Sunday, November 25, 2012

Common Skin Infections

Common Skin Infections

Nathaniel C. Cevasco

Kenneth J. Tomecki

Bacterial infections

Humans are natural hosts for many bacterial species that colonize the skin as normal flora.Staphylococcus aureus and Streptococcus pyogenes are infrequent resident flora, but they account for a wide variety of bacterial pyodermas. Predisposing factors to infection include minor trauma, preexisting skin disease, poor hygiene, and, rarely, impaired host immunity.


Definition and Etiology
Impetigo is a superficial skin infection usually caused by S. aureus and occasionally by S. pyogenes.

Prevalence and Risk Factors
Impetigo affects approximately 1% of children.

Pathophysiology and Natural History
S. aureus produces a number of cellular and extracellular products, including exotoxins and coagulase, that contribute to the pathogenicity of impetigo, especially when coupled with preexisting tissue injury. Impetigo commonly occurs on the face (especially around the nares) or extremities after trauma.

**Also included in this article:
Folliculitis, Furunculosis, Carbunculosis, Candidiasis, Ecthyma, Erysipelas, Cellulitis, Necrotizing Fasciitis, Dermatophytosis, Herpes Zoster, Tinea (Pityriasis) Versicolor, Viral infections**

Sunday, November 11, 2012

Clinical symptoms and therapy of necrotizing skin and soft tissue infections

Clinical symptoms and therapy of necrotizing skin and soft tissue infections

Nov 2012
[Article in German]


Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland,


Skin and soft tissue infections are among the most common diseases requiring surgical treatment. The presentation of patients varies from folliculitis to severe necrotizing infections with a fatal outcome. The diagnosis of a necrotizing infection is often difficult. The correct diagnosis is often made after deterioration of the patient's condition in the rapid course of the disease. The early and correct diagnosis and immediate surgery are decisive for the prognosis. Treatment at a specialized intensive care unit and the administration of a broad spectrum antibiotic are pivotal for the survival of individual patients.

Skin and soft-tissue infections caused by Aeromonas species.

Skin and soft-tissue infections caused by Aeromonas species.

Nov 2012


Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.


This study investigated the clinical characteristics of patients with skin and soft-tissue infections (SSTIs) due to Aeromonas species. Patients with SSTIs caused by Aeromonas species during the period from January 2009 to December 2011 were identified from a computerized database of a regional hospital in southern Taiwan. The medical records of these patients were retrospectively reviewed. A total of 129 patients with SSTIs due to Aeromonas species were identified. A. hydrophila (n = 77, 59.7 %) was the most common pathogen, followed by A. veronii biovar sobria (n = 22, 17.1 %), A. veronii biovar veronii (n = 20, 15.5 %), A. caviae (n = 9, 7.0 %), and A. schubertii (n = 1, 0.8 %). The most common isolates obtained from patients with polymicrobial infections were Klebsiella species (n = 33), followed by Enterococcus spp. (n = 24), Enterobacter spp. (n = 21), Escherichia coli (n = 17), Staphylococcus spp. (n = 17), Streptococcus spp. (n = 17), and Acinetobacter spp. (n = 15). Liver cirrhosis and concomitant bacteremia were more common among patients with monomicrobial Aeromonas SSTIs than among patients with polymicrobial SSTIs. Nine (7 %) patients required limb amputations. The in-hospital mortality rate was 1.6 %. In conclusion, Aeromonas species should be considered as important causative pathogens of SSTIs, and most infections are polymicrobial. In addition, the clinical presentation differs markedly between patients with monomicrobial and those with polymicrobial Aeromonas SSTIs.

Systemic antioxidants and skin health.

Systemic antioxidants and skin health.

Sept 2012


Most dermatologists agree that antioxidants help fight free radical damage and can help maintain healthy skin. They do so by affecting intracellular signaling pathways involved in skin damage and protecting against photodamage, as well as preventing wrinkles and inflammation. In today's modern world of the rising nutraceutical industry, many people, in addition to applying topical skin care products, turn to supplementation of the nutrients missing in their diets by taking multivitamins or isolated, man-made nutraceuticals, in what is known as the Inside-Out approach to skin care. However, ingestion of large quantities of isolated, fragmented nutrients can be harmful and is a poor representation of the kind of nutrition that can be obtained from whole food sources. In this comprehensive review, it was found that few studies on oral antioxidants benefiting the skin have been done using whole foods, and that the vast majority of current research is focused on the study of compounds in isolation. However, the public stands to benefit greatly if more research were to be devoted toward the impact that physiologic doses of antioxidants (obtained from fruits, vegetables, and whole grains) can have on skin health, and on health in general.

