Cutis
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Chromobacterium violaceum is a gram-negative bacillary organism that characteristically produces the purple pigment violacein. Documented as the cause of clinically relevant human infections in only 35 cases in the United States, C violaceum is particularly seen in patients with a history of cutaneous injury or trauma. We report the case of an 18-year-old woman who was struck by a propeller in a boating accident and sustained multiple deep lacerations of her right lower extremity. ⋯ Antimicrobial therapy was initiated, but 2 days after admission, the skin and subcutaneous tissue surrounding the patient's wounds became necrotic, necessitating an above-the-knee amputation of the right lower extremity (transfemoral amputation). The patient's condition improved after continued antimicrobial therapy and she was subsequently discharged in good health. This case represents a successful outcome of a rare but frequently fatal infection due to a morphologically and geographically distinct human pathogen.
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Chromhidrosis is a rare sweat gland disorder that produces pigmented sweat. The etiology of this disorder often is unknown and the clinical presentation can vary. ⋯ She is the first reported patient with orange-pigmented sweat in chromhidrosis. She also is the first postmenopausal patient with chromhidrosis.
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A major issue in treating acne in individuals of color is the need to treat and prevent postinflammatory hyperpigmentation (PIH), which is common in this population. This subset analysis reports the pigmentary changes in subjects of color with acne who were enrolled in a community-based trial comparing 3 different topical therapeutic regimens. ⋯ Subjects were randomized to receive this combination therapy in addition to either a tretinoin microsphere (RAM) gel at concentrations of either 0.04% or 0.1% or adapalene (AP) gel 0.1%. There was a trend toward better resolution of hyperpigmentation in the subjects receiving the clindamycin-BPO topical gel in combination with RAM gel 0.04%.
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Review
Status update: hospital-acquired and community-acquired methicillin-resistant Staphylococcus aureus.
Methicillin-resistant Staphylococcus aureus (MRSA) is a common bacterial pathogen that has long been considered a hospital-acquired pathogen. However, newer community-acquired strains have appeared that differ from nosocomial strains in their susceptibility to different antibiotics. ⋯ A variety of antibiotics are available for the treatment of hospital-acquired MRSA (HAMRSA) and community-acquired MRSA (CAMRSA). Incision and drainage is of paramount importance in the treatment of cutaneous abscesses and is sufficient treatment in most uncomplicated skin and soft tissue infections.
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Antimicrobial prophylaxis is rarely appropriate for dermatologic surgery. Dermatologic procedures seldom cause bacteremia, and they have been implicated as a cause in only an extremely small number of cases of endocarditis or infections of vascular grafts or orthopedic prostheses. ⋯ Topical antibiotic ointments for that purpose are ineffective. Whether prophylactic antivirals are helpful in preventing herpes simplex infections after facial resurfacing is uncertain.