The potential role for phage therapy for genetic modification of cutaneous diseases.

Antimicrobial resistance has become increasingly common across the globe, claiming more than 33,000 lives annually in Europe and 35,000 lives in the United States alone. The problem lies in trying to find potential solutions capable of tackling resistance and being able to fight infections that may resist various antimicrobials. Since Alexander Fleming's discovery in 1928, every antimicrobial synthesized in the past 70 years has developed at least one or more strains of resistant bacteria. One particular alternative to antimicrobials has brought hope to many in the scientific community: the bacteriophage. Bacteriophages are viruses that can replicate within bacteria, triggering genetic alterations and changes in pathways of protein expression by encoding a few to hundreds of genes within their genomes. The bacteriophage can hijack the cell, using the cell's genetic apparatus to replicate within the bacterium until bacterial lysis occurs. This therapy has been used in the genodermatosis Netherton syndrome, which has been associated with the increased risk of Staphylococcus aureus infections. Emerging data support the potential role of bacteriophage therapy for Cutibacterium acnes in acne vulgaris, with a potential role in genetic disorders with severe acne vulgaris, including Apert syndrome. Bacteriophages hold benefits for genodermatoses associated with recurrent cutaneous infections, that is, the immunodeficiencies with distinctive cutaneous features as well as conditions such as atopic dermatitis, in which bacterial colonization plays a strong role.

A Retrospective Chart Review of Inflamed Epidermal Inclusion Cysts.

BACKGROUND: Epidermal inclusion cysts (EIC) are one of the most common forms of cysts found on and/or underneath the skin. Inflamed EICs typically show signs and symptoms such as pain and erythema, mimicking cutaneous abscess. However, prior studies have demonstrated at least 20% of lesions are culture negative. OBJECTIVE: To determine the rate of culture positivity in mild inflamed epidermal inclusion cysts, in particular to identify whether empiric antibiotics are warranted. METHODS: In a retrospective chart review 76 cases of inflamed EIC that were mild (lacking systemic symptoms) were analyzed who presented to the department of dermatology at Mount Sinai between 2016–2019. RESULTS: Of cultures taken from inflamed cysts, 47% resulted in no bacterial growth or growth of normal flora, 38.4% resulted in growth of aerobic bacteria with methicillin-resistant Staphylococcus aureus (8%), Staphylococcus lugdunensis (5%), and methicillin-sensitive Staphylococcus aureus (13%) predominating, and 9.3% resulting in growth of anaerobic bacteria with Finegoldia magna, Peptostreptococcus, and Cutibacterium acnes presenting. Review of prescribed treatment regimens often involved antibiotic medication, despite a high prevalence of negative culture. CONCLUSIONS: Almost half of cases of mild inflamed EIC (lacking systemic symptoms) cultured will not grow pathogenic bacteria, therefore incision and drainage with culture and appropriate therapy is a viable therapeutic option in uncomplicated inflamed EIC lesions. In this way, over prescription of antibiotics can be minimized. J Drugs Dermatol. 2021;20(2):199-202. doi:10.36849/JDD.5014.

Large inflamed facial cysts in teenagers.

BACKGROUND: Facial cysts can become large (1-5 cm) or giant (>5 cm) on the face. OBJECTIVE: To describe the medical course of large and giant facial cysts in adolescents. METHODS: A case series of 11 patients with large or giant facial cysts seen in an outpatient pediatric dermatology practice. RESULTS: Seven patients underwent incision and drainage with culture of cyst contents growing Cutibacterium acnes in six, while the seventh grew Cutibacterium acnes from a frequently worn hat. All patients were treated with traditional therapeutics for cystic acne including intralesional triamcinolone (n = 9), oral antibiotics (n = 10), and isotretinoin (n = 1). Three patients who did not undergo cyst drainage had persistent symptomatology requiring cyst excision, whereas the seven patients whose cysts were drained (3 on initial management and 4 after recurrence) eventually had complete healing without need for surgery. CONCLUSION: Incision and drainage (I & D) and culture of cyst contents can identify cases of cysts related to Cutibacterium acnes. For some cases of large facial cysts related to Cutibacterium acne, I&D combined with conservative acne management (using standard acne guidelines) can prevent the need for surgical excision in some patients. Prospective studies are needed to determine whether this combination of therapy leads to best outcomes clinically and cosmetically.