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Armillei MK, Lomakin IB, Del Rosso JQ, Grada A, Bunick CG. Scientific Rationale and Clinical Basis for Clindamycin Use in the Treatment of Dermatologic Disease. Antibiotics (Basel) 2024; 13:270. [PMID: 38534705 DOI: 10.3390/antibiotics13030270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Clindamycin is a highly effective antibiotic of the lincosamide class. It has been widely used for decades to treat a range of skin and soft tissue infections in dermatology and medicine. Clindamycin is commonly prescribed for acne vulgaris, with current practice standards utilizing fixed-combination topicals containing clindamycin that prevent Cutibacterium acnes growth and reduce inflammation associated with acne lesion formation. Certain clinical presentations of folliculitis, rosacea, staphylococcal infections, and hidradenitis suppurativa are also responsive to clindamycin, demonstrating its suitability and versatility as a treatment option. This review describes the use of clindamycin in dermatological practice, the mechanism of protein synthesis inhibition by clindamycin at the level of the bacterial ribosome, and clindamycin's anti-inflammatory properties with a focus on its ability to ameliorate inflammation in acne. A comparison of the dermatologic indications for similarly utilized antibiotics, like the tetracycline class antibiotics, is also presented. Finally, this review addresses both the trends and mechanisms for clindamycin and antibiotic resistance, as well as the current clinical evidence in support of the continued, targeted use of clindamycin in dermatology.
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Affiliation(s)
- Maria K Armillei
- Program in Translational Biomedicine, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Ivan B Lomakin
- Department of Dermatology, Yale University, New Haven, CT 06520, USA
| | - James Q Del Rosso
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA
- JDR Dermatology Research, Las Vegas, NV 89148, USA
- Clinical Research and Strategic Development, Advanced Dermatology and Cosmetic Surgery, Maitland, FL 32751, USA
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Christopher G Bunick
- Program in Translational Biomedicine, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
- Department of Dermatology, Yale University, New Haven, CT 06520, USA
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2
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Leeyaphan C, Kulthanachairojana N, Taychakhoonavudh S, Chanyachailert P, Kobkurkul P, Buranaporn P, Yenyuwadee S, Matthapan L, Prasong W, Panyawong C, Bunyaratavej S. Randomized controlled trial and cost-effectiveness analysis: Comparing chlorhexidine scrub, ZnO-nanoparticle socks, and their combination in pitted keratolysis treatment. J Dermatol 2023; 50:1427-1432. [PMID: 37475211 DOI: 10.1111/1346-8138.16903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/24/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
A cost-effective treatment for pitted keratolysis (PK) is the use of 4% chlorhexidine scrub. Zinc oxide nanoparticle (ZnO-NP)-coated socks have also shown efficacy in PK prevention. In this study, we aimed to assess the cost-effectiveness and safety of combined 4% chlorhexidine scrub and ZnO-NP-coated sock treatment compared to monotherapy. This randomized, controlled trial included 60 male security guards and hospital porters aged ≥18 with PK. Participants were randomly assigned to one of three treatment groups: 4% chlorhexidine scrub, ZnO-NP-coated socks, or combination therapy. Treatment outcomes were evaluated after 4 weeks. Incremental cost-effectiveness ratios (ICERs) were calculated using cost-utility analysis. The greatest reduction in visual analog scale scores for foot odor was observed in the combination therapy group, but it was nonsignificant (P = 0.186). Clinical improvement was observed across all groups. The cost-utility analysis revealed that chlorhexidine scrub and regular socks were the least expensive options. The placebo and ZnO-NP-coated sock group had an ICER of US $31 082/quality-adjusted life years (QALYs) gain, while the combination therapy gained US $45 105/QALYs compared to the chlorhexidine scrub and regular sock group. Based on our findings, for the treatment of PK, 4% chlorhexidine scrub remains the most cost-effective choice.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattanichcha Kulthanachairojana
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Pattriya Chanyachailert
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pantaree Kobkurkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panyapat Buranaporn
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasitorn Yenyuwadee
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lalita Matthapan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waranyoo Prasong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatisa Panyawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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3
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Palaniappan V, Murthy AB, Karthikeyan K. Pitted keratolysis. Clin Exp Dermatol 2023; 48:978-983. [PMID: 37151115 DOI: 10.1093/ced/llad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/28/2023] [Accepted: 05/02/2023] [Indexed: 05/09/2023]
Abstract
Pitted keratolysis (PK) is a common superficial bacterial skin infection confined to the stratum corneum. It is clinically characterized by multifocal, discrete, pits or crater-like punched-out lesions, commonly over the pressure-bearing aspects of the foot. It is asymptomatic and associated with malodour. The surface is often moist and macerated. The diagnosis of PK is often clinical and diagnostic procedures are usually unnecessary. Lifestyle modifications form the cornerstone of the management of PK. It responds well to topical antimicrobials.
