Treatment of canine periocular dermatitis with rhytidectomy (surgical face-lift) and fluorescence photobiomodulation: A case report

Canine periocular dermatitis may be associated with excessive facial folds and heavy brows (EFF-HB). There is no gold standard therapy for EFF-HB-associated periocular dermatitis, and conventional medical management may fail. Herein, we describe periocular fluorescence photobiomodulation and rhytidectomy as novel approaches to treat EFF-HB-associated periocular dermatitis refractory to medical management.

The diagnosis, management and prevention of intertrigo in adults: a review

Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.

Toe Web Infections, the Microbiome, and Toe Web Psoriasis: A Review

OBJECTIVE

To present the toe web space as an anatomically, physiologically, and pathologically unique part of the human body; characterize toe web infections and discuss why they occur; and highlight toe web psoriasis as an uncommon condition that providers should consider if toe web intertrigo does not respond to treatment.

DATA SOURCE

This review encompassed many years of clinical observation and photographs; medical textbooks; and a literature search of MEDLINE, PubMed, and Google Scholar.

STUDY SELECTION

Primary research keywords included intertrigo, toe web intertrigo, toe web infection, tinea pedis, microbiome, skin microbiome, toe web microbiome, ecology, psoriasis, psoriasis microbiome, intertriginous psoriasis, and Wood's lamp. More than 190 journal articles met the search criteria.

DATA EXTRACTION

The authors sought data relating to what makes for a healthy toe web space and what makes for disease. They extracted and collated relevant information to compare and contrast among sources.

DATA SYNTHESIS

After understanding the normal toe web space and the microorganisms that normally reside there, the authors investigated why infections occur, how they should be treated, what complications may result, and what other diseases occur in the toe web area.

CONCLUSIONS

This review of toe web infection illustrates the effect of the microbiome and reports a rare form of psoriasis that is usually misdiagnosed as athlete's foot. The toe web space is a unique part of the human body that can be affected by a variety of both common and unusual conditions.

A novel treatment of intertrigo in athletes and overweight subjects

Background

Intertrigo is a recurrent inflammatory dermatosis involving large/small body folds. Skin barrier products represent the mainstay of treatment in uncomplicated mild/moderate intertrigo.

Aims

To assess by clinical and instrumental evaluation the efficacy and tolerability of a new barrier spray containing zinc gluconate‐taurine complex and zinc oxide combined with panthenol, glycerin, and Shea (Butyrospermum parkii) butter in mild‐to‐moderate intertrigo in athletes and overweight subjects.

Methods

In this open‐label prospective trial, 20 adult patients, with mild/moderate intertrigo enrolled at the Dermatology University Clinic of Catania (Italy), were instructed to apply the spray twice daily for 30 days. Degree of erythema was performed clinically and by polarized dermoscopy using a 5‐point severity scale (from 0=no erythema to 4=severe erythema) at baseline, and at 15 and 30 days. The measurement of pruritus was carried out by a subject‐completed visual analog scale (VAS) (from 0 mm=no pruritus to 100 mm=severe pruritus), at all time points. An Investigator Global Assessment (IGA) using a 6‐point scale (from −1=worsening to 4=complete response/clear) was also conducted at 30 days, along with a self‐administered tolerability questionnaire. Statistical analysis was performed using SAS version 9.

Results

At 15 days, a statically significant reduction from baseline in erythema severity (mean from 3.4 ± 0.3 to 2.5 ± 0.2) along with pruritus intensity (mean from 70 ± 15.4 mm to 40 ± 9.5 mm) was observed. At 30 days, all evaluated parameters showed a further progressive statistically significant reduction from baseline. No relevant side effects were recorded.

Conclusions

Our results suggest that the tested spay containing antiseptic/anti‐inflammatory and anti‐irritation agents may represent a valid therapeutic option for mild/moderate intertrigo.

A randomized controlled trial to compare the effectiveness and safety of adsorbent lotion containing tapioca starch, spent grain wax, Butyrospermum parkii extract, argania spinosa kernel oil, aloe barbadensis, rosehip oil, and allantoin with a low-potency topical corticosteroid in the treatment of intertrigo

BACKGROUND

Intertrigo is an inflammatory skin-fold condition. Candida infections may occur concurrently or afterward. Topical corticosteroids may reduce inflammation but exacerbate Candida infections. The treatment is contentious.

OBJECTIVE

To evaluate the efficacies and safety of adsorbent lotion containing tapioca starch, spent grain wax, Butyrospermum parkii extract, argania spinosa kernel oil, aloe barbadensis, rosehip oil, and allantoin for the treatment of mild-to-moderate intertrigo, relative to 1% hydrocortisone cream.

METHODS

This randomized, double-blinded study enrolled 40 intertrigo patients. Twice daily, 20 patients applied adsorbent lotion while the remainder used 1% hydrocortisone cream. Efficacy evaluation, skin biophysical measurements, skin tolerability, safety, and visual analog scale (VAS) patient-satisfaction scores were evaluated at baseline and Week 2.