Tuesday, November 6, 2012

Probiotics Boosts Skincare Regimen

Probiotics Boosts Skincare Regimen

Probiotics help maintain a healthy body -- but what about using probiotics in a regular skincare regimen? The latest article by Probiotics: Learn How Some Bacteria Can be Good for Your Skin explains how the beneficial bacteria in probiotics can help create and sustain a clear, healthy complexion for all skin types. From severe acne to preventing anti-aging, these valuable bacteria are a beautifying addition to any skincare regimen.

Using probiotics as part of a healthy skincare regimen is becoming more and more popular. What makes probiotics a heavenly find for skincare, and how can probiotics found in skincare products, supplements and foods treat skin conditions such as acne and eczema? Plus, for those concerned with the signs of aging, how do probiotics contribute to the effectiveness of anti-aging products? 

One of the greatest benefits of adding probiotics to a daily routine is its convenience and accessibility. Found in many forms, from staple foods like yogurt and pickles to anti-aging serums, there are various ways to integrate probiotics into a daily routine. What are the best probiotic-containing foods, and what are some tips for ensuring maximum benefits?

Skin care tips to combat the effects of cold weather

Skin care tips to combat the effects of cold weather

By Tiffany Bentley | The Express-Times 
on November 04, 2012 at 7:06 AM, updated November 04, 2012 at 7:11 AM

Colder weather can take its toll even on the healthiest skin. Laura Parker, esthetician and owner of The Skin Clinic in Easton, offers the following basic tips on how to make sure the season doesn't diminish your glow

  • Switch to a heavier lotion and cleanse the skin only once a day at night to prevent dryness. Over-cleansing the skin can actually strip the skin of necessary oils that keep it looking healthy.
  • Try to take shorter showers. Winter usually means we take hotter showers, which zaps the skin of moisture. Make sure to moisturize head to toe immediately after and towel dry. The skin will be able to absorb the moisturizer more effectively if it is still moist.
  • Don’t skip sunscreen. This is one of the biggest skin care mistakes people make during the winter. UVA and UVB rays are still out in the winter and you can even catch damage through your windshield driving to and from work. If you plan on spending a lot of time outside, such as skiing, make sure to wear an SPF of 30 or higher.
  • Exfoliate. One of the best ways to prepare skin for winter and repair damage caused by the summer is exfoliation. Alpha hydroxy acids (AHAs) are my favorite form of exfoliation because they dissolve dead skin without the irritation of a harsh scrub. AHAs are also water-loving. After you use them they actually help bind moisture to the skin. They also increase cellular turnover, improving skin tone and texture. Common AHAs are glycolic acid (derived from sugar), lactic acid (derived from milk) and mandelic acid (derived from almonds). The Skin Clinic offers AHA exfoliating pads that retail at $15.
  • Stay hydrated. Drink at least six to eight glasses of water a day. A healthy dose of water increases the body’s ability to remove toxins, which can lead to acne breakouts, dry skin and inflammation.
  • Monitor the heater. As the weather becomes cold, we tend to crank up the heat, which can throw your skin's balance out of whack. The combination of an indoor heater and drier weather can cause skin to become dehydrated and as a result, send oil production into overdrive. This increase in oil or sebum production and skin dehydration can cause pore-clogging buildup and lead to breakouts.
  • Treat yourself to a facial. Facials provide a professional level of exfoliation, balancing and deep cleansing the skin while addressing a multitude of skin conditions including acne, rosacea and prematurely aging skin. 

