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Infectious skin diseases constitute a significant public health problem. Despite the systematic development of many modern diagnostic and therapeutic tools, they still pose a serious challenge for clinicians. Due to their prevalence and mild course in most cases, they are often marginalized, which can delay their diagnosis and treatment initiation. Such an approach in more clinically advanced cases can have serious consequences, sometimes leading to tragic outcomes. This work presents a series of four cases of common infectious skin diseases with an unusually atypical clinical picture: the history of a 49-year-old female patient with recurrent erysipelas of the right lower leg co-occurring with a SARS-CoV-2 infection, a 75-year-old male patient with a generalized form of herpes zoster, a 38-year-old female patient with a complicated severe course of head lice, and a 34-year-old male patient with a severe form of post-steroid mycosis. In each of these cases, difficulties in making the correct diagnosis were highlighted, even though they represent some of the most common bacterial, viral, parasitic, and fungal dermatoses. The paper discusses the risk factors for these diseases, the pathophysiology of their atypical course, the effects and challenges in the therapeutic approach conducted. Infectious skin dermatoses require aggressive treatment and should never be underestimated.

We aimed to describe the frequency of treatment failure and associated risk factors for treatment failure amongst neonates with skin and soft tissue infections (SSTIs). We conducted a retrospective cohort study of neonates 0 to 28 days old with uncomplicated SSTIs presenting to the emergency department of a quaternary care children's hospital from 2009 to 2017. Data were collected via chart review. Skin and soft tissue infections included the following: cellulitis, abscess, mastitis, perirectal SSTI, carbuncle, and furuncle. Of the 202 neonates in the study, most were term, afebrile with mastitis, or perirectal SSTI. Treatment failure occurred in 8% (17/202) of neonates receiving oral antibiotics; 10 of these neonates had perirectal SSTIs and 2 had clindamycin and methicillin-resistant Staphylococcus aureus . Neonates with treatment failure had increased odds of having perirectal SSTIs (odds ratio [OR] = 4.08, 95% confidence interval [CI] = 1.46-11.31). Further studies are needed to identify strategies to prevent treatment failure in neonates with perirectal SSTIs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Human protothecosis is a rare achlorophyllic algal infection found in immunocompromised hosts; commonly those patients on glucocorticoids. Irradiation of the infection is uncommon, but has been previously attempted with antifungal therapy. We present a case of hard-to-heal wounds on an 89-year-old female patient taking glucocorticoids. A wound biopsy noted the wounds to be infected with Prototheca . The patient underwent operative debridement of her wounds, which began to improve and show signs of granulation. This report details the oldest known case of human protothecosis invasion, to our knowledge, and the successful treatment of a Prototheca infection by operative debridement.

Direct microscopy is a valuable skill in the management of skin infections and infestations, yet it is underutilized in dermatology clinics. This review details its use in identifying fungal skin infections and scabies infestations, outlining the steps involved in sample collection, preparation and interpretation., (© 2022 The Authors. Clinical and Experimental Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Patients with a variety of dermatologic conditions, ranging from mild to life-threatening course of disease, present to the dermatological emergency service. The article provides an overview of prevalent conditions and recommendations for diagnosis and treatment according to guidelines. Major acute allergic diseases such as anaphylaxis, urticaria, angioedema and cutaneous drug reactions are discussed. In the field of infectious skin diseases, herpes zoster and erysipelas are common reasons for dermatological consultation. In recent years, scabies has reemerged. Educating patients properly about scabies management can prevent further treatment failures. Finally, the article focuses on sexually transmitted infections including urogenital gonorrhea and chlamydia., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Microorganisms, usually bacteria and fungi, grow and spread in skin wounds, causing infections. These infections trigger the immune system and cause inflammation and tissue damage within the skin or wound, slowing down the healing process. The use of photodynamic therapy (PDT) to eradicate microorganisms has been regarded as a promising alternative to anti-infective therapies, such as those based on antibiotics, and more recently, is being considered for skin wound-healing, namely for infected wounds. Among the several molecules exploited as photosensitizers (PS), porphyrinoids exhibit suitable features for achieving those goals efficiently. The capability that these macrocycles display to generate reactive oxygen species (ROS) gives a significant contribution to the regenerative process. ROS are responsible for avoiding the development of infections by inactivating microorganisms such as bacteria but also by promoting cell proliferation through the activation of stem cells which regulates inflammatory factors and collagen remodeling. The PS can act solo or combined with several materials, such as polymers, hydrogels, nanotubes, or metal-organic frameworks (MOF), keeping both the microbial photoinactivation and healing/regenerative processes' effectiveness. This review highlights the developments on the combination of PDT approach and skin wound healing using natural and synthetic porphyrinoids, such as porphyrins, chlorins and phthalocyanines, as PS, as well as the prodrug 5-aminolevulinic acid (5-ALA), the natural precursor of protoporphyrin-IX (PP-IX).

Skin and soft tissue infections are common in diabetics. Diabetic foot infection usually results from disruption of the skin barrier, trauma, pressure, or ischemic wounds. These wounds may become secondarily infected or lead to development of adjacent soft tissue or deeper bone infection. Clinical assessment and diagnosis of these conditions using a multidisciplinary management approach, including careful attention to antibiotic selection, lead to the best outcomes in patient care., Competing Interests: Disclosure C. Polk has received research funding from Merck, United States., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Skin and soft tissue infections among the non-human immunodeficiency virus infected immunosuppressed population are a serious and growing concern. Many pathogens can cause cutaneous infections in these patients owing to the highly varied and profound immune deficits. Although patients can be infected by typical organisms, the diversity and antimicrobial-resistant nature of the organisms causing these infections result in significant morbidity and mortality. The diagnostic approach to these infections in immunocompromised hosts can differ dramatically depending on the potential causative organisms. An understanding of new immunosuppressive treatments and evolving antimicrobial resistance patterns are required to optimally manage these difficult cases., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Animal and human bite injuries are a public health burden. Dog bites outnumber cat bites, but cat bites pose the greatest risk for infection. Skin and soft tissue infections are the most frequent infectious manifestations resulting from bite injury, although invasive infection may occur through direct inoculation or dissemination through the bloodstream. Although contemporary, well-designed trials are needed to inform clinical practice, preemptive antibiotic therapy after a bite injury is warranted for injuries posing high risk for infection and for patients at risk of developing severe infection; antibiotics should target aerobic and anaerobic microbes that comprise the oral and skin flora., Competing Interests: Disclosure This work was supported in part by a grant from the Agency for Healthcare Research and Quality (R01-HS024269). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Persons who inject drugs are at high risk for skin and soft tissue infections. Infections range from simple abscesses and uncomplicated cellulitis to life-threatening and limb-threatening infections. These infections are predominantly caused by gram-positive organisms with Staphylococcus aureus, Streptococcus pyogenes, and other streptococcal species being most common. Although antimicrobial therapy has an important role in treatment of these infections, surgical incision, drainage, and debridement of devitalized tissue are primary. Strategies that decrease the frequency of injection drug use, needle sharing, use of contaminated equipment, and other risk behaviors may be effective in preventing these infections in persons who inject drugs., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The authors reviewed outpatients in a tertiary dermatology clinic in Botswana to expand knowledge on patterns of skin disease in this population with a high prevalence of human immunodeficiency virus (HIV). Approximately one-third of new and follow-up patients were HIV positive. Common dermatologic conditions included eczematous eruptions, viral and fungal infections, malignant neoplasms, vascular disorders, disorders of pigmentation, and mechanical/physical injury-related disorders. HIV has impacted patterns of dermatologic disease in Botswana, with Kaposi sarcoma being the most frequently biopsied condition. Given the shortage of dermatology specialists, resources should be allocated toward education and management of these most prevalent skin conditions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Acute bacterial skin and skin-structure infections (ABSSSI) is defined in 2013 by the US Food and Drug Administration as a bacterial cellulitis/erysipelas, major skin abscesses, and wound infections. The Infectious Diseases Society of America (IDSA) in 2014 classifies skin and soft-tissue infection (SSTI) as either non-purulent (which includes cellulitis, erysipelas, and necrotizing infection) or purulent (including furuncle, carbuncle, and abscess). Among hospitalized patients with SSTI, healthcare-associated infections account for 73.5% of all cases. Notably, skin and skin-structure infections caused by Pseudomonas aeruginosa, a common hospital pathogen, was reported to cause higher total cost and longer hospital length of stay compared to non-P. aeruginosa cases, despite causing only approximately 5.7% of all healthcare-associated SSTIs. Infection with P. aeruginosa should always be considered in non-healing skin infections in patients with prolonged hospitalization and antibiotic exposure. Tissue culture, preferably taken by surgical debridement, should be promptly performed; and when hospital-infection is suspected, appropriate antibiotics should be started along with removal of all devitalized tissue and to promote skin and soft tissue healing. Expedited discharge should be considered when possible, with adequate antibiotic treatment and follow up for definitive wound treatment.

"Currently, an estimated 70.8 million individuals worldwide are forcibly displaced due to war, violence, and persecution. Barriers to providing dermatologic care include the large number of affected people, their movement within and across international borders, security issues, and limited access to dermatology expertise and formularies. Screening protocols for skin diseases and sexually transmitted infections differ worldwide, raising the need for shared guidelines to assess migrants' health. This article reviews the literature of skin and sexually transmitted infections in migrants and displaced persons, highlighting the impact of social determinants on skin health and challenges faced in providing care.", (Copyright © 2020 Elsevier Inc. All rights reserved.)

