Common Skin Conditions in Children and Adolescents: Bacterial Infections.

Bacterial skin infections represent a significant health care burden. Cellulitis and erysipelas are rapidly spreading, painful, superficial skin infections, usually caused by streptococci or Staphylococcus aureus. Folliculitis is an infection of hair follicles mostly caused by S aureus. Simple folliculitis typically is self-limited. Topical benzoyl peroxide is a first-line nonantibiotic treatment. Mupirocin and clindamycin are topical antibiotic options. For treatment-resistant cases, oral cephalexin or dicloxacillin is an appropriate option. Impetigo is a common, self-limited infection in children. Bullous impetigo is caused by S aureus, and nonbullous impetigo is caused by beta-hemolytic streptococci, S aureus, or both. In most cases, topical mupirocin or retapamulin (Altabax) is effective. Oral antibiotics should be considered for household outbreaks or patients with multiple lesions. Abscesses are red, painful collections of purulence in the dermis and deeper tissues caused by S aureus or polymicrobial infections. Furuncles are abscesses of a hair follicle, whereas carbuncles involve several hair follicles. In recurrent cases of these lesions, culture of the exudate is recommended. Abscess, furuncle, and carbuncle management consists of incision and drainage. Oral antibiotics are not necessary in most cases but should be prescribed for patients with severe immunocompromise or systemic signs of infection. In bacterial skin infections, methicillin-resistant S aureus coverage should be considered for patients with infections that have not improved with treatment.

Pressure- and dose-controlled transcutaneous pneumatic injection of hypertonic glucose solution for the treatment of atrophic skin disorders.

BACKGROUND: Needleless transcutaneous pneumatic injections (TPIs) are a minimally invasive way to deliver the solution into the skin for therapeutic purposes. The suggested action mechanisms of TPI therapy include mechanical stimulation, immediate tissue shrinkage and late wound healing. METHODS: Thirteen Korean patients were treated with TPI for atrophic skin disorders, including acne scars, striae albae, post-furuncle, or carbuncle scars, and horizontal wrinkles with lipoatrophy. At each TPI treatment session, a single pass was made along with the atrophic skin lesions without overlapping. Thereafter, two dermatologists objectively evaluated the clinical improvement in the lesions in the photographs via the global aesthetic improvement scale (GAIS). RESULTS: One month after the final treatment, the overall mean GAIS score was 2.3 ± 0.8. Six of the 13 (46.2%) patients exhibited clinical improvement of grade 3, five (38.5%) patients grade 2 and two (15.4%) patients grade 1. The overall mean subjective satisfaction score with the TPI treatment was 2.3 ± 0.9. Six of the 13 (46.2%) patients achieved subjective satisfaction of grade 3, six (46.2%) patients grade 2 and one (7.7%) patient grade 0. CONCLUSIONS: The present study demonstrated that the TPI treatment is effective and safe for treating atrophic skin disorders of varying causes in Korean patients.

An Unusually Large Carbuncle of the Temporofacial Region Demonstrating Remarkable Post-debridement Wound Healing Process: A Case Report.

Skin carbuncles are debilitating skin infections commonly seen in elderly patients with diabetes. These infections develop when a cluster of adjacent furuncles coalesce to form one inflammatory mass. While they commonly occur on the nape of the neck and back, rarer sites involving the face and head have been noted. Management of these rare sites is urgent because of the potential intracranial complications and the surgical outcome is often unsatisfactory due to associated facial scarring. Intraoral drainage is advocated to avoid this; however, when the carbuncle involves a larger area, debridement from the exterior is necessary. The resultant soft-tissue defect requires a skin graft or a flap for coverage, but this may still lead to an unsatisfactory cosmetic outcome. The authors report a case of a carbuncle involving an extensive area over the right temporofacial region, including its management and the remarkable post-debridement cosmetic outcome despite avoidance of plastic surgery techniques due to the patient's high risk associated with anesthesia.

Facial carbuncle - a new method of conservative surgical management plus irrigation with antibiotic-containing solution.

OBJECTIVE: This paper reports on a non-conventional method for the management of facial carbuncles, highlighting its superiority over conventional surgical treatment in terms of cosmetic outcome and shorter duration of wound healing. BACKGROUND: The mainstay of treatment for carbuncles involves the early administration of antibiotics in combination with surgical intervention. The conventional saucerisation, or incision and drainage, under normal circumstances results in moderate to large wounds, which may need secondary surgery such as skin grafting, resulting in a longer duration of wound healing and jeopardising cosmetic outcome. CASE REPORTS: The reported three cases presented with extensive carbuncles over the chin, face and lips region. In addition to early commencement of intravenous antibiotics, the pus was drained, with minimal incision and conservative wound debridement, with the aim of maximal skin conservation. This was followed by thrice-daily irrigation with antibiotic-containing solution for a minimum of 2 consecutive days. The wounds healed within two to four weeks, without major cosmetic compromise. CONCLUSION: The new method showed superior cosmetic outcomes, with a shorter duration of wound healing. Conservative surgical management can be performed under regional anaesthesia, which may reduce morbidity and mortality; patients with facial carbuncles often have higher risks with general anaesthesia.

