Can Nonsterile Gloves for Dermatologic Procedures Be Cost-Effective without Compromising Infection Rates?

Over the last decade, studies have compared the use of sterile gloves (SGs) versus nonsterile gloves (NSGs) on surgical site infection (SSI) rates in Mohs micrographic surgery (MMS). In this study, we sought to determine SSI rates before and after employment of NSGs for dermatologic procedures. Infection data were collected from January 2009 to December 2015 on 7365 tumors treated with MMS and 1620 tumors treated by surgical excision. For MMS procedures using chlorhexidine as the antiseptic, the SSI rate with SGs was 3.39% compared to 3.06% with NSGs. For surgical excisions, the SSI rate was 3.02% with SGs and 4.17% with NSG. Using NSGs for MMS tumor resection and reconstruction can provide cost savings without adversely affecting SSI rates, and could also be considered in dermatologic procedures, including electrodessication and curettage and surgical excisions.

Sporotrichoid-Like Spread of Cutaneous Mycobacterium chelonae in an Immunocompromised Patient.

Mycobacterium chelonae is a rapidly growing mycobacterium found in water and soil that can cause local cutaneous infections in immunocompetent hosts but more frequently affects immunocompromised patients. Typically, patients will present with painful subcutaneous nodules of the joints or soft tissues from traumatic inoculation. However, exhibiting a sporotrichoid-like pattern of these nodules is uncommon. Herein, we report a case of sporotrichoid-like distribution of cutaneous Mycobacterium chelonae in a patient with systemic lupus erythematosus on significant immunosuppressive medications. Clinicians treating immunocompromised patients should be cognizant of their propensity to develop unusual infections and atypical presentations.

Misbalanced CXCL12 and CCL5 Chemotactic Signals in Vitiligo Onset and Progression.

Generalized nonsegmental vitiligo is often associated with the activation of melanocyte-specific autoimmunity. Because chemokines play an important role in the maintenance of immune responses, we examined chemotactic signatures in cultured vitiligo melanocytes and skin samples of early (≤2 months) and advanced (≥6 months) vitiligo. Analysis showed that melanocytes in early lesions have altered expression of several chemotaxis-associated molecules, including elevated secretion of CXCL12 and CCL5. Higher levels of these chemokines coincided with prominent infiltration of the skin with antigen presenting cells (APCs) and T cells. Most of the intralesional APCs expressed the CD86 maturation marker and co-localized with T cells, particularly in early vitiligo lesions. These observations were confirmed by in vivo animal studies showing preferential recruitment of APCs and T cells to CXCL12- and CCL5-expressing transplanted melanocytes, immunotargeting of the chemokine-positive cells, continuous loss of the pigment-producing cells from the epidermis, and development of vitiligo-like lesions. Taken together, our studies show that melanocyte-derived CXCL12 and CCL5 support APC and T-cell recruitment, antigen acquisition, and T-cell activation in early vitiligo and reinforce the role of melanocyte-derived CXCL12 and CCL5 in activation of melanocyte-specific immunity and suggest inhibition of these chemotactic axes as a strategy for vitiligo stabilization.

Ladarixin, a dual CXCR1/2 inhibitor, attenuates experimental melanomas harboring different molecular defects by affecting malignant cells and tumor microenvironment.

CXCR1 and CXCR2 chemokine receptors and their ligands (CXCL1/2/3/7/8) play an important role in tumor progression. Tested to date CXCR1/2 antagonists and chemokine-targeted antibodies were reported to affect malignant cells in vitro and in animal models. Yet, redundancy of chemotactic signals and toxicity hinder further clinical development of these approaches. In this pre-clinical study we investigated the capacity of a novel small molecule dual CXCR1/2 inhibitor, Ladarixin (LDX), to attenuate progression of experimental human melanomas. Our data showed that LDX-mediated inhibition of CXCR1/2 abrogated motility and induced apoptosis in cultured cutaneous and uveal melanoma cells and xenografts independently of the molecular defects associated with the malignant phenotype. These effects were mediated by the inhibition of AKT and NF-kB signaling pathways. Moreover, systemic treatment of melanoma-bearing mice with LDX also polarized intratumoral macrophages to M1 phenotype, abrogated intratumoral de novo angiogenesis and inhibited melanoma self-renewal. Collectively, these studies outlined the pre-requisites of the successful CXCR1/2 inhibition on malignant cells and demonstrated multifactorial effects of Ladarixin on cutaneous and uveal melanomas, suggesting therapeutic utility of LDX in treatment of various melanoma types.

Adult Manifestation of Henoch-Schönlein Purpura.

A 51-year-old man initially presented to the hospital with a 2-week history of constipation, intermittently diffuse abdominal pain, nausea, vomiting, and productive cough. Results from chest x-ray and obstruction series appreciated a right lower lobe opacity and small right pleural effusion. The patient met sepsis criteria and was empirically covered for community-acquired pneumonia with vancomycin, piperacillin-tazobactam, moxifloxacin, and tobramycin. His hospital course was complicated by oliguria, acute kidney injury with a normal renal ultrasound, and transaminitis with a negative hepatitis panel. After clinical improvement, he was discharged on 2 additional days of levofloxacin to complete a 7-day antibiotic course.