Little is known about the classification and bacterialinfection in outpatients with eczema and dermatitis in China.To investigate the prevalence of eczema and dermatitis in outpatients of dermatology clinics in China, examine classification and proportion of common types of dermatitis and the possible bacterialinfection, and analyze the possible related factors.Outpatients with eczema or dermatitis from 39 tertiary hospitals of 15 provinces in mainland China ...
There are limited data evaluating the utilization of dermatologists for the care of patients with hidradenitis suppurativa.To determine the utilization of the dermatology ambulatory encounter among hidradenitis suppurativa patients, and to evaluate whether ... defined as having at least 1 ambulatory encounter with a dermatologist over a 3-year period.Overall, 21.8% (9,170/42 ...
... clinical trials: Visual Analog Scale (VAS) for pain, Total Work Productivity Impairment, Dermatology Life Quality Index; EuroQOL 5D VAS, and Short Form-36 Health Survey ... HS reported higher scores for VAS-pain (54.3 vs 36.1 [P < .0001]), Dermatology Life Quality Index (15.3 vs 11.3 [P < .0001]), EuroQOL 5D VAS (58.8 ...
Dermatology (8) Psoriasis (6), Hidradenitis Suppurativa (2), more mentions
We performed a comparative cross-sectional study of the potential association of HS and the three outcome events: self-reported MI, self-reported stroke, and PAD measured by ankle-brachial index (ABI) ≤ 0.9. We included a self-reported HS group (n=430) identified in the general suburban population study (GESUS) using a validated questionnaire (2) (Table 1).The control group comprised participants from GESUS without HS, n=20,780. This article is protected by copyright. All rights reserved.
... of immune response and, especially, on their role in many inflammatory skin diseases... IL-36α, IL-36β, and IL-36γ are increased in lesional skin of acne and HS, highlighting their possible pathogenetic contribution to these two skin conditions ... 36/IL36Ra functions could play a role in the phenotype of skin damage.
Patients suffering from Hidradenitis Suppurativa often complain of fatigue or tiredness, a common symptom in other chronic systemic inflammatory conditions.(1) Fatigue has been reported as a prodromal symptom in 32% of HS patients(1) , indicating that it is an important symptom in HS. This article is protected by copyright. All rights reserved.
BACKGROUND: Fournier's gangrene is an uncommon but often devastating infection. There are few contemporary data on the risk factors and evolving microbiologic trends including drug-resistant organisms implicated in these life-threatening infections.
METHODS: A retrospective study of Fournier's gangrene from 2006 to 2015 at a large academic hospital was conducted. Cases were identified using ICD codes (ICD-9: 608.83, V13.89; ICD-10: N49.3, Z87.438), and a review of medical, radiographic, and pathology records was performed to confirm each case. Data collected included socio-demographics, medical conditions, bacterial pathogens and their resistance patterns, treatments, and outcome. Descriptive and univariate statistics were performed.
RESULTS: A total of 59 cases were evaluated with an overall incidence of 31.8 cases per 100,000 admissions which remained stable over the study period. Mean age was 56 years (range 18-91), 71% were male, and 44% white. Risk factors included overweight/obesity (61%), diabetes (44%, with a mean A1c of 9.6%), immunocompromised state (34%), and illicit use (20%). A causative organism was identified in all except 2 cases; 12 patients (21%) had a multidrug-resistant organism (MDRO) with MRSA being the most common pathogen (n = 8, 14% of all cases), followed by ESBL E. coli (n = 3) and MDRO Acinetobacter (n = 1). MRSA was the sole pathogen isolated in five (63%) of the eight cases involving this organism. Among those with an aerobic Gram-negative rod (GNR) isolated, 32% were fluoroquinolone-resistant. Overall, 30% of cases had a poor outcome (15% died and an additional 15% had loss of an organ/body part). Those with an MDRO were more likely to experience a poor outcome (42% vs. 28%), although this was not statistically significant (p = 0.48); of note, most (83%) MDRO cases were initially treated with an antibiotic that the organism was susceptible.
CONCLUSIONS: This report highlights the emergence of MDROs as an important cause of Fournier's gangrene including MRSA and drug-resistant GNRs. Antibiotics should be chosen with broad-spectrum, anti-MDRO activity given the high morbidity and mortality associated with these infections.
Infectious Diseases (2), Anti-Obesity and Weight Loss (2), Endocrine Disorders (1) Fournier Gangrene (5), Infections (3), Obesity (1), more mentions
BACKGROUND: The "obesity paradox" has been demonstrated in chronic diseases but not in acute surgery. We sought to determine whether obesity is associated with improved outcomes in patients with severe soft tissue infections (SSTIs).