Cura local con apiterapia en una paciente con ántrax / Local cure with apitherapy in a patient with anthrax

Se describe el caso clínico de una paciente de 67 años de edad, quien ingresa en el en Servicio de Dermatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso con diagnóstico de ántrax en región posterosuperior del tórax. Se realiza necrectomía y radiografía simple de tórax que muestra un derrame pleural izquierdo de gran cuantía; por tanto, se traslada al Servicio de Neumología donde se le diagnostica neoplasia de pulmón. La infección de piel se trató con antimicrobianos de uso parenteral y curas locales con miel de abejas, así se logró la resolución total de la lesión(AU)

The case report of a 67 years patient who was admitted in the Dermatology Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital with diagnosis of anthrax in postero-superior region of the thorax is described. A necrectomy and simple x-ray of thorax are carried out that which show a significant left pleural effusion; therefore, he was transferred to the Pneumology Service where he is diagnosed with lung neoplasia. The skin infection was treated with antimicrobials of parenteral use and local cures with honey, thus, the total resolution of the lesion was achieved(AU)

Furúnculo, furunculosis y ántrax: abordaje y tratamiento / Management of furuncle, furunculosis and anthrax

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[Facial furuncles and carbuncles incidence and morbidity].

The retrospective study included analysis of 5764 hospital records in maxillo-facial surgery unit of Samara State Medical University Clinic to reveal facial furuncles and carbuncles incidence and morbidity. Patients attended in 2007-2010 were included in the study. Treatment options in 380 patients with facial furuncles and carbuncles were also analyzed. The authors recommend early treatment in the in-patient maxillofacial unit and adequate active surgical tactic.

[Probiotics use in local comprehensive treatment of patients with suppurative-inflammatory diseases of maxillofacial region].

In spite of many studies in the field of suppurative-inflammatory diseases of maxilla-facial region diagnostics and treatment (in particular furuncle and carbuncle) the quantitative measures of the pathology does not have tendency to reduce. Patient contingent is predominantly young able-bodied age. The existing diagnostic methods are not always meeting the modern requirements all along the time and quality. On the background of conducted comprehensive antibacterial treatment unwanted consequences are seen, terms of such treatment are long stationary stage includes. Probiotics use in the comprehensive local and general treatment of such patient category let to shorten terms of treatment and rehabilitation, to avoid negative effects of antibacterial treatment and laser fluorescence diagnostic method use considerably speeds up the process of pathogenic flora diagnosis.

[Maggots of Lucilia sericata in treatment of intractable wounds]. / Zastosowanie larw muchy Lucilia sericata w leczeniu trudno gojacych sie ran.

Although beneficial effects of wound infestation with maggots had been known for many centuries, it was not until dr Zacharias recognized medical importance of maggots during the American Civil War. He intentionally introduced maggots into the wound for its debridement. Baer successfully used maggots in treatment of osteomyelitis in 4 children in the 1930'. After many successes in the 1930' maggots therapy had become limited to intractable wounds after introducing sulphonamides and mass-production of Flemming's penicillin. Present use of maggots came in the 1980' when better methods of sterilization both eggs and maggot were developed and clinical efficiency of antibiotics used for wound treatment decreased dramatically. Today maggots' therapy became less treatment of last resort but of first choice in leg ulcers, carbuncules, pressure ulcers and infected traumatic wounds. Its beneficial effect was noted in diabetic foot and in destroying malignant tissue as well. Easiness in application, safety, near no side effects and often exceptional efficiency in wound debridement makes maggots therapy the first line therapeutic tool in both hospital and out-patient surgery. Clinical experience has demonstrated that maggot therapy may reduce costs of treatment considerably by shortening hospital stay and decrease usage of antibiotics.

[Experimental and clinical study of immunomodulators Immunomax and Gepon in complex treatment of acute purulent surgical infection]. / Immunomoduliatory Immunomaks i Gepon v kompleksnom lechenii ostroi gnoinoi khirurgicheskoi infektsii v éksperimente i klinike.