The concept of skin neglected tropical diseases has been widely adopted into the policy and strategy of various organizations, governments, nongovernmental organizations, and health agencies. By pooling information and resources across different diseases, whose primary manifestations affect the skin, it is possible to deliver integrated surveillance and control programs and promote advocacy and reduction of disability and stigma. A further key part of the skin neglected tropical diseases program is the development and validation of training methods for front-line health workers. Networks that allow those involved in this work to share and compare expertise are being developed through various organizations., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: There is increasing evidence for the use of point-of-care ultrasound (POCUS) in pediatric patients with skin and soft tissue infections (SSTI), but there is a lack of sufficient data on its impact on SSTI outcomes. The objective of this study was to determine whether POCUS use is associated with fewer complications after discharge from the pediatric emergency department., Methods: This was a prospective cohort study in patients presenting to the emergency department with SSTI between the ages of 2 months and 19 years old. Adverse outcomes included hospitalization after discharge, change in antibiotics, subsequent procedures, or reevaluation by a medical professional. Outcome information was obtained 1 week later. Descriptive statistics and χ 2 tests were used., Results: Of 456 patients screened, 250 were enrolled. POCUS was performed on 113 (45%) patients. The median age was 5 years, with more females in the non-POCUS group compared with the POCUS group (58% vs. 52%). Cellulitis without abscess was more commonly diagnosed in the POCUS group than in the non-POCUS group (26% vs 14%, P = 0.02.) The patients in the non-POCUS group were more likely to undergo incision and drainage than those in the POCUS group (62% vs 45%, P = 0.008). Overall, a greater number of patients in the POCUS group did not undergo any procedure (45% vs 27%, P = 0.003). The outcomes at 1 week did not differ significantly between the two groups., Conclusions: POCUS use may lead to fewer procedures, but it does not lead to significantly better outcomes. Large randomized controlled trials are needed to confirm or refute our findings.

The use of dermal fillers has increased manifold over the past decade, which has been attributed to the ever-increasing need of the population for being young. Fillers have become quite popular both among patients and treating physicians due to their quick and quite predictable results. Filler injection is a safe procedure in the hands of an experienced provider using appropriate technique. Nevertheless, various adverse effects to fillers have been reported that range from mild injection site complications, such as pain and bruising, to severe complications, like tissue necrosis, retinal artery occlusion, and infections. The esthetic provider should be aware of and be able to quickly recognize such complications, and be confident in managing them. In this article we highlight the various adverse effects noted with the use of fillers and discuss prevention and management. J Drugs Dermatol. 2020;19(9):829-832. doi:10.36849/JDD.2020.5084.

Skin infections are a frequent cause of consultation, yet the diagnosis can be challenging for physicians. Microbiological documentation is rare, and empiric antibiotic regimens should cover the most commonly identified bacteria, i.e. streptococci Staphylococcus aureus. Other pathogens should be considered in case of immunosuppression or certain exposures. Necrotizing fasciitis (NF) is a severe but rare infection. Early surgical management in parallel with antibiotics is the cornerstone of treatment. Despite the high incidence of these infections, little progress has been made in their management and some areas of uncertainty exist, especially regarding the optimal duration of treatment, the prevention of recurrences and the use of polyclonal immunoglobulins for NF. This article reviews the main aspects of diagnosis and treatment of these infections., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

While many hand infections are superficial, diligent evaluation, diagnosis, and treatment of these infections are central for preventing disability and morbidity. Maintaining a wide differential diagnosis is important as some hand infections may mimic others. In geographic areas with more than a 10% to 15% prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) hand infections, empiric antibiotics should adequately cover MRSA. Once culture results are available, antibiotic regimens should be narrowed to reduce the development of resistant pathogens.

