Raoultella Planticola: A Rare Cause of Wound Infection


Shana S. Kalaria, MD; Kristina Elliott, FNP; Neal Combs, RN; Linda G. Phillips, MD   Wounds. 2017;29(11):E103-E105. 


Raoultella planticola is a gram-negative, aerobic, rod bacterium commonly found in the environment, particularly in water, soil, and fish. This organism has been found to cause a variety of infections, such as necrotizing fasciitis, cystitis, cholecystitis, pancreatitis, hepatic disease, and soft tissue infections. The authors report the case of a 73-year-old-woman who presented with a R planticola wound infection of her left lower extremity after a dog scratch.

She was treated successfully with local wound care using dehydrated human amnion/chorion and oral levofloxacin. Her wound healed completely in 4 months but may have been delayed due to her comorbidities. Her chronic proton pump inhibitor use and trial of antibiotics prior to diagnosis of this infection may have selected for this particular organism. Although not commonly reported as a cause of wound infections, practitioners should consider R planticola as a differential diagnosis for a nonhealing wound as prompt identification can allow for timely treatment and decreased morbidity of this serious pathogen.



Relative Risk of and Determinants for Adverse Events of Methotrexate Prescribed at a Low Dose

A Systematic Review and Meta-analysis of Randomized Placebo-controlled Trials


The British Journal of Dermatology. 2017;177(4):978-986.   C. Mazaud; L. Fardet


Low-dose (i.e. ≤ 30 mg per week) methotrexate is widely prescribed by dermatologists. However, there is limited evidence-based information regarding the relative risk of and determinants for adverse events associated with this treatment. The aims of this review were to assess the relative risk of and the determinants for adverse events associated with low-dose methotrexate exposure. A systematic review was undertaken using the MEDLINE, Embase and CENTRAL databases. Randomized controlled trials comparing low-dose methotrexate with placebo were eligible. Random effect meta-analyses were conducted to assess the risk ratios (RRs) of adverse events associated with methotrexate exposure. Subgroup analyses and random effect meta-regressions were performed to examine the determinants of adverse events. In total, 68 trials (6938 participants) were included. Compared with placebo, low-dose methotrexate slightly increased the risk of adverse events (mean number per individual: 1·78 ± 2·00 in the methotrexate group, 1·53 ± 1·89 in the placebo group; P < 0·001), including nausea/vomiting, elevated transaminase levels, mucosal ulcerations, leucopenia, thrombopenia and infectious events, but not the risk of serious adverse events or death. Low-dose methotrexate also increased the number of withdrawals from studies because of adverse events [RR 1·32 (1·13–1·53)]. The concomitant prescription of folic/folinic acid was associated with a significant lower risk of any adverse events, and methotrexate prescribed orally was associated with a higher risk of abdominal pain than when prescribed subcutaneously or by intramuscular injection. On the other hand, the risk of adverse events did not increase with the weekly dose or with duration of exposure. Similar studies comparing methotrexate with other systemic/biological treatments are needed.



Updated Review of Genetic Reticulate Pigmentary Disorders


The British Journal of Dermatology. 2017;177(4):945-959.      J. Zhang; M. Li; Z. Yao


Reticulate pigmentary disorders are a group of disorders characterized by hyper- and/or hypopigmented macules with varying sizes and amounts of pigment. Some of the disorders are heritable, such as Dowling-Degos disease, dyschromatosis universalis hereditaria, dyschromatosis symmetrica hereditaria, reticulate acropigmentation of Kitamura and X-linked reticulate pigmentary disorder. Although each condition possesses unique phenotypic characteristics and the prognosis for each is somewhat different, there is a large degree of overlap between the disorders and therefore they are difficult to differentiate in the clinical setting. This updated review provides a clinical and molecular delineation of these genetic reticulate pigmentary disorders and aims to establish a concise diagnostic strategy to allow clinical dermatologists to make an accurate diagnosis, as well as to provide useful information for clinical and genetic counselling.



Emollients and Moisturizers for Eczema


The British Journal of Dermatology. 2017;177(5):1256-1271.  E.J. van Zuuren; Z. Fedorowicz; B.W.M. Arents  


Eczema is a chronic inflammatory skin disorder with considerable impact on quality of life. Emollients or moisturizers are widely recommended, but are these effective and safe? We searched for randomized controlled trials (RCTs) in the Cochrane Skin Group Specialised Skin Register, CENTRAL in The Cochrane Library, MEDLINE, Embase, LILACS, the GREAT database and five trial registers to December 2015. We included 77 RCTs with 6603 participants. Seven studies (9%) were at low risk of bias, 34 (44%) had unclear risk and 36 (47%) were at high risk. The quality of the evidence was mainly low or moderate for the prespecified outcomes. The most important comparison, 'moisturizer vs. no moisturizer', showed improved Scoring Atopic Dermatitis values in the moisturizer group compared with no moisturizer [mean difference −2·42, 95% confidence interval (CI) −4·55 to −0·28], but did not meet the minimal important difference of 8·7. Fewer flares were seen (risk ratio 0·40, 95% CI 0·23–0·70) and the rate of flares was reduced (hazard ratio 3·74, 95% CI 1·86–7·50). The groups applying moisturizer used less topical corticosteroids over 6–8 weeks (mean difference −9·30 g, 95% CI 15·3 to −3·27). Glycyrrhetinic acid-, urea- and glycerol-containing creams worked better than their controls (vehicle, placebo or no moisturizer) according to both participants and physicians. More flares were reported with moisturizer alone than when combined with twice-weekly fluticasone propionate (risk ratio 2·17, 95% CI 1·55–3·11). Adding moisturizers to topical anti-inflammatory treatment was more effective than anti-inflammatory treatment alone and resulted in fewer flares.


