Jorge A. Hinojosa

Antimicrobial efficacy of contact lens care solutions against neutrophil-enhanced bacterial biofilms

Purpose Neutrophil-derived extracellular debris has been shown to accelerate bacterial biofilm formation on hydrogel and silicone hydrogel contact lens surfaces compared to lenses inoculated with bacteria alone. The purpose of this study was to evaluate the disinfection efficacy of four standard commercial contact lens cleaning regimens against neutrophil-enhanced bacterial biofilms formed on silicone hydrogel contact lenses. Methods Four reference strains were used: Pseudomonas aeruginosa, Serratia marcescens, Stenotrophomonas maltophilia, and Staphylococcus aureus. Human neutrophils were isolated from peripheral blood by venipuncture. Unworn Lotrafilcon B lenses were incubated overnight in each respective strain with stimulated neutrophils. Contact lenses were then cleaned using one of four contact lens care solutions according to manufacturer instructions. Bacterial viability was assessed by colony counts and confocal microscopy. Volume of residual debris on lens surfaces after cleaning was quantified using IMARIS software. Results All four solutions tested showed effective antimicrobial activity against each bacterial strain; however, substantial amounts of nonviable bacteria and cellular debris remained on the lens surface despite concomitant digital cleaning. Conclusions Necrotic cellular debris that accumulates under the posterior lens surface during wear of an inoculated contact lens is not fully removed during routine cleaning and disinfection. Translational Relevance The accumulation of residual cellular debris on the contact lens surface may contribute to new colonization of the lens and represents a significant risk factor for a contact lens–related adverse event. Additional studies are needed to correlate these findings with risk for corneal infiltrative and/or infectious events in a standard animal model.

The majority of patients presenting with vitiligo have a clinical sign of activity

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Diversity in the dermatology workforce

The United States is becoming increasingly diverse, and minorities are projected to represent the majority of our population in the near future. Unfortunately, health disparities still exist for these groups, and inequalities have also become evident in the field of dermatology. There is currently a lack of diversity within the dermatology workforce. Potential solutions to these health care disparities include increasing cultural competence for all physicians and improving diversity in the dermatology workforce.

Non-cultured epidermal suspension grafting using suction blisters as donor tissue for vitiligo

In the literature, 3%-22% of invasive melanomas were initially considered in situ on partial biopsy specimens. In our study, 90.7% (107/118) of partial biopsies were 3e4-mm punch biopsies, which reduced the surface area analyzed in comparison with the remaining 11 incisional biopsies and increased the risk of missing an invasive component. Missing an invasion could lead to additional surgical procedures (ie, enlargement of the peripheral margin up to 1-2 cm according to Breslow thickness), resulting in the destruction of the prior wound closure and compromising the implementation of sentinel lymph node biopsy. Moreover, this might also lead to inadvertently treating occult invasive LMM nonsurgically. Alternative treatments to surgery, such as imiquimod (4.2%-50%), radiotherapy, or laser therapy, can represent interesting options for nonoperable patients. But, these techniques are not indicated in cases of LMM and not recommended as first-line therapy for LM in guidelines. Our study identified 2 independent pathologic predictors of dermal invasion on biopsy specimens of LM: pagetoid spread of tumor cells and presence of moderate-to-strong dermal inflammation. The presence of 1 of these criteria should lead to the performance of an additional hematoxylin-eosin stain or immunostain to search for an invasion or additional biopsies. Of note, we did not take into account regression, which is conceptually defined as an indirect sign of a previous invasion and thus LMM. We propose an algorithm (Fig 1) to optimize LM and LMM management according to the presence of these 2 predictors of invasion.

Arsenical keratosis secondary to Fowler solution

SCC: squamous cell carcinoma INTRODUCTION Chronic arsenic exposure is rare in developed nations. The few cases of arsenical keratosis in the United States have primarily been attributed to occupational and medicinal exposures. Here, we describe a case of an elderly man in whom arsenical keratoses and cutaneous cancers developed decades after being treated with oral Fowler solution, for the treatment of acne during adolescence.

Addition of oral minipulse dexamethasone to narrowband ultraviolet B phototherapy and topical steroids helps arrest disease activity in patients with vitiligo

Vitiligo is a common autoimmune disease affecting 0.5-1% of the worlds population with significant effects on quality of life. Unfortunately, there are currently no FDA-approved treatments to induce repigmentation of affected areas. Rapidly progressive disease has been shown to respond to systemic corticosteroids, however, this treatment is associated with a high incidence of side effects when given continuously. This article is protected by copyright. All rights reserved.

Successful treatment with narrowband ultraviolet B phototherapy of burn-induced leucoderma

DEAR EDITOR, A 58-year-old woman presented with a 3-month history of right-sided facial depigmentation following a radiator-fluid burn from her automobile (Fig. 1a). The patient was started on a 3-month trial of narrowband ultraviolet B (NBUVB) phototherapy thrice weekly prior to considering surgical intervention. After 1 month, the patient achieved 50% repigmentation (Fig. 1b). After 7 months, 100% repigmentation with excellent colour match was achieved (Fig. 1c). Repigmentation has remained 6 months after discontinuing phototherapy. This case suggests that early intervention with NB-UVB phototherapy may benefit patients with leucoderma after burns.