Pyodermatitis-pyostomatitis vegetans complicated by methicillin-resistant Staphylococcus aureus infection

Pyodermatitis vegetans after total colectomy

Pyostomatitis-pyodermatitis vegetans (PPV) is a rare dermatological manifestation of inflammatory bowel disease, characterized by erythematous, vesiculopustular, exudative, annular, and/or vegetating plaques over the intertriginous regions that may precede or appear at the same time as the mucosal lesions. Systemic corticosteroids, dapsone, sulfasalazine, azathioprine, cyclosporine, and subtotal/total colectomy are the most common treatment options. A 16-year-old male patient presented to our outpatient clinic with a four months history of thickly crusted erosions on his trunk, back, and lower extremity. He had ulcerative colitis for four years and total colectomy was done seven months ago. Clinical and histopathological examination of his lesions were consistent with pyostomatitis vegetans. Although subtotal/total colectomy has been reported as a treatment option for PPV, lesions reappeared three months after total colectomy in our patient.

Blastomycosis-like Pyoderma with Good Response to Acitretin

Blastomycosis-like pyoderma is a rare, vegetating skin lesion that is an unusual exaggerated tissue reaction possibly to prolonged primary or secondary bacterial infection. We report a case of blastomycosis-like pyoderma in a man with Down syndrome, diabetes mellitus and hypothyroidism who responsed poorly to conventional therapies, including antibiotics and correction of predisposing factors for a long time, but experienced dramatic improvement after 3 months of acitretin treatment.

Pyodermatitis-pyostomatitis vegetans after subtotal colectomy for ulcerative colitis

A 51-year-old Japanese woman underwent subtotal colectomy for ulcerative colitis 5 years before her first visit to our hospital, and her symptoms stabilized. She presented with a 2-month history of proliferative, pustular lesions on her face, scalp, and gingival and anal mucosae. Histological examination showed features similar to those of pemphigus vegetans. However, the results of immunofluorescence studies, immunoblot analysis and enzyme-linked immunosorbent assay for pemphigus were negative, and colonoscopy revealed a relapse of ulcerative colitis in the remaining rectal mucosa, so a diagnosis of pyodermatitis-pyostomatitis vegetans was made. This is the first report of mucocutaneous lesions that developed with a relapse of ulcerative colitis in the remaining rectum after subtotal colectomy. Moreover, a close correlation was found between the condition of bowel inflammation and that of mucocutaneous lesions.

Community-acquired methicillin-resistant Staphylococcus aureus skin infections: implications for patients and practitioners

Dermatologists and other healthcare providers need to be aware of the epidemiology, clinical features, management, and prevention of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection. Currently, infection caused by CAMRSA is considered to represent a worldwide epidemic and infectious skin lesions are a frequent occurrence. Athletes, certain ethnic populations, children, homeless persons, homosexual men, household members of infected people, HIV-infected patients, intravenous drug abusers, military personnel, newborns, pregnant and postpartum women, tattoo recipients, and urban dwellers of lower socioeconomic status in crowded living conditions are individuals at increased risk of developing CAMRSA infection. Although the observed incidence of cutaneous CAMRSA lesions in patients with atopic dermatitis or other conditions that are characterized by a non-intact skin barrier is less than that reported in other groups of people at risk for this skin infection, close surveillance for the emergence of CAMRSA skin infection in children and adults with atopic dermatitis and other patients whose skin barrier is disrupted is justified since colonization by S. aureus in these individuals represents a potential reservoir for CAMRSA. It is also important to note that infection-associated risk factors are absent in many individuals who develop cutaneous CAMRSA infection. CAMRSA skin lesions are pleomorphic. The most common presentations of CAMRSA infection are abscess, cellulitis, or both. These infectious lesions are not uncommonly misinterpreted by the patient as spider bites or insect bites. Other manifestations of cutaneous CAMRSA infection are impetigo, folliculitis, and paronychia. Incision and drainage of abscesses, systemic antibacterial therapy, and adjunctive topical antibacterial treatment are the essential components of management of CAMRSA skin infections. At the initial visit, a bacterial culture of the infectious lesion is recommended to confirm identification of the pathogen and to determine antimicrobial susceptibility. Subsequently, based upon the reported antibacterial sensitivity, alteration (if necessary) of the patient's empiric systemic antimicrobial treatment can be initiated. Direct skin-to-skin transmission of the causative bacteria, damage to the skin's surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of CAMRSA skin infection. The spread of cutaneous CAMRSA infection can potentially be prevented by incorporating personal, environmental, and healthcare measures that strive to eliminate the causes of acquisition and transmission of the bacteria.

Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and prevention

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia. The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection.