Introduction: Impetigo herpetiformis is a rare pustular disorder that affects pregnant women. It is also otherwise termed as “pustular psoriasis of pregnancy”, owing to the fact that the pustules are sterile and are not associated with a viral etiology. The classic lesions are erythematous patches or plaques with margins studded with subcorneal pustules spreading centrifugally. A cardinal feature of this disorder is the rapid resolution of lesions after delivery. Case Summary: This is a case report of a 33-year-old female, gravida 3, para 2 (2-0-0-2) at 36 weeks age of gestation who presented with one week history of multiple well defined irregularly shaped erythematous annular patches and plaques with marginal pustules on the trunk and extremities. The lesions began on the trunk spreading centrifugally, sparing the face, palms, soles and mucus membrane. Biopsy showed scale crust in the stratum corneum, the epidermis showed acanthosis, spongiosis and neutrophilic microabscesses with focal vacuolar alteration and small sub-epidermal nests on the basal cell layer. The dermis revealed dilated blood vessels and mild superficial perivascular lymphocytic infiltrates. Patient was given Prednisone and Cetirizine with noted resolution of lesions. Conclusion: Recurrences of impetigo herpetiformis in subsequent pregnancies are common with earlier onset in gestation and are characteristically more severe. The complications are placental insufficiency, stillbirth or neonatal death. Early detection is of utmost importance. Management must be multidisciplinary involving a dermatologist, obstetrician and pediatrician.
Pregnancy ; Female ; Impetigo ; Psoriasis ; Skin Diseases, Vesiculobullous ; Exanthema

BACKGROUND: Mutation in the gene encoding filaggrin (FLG) is a major predisposing factor for atopic dermatitis (AD), in association with distinct features such as increased allergic sensitization, higher severity, and frequent skin infections. Genetic diversity in FLG mutations exists across ethnicities. OBJECTIVE: This study aimed to investigate the clinical features of AD according to the presence of FLG mutation in Korean individuals. METHODS: We performed reverse blot hybridization assay to detect FLG mutation in Korean patients with AD. Classifying subjects into AD with or without FLG mutation, clinical features of AD and patch test results were compared between the two groups. RESULTS: Among a total of 281 subjects, 39 (13.9%) were found to have FLG mutation. AD with FLG mutation was associated with higher risk of impetigo and eczema herpeticum but lower risk of prurigo nodularis. In the patch test, there was no difference in positive reactions of major contact allergens between the groups. CONCLUSION: In Korean patients with AD, FLG mutation was associated with more frequent skin infections but not with personal or family history of atopic diseases, allergic sensitization, contact allergy, and protracted course. It is important to consider other skin-barrier-related genes, such as KLK7 and SPINK5, and immune response-related genes in conjunction.
Allergens ; Causality ; Dermatitis, Atopic ; Genetic Variation ; Humans ; Hypersensitivity ; Impetigo ; Kaposi Varicelliform Eruption ; Patch Tests ; Prurigo ; Skin

BACKGROUND: Bacterial skin infections occur secondarily in conditions involving a vulnerable skin barrier such as atopic eczema, as well as primarily such as impetigo. They are mainly caused by Staphylococcus aureus and Streptococci. Recently, the prevalence of methicillin-resistant S. aureus has been increasing. OBJECTIVE: To determine the characteristics of community-acquired bacterial skin infections, to observe their antibiotic susceptibility patterns, and to evaluate factors contributing to the treatment response. METHODS: We retrospectively reviewed outpatients under 30 years old from 2010 to 2015, from whom we had taken skin swabs for antibiotic susceptibility testing. We collected clinical and microbiological characteristics from the medical records. RESULTS: We evaluated the culture results of 197 patients and reviewed their medical records. Overall, 86.3% (n=170) of the patients responded to the initial treatment regimen. S. aureus was the most commonly isolated pathogen (52.6%) and showed a high resistance rate to penicillin (90.9%) and oxacillin (36.3%). In the multivariable logistic regression analysis, resistance to 3 or more antibiotics (p=0.044), culture amounts described as “many” (p=0.040), and non-systemic antibiotic use (p < 0.001) were significantly associated with lower treatment response. However, methicillin resistance was not associated with lower treatment response both in univariable and multivariable analyses. CONCLUSION: Among young patients, S. aureus was the most predominant pathogen present in bacterial skin infections. Resistance to high numbers of antibiotics and the use of non-systemic antibiotics were associated with lower treatment response. First-generation cephalosporins may be the most effective first-line empirical regimen for bacterial skin infections treated in outpatient settings, regardless of methicillin resistance.
Anti-Bacterial Agents ; Cephalosporins ; Dermatitis, Atopic ; Humans ; Impetigo ; Logistic Models ; Medical Records ; Methicillin Resistance ; Outpatients ; Oxacillin ; Penicillins ; Prevalence ; Retrospective Studies ; Skin Diseases, Infectious ; Skin* ; Staphylococcus aureus