Background: Previous studies showed a large inpatient burden of psoriasis in the United States. Less is known about the hospital readmission for psoriasis., Objectives: To determine the patterns and predictors of hospital readmission rates for psoriasis., Methods: We analyzed data from the 2012-2014 Nationwide Readmissions Database, a representative sample of hospital readmissions in the United States., Results: Among 2606 admissions for psoriasis, 216 had ≥1 readmissions for psoriasis (prevalence [95% confidence interval]: 8.3% [6.6%-10.0%]) and 918 for all-causes (35.2% [32.2%-38.3%]). The mean annual cost of first readmission for any reason was $3,500,141, with $8,357,961 for subsequent readmissions. In multivariable regression models, readmission for psoriasis was associated with ≥6 day-long index hospitalization (adjusted hazard ratio [95% confidence interval]: 1.82 [1.06-3.12]), teaching hospital (1.93 [1.13-3.31]), comorbid skin infection (2.13 [1.11-4.08]), and hospitalization in the autumn (4.51 [2.54-8.00]), but inversely associated with other infections (0.49 [0.26-0.92]). Readmissions for psoriasis increased from 2012 to 2014 (1.93 [1.26-2.93])., Limitations: No data on psoriasis characteristics., Conclusion: Inpatients with psoriasis had high rates of readmission overall but low rates of readmission for psoriasis per se. A subset of psoriasis patients was hospitalized repeatedly and responsible for most inpatients costs. Future interventions are needed to lower readmission rates among psoriasis patients., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Impetigo, scabies, cellulitis and abscesses are common in Australian Aboriginal children. These conditions adversely affect wellbeing and are associated with serious long term sequelae, including invasive infection and post-infectious complications, such as acute post-streptococcal glomerulonephritis and acute rheumatic fever, which occurs at the highest documented rates in the world in remote Aboriginal communities. Observational research in remote communities in northern Australia has demonstrated a high concurrent burden of scabies and impetigo and their post-infectious complications. Few data are available for other Australian states, especially for urban Aboriginal children; however, nationwide hospital data indicate that the disparity between Aboriginal and non-Aboriginal children in skin infection prevalence also exists in urban settings. The Australian National Healthy Skin Guideline summarises evidence-based treatment of impetigo, scabies and fungal infections in high burden settings such as remote Aboriginal communities. It recommends systemic antibiotics for children with impetigo, and either topical permethrin or oral ivermectin (second line) for the individual and their contacts as equally efficacious treatments for scabies. β-Lactams are the treatment of choice and trimethoprim-sulfamethoxazole and clindamycin are effective alternatives for treatment of paediatric cellulitis. Abscesses require incision and drainage and a 5-day course of trimethoprim-sulfamethoxazole or clindamycin. Addressing normalisation of skin infections and the social determinants of skin health are key challenges for the clinician. Research is underway on community-wide skin health programs and the role for mass drug administration which will guide future management of these common, treatable diseases., (© 2019 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Established conventional treatments for postherpetic neuralgia (PHN) and postherpetic itch (PHI) are difficult and often disappointing. In this study, the authors investigated the effect and mechanisms of extracorporeal shockwave therapy (ESWT) on pain and itch associated with PHN and PHI.Thirteen patients, 50 to 80 years of age, with symptoms associated with PHN or PHI (duration of persistent pain >3 months) and complaints of pain or itch rated >4 on a numerical rating scale (NRS), were included. ESWT was administered using a shockwave device (Piezo Shockwave, Richard Wolf GmbH, Knittlingen, Germany) to skin areas affected by pain or itch. An energy flux density of 0.09 to 0.16 mJ/mm at a frequency of 5 Hz and 2000 impulses was administered at 3-day intervals for 6 sessions. The NRS, 5D-Itch Scale, and Patients Global Impression of Change (PGIC) scale were used to evaluate the efficacy of ESWT.NRS scores of pain and itch and 5D-Itch Scale scores decreased significantly compared with before treatment and at the end of the treatment sessions (P < .0001, P = .001, P = .0002, respectively). There was a statistically significant difference between PGIC scores, which were checked every 2 sessions (P < .0001).ESWT is a noninvasive modality that significantly reduced PHN-associated pain and itch.

This report adds to the limited existing literature concerning dermatoses in Samoa. Conditions encountered during a 4-day private clinic are reported. Amongst the 75 patients reviewed, eczema was the most frequent condition diagnosed. This was followed by infective dermatoses particularly pityriasis versicolor and tinea infections. Reassuringly, in 97% of cases, suitable medications were available locally., (© 2019 The Australasian College of Dermatologists.)

In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the Pilbara region of Western Australia to explore factors that affected health service utilisation for childhood skin infections in this setting. The study consisted of semistructured interviews and focus group discussions with parents and carers ( n = 16), healthcare practitioners ( n = 15) and other community service providers ( n = 25). We used Andersen's health service utilisation model as an analytical framework. Our analysis captured a wide range of barriers that may undermine timely use of health services for childhood skin infections. These included general factors that illustrate the importance of cultural competency amongst healthcare providers, patient-centred care and community engagement. Relating specifically to health service utilisation for childhood skin infections, we identified their apparent normalisation and the common use of painful benzathine penicillin G injections for their treatment as important barriers. Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections, actively engaging parents and carers in consultation and treatment processes and strengthening community involvement in health service activities., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Background: Injection drug use is on the rise in the USA, and skin and soft tissue infections (SSTI) are a common complication, resulting in significant morbidity and mortality. Due to structural barriers to care-seeking, many people who inject drugs avoid formal care and resort to self-care techniques, but little is known about the nature of these techniques, or more generally about the accuracy or breadth of this population's knowledge of SSTIs., Methods: Semi-structured qualitative interviews were conducted with 12 people who inject heroin in two metropolitan areas: Sacramento and Boston, USA., Results: These interviews reveal a robust and accurate knowledge base regarding skin infections, including the progression from simple cellulitis to an abscess, and acknowledgment of the possibility of serious infections. Nonetheless, there remains a reticence to seek care secondary to past traumatic experiences. A step-wise approach to self-care of SSTI infections was identified, which included themes of whole-body health, topical applications, use of non-prescribed antibiotics, and incision and drainage by non-medical providers., Conclusions: The reported SSTI self-care strategies demonstrate resilience and ingenuity, but also raise serious concerns about inappropriate antibiotic consumption and complications of invasive surgical procedures performed without proper training, technique, or materials. Harm reduction agencies and health care providers should work to obviate the need for these potentially dangerous practices by improving healthcare access for this population. In the absence of robust solutions to meet the needs of this population, education materials should be developed to optimize the efficacy and minimize the harms of these practices, while empowering and supporting the autonomy of people who use drugs and providing clear guidance on when self-care should be abandoned in favor of formal medical care.

