Current Issue : October-December Volume : 2025 Issue Number : 4 Articles : 5 Articles
Introduction: Acrodermatitis chronica atrophicans (ACA) is a late-stage cutaneous manifestation of Lyme borreliosis, primarily caused by Borrelia afzelii. It mainly affects the distal limbs and leads to progressive skin atrophy. Unlike other Lyme disease rashes, ACA does not resolve on its own and can worsen into severe atrophy and fibrosis if left untreated. Diagnosing ACA can be difficult due to its delayed onset and subtle symptoms, requiring clinical evaluation, multiple blood tests, and skin biopsy. Case presentation: We present the case of a 48-year-old female with a history of pulmonary sarcoidosis who presented to our clinic with multiple erythemato-violaceous patches over her left lower leg and was initially misdiagnosed with venous insufficiency. Histopathological and serological analyses confirmed ACA in its inflammatory phase. The patient responded well to a 30-day course of doxycycline, achieving complete resolution. This report underscores the importance of considering ACA in differential diagnoses and provides a comprehensive review of its pathogenesis, clinical progression, histopathological features, and epidemiology. Conclusions: This case emphasizes the need to consider acrodermatitis chronica atrophicans (ACA) in the differential diagnosis of chronic skin lesions. Clinicians should maintain a high index of suspicion for ACA, particularly in atypical presentations. When the diagnosis is uncertain but clinical suspicion persists, skin biopsy is recommended for histopathologic confirmation. Early diagnosis and appropriate antibiotic therapy are essential to prevent disease progression and irreversible cutaneous atrophy. Accurate diagnosis and effective management require a multidisciplinary approach, involving close collaboration between dermatologists, pathologists, and infectious disease specialists....
Background/objectives: According to the Chapel Hill Consensus Conference nomenclature, single-organ cutaneous small vessel vasculitis (SOCV) is defined histopathologically by immune complex-mediated vasculitis of the dermal capillaries/venules without systemic involvement. There is a lack of investigations studying predictors of SOCV outcomes. This multicenter retrospective study aimed to assess whether baseline serum liver scores could predict SOCV recurrence. Methods: Data from 204 inpatients with histopathologically confirmed idiopathic SOCV treated between 2000 and 2022 were analyzed. All patients had baseline blood tests for platelets and liver parameters; those with systemic diseases were excluded. The study evaluated the AST to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) index, and De Ritis ratio (DRR). Results: Recurrence was observed in 17.6% of patients. Univariable analysis identified hospital stay length, DRR, cutaneous extent, and cardiovascular comorbidities as predictors, but logistic regression confirmed only cutaneous extent and DRR as independent predictors of disease recurrence. Conclusions: A higher DRR (cut-off > 1.13) may indicate necrosis from reduced blood flow, making it a potential predictor of SOCV recurrence....
Background: Fluoroquinolones, available in topical and oral formulations, are used to manage bacterial skin and soft tissue infections, including Pseudomonas aeruginosa, atypical mycobacteria, and select multidrug-resistant Gram-negative organisms. Their excellent tissue penetration, bactericidal activity, and convenient dosing make them effective for certain skin and soft tissue infections. However, their use is limited by potential safety concerns, including tendinopathy (odds ratio up to 9.1 in corticosteroid users), QT interval prolongation with risk of torsades de pointes, phototoxicity, and rising antimicrobial resistance. Methods: A literature search of PubMed, Scopus, andWeb of Science was conducted for articles from January 1985 to April 2025 with the search terms (quinolone OR fluoroquinolone) AND (dermatology OR “skin and soft tissue infection” OR “skin structure infection”). Abstracts and presentations were excluded. A Google search used the same terms for articles from government regulatory agencies. Results: This review provides practical guidance on the clinical use of topical and oral fluoroquinolones in dermatology. Delafloxacin demonstrated over 90% cure rates in trials for complicated skin infections. However, serious safety concerns remain, including a ninefold increase in tendinopathy risk among older adults on corticosteroids and corrected QT intervals exceeding 500 milliseconds in high-risk patients. Phototoxicity varies, with agents like sparfloxacin linked to heightened ultraviolet sensitivity. Resistance to ciprofloxacin exceeds 20 percent in Escherichia coli and P. aeruginosa in some populations. Culture-based prescribing, shorter treatment courses, and preference for topical treatments can reduce risk and preserve efficacy. Conclusions: Fluoroquinolones remain clinically useful in dermatology when prescribed selectively. Their appropriate use requires careful attention to patient risk factors along with their evolving resistance patterns and ongoing stewardship efforts....