PURPOSE: This study evaluated the clinical characteristics and risk factors associated with atopic dermatitis patients complicated by eczema herpeticum. METHODS: This study included 45 patients under the age of 18 with atopic dermatitis complicated by eczema herpeticum in the disease group (ADEH+), and 50 patients under the age of 18 with atopic dermatitis without any episode of eczema herpeticum in the control group (ADEH−). We retrospectively reviewed the clinical features, treatment and prognosis of the 2 groups. RESULTS: In this study, eczema herpeticum occurred in 2.7% of the AD patients. No significant difference in percentage of boys or mean age was found between the ADEH+ and ADEH− groups. In the ADEH+ group, eczema herpeticum occurred more frequently in the head and neck. Severe atopic dermatitis, recurrent impetigo, IgE−mediated atopic dermatitis and food allergy were identified as the risk factors of eczema herpeticum. The mean white blood cell count, erythrocyte sedimentation rate, percent of eosinophils and total serum IgE were higher in the ADEH+ group than in the ADEH− group. More than 2 recurrences were confirmed in 12 patients (26.7%). CONCLUSION: In the ADEH+ group, skin lesions were dominant on the head and neck. We revealed that severe atopic dermatitis, frequent impetigo, IgE-mediated atopic dermatitis, and food allergy are risk factors for eczema herpeticum.
Blood Sedimentation ; Child ; Dermatitis, Atopic* ; Eczema* ; Eosinophils ; Food Hypersensitivity ; Head ; Humans ; Immunoglobulin E ; Impetigo ; Kaposi Varicelliform Eruption* ; Leukocyte Count ; Neck ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Simplexvirus ; Skin

Skin and soft tissue infection (SSTI) is common and important infectious disease. This work represents an update to 2012 Korean guideline for SSTI. The present guideline was developed by the adaptation method. This clinical guideline provides recommendations for the diagnosis and management of SSTI, including impetigo/ecthyma, purulent skin and soft tissue infection, erysipelas and cellulitis, necrotizing fasciitis, pyomyositis, clostridial myonecrosis, and human/animal bite. This guideline targets community-acquired skin and soft tissue infection occurring among adult patients aged 16 years and older. Diabetic foot infection, surgery-related infection, and infections in immunocompromised patients were not included in this guideline.
Adult ; Cellulitis ; Communicable Diseases ; Diabetic Foot ; Diagnosis ; Erysipelas ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Immunocompromised Host ; Impetigo ; Methods ; Pyomyositis ; Skin* ; Soft Tissue Infections*

Cutaneous leishmaniasis (CL) is a protozoan disease which is endemic in Iran. It is transmitted by the Phlebotomus sand fly. The eyelid is rarely involved possibly because the movement of the lids impedes the sand fly from biting the skin in this region. Here, we report 6 rare cases of eyelid CL. The patients were diagnosed by skin scraping, culture, and PCR from the lesions. Skin scraping examination showed Leishmania spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for Leishmania spp. PCR was positive for Leishmania major and Leishmania tropica. The lesions were disguised as basal cell carcinoma, chalazion, hordeolum, and impetigo. The patients were treated with intramuscular meglumine antimoniate (20 mg/kg/day) for at least 3 weeks. They showed a dramatic response, and the lesions almost completely disappeared. We emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic relationship of isolated parasites, and reviewed the literature on ocular leishmaniasis.
Carcinoma, Basal Cell ; Chalazion ; Cytoplasm ; Eyelids* ; Hordeolum ; Humans ; Impetigo ; Iran ; Leishmania ; Leishmania major ; Leishmania tropica ; Leishmaniasis ; Leishmaniasis, Cutaneous* ; Macrophages ; Meglumine ; Parasites ; Phlebotomus ; Polymerase Chain Reaction ; Psychodidae ; Skin