Background: Cellulitis has many potential mimickers, and its misdiagnosis often leads to unnecessary hospitalizations and higher health care costs. The ALT-70 predictive model offers an objective tool to help differentiate between cellulitis and other clinically similar conditions at the time of initial emergency department (ED) presentation., Objective: To evaluate the performance of the ALT-70 predictive model at 24 and 48 hours following ED presentation., Methods: We performed a retrospective review of our prior cohort and expanded our data collection to include data at 24 and 48 hours after initial ED presentation. We compared classification measures for the ALT-70 at the time of initial ED presentation, 24 hours after presentation, and 48 hours after presentation., Results: There was a statistically significant difference in median ALT-70 score between patients with true cellulitis and those with mimickers of cellulitis at all time points. Sensitivity, specificity, positive predictive value, and negative predictive value of the ALT-70 score was similar across all 3 time points., Limitations: Single-center design may reduce generalizability., Conclusion: At 24 and 48 hours, the ALT-70 performed similarly to the way it performed at the time of initial ED presentation, allowing for its use in a wider array of clinical settings., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

In view of globalization and the associated transport of goods as well as rising travel activity, imported infections with subtropical and tropical pathogens are increasing in Germany. In returning travelers presenting with fever, general symptoms and skin rash, a number of diseases need to be considered. The clinical appearance of the skin rash, accurate travel history and epidemiological information on country-specific risks are helpful in making the correct diagnosis. In this article we provide an overview of the most common exanthemas in travelers who have returned, associated symptoms, diagnostic methods, therapies, as well as prevention strategies.

There are numerous disorders of the skin that occur in athletes. These include infections, mechanical injury, and inflammatory skin diseases such as dermatitis, urticaria, and others. This paper discusses some of the most common athletic skin diseases., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Hospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA., Objective: We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalisation in WA children, focussing on Aboriginal children aged <17 years., Methods: We conducted a retrospective population-based cohort study with linked perinatal and hospitalisation data on WA-born children (1996-2012), of whom 31 348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to first hospitalisation with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year., Results: Overall, 5439 (17.4%) Aboriginal and 6750 (1.5%) non-Aboriginal children were hospitalised at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalisation rate (63.2 per 1000 child-years). The strongest risk factors in Aboriginal children aged <17 years were socio-economic disadvantage, very remote location at birth, and multi-parity (≥3 previous pregnancies) accounting for 24%, 23%, and 15% of skin infection hospitalisations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy, and low birthweight., Conclusions: We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalisations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalisations. Our evidence not only supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for families., (© 2019 John Wiley & Sons Ltd.)

