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Eczema (dermatitis)
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Patients with atopic dermatitis are particularly prone to skin infection, which contributes to the flare-up of dermatitis. Infection with staphylococci and possibly other bacteria cause pustules, impetiginized lesions, and cellulitis. Bacterial swabs from suspected infected lesions should be taken before starting treatment with either topical or systemic antibacterial agents. Diluted bleach baths may reduce the bacterial load and decrease skin infections. The infected area can be soaked or bathed in 1 in 8000 potassium permanganate solution or aluminium subacetate solution. Topical mupirocin may be used, but other antibiotics should be avoided because of the risk of inducing microbial resistance and allergic contact dermatitis. If the infection is severe, systemic antibiotics should be given.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Mupirocin is a natural crotonic acid derivative and antibiotic extracted from a strain of Pseudomonas fluorescens. It inhibits bacterial protein synthesis by specific reversible binding to bacterial isoleucyl tRNA synthase. With excellent activity against gram-positive staphylococci and streptococci, mupirocin is primarily used for the topical treatment of primary and secondary bacterial skin infections, nasal infections, and for wound healing. In pharmaceutical products, ointments usually contain mupirocin and creams mupirocin calcium (dihydrate) (CAS number 115074-43-6, EC number not available, molecular formula C52H90CaO20) (1).
Atopic Dermatitis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Luz Fonacier, Amanda Schneider
Occasionally AD lesions can become infected with Herpes Simplex Virus (HSV), which can be diagnosed via viral PCR, Tczank preps or culture from unroofed intact vesicles. These cases respond well to antiviral therapy (Boguniewicz and Leung 2006). In addition to bacterial and viral superinfections, Malassezia species infection can occur commonly in the seborrheic areas of the head and neck. Sensitization to M. sympodialis can be detected via ImmunoCAP assay. Antifungal therapy (topical or rarely systemic) has been effective in these patients (Boguniewicz et al. 2006). Since colonization with S. aureus can exacerbate acute AD and promote chronic skin inflammation, use of anti-staphylococcal therapy should be considered in poorly controlled AD with evidence of infection. Systemic antibiotics should be reserved for those that are heavily colonized or infected when it is clear that infection with S. aureus is a trigger. Erythromycin-resistant organisms are common, thus semi synthetic penicillins or first- or second- generation cephalosporins for 7 to 10 days can be effective (Boguniewicz et al. 2001). If Methacillin Resistant Staphylococcus aureus (MRSA) colonization exists, clindamycin, or trimethoprimsulfamethoxazole and intranasal Mupirocin can be used. Topical Mupirocin three times daily for 7 to 10 days may be effective. The combination of topical corticosteroids and topical Mupirocin has been shown to be more effective than corticosteroids alone in achieving skin clearance and decreased colonization of S. aurueus (Lever et al. 1988).
High-intensity focused ultrasound therapy for pediatric and adolescent vulvar lichen sclerosus
Published in International Journal of Hyperthermia, 2022
All patients successfully underwent HIFU therapy. The results pertaining to the treatment are shown in Table 2. The device output power in 26 (72.2%) patients was set at level 2, and in 10 (27.8%) patients it was set at Level 3. The sonication time was 20.3 ± 8.6 min, and the median treatment energy was 3579.0 J. A few blisters developed in eight (22.2%) patients, of which two patients developed superficial skin ulcers. About 1 week after the treatment, the six patients who had a few blisters in the vulvar treatment area improved after topical treatment with moist burn ointment without obvious pain, infection and scar formation. An 18-year-old patient was treated with output power Level 2 for 10 min and 15 s, with a total energy of 1393 J. On the seventh day of treatment, multiple ulcers and inflammatory exudation were found during the outpatient follow up review. The patient was given anti-infection treatment, moist burn ointment and epidermal growth factor, which were applied externally, and the wound healed 1 month later. Another 8-year-old child was treated with HIFU for 8 min with an energy of 1494 J. A few blisters appeared immediately after therapy. One week later, multiple superficial ulcers were seen in the treatment area. Mupirocin was given as a local anti-infection treatment. Moist burn ointment and epidermal growth factor were also applied. The wound healed within 1 month of treatment without scar formation.
Proposition of standardized protocol for photodynamic therapy for vulvar lichen sclerosus
Published in Journal of Dermatological Treatment, 2022
Alicia Declercq, Canan Güvenç, Petra De Haes
Furthermore, Lan et al. (27), Shi et al. (34), and Olejek et al. (35) used a 10% concentration of 5-ALA. They all used the same protocol in their studies: lesions were treated 3 h after 10% concentration of 5-ALA application – with or without occlusion – with red light (630–635 nm) at a total light dose of 100 J/cm2. They all reported improvement in subjective symptoms, but histopathological differences were not demonstrated (Table 2). Olejek et al. (35), one of the largest studies (n = 100) on the subject, used two light sources, group I was treated with red light (DIOMED 630 nm) as group II was treated with a combination of visible light and water-filtered infrared A (PhotoDyn® 750, 580–1400 nm). Only, in Shi et al. (34) erosions after PDT were treated with mupirocin ointment for 1 week. The other two articles did not report any after-treatment (27,35). In summary, the three studies reported decrease in subjective symptoms. Olejek et al. (35) concluded a relevant subjective symptom reduction with both types of lamps, without significant difference in results between the two groups. The two smallest studies Lan et al. (27) (n = 10) and Shi et al. (34) (n = 20) also described a substantial improvement in objective lesion characteristics.
The majority of MRSA colonized children not given eradication treatment are still colonized one year later. Systemic antibiotics improve the eradication rate
Published in Infectious Diseases, 2018
Jimmy Jörgensen, Fredrik Månsson, Håkan Janson, Ann Cathrine Petersson, Anna C. Nilsson
Treatment attempting to eradicate MRSA was given simultaneously to all MRSA positive household members if any member in the household had repeated infectious problems or an ongoing MRSA infection requiring treatment, expected frequent healthcare contacts, health care work or if any form of social reasons existed (mostly strong wishes to attempt eradication by treatment). None of the children in the followed untreated group had a household member receiving eradication treatment since all members in a household were treated simultaneously. Information about antibiotic treatment initiated in the primary care was not available in this evaluation. The practice used in the area was, however, that MRSA carriers with SSTIs were referred to the infectious disease department for treatment but respiratory or urinary tract infections could be treated in the primary care mostly with MRSA inactive antibiotics. The eradication treatment was standardized except regarding the type of antibiotics used. The choice to treat, and antibiotics used, was made on the discretion of the physician in charge. Topical treatment consisting of 7 days nasal mupirocin three times daily and a 14 day hygiene program, including showering with chlorhexidine and the change of clothing and bed linen at least twice a week, was used. For the great majority of treated children who carried MRSA in the throat systemic antibiotic treatment for 14 days was included in the treatment regime. The antibiotics used in nearly all the cases was rifampicin (if susceptible) in combination with one other drug the strain was susceptible to; clindamycin, fucidic acid or trimethoprim/sulfamethoxazole.