The efficacy of the immunomodulators immunomax and gepon in the treatment of acute purulent surgical infection of soft tissues was studied under experimental and clinical conditions. Gepon was used in the form of 0.04% ointment in the phase of the wound infection regeneration vs. the routine use of 10% methyluracil ointment. Immunomax was administered in a dose of 40 units under the experimental conditions and 200 units in the clinical trial 3 times every 2nd day intramuscularly. The experimental investigation was performed on 20 male guinea pigs in a model of a suppurating wound. The animals were divided into 2 groups (main and control) of 10 animals each. Flat wounds were prepared according to the A. V. Nikolaev's method. The clinical trial enrolled 126 patients with acute surgical infection of the soft tissues. The patients were treated in the Hospital of General Surgery of the Faculty of Pediatrics of the Russian State Medical University during the period from 2003 to 2004. The patients were divided into 2 groups (main and control). The structure of the main and control groups was comparable by the sex and age of the patients, nosological forms and severity of the disease. The patients of the main group (65 subjects) were given the immunomodulators in complex with the routine surgical treatment and drug therapy. The patients of the control group (61 subjects) were given the same surgical treatment and drug therapy but without the use of the immunomodulators. General and local manifestations of the purulent infection were considered as the criteria of the treatment efficacy. The qualitative and quantitative composition of the wound bacterial infection was determined and histological examination of the wound bioptates was performed. Planimetry of the wound surface was carried out and the acceleration index of the wound clearing and healing was evaluated. In the total, high therapeutic efficacy of immunomax and gepon, practically no contraindications and adverse reactions to their use, the ease and simplicity of their handling can be stated.

Diagnóstico y tratamiento del ántrax: medicina tradicional vs medicina científica / Diagnosis and treatment of the anthrax: traditional medicine vs scientific medicine

Actualmente en algunos poblados peruanos muchos pacientes con ántrax acuden a la medicina tradicional. Por tal motivo se realizó un estudio con el fin de obtener información sobre los conocimientos, actitudes y prácticas de la población utilizados en una zona endémica de ántrax: distrito de Santiago de Chocorvos, en Huancavelica, Perú, y compararlos con los de la medicina científica. La información se obtuvo a través de un trabajo de campo realizado de octubre 1992 a septiembre 1993 y se realizaron 100 entrevistas individuales a pobladores de la zona. Treinta de los entrevistados fueron pacientes con diagnóstico clínico de ántrax. Los resultados indicaron que el 96 por ciento de entrevistados conocían la enfermedad con una palabra quechua: "Waytacha". El 94 por ciento de los entrevistados referían que el tratamiento debía ser a base de quemaduras. Las consecuencias de estas prácticas eran grandes cicatrices y parestesias que contrastan con la terapia a base de penicilina.

Common bacterial skin infections.

Skin infections account for a significant portion of dermatologic disease, often resulting in or as a consequence of a disruption in the skin's integrity. This article covers the presentation, diagnosis, and treatment of the more common bacterial infections. The infections presented herein include impetigo, ecthyma, folliculitis, carbuncles/furuncles, cellulitis, toxic shock syndrome, and ecthyma gangrenosum. Once a diagnosis is made, treatment is based on the culture and antibiotic sensitivities of the offending organisms.

[Septic metastatic complications in facial furuncles and carbuncles]. / Septico-metastaticheskie oslozhneniia pri furunkulakh i karbunkulakh litsa.

According the information of Maxillo-Facial Surgery Clinic of Moscow Medical Academy the percentage of the patients with face furuncles and carbuncles from all the hospitalised is the following: 1994--4.5%, 1995--7.9%, 1996--11.4%, 1997--17.0%. That gives about 3.7 times during the last 2 years. The rate of dangerous for life septic metastatic complications in the course of such diseases considerably exceeds those at phlegmons. This figure has increased 2 to 2.5 times during the last 2 years. Two clinical cases which demonstrate possibility of bacterial thromboemboli spreading in face furuncles and carbuncles not only through small, but also through large blood circulation with formation of septic centres in organs are described. The treatment tactics for such patients requires a strictly individual approach. At slightest suspicion of the complication urgent hospitalisation of the patients for active conservative therapy is necessary. In case of purulent process extension surgery is indicated.

Dermatological problems in the athlete.

Sports activities expose the skin to a variety of risk factors that can affect an athlete's performance. The sports physical therapist must be able to identify and properly manage dermatological problems encountered by athletes. Common dermatological conditions resulting from mechanical, infectious, environmental, and sexual factors are presented. Discussion of etiology, signs and symptoms, treatment options, and preventative measures are intended to guide the physical therapist in making appropriate decisions regarding skin disorders.