Study Objective: We examine the utility of emergency department (ED) ultrasonography in treatment of skin and soft tissue infections., Methods: We enrolled ED patients with skin and soft tissue infections and surveyed clinicians in regard to their pre-ultrasonography certainty about the presence or absence of an abscess, their planned management, post-ultrasonography findings, and actual management. We determined sensitivity and specificity of ultrasonography and clinical evaluation, and assessed appropriateness of management changes based on initial clinical assessment and outcomes through 1-week follow-up., Results: Among 1,216 patients, clinicians were uncertain of abscess presence in 105 cases (8.6%) and certain for 1,111 cases (91.4%). Based on surgical exploration and follow-up through 1 week, sensitivity and specificity for abscess detection by clinical evaluation were 90.3% and 97.7%, and by ultrasonography were 94.0% and 94.1%, respectively. Among 1,111 cases for which the clinician was certain, sensitivity and specificity of clinical evaluation were 96.6% and 97.3% compared with ultrasonographic evaluation sensitivity and specificity of 95.7% and 96.2%, respectively. Of 105 uncertain cases, sensitivity and specificity of ultrasonography were 68.5% and 80.4%. Ultrasonography changed management in 13 of 1,111 certain cases (1.2%), appropriately in 10 of 13 (76.9%) and inappropriately in 3 of 13 (23.1%). Of 105 uncertain cases, ultrasonography changed management in 25 (23.8%), appropriately in 21 of 25 (84.0%) and inappropriately in 4 of 25 (16.0%)., Conclusion: Ultrasonography rarely changed management when clinicians were certain about the presence or absence of an abscess. When they were uncertain, ultrasonography changed drainage decisions in approximately one quarter of cases, of which most (84%) were appropriate., (Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Atopic dermatitis (AD) is a chronic, inflammatory disease affecting both children and adults. AD is associated with multiple comorbidities and complications. In particular, AD patients are susceptible to developing cutaneous infections. Studies show that comorbidities have contributed significantly to increased health care utilization and costs in AD. However, evidence regarding the degree to which this increased health care utilization and expenditure in AD is attributable to cutaneous infections is lacking. The aim of this study was to assess the impact of skin infections on health care utilization and expenditures among patients with atopic dermatitis., Methods: This cross-sectional study examined health care utilization and expenditures for AD patients of all ages with and without skin infections in the United States using the nationally representative 1996-2015 Medical Expenditure Panel Survey (MEPS) data., Results: In this study, a total of 4 825 668 (weighted) patients had a diagnosis of AD (mean age 5.7). Of these, 776 753 patients (16%) experienced skin infections (mean age 4.4). Compared to AD patients without skin infections, those with skin infections had more frequent visits to ambulatory clinics (P = 0.001) and the emergency department (P = 0.011), and increased hospitalization (P = 0.010), after adjustments for demographic and clinical factors. AD patients with skin infections were also given 3.3 more prescriptions (P < 0.0001). AD patients with skin infections incurred significantly greater health care costs, which included an additional $351/patient/year for ambulatory visits (P < 0.0001) and an additional $177/patient/year for prescription medications (P < 0.0001)., Conclusions: Atopic dermatitis patients with cutaneous infections incurred significantly greater health care utilization and expenditures than those without cutaneous infections., (© 2019 Wiley Periodicals, Inc.)

Study Objective: Serious adverse outcomes associated with skin and soft tissue infections are uncommon, and current hospitalization rates appear excessive. It would be advantageous to be able to differentiate between patients who require high-level inpatient services and those who receive little benefit from hospitalization. We sought to identify characteristics associated with the need for high-level inpatient care among emergency department patients presenting with skin and soft tissue infections., Methods: We conducted a nonconcurrent review of existing records to identify emergency department (ED) patients treated for skin and soft tissue infections. For each case, we recorded the presence or absence of select criteria and whether the patient needed high-level care, defined as ICU admission, operating room surgical intervention, or death as the primary outcome. We applied recursive partitioning to identify the principal criteria associated with high-level care., Results: We identified 2,923 patients, including 84 experiencing high-level events. Recursive partitioning identified 6 variables associated with high-level outcomes: abnormal computed tomography, magnetic resonance imaging, or ultrasonographic imaging result; systemic inflammatory response syndrome; history of diabetes; previous infection at the same location; older than 65 years; and an infection involving the hand. One or more of these variables were present in all 84 patients requiring high-level care., Conclusion: A limited number of simple clinical characteristics appear to be able to identify skin and soft tissue infection patients who require high-level inpatient services. Further research is needed to determine whether patients who do not exhibit these criteria can be safely discharged from the ED., (Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Study Objective: The addition of antibiotics to standard incision and drainage is controversial, with earlier studies demonstrating no significant benefit. However, 2 large, multicenter trials have recently been published that have challenged the previous literature. The goal of this review was to determine whether systemic antibiotics for abscesses after incision and drainage improve cure rates., Methods: PubMed, the Cumulative Index of Nursing and Allied Health Literature, Scopus, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all randomized controlled trials comparing adjuvant antibiotics with placebo in the treatment of drained abscesses, with an outcome of treatment failure assessed within 21 days. Data were dual extracted into a predefined worksheet and quality analysis was performed with the Cochrane Risk of Bias tool., Results: Four studies (n=2,406 participants) were identified. There were 89 treatment failures (7.7%) in the antibiotic group and 150 (16.1%) in the placebo group. The calculated risk difference was 7.4% (95% confidence interval [CI] 2.8% to 12.1%), with an odds ratio for clinical cure of 2.32 (95% CI 1.75 to 3.08) in favor of the antibiotic group. There was also a decreased incidence of new lesions in the antibiotic group (risk difference -10.0%, 95% CI -12.8% to -7.2%; odds ratio 0.32, 95% CI 0.23 to 0.44), with a minimally increased risk of minor adverse events (risk difference 4.4%, 95% CI 1.0% to 7.8%; odds ratio 1.29, 95% CI 1.06 to 1.58)., Conclusion: The use of systemic antibiotics for skin and soft tissue abscesses after incision and drainage resulted in an increased rate of clinical cure. Providers should consider the use of antibiotics while balancing the risk of adverse events., (Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

