Shailee Patel

Interactions of Methicillin Resistant Staphylococcus aureus USA300 and Pseudomonas aeruginosa in Polymicrobial Wound Infection

Understanding the pathology resulting from Staphylococcus aureus and Pseudomonas aeruginosa polymicrobial wound infections is of great importance due to their ubiquitous nature, increasing prevalence, growing resistance to antimicrobial agents, and ability to delay healing. Methicillin-resistant S. aureus USA300 is the leading cause of community-associated bacterial infections resulting in increased morbidity and mortality. We utilized a well-established porcine partial thickness wound healing model to study the synergistic effects of USA300 and P. aeruginosa on wound healing. Wound re-epithelialization was significantly delayed by mixed-species biofilms through suppression of keratinocyte growth factor 1. Pseudomonas showed an inhibitory effect on USA300 growth in vitro while both species co-existed in cutaneous wounds in vivo. Polymicrobial wound infection in the presence of P. aeruginosa resulted in induced expression of USA300 virulence factors Panton-Valentine leukocidin and α-hemolysin. These results provide evidence for the interaction of bacterial species within mixed-species biofilms in vivo and for the first time, the contribution of virulence factors to the severity of polymicrobial wound infections.

The risk of malignancy or progression of existing malignancy in patients with psoriasis treated with biologics: case report and review of the literature.

There is some debate regarding the risk of developing malignancy and progression of malignancy in patients with psoriasis treated with biologics. The lack of extensive, long‐term, and large studies, including patients with psoriasis, to assess these aforementioned risks makes it difficult to ascertain the safety profile of biologic therapy in these patients. Several studies do support the favorability of the safety profile of biologics in patients with psoriasis in terms of the risk of developing malignancy. A few studies include patients with a previous history of cancer that were thereafter treated with biologics and show no increased risk of recurrence in those treated with biologics compared to non‐biologic therapy. Although recent studies do not show an increased risk of new or recurrent malignancy in patients with psoriasis treated with biologic agents, there is still hesitancy in the widespread use of biologic agents in these patients. Considering all of the current data and opinions, the benefits of biologic therapy to improve quality of life often outweigh the negligible risk of solid organ malignancy associated with biologics in patients with existing or previous malignancies. Coordinating the management of patients that develop or have a history of previous malignancy with an oncology team is crucial for patient‐centered care until clear evidence‐based guidelines are developed.

Dermoscopy of Nail Psoriasis

The authors report on their experience with the use of dermoscopy in nail psoriasis and describe their findings with this diagnostic tool.

Acne and Rosacea

Numerous skin conditions have been associated with stress through both a cause and effect relationship. Both acne and rosacea are such diseases. Although various efforts have been made in order to understand the pathogenesis behind this unique association between these conditions and psychological stressors, there is still much more that needs to be done in order to fully understand this relationship. Underlying inflammation, oxidative stress, and other pathogenic processes have all been contributed to this relationship. However, the true nature of this connection between stress and the skin remains a mystery. In this chapter, we discuss this relationship and the current understanding of unique phenomenon.

Topical irritant plus allergen for treatment of warts.

To the Editor: Like ‘‘skinning cats,’’ there are many ways to treat warts. In heralding publication in this issue of a review on contact allergen therapy, it is propitious to call attention to a method that has yet to be reported in the literature, in which warts are treated with topical application of an irritant followed immediately by an allergen. For more than 2 decades, we have routinely used the irritant, cantharidin, and the allergen, dinitrochlorobenzene (DNCB), to treat warts at medical facilities affiliated with The University of Texas Southwestern Medical Center in Dallas. Topical DNCB alone has been shown in randomized controlled trials to clear up to 80% of warts (vs 40% or less for placebo).1Y3 By contrast, topical cantharidin alone has not been subjected to similar testing, although much anecdotal evidence vouches for its efficacy, at least for simple warts. In 1998, the US Food and Drug Administration approved a bylaw that allowed restricted in-office use of cantharidin by physicians. Our experience strongly suggests that combined use of cantharidin with DNCB can improve the therapeutic efficacy of either chemical alone, especially for recalcitrant warts, including large, periungual, or multiple ones. We believe cantharidin allows DNCB to penetrate deeper into thicker warts and provides added inflammation akin to an adjuvant effect on the DNCB-induced T-cell response. Head-to-head randomized studies and laboratory-based research should be conducted to test these hypotheses.

Diagnostic challenges in determining alopecia areata

Alopecia areata (AA) is the second most common cause of hair loss. It is crucial for the clinician to differentiate AA from other types of hair loss as it differs in prognosis and treatment. The diagnosis of AA can be made clinically; however, there are many nuances making an exact diagnosis challenging. This paper describes the differential diagnoses of both scarring and non-scarring hair loss that may mimic AA. It also highlights the diagnostic tests and pertinent findings that help distinguish AA from other types of hair loss.