Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound

BACKGROUND

Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice.

OBJECTIVES

To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS.

METHODS

The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS.

RESULTS

All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions.

CONCLUSIONS

We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.

Fractional ablative carbon dioxide laser followed by topical sodium stibogluconate application: A treatment option for pediatric cutaneous leishmaniasis

BACKGROUND

Leishmaniasis is a protozoan zoonotic parasitic infection with cutaneous, mucocutaneous, and visceral manifestations. Israel is endemic for cutaneous leishmaniasis, which is a self-limited disease but is associated with scarring, which is often a source of psychological and social burden for patients. Scars can be especially devastating for children and teenagers. A wide range of physical and medical approaches is used to treat cutaneous leishmaniasis, among which intralesional injections of sodium stibogluconate rank among the most frequently used. Unfortunately, despite being effective, this therapeutic modality can be very painful. Fractional ablative laser creates a controlled mesh-like pattern of tissue ablation in the skin that promotes dermal remodeling and collagen production while at the same time facilitating enhanced delivery of topically applied medications.

METHODS

Patients were treated with fractional ablative carbon dioxide laser followed by immediate topical application of sodium stibogluconate. All children were diagnosed with cutaneous leishmaniasis prior to treatment initiation..

RESULTS

Ten children were treated. One leishmania tropica-positive girl failed to respond. The other nine patients achieved clinical cure and demonstrated good to excellent final cosmesis. Self-rated patient satisfaction and tolerance were high No adverse effects were observed or reported during treatment.

CONCLUSION

Fractional ablative carbon dioxide laser followed by topical sodium stibogluconate application appears to be a safe and promising treatment for cutaneous leishmaniasis infection in children. Future controlled studies are required to validate these findings and compare this technique with traditional approaches.

Successful treatment of Schamberg's disease with fractional non-ablative 1540 nm erbium:glass laser

Schamberg's disease is one of the pigmented purpuric dermatoses (PPD). PPD encompass a large and heterogeneous group of dermatologic disorders featuring purpuric lesions often located on the lower limbs. The various forms of PPD are notoriously known to be resistant to treatment. Fractional photothermolysis has been described as a successful and safe method to induce dermal remodeling. We report three patients with Schamberg's disease who were successfully treated with 4 monthly sessions of fractional non-ablative 1540 nm erbium:glass laser, with resolution of their purpuric pigmented rash lasting up to 9 months after the last treatment session.

The impact of new epidemiological cutoff values on Candida glabrata resistance rates and concordance between testing methods

Interpretive criteria for Candida susceptibility testing were recently revised with the establishment of species-specific epidemiological cutoff values (ECV). To assess the effect of modified cutoff values on Candida glabrata resistance rates and agreement between testing methods, we tested the susceptibility of 598 clinical isolates to fluconazole, itraconazole, voriconazole, posaconazole, caspofungin, and amphotericin B using CLSI M27-A3 and E-test methods. The caspofungin MICs clustered above the ECV and below the CLSI cutoff (MIC50, 0.5 μg/mL). Applying the ECV reduced the proportion of itraconazole-nonsusceptible strains from 83% to 0.3% but minimally affected resistance rates of other drugs. Categorical agreement between broth microdilution and E-test was increased for itraconazole and reduced for voriconazole and caspofungin. The current caspofungin ECV may not reproducibly differentiate resistant and susceptible C. glabrata strains in hospitals with varying MIC distributions.