The Importance of Skincare for Neonates and Infants: An Algorithm

BACKGROUND

The skin of neonates and infants undergoes a maturation process from birth and is susceptible to barrier disruption. The current algorithm follows a US-based consensus paper on skincare approaches using gentle cleansers and moisturizers in neonatal and healthy infant skin. This summary provides clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating neonates and infants.

METHODS

The project used a modified Delphi process comprising virtual discussions followed by an online follow-up replacing the use of a questionnaire. During the virtual meeting, the systematic literature review results and a draft algorithm addressing over-the-counter skincare for neonates and infants with healthy skin were discussed and adopted using evidence coupled with the expert opinion and experience of the panel.

RESULTS

The algorithm addresses three clinical signs: xerosis, erythema, and erosion/bulla. A growing body of evidence recognizes the benefits of ongoing daily use of non-alkaline cleansers and ceramides containing moisturizers to reduce inflammation and maintain a healthy skin barrier function. Diaper rash is common in infants presenting as erythema or, in more severe cases, skin erosion. Skin protection with a barrier cream and frequent diaper changes using disposable diapers resolves most cases; however, if the rash continuous despite appropriate care, rule out a candida infection.

CONCLUSION

The current algorithm focuses on neonatal and infant healthy skin that can benefit from skincare. When applied from birth onwards, gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier. J Drugs Dermatol. 2021;20(11):1195-1205. doi:10.36849/JDD.6219.

Life-threatening Escherichia coli cellulitis in patients with haematological malignancies

Cellulitis due to Escherichia coli is rare and usually secondary to a cutaneous portal of entry. Skin and soft tissue infections (SSTI) secondary to E. coli bacteraemia have been reported exclusively in immunodeficient patients. Here, we report two cases of serious cellulitis secondary to E. coli bacteraemia in patients with haematological malignancies. Both isolated strains belonged to phylogenetic group B2 and harboured some of the main virulence factor genes commonly found in extra-intestinal pathogenic E. coli (ExPEC), including neuC, iro and fimH. Cellulitis due to E. coli seems to be linked to the immunocompromised status of patients rather than to a highly virulent clone. Nevertheless, some of the virulence factors appear to be important because both isolates belong to phylogenetic group B2. This aetiology should be considered in SSTI in patients with haematological malignancies.

Quality of life and depression assessment in nevoid basal cell carcinoma syndrome

BACKGROUND

Nevoid basal cell carcinoma syndrome (NBCCS) is a rare genetic disease which causes a variety of dermatological lesions, especially basal cell carcinomas (BCCs), often on the face, neck, and head.

METHODS

Persons attending a national NBCCS support group meeting were asked to participate in survey-based assessments of quality of life and depressive symptoms. Inclusion criteria required a self-reported NBCCS diagnosis, voluntary agreement to participate, and age over 18 years. Exclusion criteria included cognitive impairment. Skin-related quality of life was assessed with Skindex-29, completed by 32 participants. Depressive symptomatology was determined with the Center for Epidemiological Studies Depression Scale (CES-D), completed by 18 participants. Sociodemographic, medical, and social variables were also analyzed.

RESULTS

Median Skindex-29 scores for the emotions, symptoms, and functioning scales were 42.50, 32.14, and 28.13, respectively (means: 41.17, 37.05, and 29.30, respectively). These scores were slightly higher than those observed in patients with neurofibromatosis type 1, a similar genetic disease with skin symptoms. The CES-D scores (median = 15.50, mean = 17.50) suggested that 50% of participants had significant depressive symptomatology. Variables showing moderate associations with the scores included diet, number of affected family members, and treatment type. Interestingly, the number of BCCs had no effect.

CONCLUSIONS

Nevoid basal cell carcinoma syndrome impacts the quality of life of its subjects in a similar manner to other genodermatoses. Depressive symptoms are particularly prevalent. Several demographic, medical, and social characteristics affect these outcomes. Thus, the psychological impact of this disorder should be evaluated in the course of considering the care of persons with NBCCS.

Mitotic recombination in patients with ichthyosis causes reversion of dominant mutations in KRT10

Somatic loss of wild-type alleles can produce disease traits such as neoplasia. Conversely, somatic loss of disease-causing mutations can revert phenotypes; however, these events are infrequently observed. Here we show that ichthyosis with confetti, a severe, sporadic skin disease in humans, is associated with thousands of revertant clones of normal skin that arise from loss of heterozygosity on chromosome 17q via mitotic recombination. This allowed us to map and identify disease-causing mutations in the gene encoding keratin 10 (KRT10); all result in frameshifts into the same alternative reading frame, producing an arginine-rich C-terminal peptide that redirects keratin 10 from the cytokeratin filament network to the nucleolus. The high frequency of somatic reversion in ichthyosis with confetti suggests that revertant stem cell clones are under strong positive selection and/or that the rate of mitotic recombination is elevated in individuals with this disorder.