RESULTS

The adsorbent lotion showed higher complete cure rates for color, partial epidermal loss, papules/pustules/vesicles/patches, dryness, and scaling than the corticosteroid without statistical significance. Adsorbent lotion demonstrated significantly higher reduction in pruritus than the corticosteroid treatment. Reduction of erythema level using Mexameter and VAS patient-satisfaction scores were not statistically different between adsorbent lotion and hydrocortisone cream. No adverse effects or superimposed infections were reported.

CONCLUSIONS

The anti-inflammatory efficacies of adsorbent lotion and low-potency steroid were equivalent. The lotion was safe and produced excellent pruritus reduction. Patient satisfaction was high.

Incidence of udder cleft dermatitis (UCD) in dairy cows and risk factors for transitions to UCD

Udder cleft dermatitis (UCD) is a common skin condition in Swedish dairy cows, affecting the anterior parts of the udder. The main objective of this study was to investigate incidence rate and duration of UCD in a 1-yr longitudinal study. Other objectives were to investigate risk factors for transitions from being healthy to having mild or severe UCD, and from having mild UCD to having severe UCD, and associations between UCD and clinical mastitis, somatic cell count (SCC) and hock lesions. Seven herds were included in the study and visited 9 times each at 6-wk intervals. At the visits, mild and severe UCD lesions, hock lesions, udder conformation traits, and hygiene scores were registered for each cow milked in the milking parlor. Information on breed, parity, days in milk (DIM), results from test milkings (milk production, SCC, and urea level), and veterinary treatments was also obtained. A UCD case was defined as one or several consecutive observations of UCD. The incidence and duration of UCD were described. Mixed-effect logistic regression models were used to analyze associations between potential risk factors and transitions to any type of UCD. Separate risk factor analyses were performed for transitions to mild and severe UCD. Associations with SCC, mastitis, and hock lesions were also analyzed with mixed-effect logistic regression models. The mean overall incidence of new UCD cases for all visits and herds was 0.5 cases per cow-year at risk. Risk factors associated with a higher risk of a transition to any type of UCD and mild UCD were breed (Swedish Red vs. Swedish Holstein), an indentation or fold at the fore udder attachment, and increasing DIM. In addition, a low milk urea level was associated with a lower risk of transition to any type of and mild UCD. Cows with previous mild UCD and high-yielding cows had increased risk for a transition to severe UCD. Cows that had an observed transition to severe UCD had an increased risk of veterinary-treated clinical mastitis within 6 wk after the UCD observation. No associations were found between UCD and SCC or hock lesions. The median observed duration of a UCD case was 12 wk, but most cases did not have an observed start or end during the study period. The observed duration of cases including severe UCD was longer than for cases involving only mild UCD. The high incidence and often long duration of UCD emphasize the need for preventive measures and treatment strategies.

Superficial Cutaneous Zygomycosis Presenting as Resistant Intertrigo: A Case Report

Zygomycosis is an angioinvasive fungal infection with a high mortality rate. Cutaneous zygomycosis is the second most common form of the disease, typically characterized by necrotic eschars in an immunocompromised host. We report an unusual case of superficial intertrigo resistant to conventional therapies caused by Mucor circinelloides in a patient with HIV and diabetes.

Case of severe bullous erythema including intertrigo-like eruptions with angioedema induced by pegylated liposomal doxorubicin

Pegylated liposomal doxorubicin (PLD) is an anthracycline anticancer agent used in ovarian cancer and a form of doxorubicin enclosed in pegylated liposomes. There are only a few reports on intertrigo-like eruptions caused by PLD. We describe the first case of severe bullous erythema, including intertrigo-like eruptions with angioedema, induced by PLD in Japan. We present the case of a 53-year-old woman who was diagnosed with stage IIIC ovarian cancer. After receiving three cycles of PLD, the patient developed swelling of the upper lip and painful erythema with blisters and erosions on the axilla, upper back, flank and wrists. The patient was diagnosed with angioedema and severe skin lesions, including intertrigo-like eruptions induced by PLD. Although treatment with oral prednisolone and topical steroids was effective against these eruptions, the administration of PLD was discontinued because of its ineffectiveness against the primary disease. Several risk factors, such as obesity, perspiration and racial differences, may contribute toward a severe manifestation such as that seen in our patient. Moreover, our case was the first accompanied by angioedema. The mechanism of coexistence of intertrigo-like eruptions and angioedema is not clear; further studies are required to clarify the pathological mechanism of intertrigo-like eruptions.

Recurrent candidal intertrigo: challenges and solutions

Intertrigo is a common inflammatory dermatosis of opposing skin surfaces that can be caused by a variety of infectious agents, most notably candida, under the effect of mechanical and environmental factors. Symptoms such as pain and itching significantly decrease quality of life, leading to high morbidity. A multitude of predisposing factors, particularly obesity, diabetes mellitus, and immunosuppressive conditions facilitate both the occurrence and recurrence of the disease. The diagnosis of candidal intertrigo is usually based on clinical appearance. However, a range of laboratory studies from simple tests to advanced methods can be carried out to confirm the diagnosis. Such tests are especially useful in treatment-resistant or recurrent cases for establishing a differential diagnosis. The first and key step of management is identification and correction of predisposing factors. Patients should be encouraged to lose weight, followed up properly after endocrinologic treatment and intestinal colonization or periorificial infections should be medically managed, especially in recurrent and resistant cases. Medical treatment of candidal intertrigo usually requires topical administration of nystatin and azole group antifungals. In this context, it is also possible to use magistral remedies safely and effectively. In case of predisposing immunosuppressive conditions or generalized infections, novel systemic agents with higher potency may be required.

Mild and severe udder cleft dermatitis-Prevalence and risk factors in Swedish dairy herds

Udder cleft dermatitis (UCD) is an inflammatory skin condition affecting the anterior parts of the udder of dairy cows. The lesions may present as mild or severe skin lesions and have been associated with mastitis and digital dermatitis. The full etiology and pathogenesis are not understood and no large-scale studies have investigated prevalence and risk factors. Therefore, the main objectives of the study were to investigate the prevalence of mild and severe UCD in Swedish dairy herds and to identify risk factors associated with such lesions. We also wanted to investigate risk factors for all cases of UCD and to determine whether UCD increases the risk for mastitis and culling. A random sample of 100 freestall dairy herds were included in the study, and each herd was visited once. Cows were registered as having no, mild, or severe UCD. Additional cow and herd data were obtained via observations, interviews, and the Swedish Official Milk Recording Scheme. The data were analyzed using logistic regression models to identify risk factors for mild and severe UCD. In total, data from 3,479 cows in 99 herds were analyzed. The prevalence of mild and severe UCD was 19 and 9%, respectively. Lesions were found in 98 of 99 herds but the within-herd prevalence of mild (0-43%) and severe (0-33%) UCD varied notably between herds. Breed (Swedish Red compared with Swedish Holstein), certain udder conformation traits, and higher parity were risk factors associated with increased risk of UCD. In addition, cows with hock lesions and cows in herds with high incidence of culling due to hoof and leg diseases had a higher risk for mild UCD. More days in milk and high milk yield were cow-related risk factors associated with severe UCD. Three housing-related factors (shorter cubicles, mattress as cubicle base, and cubicles installed before 2001 compared with 2001-2005), a high incidence of veterinary-treated clinical mastitis and culling due to udder diseases, and a low incidence of culling of first-parity cows in early lactation were herd-related risk factors associated with increased risk for severe UCD. In addition, cows in herds with a high proportion of heifers older than 17 mo that were not inseminated were associated with lower risk of all UCD. Finally, UCD was not associated with the outcomes milk somatic cell count, veterinary-treated clinical mastitis, or culling in the multivariable analyses. The etiology of UCD is most likely multifactorial, involving udder conformation traits and other cow-related risk factors as well as herd-related risk factors. The high prevalence of severe UCD lesions in Swedish dairy cows emphasizes the need for preventive measures and efficient treatments.

Intertrigo Caused by Streptococcus pyogenes

Well-demarcated, beefy-red lesions of the skin folds, without satellite lesions, are the clinical hallmarks of intertrigo, frequently misdiagnosed especially in young children. We present 6 cases of streptococcal intertrigo to draw attention to this easily diagnosed and treated, but frequently overlooked, infection.

Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India: A Case-Control Study

Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo.

Clinical evaluation of the efficacy of Khadiradi yoga avachoornana in Kachchu with special reference to genitoinguinal intertrigo

Kachchu is a simple localized dermatological infection of the genitoinguinal region, which occurs because of unhygienic observance, and manifests in the form of inflammation followed by secondary bacterial or fungal infections that can be best correlated to genitoinguinal intertrigo. Even though it rarely causes systemic manifestations, its mere presence itself is disturbing because of intractable itching and pain. It may delay the proper healing of the episiotomy wound and may cause difficulty in walking because of severe pain. Candida powder is the highest selling medicine for the intertrigo, as the incidence of intertrigo is as high as 40% in some particular seasons. In the Ayurveda fraternity, there is no established preparation that can be preserved safely in all the epochs of life in females and which is easy to apply. After understanding the disease in the perspective of the ayurvedic and modern medicinal systems, Khadiradi yoga choorna - a new ayurvedic formulation - was prepared on the basis of stringent ayurvedic principles. Hence, an attempt has been made to study the efficacy of the khadiradi yoga avachurnana(1) in Kachchu, with special reference to genitoinguinal intertrigo in females.