or cellular. These skin substitutes are to be used in concert with standard of care to provide the stalled wound with a scaffold and key elements such as cytokines, growth factors, and extracellular matrix substances. Skin substitutes help initiate and accelerate wound healing through granulation, cell migration, re-vascularization, and re-epithelialization. Wounds of varying etiologies have been shown to benefit from the multitude of acellular and cellular skin substitutes that are available. This chapter provides clinically relevant background and practical guidance about skin substitutes to allow dermatologists to effectively incorporate these powerful tools into their wound healing armamentarium.

The effects of nonlinear dynamical phenomena on strategies for creating large amplitude excitations in molecular systems are studied. A simple area‐preserving mapping modeling a Morse oscillator coupled to a second intramolecular degree of freedom is considered. The optical field is approximated by a finite sequence of impulsive interactions with arbitrary amplitudes and time increments. The goal of exciting the system to 75% of its dissociation energy is established. For the uncoupled Morse oscillator, an analytic solution for the optimal spacing between pulses of minimal equal intensity is given. When intramolecular coupling is present, the existence of a nonlinear resonance zone is shown to strongly interfere with the efficacy of this strategy. Dramatic improvements in efficiency can be obtained by employing pulse sequences that explicitly take into account the presence of strong perturbations of the zeroth order phase portrait.