Group A Streptococcus (GAS) infections cause substantial worldwide morbidity and mortality, mostly associated with suppurative complications such as pharyngitis, impetigo, and non-suppurative immune syndromes such as acute rheumatic fever, rheumatic heart disease, and acute post-streptococcal glomerulonephritis. Deaths occur mostly in children, adolescents, and young adults in particular pregnant women in low- and middle-income countries. GAS strains are highly variable, and a GAS vaccine would need to overcome the issue of multiple strains. Several approaches have been used multivalent vaccines using N-terminal polypeptides of different M protein; conserved M protein vaccines with antigens from the conserved C-repeat portion of the M protein; incorporation selected T- and B-cell epitopes from the C-repeat region in a synthetic polypeptide or shorter single minimal B-cell epitopes from this same region; and non-M protein approaches utilizing highly conserved motives of streptococcal C5a peptidase, GAS carbohydrate and streptococcal fibronectin-binding proteins. A GAS vaccine represents urgent need for this neglected disease and should therefore deserve the greatest attention of international organizations, donors, and vaccine manufacturers.
Adolescent ; Child ; Epitopes, B-Lymphocyte ; Female ; Glomerulonephritis ; Humans ; Impetigo ; Mortality ; Neglected Diseases ; Peptides ; Pharyngitis ; Pregnant Women ; Public Health* ; Rheumatic Fever ; Rheumatic Heart Disease ; Streptococcus* ; Tissue Donors ; Vaccines ; Young Adult

Impetigo herpetiformis (IH) is an extremely rare pustular disorder and potentially life-threatening condition for both mother and fetus. Intrauterine growth retardation, fetal abnormalities, and even fetal/neonatal death can occur with worsening maternal disease and are probably related to placental insufficiency. Maternal risk is linked to fluid and electrolyte abnormalities, in particular, hypocalcemia- induced convulsions and sepsis. Therefore, early recognition is crucial to reduce both maternal and fetal morbidities, and a patient with IH may require emergency caesarean delivery. Here, we report a case of a 34-year-old pregnant woman with IH who underwent successful urgent general anesthesia for caesarean section.
Adult ; Anesthesia ; Anesthesia, General ; Cesarean Section* ; Emergencies ; Female ; Fetal Growth Retardation ; Fetus ; Humans ; Impetigo* ; Mothers ; Placental Insufficiency ; Pregnancy ; Pregnant Women ; Psoriasis ; Seizures ; Sepsis

Impetigo herpetiformis (IH) is an extremely rare pustular dermatosis of pregnancy with typical onset during the second or third trimester of pregnancy and generally rapid resolution after delivery. Recurrent case of IH in subsequent pregnancy tend to earlier onset and greater severity. We report a 33-year-old pregnant woman, with a history of mild IH in the first pregnancy, who presented with generalized lesions at nearly 29 weeks' gestation. Her condition had become worse suddenly at 34 weeks' gestation. She developed fever, small for gestational age, and gait disturbance due to ache in both thighs. So we decided to terminate the pregnancy by repeat cesarean section. After delivery, her skin lesions had worsen rapidly in spite of treatment with corticosteroids. So she was treated with a large dose of acitretin. Three months after her delivery, her skin was returned to original state, except for residual pigmentation. In conclusion, our case indicates that clinicians should be aware of the possibility of sudden deterioration of the maternal lesions and fetal condition associated with IH.
Acitretin* ; Adrenal Cortex Hormones ; Adult ; Cesarean Section, Repeat ; Female ; Fever ; Gait ; Gestational Age ; Humans ; Impetigo* ; Pigmentation ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Skin ; Skin Diseases ; Thigh

Kerion celsi is an inflammatory infection, caused by a vigorous T-cell mediated host response to the dermatophyte infection. In the case of severe inflammation, it can be misdiagnosed as other disease like cellulitis, impetigo, furuncle and epidermal cyst. Microsporum(M.) canis is most likely transmitted by contact of animal hosts such as cats and dogs with humans. We report the 75-year-old female who presented two months history of tender erythematous scaly plaques with pustules, crusts on right scalp area. At first, from the histopathologic findings of the lesion, the patient was diagnosed epidermal cyst because of cyst-like structure in mid-dermis. But the fungal culture revealed M. canis as the causative fungus. Herein we report a educational case of kerion celsi mistaken for ruptured epidermal cyst.
Aged ; Animals ; Arthrodermataceae ; Cats ; Cellulitis ; Dogs ; Epidermal Cyst* ; Female ; Fungi ; Furunculosis ; Humans ; Impetigo ; Inflammation ; Scalp ; T-Lymphocytes ; Tinea Capitis*