METHODS: The 2006 to 2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Patients were categorized into nonobese and obese (nonmorbid [body mass index 30 to 39.9] and morbid [body mass index ≥ 40]). Logistic regression provided risk-adjusted association between obesity categories and inhospital mortality.
RESULTS: There were 2,868 records with SSTI weighted to represent 14,080 patients. Obese patients were less likely to die in hospital than nonobese patients (odds ratio [OR] = .42; 95% confidence interval [CI], .25 to .70; P = .001). Subanalysis revealed a similar trend, with lower odds of mortality in nonmorbid obesity (OR = .46; 95% CI, .23 to .91; P = .025) and morbid obesity (OR = .39; 95% CI, .19 to .80; P = .011) groups.
CONCLUSIONS: Obesity is independently associated with reduced inhospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population.
Anti-Obesity and Weight Loss (14) Obesity (9), Soft Tissue Infections (2), Gas Gangrene (1), more mentions
BACKGROUND: Necrotizing fasciitis following venomous snakebites is uncommon. The purpose of this study was to describe the initial clinical features of necrotizing fasciitis after snakebites, and to identify the risk factors for patients with cellulitis who later developed necrotizing fasciitis.
METHODS: Sixteen patients with surgically confirmed necrotizing fasciitis and 25 patients diagnosed with cellulitis following snakebites were retrospectively reviewed over a 6-year period. Differences in patient characteristics, clinical presentations, snake species and laboratory data were compared between the necrotizing fasciitis and the cellulitis groups.
RESULTS: None of the 41 patients died after being bitten by a snake. Twenty-nine patients (70.7%) were bitten by a cobra. Enterococcus species and Morganella morganii were the most common pathogens identified in wound cultures. Relative to the cellulitis group, the necrotizing fasciitis group had significantly higher rates of hemorrhagic bullae (p=0.000), patients with underlying chronic disease (p=0.019), white blood cell counts (p=0.035), segmented white cell counts (p=0.02), and days of hospitalization (p=0.001).
CONCLUSIONS: Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000cells/mm(3) and ≥80% of segmented leukocyte forms). Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.
While sharp, penetrating trauma is often associated with group A Streptococcus (GAS) infections and subsequent necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS), there are scant reports in the oral and maxillofacial surgery literature regarding blunt, non-penetrating trauma in association with these conditions. With a clinical course that initially appears relatively benign following blunt trauma, NF can progress swiftly through the fascial planes and may quickly become life-threatening if the oral and maxillofacial surgeon fails to recognize some of the critical pathognomonic signs. The case of a 64-year-old female who suffered a ground-level mechanical fall with a minimally displaced lateral orbital wall fracture is reported here. This seemingly benign, non-penetrating injury subsequently developed into rapidly progressive, fatal NF and STSS. This case is used to highlight the necessity for early detection of NF and STSS prior to rapid clinical decline, as these scenarios, particularly bilateral peri-orbital NF with resulting mortality, have been reported infrequently following blunt, craniofacial trauma in the literature related to this specialty.
Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although there are clinical practice guidelines in place, there still remains much variability in choice and duration of antibiotic therapy, time to initial surgical debridement, and use of adjuvant medical therapies. This article offers an overview of necrotizing soft tissue infections with a focus on current diagnostic and treatment modalities.
Clinical details, comorbidities and biochemistry results were recorded. Investigations included cultures of skin swab and blood and tests for streptococcal antibodies during the acute and convalescent stages AbstractText: Sixty-five patients were included. Serology, cultures and response to penicillin monotherapy identified probable or confirmed β-haemolytic streptococci (BHS) aetiology in 75% (49/65) of cases.
... DNA methylation and hydroxymethylation status in lesional and perilesional HS skin compared to healthy controls AbstractText: Immunohistochemical analysis was performed for ... lower in healthy-appearing perilesional (p < 0.0001) and lesional HS skin (p < 0.0001) when compared to healthy controls. There was no significant difference between lesional HS skin and perilesional HS skin regarding 5-hmC levels (p = 0.6654.
... antagonistic cytokines IL-36Ra, IL-37, and IL38 in the skin of hidradenitis suppurativa (HS) patients.Skin samples from lesional and corresponding perilesional HS skin, and from healthy controls were included in this study and ... 37 and IL-38 were significantly higher in perilesional HS skin compared to healthy controls and decreased in lesional HS skin.Descriptive study and small sample size.Our results showed a ...
HS is a debilitating chronic skin disease of the hair follicle... Patients were treated with a pulse width of either 20 or 100 nm, using a fluence between 18 and 34 J/cm(2) depending on the area treated, pain response and skin type. Patients were treated every 4 to 6 weeks.