With manned missions to Mars on the horizon, understanding and preparing for the medical conditions these astronauts might face becomes vital. According to the literature, the most commonly reported medical events in space are dermatological in nature. Dermatologic conditions rarely threaten an astronaut's life or the mission. However, manifestations and management of dermatologic events become an important consideration in anticipation of spaceflights to Mars and beyond. Given the limited number of articles written about dermatological conditions in this specific population, this review summarizes current knowledge related to dermatology in space. Overall, common dermatologic conditions found during spaceflight include viral reactivations, contact dermatitis or eczematous patches, and skin infections. Diagnosis and treatment can be difficult given the lack of resources in space as well as the hazards and side effects of certain treatments. In this review article we aim to summarize common skin changes induced by spaceflight, describe previously reported skin conditions including current treatment options, explore the risk of skin cancer in this unique population, and address the challenge of remote diagnosis.

Objective: The aim of this study was to compare the incidence of skin and soft tissue infections (SSTIs) across healthcare settings and analyze direct healthcare expenditures related to SSTIs in 2000 and 2012 in the United States., Methods: We performed a retrospective, cross-sectional analysis of nationally representative data from the Medical Expenditure Panel Surveys. Population-based incidence rates were examined for all healthcare settings that include inpatient visits, emergency department visits and ambulatory visits for SSTIs. The direct costs of healthcare services utilization were reported. Population-based prescribing rates for each antimicrobial class during ambulatory visits were compared., Results: A total of 2.4 million patients experienced an SSTI in 2000 compared to 3.3 million in 2012 (40% increase). From 2000 to 2012, the incidence of patients with at least one hospital visit for SSTIs increased 22%, ambulatory care visits increased 30%, and emergency department visits increased 40%. The incidence of SSTIs in children and adolescents declined 50% (from 150 to 76 per 10,000 person; RR = 0.51, 95% CI: 0.38-0.67; p<0.001) whereas SSTIs in older adults (> 65 years of age) increased almost 2-fold (from 67 to 130 per 10,000 person; RR = 1.94, 95% CI: 1.44-2.61; p<0.001). The annual incidence of SSTI in adults did not change significantly from 2000 to 2012 (from 84 to 81 per 10,000 person; RR = 0.96, 95% CI: 0.71-1.31; p = 0.41). The total estimated direct healthcare costs of SSTIs increased 3-fold from $4.8 billion in 2000 to $15.0 billion in 2012, largely driven by an 8-fold increase in ambulatory expenditures for SSTIs. Total population-based antimicrobial prescription rates for SSTIs increased 4-fold from 2000 to 2012 (from 59.5 to 250.4 per 10,000 person)., Conclusions: The highest healthcare utilization for SSTI treatment occurred in the ambulatory care setting and also accounted for the largest increase in overall direct expenditures from 2000 to 2012., Competing Interests: The authors have declared that no competing interests exist.

Aquatic-based infections can present a treatment challenge for primary care physicians because of the likely polymicrobial nature of the infection and the possibility of uncommon pathogenic organisms. Although Staphylococcus and Streptococcus species that colonize the skin are the most common etiologic agents associated with saltwater and freshwater skin and soft tissue infections, other significant pathogens can include Vibrio, Aeromonas, Edwardsiella, Erysipelothrix, and Mycobacterium. Early detection and appropriate management of aquatic infections can significantly decrease morbidity and mortality. This article reviews the pathophysiology, presentation, and management for the most common water-borne pathogens causing skin and soft tissue infections., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The aim of the present study was to investigate the eradicating effects of 460 nm blue light (BL) on Candida albicans in vitro and in C. albicans‑infected skin wounds in a mouse model. In the present study, the antifungal effects of irradiation with BL on C. albicans in vitro and in vivo were investigated. C. albicans colonies and cell numbers were investigated using the spread plate method and flow cytometry respectively following treatment with BL irradiation. In order to determine whether BL can eradicate C. albicans cells within biofilms, an in vitro C. albicans biofilm model was established, and the effect of BL was subsequently investigated using a confocal laser scanning microscope and a Live/Dead staining kit. Furthermore, a mouse skin wound infection model infected with C. albicans was established. Wound healing rates and histological examinations were determined 0, 3, 7, 10 and 14 days post‑wounding. The results revealed that C. albicans was eradicated by BL in a dose‑dependent manner, with a minimum fluence of 60 J/cm2. Irradiation with BL almost completely eradicated C. albicans when the light fluence was 240 J/cm2. C. albicans inside biofilms was also eradicated and biofilms were destroyed following BL irradiation at 240 J/cm2. In addition, BL was revealed to significantly suppress C. albicans infection in vivo. Irradiation with BL promoted the wound healing of C. albicans infected‑skin wounds in a mouse model. In conclusion, the results of the present study demonstrated that 460 nm BL may eradicate planktonic and biofilm C. albicans in vitro, and represents a novel therapeutic strategy for the treatment of C. albicans infections in vivo.