Background/Objectives: Accurately determining the bacterial bioburden that survives preoperative skin preparation (PSP) is critical in understanding PSP efficacy and its limitations. Clinical PSP approval relies on a bacterial sampling method described in the American Society for Testing and Materials (ASTM) standard E1173-15. Though common, this technique may overlook deep-dwelling skin bacteria. The objective of this study was to test the hypothesis that deep-dwelling skin flora would survive PSP, and more growth would be detected using a destructive sampling method compared with ASTM E1173-15. Methods: Twelve female participants with a scheduled deep inferior epigastric perforator (DIEP) artery flap procedure at the Huntsman Cancer Institute in Salt Lake City, UT, were enrolled between January and August 2024. PSP was performed using three 26 mL ChloraPrep applicators (2% CHG), and excess tissue was collected. Bacteria in the skin were quantified using a destructive sampling method and ASTM E1173-15, and bioburden outcomes were compared. Two participants were excluded from the quantitative analysis. Results: Bacteria survived PSP in every participant. A greater diversity and more bacteria were quantified with destructive sampling than ASTM E1173-15 (p < 0.01). Generally, anaerobic bioburden values were higher than aerobic bioburden values. Higher bioburden correlated with processing more skin from a participant. Genotypic identification of select isolates identified Staphylococcus epidermidis and Cutibacterium acnes (formerly known as Propionibacterium acnes) as surviving bacteria, among others. Immunofluorescence revealed bacteria in all skin layers. No participant exhibited clinical signs of infection in the abdominal region. Human data corroborated previous porcine data collected using destructive skin sampling after PSP. Conclusions: Clinical PSP application does not create a sterile field. Destructive skin sampling techniques may be more effective than ASTM E1173-15 at resolving bacterial PSP survivors contributing to SSI risk....
Background: Artificial intelligence (AI) has emerged as a transformative tool in modern medicine, particularly in dermatology, where it supports the diagnosis and management of various skin diseases, including skin cancer. Through machine learning and deep learning techniques, AI enables accurate analysis of clinical and dermoscopic images, improving early detection and clinical outcomes. Objective: This systematic review aimed to evaluate the clinical applications of AI in dermatology, focusing on its impact on diagnostic accuracy, workflow efficiency, and access to specialized care. Methods: The review was conducted according to PRISMA guidelines. Peer-reviewed studies published between January 2020 and March 2025 in English or Spanish were included if they evaluated AI-based tools for dermatological diagnosis, classification, or treatment. Animal studies, editorials, non-peer-reviewed articles, and studies with an unclear methodology were excluded. A comprehensive search was performed in PubMed, Scopus, IEEE Xplore, and Google Scholar between December 2024 and March 2025. The risk of bias was assessed qualitatively, using a tailored framework based on study design, dataset transparency, and clinical applicability. Results: A total of 29 studies met the inclusion criteria. AI tools demonstrated high performance in melanoma detection, achieving up to 90% accuracy and 85% sensitivity. In clinical settings, AI support reduced mismanagement of malignant lesions from 58.8% to 4.1% and avoided 27% of unnecessary procedures in benign cases. Additional tools such as convolutional neural networks and imaging systems like FotoFinder also showed promising results. Limitations: Limitations of the evidence include the heterogeneity of AI models, lack of external validation, and a moderate-to-high risk of bias. Conclusions: AI has demonstrated robust clinical potential in dermatology, particularly in cancer detection and workflow optimization. However, further studies are required to address challenges such as algorithmic bias, data privacy, and regulatory oversight. Funding and registration: This review received no external funding and was not registered in a systematic review registry....
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