Association Between Facial Rejuvenation and Observer Ratings of Youth, Attractiveness, Success, and Health.


JAMA Facial Plast Surg. 2017 Sep 1;19(5):360-367. doi: 10.1001/jamafacial.2017.0126. Bater KL, et al.    


Surgical procedures for the aging face-including face-lift, blepharoplasty, and brow-lift-consistently rank among the most popular cosmetic services sought by patients. Although these surgical procedures are broadly classified as procedures that restore a youthful appearance, they may improve societal perceptions of attractiveness, success, and health, conferring an even larger social benefit than just restoring a youthful appearance to the face.

The data presented in this study demonstrate that patients are perceived as younger and more attractive by the casual observer after undergoing face-lift and upper facial rejuvenation surgery. These procedures also improved ratings of perceived success and health in our patient population. These findings suggest that facial rejuvenation surgery conveys an even larger societal benefit than merely restoring a youthful appearance to the face.


Melanoma 2018: 28th Annual Cutaneous Malignancy Update


During this course nationally recognized experts will present information on prevention, risk assessment, early detection, genetic factors, and current and future treatment choices for melanoma patients. Issues concerning surgical management, adjuvant therapy, advanced disease therapy, and personalizing the course of treatment for individual patients will also be discussed. This course is designed to provide information that will help clinicians in their decision making regarding these difficult patient problems. The course will be taught by a wide range of experts as this most serious of skin cancers will require multidisciplinary efforts to conquer.
Venue: Hilton San Diego Resort Mission Bay

January 20-21, 2018 

San Diego, California 92109, United States


Melanoma during pregnancy: A report of 60 pregnancies complicated by melanoma

Melanoma Research  May 05, 2017  de Haan J, et al.


The target of this study was to analyze the incidence, the demographic and clinical features and the treatment modalities related to melanoma during pregnancy. It was inferred that new systemic therapies were advantageous for metastatic melanoma patients. However, these were possibly not pregnancy compatible. In these patients, preterm induction of labour had to be assessed, despite the short–term and long–term negative impact on the child.




Imaging of gastrointestinal melanoma metastases: Correlation with surgery and histopathology of resected specimen


European Radiology   May 03, 2017  Othman AE, et al.


This study sought to evaluate the appearance of gastrointestinal melanoma metastases on CT and PET/CT and evaluate the diagnostic value of CT and PET/CT compared with surgery and histopathology. It was considered that most gastrointestinal melanoma metastases were located in the small bowel. They observed that large and polypoid metastases were correlated with higher complication rates. PET/CT was superior for detection of gastrointestinal melanoma metastases and should be considered in patients with limited disease undergoing surgery.


Ipilimumab combined with local peripheral treatments may improve survival in melanoma patients


Liz Meszaros, MDLinx   Ipilimumab, used in combination with radiotherapy, electrochemotherapy, or internal radiotherapy, may significantly prolong overall survival in patients with melanoma compared with treatment with ipilimumab alone, according to research published in the journal Cancer Immunotherapy Research.

Systemic therapy with ipilimumab in conjunction with local peripheral treatments doubled survival chances in patients with melanoma, without increasing immune-related side effects.

“Our results are concordant with those previously reported for 29 patients treated in the United States with ipilimumab and local radiotherapy (Cancer Immunology Research, published online July 25, 2013),” said lead author Sebastian Theurich, MD, lecturer and physician-scientist in the Center of Integrated Oncology (CIO) at the University Hospital of Cologne, Germany.

For this retrospective study, Dr. Theurich and colleagues collected and analyzed data from 127 patients with malignant melanoma treated consecutively at four cancer centers in Germany and Switzerland. In all, 82 patients were treated with ipilimumab only, while 45 received ipilimumab and local peripheral treatment for relief of tumor-related symptoms.


Prognostics factors and survival in acral lentiginous melanoma


British Journal of Dermatology   April 25, 2017  Asgari MM, et al.


This study aimed at analyzing how patient, tumor and clinical management variables influence the overall and melanoma–specific survival. It was observed that the melanoma–specific mortality among acral lentiginous melanomas patients correlated with raised tumor thickness and more advanced stage at presentation. This was not true of race–ethnicity. Advanced tumor features at presentation and access to care resulted in a less favorable survival outcomes, among non–white patients.


·         This study involved a consecutive cohort of 123 acral lentiginous melanomas diagnosed from 1987-2013.