Thursday, November 1, 2012

Lymphomatoid papulosis

Lymphomatoid papulosis

Related Terms and Key Words: CD30+ lymphoma, eccrinotropic, granulomatous, lymphomatoid papulosis, methotrexate, lymphedema, papulonodular skin eruption, Primary cutaneous CD30 + lymphoproliferative disorder, Cutaneous T-cell lymphoma, Proliferative T-cell disorder, WHO/EORTC classification, chemokines, chemokine receptors
A chronic skin disease that presents with characterists of malignant T-cell lymphoma. However, it is important to remember that lymphotoid papulosis (LyP) is not classified as a true lymphoma. Also, it does not spread and is not fatal. It is therefore described as histologically malignant, but clinically benign. (1)
It is classified as a lymphoproliferative disorder. These account for about 25% of cutaneous T-cell lymphomas. The condition occurs equally between men and women and usually occurs in the fifth decade. Clinically, black people appear to have the disease much less frequently then other races.
The term lymphomatoid papulosis originally was used by Macaulay[1] in 1968 to describe “a self-healing rhythmical paradoxical eruption, histologically malignant but clinically benign.” Due to the typical waxing and waning clinical course, lymphomatoid papulosis was previously considered a pseuodolymphomatous inflammatory process. However, the classification system for cutaneous lymphomas has evolved rapidly, and, during consensus meetings in 2003-2004, the World Health Organization—European Organization for Research and Treatment of Cancer (WHO-EORTC) classification grouped lymphomatoid papulosis among the indolent cutaneous T-cell lymphomas. (2)
LyP is divided into three subtypes, they include:
Type A - characterized by large CD30 atypical cells intermingled with a prominent inflammatory infiltrate. The large tumor cells have polymorphic convoluted nuclei with a minimum of 1 prominent nucleolus and resemble Reed-Sternberg cells when binucleate, as is seen in HD. Type A lymphomatoid papulosis is the most common histologic variant and accounts for 75% of all lymphomatoid papulosis specimens.
Type B is characterized by smaller (8-15 µm) atypical cells with hyperchromatic cerebriform nuclei resembling the atypical lymphocytes in MF. CD30+ large cells are rare, but epidermotropism is more common in this variant. There is some concern that Type B lymphomatoid papulosis may be better classified as a papular variant of MF.
Type C (diffuse large cell type) is characterized by sheets of CD30+ anaplastic large cells indistinguishable from ALCL, with the exception of the minimal subcutaneous invasion. These lesions resolve spontaneously and are therefore classified as lymphomatoid papulosis; however, some authorities view this histologic variant as borderline ALCL or, perhaps, pcALCL. (2)
Uncommonly, patients may have more than one histologic subtype of lymphomatoid papulosis or other recently described associated histologic patterns.
Risk Factors:
Unknown at the present time and there is debate on whether or not it may be genetically caused. Several genetic defect have been identified in LyP lesions, but the specific cause has not been identified.
A few investigators have also discovered viruslike particles in lymphomatoid papulosis lesions examined under electron microscopy.
Signs and Symptoms:
Lymphomatoid papulosis appears as recurrent small, raise skin lesions. The color ranges from red to brown in color. The most commonly occur on the trunk, arms, and legs in crops but may also occur on the palms, soles, face, and scalp. Very rarely, LyP lesions may be present in the mouth and throat. The lesions heal spontaneously within several weeks and leave a small, hypopigmented scar.
Done by skin biopsy. This is critical as the lesions may appear as the same for numerous other skin nodular growths.
Biopsies are also critical to rule out mycoses fungoides, cutaneous anaplastic large cell lymphoma, cutaneous Hodgkin’s disease, cutaneous leukemia, scabies, insect bites, and drug reactions.
If after biopsy the result come back other then lymphotoid papulosis, then the treating physician will order other types of tests to establish a correct diagnosis.
Differential Diagnosis
Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma, Cutaneous T-Cell Lymphoma, Folliculitis, Insect Bites, Langerhans Cell Histiocytosis, Leukemia Cutis, Lymphocytoma Cutis, Milia, Miliaria, Scabies
The disease itself is not fatal. However, 10 to 20% of patients will also develop an associated systemic lymphoma, typically anaplastic large cell, Hodgkinís disease, or mycoses fungoides.
If any type of secondary malignancy develops, then that would alter the outlook, depending on the type of malignancy.
Patients may choose not to treat the lesions and they usually heal spontaneously over 1-2 months.
Historically, treatment for the skin lesions themselves has been corticosteroid creams or ointment. Another option that can lead to faster healing is with low dose methotrexate. This is a type of chemotherapy that inhibits cell division. The one weak point in this treatment is that the lesions treated with methotrexate will generally return several weeks after therapy.
Another strong, aggressive treatment is oral psoralen plus ultraviolet light, so-called PUVA therapy.
Other treatments might include: carmustine, topical nitrogen mustard, topical MTX, topical imiquimod cream, intralesional interferon, low-dose cyclophosphamide, chlorambucil, medium-dose UVA-1 therapy, excimer laser therapy, photodynamic therapy, and dapsone help disease suppression.
Lymphomatoid papulosis has a chronic, indolent course in most patients.
However, associated lymphomas may arise with LyP. These include immunoblastic lymphoma, lethal midline granuloma (currently considered as natural killer cell lymphoma in many patients), and systemic lymphocytic lymphoma. In most patients, the malignancy develops many years after the diagnosis of lymphomatoid papulosis.
(1) Lymphomatoid Papulosis - Know Cancer

Lymphomatoid Papulosis
see also: