Features of the Skin Microbiota in Common Inflammatory Skin Diseases

Many relatively common chronic inflammatory skin diseases manifest on the face (seborrheic dermatitis, rosacea, acne, perioral/periorificial dermatitis, periocular dermatitis, etc.), thereby significantly impairing patient appearance and quality of life. Given the yet unexplained pathogenesis and numerous factors involved, these diseases often present therapeutic challenges. The term “microbiome” comprises the totality of microorganisms (microbiota), their genomes, and environmental factors in a particular environment. Changes in human skin microbiota composition and/or functionality are believed to trigger immune dysregulation, and consequently an inflammatory response, thereby playing a potentially significant role in the clinical manifestations and treatment of these diseases. Although cultivation methods have traditionally been used in studies of bacterial microbiome species, a large number of bacterial strains cannot be grown in the laboratory. Since standard culture-dependent methods detect fewer than 1% of all bacterial species, a metagenomic approach could be used to detect bacteria that cannot be cultivated. The skin microbiome exhibits spatial distribution associated with the microenvironment (sebaceous, moist, and dry areas). However, although disturbance of the skin microbiome can lead to a number of pathological conditions and diseases, it is still not clear whether skin diseases result from change in the microbiome or cause such a change. Thus far, the skin microbiome has been studied in atopic dermatitis, seborrheic dermatitis, psoriasis, acne, and rosacea. Studies on the possible association between changes in the microbiome and their association with skin diseases have improved the understanding of disease development, diagnostics, and therapeutics. The identification of the bacterial markers associated with particular inflammatory skin diseases would significantly accelerate the diagnostics and reduce treatment costs. Microbiota research and determination could facilitate the identification of potential causes of skin diseases that cannot be detected by simpler methods, thereby contributing to the design and development of more effective therapies.

Head-and-neck dermatitis: Diagnostic difficulties and management pearls

Head-and-neck dermatitis is a variant of atopic dermatitis (AD) often seen in children and is challenging to diagnose, as it frequently overlaps with other eczematous dermatoses. Successful head-and-neck dermatitis (HND) treatment requires identification of common triggers and clinical mimickers, such as airborne dermatitis, periorificial dermatitis, and steroid-induced rosacea. Head-and-neck involvement negatively impacts quality of life and is often harder to treat than other body parts, as long-term topical corticosteroid use carries higher risks for skin atrophy on the face. Heating and flushing associated with HND further exacerbate the itch-and-scratch-cycle and disrupt sleep. We aim to address diagnostic gaps, identify clinical mimickers, and share clinical pearls in managing HND, including cooling pillows, thermal water sprays, rice starch paper facial masks, and tips to minimize food and saliva-induced facial irritation.

Topical calcineurin inhibitors for pediatric periorificial dermatitis

BACKGROUND

Data regarding the treatment of periorificial dermatitis with topical calcineurin inhibitors (TCI) in the pediatric population are limited.

OBJECTIVE

To assess the clinical utility of TCI in pediatric patients with periorificial dermatitis.

METHODS

A retrospective medical record review of all pediatric patients with periorificial dermatitis treated with TCIs was performed. Follow-up via telephone was performed to capture missing data.

RESULTS

A total of 132 patients met the inclusion criteria. The median age at diagnosis was 4.2 years (interquartile range, 2.3-8.2). The median follow-up was 5.2 months (interquartile range, 2.1-11.7). Seventy-two patients had evaluable follow-up data. Of these, 48 (67%) patients were treated with TCI alone, 12 (16.7%) were treated with a combination of TCI and topical metronidazole, and 9 (12.5%) were treated with a combination of TCI and a systemic antibiotic. Complete response was noted in 68.8% of patients treated with TCI alone, in 75% of patients treated with TCI and metronidazole, and in 77.8% of patients treated with TCI and a systemic antibiotic. Adverse events were rare and mild in severity.

CONCLUSION

Topical calcineurin inhibitors are an effective therapeutic option for pediatric patients with periorificial dermatitis and were well tolerated in this cohort.

Clinical Characteristics of 9 Adult Patients with Granulomatous Periorificial Dermatitis and Comparison with Childhood Granulomatous Periorificial Dermatitis

To our knowledge, there have been no previous reports of granulomatous periorificial dermatitis (GPD) in adult patients in contrast to childhood GPD (CGPD). We report cases of 9 adult patients with GPD with regards to the clinical and histopathological characteristics and their management. GPD in adults may be an entity that is actually underdiagnosed, especially in middle-aged females. It is a benign disorder, albeit requiring a relatively long-term treatment. Unlike CGPD, GPD in adults is frequently accompanied by pruritus with predilection for the eyelid and should be treated initially with oral medication.

Reflectance Confocal Microscopy of Adult Periorificial Dermatitis: A Case Report

Periorificial dermatitis (PD) is an inflammatory disorder of the facial skin that mainly occurs around the mouth and manifests as erythema, papules, pustules, scales and other lesions. Special attention is needed in the clinical diagnosis of PD to distinguish it from acne, seborrheic dermatitis (SD), granulomatous rosacea (GR), sarcoidosis and childhood granulomatous periorificial dermatitis (CGPD). We used reflectance confocal microscopy (RCM) images of a patient with PD to assist in the diagnosis of PD. RCM of PD showed slight oedema of the spinous layer. Numerous dendritic cells, scattered hair follicular keratotic plugging and hair follicle dilatation were observed. The dilation and congestion of superficial dermis blood vessels, an increasing vascular density and accelerated blood flow, and a greater abundance of infiltrated inflammatory cells were also detected.