Neonatal-onset multisystem inflammatory disorder: the emerging role of pyrin genes in autoinflammatory diseases

Neonatal-onset multisystem inflammatory disorder (NOMID) is a rare congenital disorder characterized by a neonatal-onset urticarial rash, arthropathy, recurrent fevers, and central nervous system disease. We report 3 cases in which patients presented with neonatal-onset urticarial eruption and other organ involvement of varying severity. Genetic testing of 2 of these patients revealed previously unreported genetic mutations in exon 3 of the CIAS1 gene, a recently discovered member of the pyrin gene family. The third patient did not demonstrate a CIAS1 mutation. These cases illustrate the genetic basis of NOMID, an autoinflammatory disorder, and highlight the emerging role of the pyrin gene family in the regulation of nuclear factor kappaB signaling and other pathways involved in inflammation and apoptosis.

[Quantitative study of the antibacterial effect of cefotaxime and ceftriaxone during experimental Escherichia coli K1 bacteremia in chickens]

In order to assess the in vivo antibacterial activity of two cephalosporins of third generation, cefotaxime and ceftriaxone, we used the model of experimental bacteremia in chickens we had developed for a few years. 93 chickens were inoculated with 10(7) E. coli K1 coming from a meningitis in a new-born baby. 19 chickens were used as a control group; 29 were given ceftriaxone (50 mg/kg); 28 cefotaxime (50 mg/kg) and 17 cefotaxime (100 mg/kg). The antibiotics were injected 4 hours after the inoculation. The bacterial concentrations found in capillaries by using quantitative blood cultures, were significantly lower in the 3 groups of chickens which were given antibiotics than in the control group, at 24, 48 and 72 hours after inoculation. At 24 hours after the inoculation, the bacterial concentration in the chickens treated by ceftriaxone (50 mg/kg) was significantly lower than that found in chickens treated by cefotaxime (50 mg/kg). At 48 or 72 hours the differences of bacterial concentration in the three groups of chickens were not significant. Over 72 hours following inoculation, 4 control and only one treated chickens died. The efficient clearance of E. coli K1 by a single dose of ceftriaxone, found at 24 hours after inoculation, confirms the possibility of using ceftriaxone once daily for serious infections.

Presence and expression of aerobactin genes in virulent avian strains of Escherichia coli

Virulent and nonvirulent isolates of avian Escherichia coli were tested for the presence of aerobactin genes by colony hybridization with a specific gene probe constructed from plasmid pABN1 (A. Bindereif and J. B. Neilands, J. Bacteriol. 153:1111-1113, 1983). Positive hybridization with the gene probe was highly correlated with virulence, as measured by the 50% lethal dose of the strains for chicks. Evidence for the expression of aerobactin genes in the virulent strains was obtained by demonstrating their susceptibility to cloacin DF13, which binds to the same receptor that binds aerobactin, and their ability to produce aerobactin, as revealed by cross-feeding the E. coli mutant WO987 (aroB fepA iuc iut+), which is unable to synthesize but capable of taking up aerobactin. We suggest that the production of aerobactin is involved in the virulence of avian septicemic E. coli.

[Comparison of capillary and venous blood cultures in experimental bacteremia in chickens]

In order to evaluate bacteraemia in chickens previously inoculated intravenously with 10(4)-10(6) Escherichia coli K12, a comparative study of the sensitivity of 500 microliters or 50 microliters venous blood cultures and 50 microliters capillary blood cultures was carried out. Results of 206 blood cultures performed on 20 different chickens were negative in 147 cases and positive in 59. After 30 minutes, the sensitivity of capillary blood cultures was comparable to that of 500 microliters venous blood cultures and significantly higher than that of 50 microliters venous blood cultures. This greater sensitivity of capillary blood cultures in cases of prolonged bacteraemia may be due to capillary sequestration of bacteria. Micro-blood cultures appear to be of major interest in the diagnosis of septicaemia in neonates, and the capillary trapping hypothesis will require confirmation by means of a quantitative study.

Bacterial conjugation in the digestive tracts of gnotoxenic chickens

Escherichia coli K-12 Hfr and F- strains were successively implanted in axenic chicks. Conjugation with exchanges of chromosomal genes occurred with high frequencies in the gut of the chicks and could continue as long as fertile strains coexisted in this environment. Almost all of the expected recombinant types were recovered in the feces under these experimental conditions. Furthermore, these recombinants were analogous to those obtained after conjugations in vitro. Recombinants formed in the gut were more numerous when the F- strain was seeded before the Hfr strain. The recombinants showed no apparent selective advantage over the parental strains in the intestinal medium. They were maintained throughout the experimental period and represented more than 10% of the total intestinal flora. The chick gut is usually rapidly colonized by other bacterial types under natural conditions. The possible effects of other components of the bacterial flora on conjugation of E. coli in holoxenic animals will require subsequent work with more complex microbiological conditions.

The Vibrational Spectra and Crystal Structure of Acenaphthylene

A study of the polarized infrared and Raman spectra of acenaphthylene single crystals has been made. These results, together with Gordon and Yang's preliminary X-ray work, suggest that the molecules pack in some disordered arrangement in the solid at room temperature. Most of the A1 fundamentals were identified in the Raman solution spectrum from their low depolarization ratio, and a few tentative assignments of nontotally symmetric fundamentals were made.