Background: There is an emerging need to develop consistent outcomes in clinical trials to allow effective comparison of treatment effects. No systematic review has previously looked at the reporting of outcome measures used in randomized controlled trials (RCTs) on the treatment and prevention of cellulitis (erysipelas)., Objectives: The primary aim of this review was to describe the breadth of outcomes reported from RCTs on cellulitis treatment and prevention. The secondary aim was to identify outcome themes from patients' and healthcare professionals' feedback from a cellulitis Priority Setting Partnership (PSP)., Methods: We conducted a review of all outcome measures used in RCTs from two recent Cochrane reviews. Free-text responses from a cellulitis priority setting survey were used to understand the perspectives of patients and healthcare professionals., Results: Outcomes from 42 RCTs on treatment of cellulitis and six RCTs on prevention of cellulitis were reviewed. Only 28 trials stated their primary outcome. For trials assessing treatment of cellulitis, clinical response to treatment was categorized in 25 different ways. Five of these trials used an outcome that was in accordance with FDA guidance and only four trials incorporated either quality of life or patient satisfaction. For trials assessing prevention of cellulitis, recurrence was the key outcome measure. From the cellulitis PSP, prevention of recurrence, clinical features and long-term disease impact were the most important outcome themes for patients., Conclusions: We have shown that in cellulitis treatment and prevention research, there is significant heterogeneity in clinical outcomes, inadequate focus on patient-reported outcomes, and a disparity between what is currently measured and what patients and healthcare professionals feel is important. We recommend that future cellulitis treatment trials consider the use of longer-term outcomes to capture recurrence and long-term morbidity, as well as short-term resolution of acute infection., (© 2017 British Association of Dermatologists.)

Aims and Objectives: To provide a scoping review of the types of treatments used to address paediatric skin-related stoma complications specific to infection, hypergranulation and gastric leakage, and explore their effectiveness and indications for use., Background: Stoma-related complications can be a common occurrence for children with gastrostomy (G) and gastrojejunostomy (GJ) tubes. Nurses require guidance to inform decision-making of the broad spectrum of treatments used in clinical practice., Design: A scoping review using a rapid review approach., Methods: Working with a multidisciplinary health professional team, search terms were generated. A systematic search of CINAHL, MEDLINE and EMBASE databases was completed, coupled with an Internet search to identify relevant clinical practice guidelines and hand searching of citation lists. Eligible articles were peer-reviewed English publications, focused on paediatric populations aged 18 years and under, dating from 2002-2016 and described complications and treatment approaches related to G- and GJ-tube stomas. Pertinent information was extracted using a standardised template, and a narrative synthesis approach was used to analyse the data., Results: Twenty-five articles were included in this review. Study designs varied, and complication management was often a secondary focus. A broad spectrum of treatments was used to manage each complication type. There was a lack of consensus on lines of therapy; however, a stepwise approach was often used for complication management, particularly for infections., Conclusions: The evidence on the comparative effectiveness of different treatment strategies of skin-related gastrostomy stoma complications in paediatric practice is sparse. Current evidence is generally limited to expert opinions. Future studies examining efficacy of treatments and their indications for use with children are warranted., Relevance to Clinical Practice: Effective management of skin-related stoma complications is important to maintain health and wellness among children who rely on G- and GJ-tubes for nutrition support., (© 2017 John Wiley & Sons Ltd.)

Purpose of Review: To review the salient features of the management of severe skin and soft tissue infections (SSTIs), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis., Recent Findings: For severe SSTIs, intensive care, source control, and broad-spectrum antimicrobials are required for the initial phase of illness. There is an increasing focus on the utility of rapid diagnostic tests to help in selection and de-escalation of antimicrobials for SSTIs. In addition, clinical prediction scores have shown promise in helping predict patients who do not require antimicrobials directed against methicillin-resistant Staphylococcus aureus. Immune status has been shown to be important in clinical outcomes of some, but not all types of SSTIs. The debate for benefits of intravenous immunoglobulin continues to be waged in the recent literature., Summary: Severe SSTIs are common and their management complex due to regional variation in predominant pathogens and antimicrobial resistance patterns, as well variations in host immune responses. Unique aspects of care for severe SSTIs are discussed including the role of surgical consultation and source control. The unique features of SSTIs in immunocompromised hosts are also described.