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Affiliation(s)
- Vijayasankar Palaniappan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
| | - Aravind Baskar Murthy
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
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4
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Maxwell J, Lam JM. Multiple malodorous pitted craters over the feet: Pitted keratolysis. Paediatr Child Health 2021; 26:390-391. [PMID: 34777654 DOI: 10.1093/pch/pxab052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer Maxwell
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M Lam
- Department of Paediatrics, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Law RWY, So E, Chu AKC, Logan DB. Pitted keratolysis: a case report and review of current literature. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818767167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The article offers a brief history of pitted keratolysis (PK), research regarding PK etiology, evaluation of PK, and current treatment modalities. The main objective of this article focuses on the current literature on PK, its presentation and symptomatology, prevalence, and available therapeutic options. We present a case report and review on PK of a patient treated with an over the counter antiperspirant, topical erythromycin, oral erythromycin, and proper education on hygiene, with complete resolution and without recurrence after a follow up of greater than 12 months.
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Affiliation(s)
| | - Eric So
- Grant Medical Center, Columbus, OH, USA
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Kontochristopoulos G, Sidiropoulou P, Tzanetakou V, Markantoni V, Platsidaki E, Agiasofitou E, Rigopoulos D, Gregoriou S. Managing pitted keratolysis: consider topical glycopyrrolate. Clin Exp Dermatol 2018; 44:713-714. [PMID: 30515854 DOI: 10.1111/ced.13851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- G Kontochristopoulos
- State Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
| | - P Sidiropoulou
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
| | - V Tzanetakou
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
| | - V Markantoni
- State Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
| | - E Platsidaki
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
| | - E Agiasofitou
- State Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
| | - D Rigopoulos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
| | - S Gregoriou
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital for Cutaneous and Venereal Diseases, 5 I. Dragoumi Street, GR-16121, Kaisariani, Athens, Greece
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7
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Bilateral plantar geographic lesions. J Paediatr Child Health 2017; 53:512. [PMID: 28470805 DOI: 10.1111/jpc.2_13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 05/30/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
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de Almeida HL, Siqueira RN, Meireles RDS, Rampon G, de Castro LAS, Silva RME. Pitted keratolysis. An Bras Dermatol 2016; 91:106-8. [PMID: 26982791 PMCID: PMC4782659 DOI: 10.1590/abd1806-4841.20164096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/04/2014] [Indexed: 11/21/2022] Open
Abstract
Pitted keratolysis is a skin disorder that affects the stratum corneum of the
plantar surface and is caused by Gram-positive bacteria. A 30-year-old male
presented with small punched-out lesions on the plantar surface. A superficial
shaving was carried out for scanning electron microscopy. Hypokeratosis was
noted on the plantar skin and in the acrosyringium, where the normal elimination
of corneocytes was not seen. At higher magnification (x 3,500) bacteria were
easily found on the surface and the described transversal bacterial septation
was observed.
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Affiliation(s)
| | | | | | - Greice Rampon
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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