Recurrent Skin Ulcers with Facial Dysmorphism and Sinopulmonary Infections: Thinking Beyond Hyper-IgE Syndrome

Prolidase deficiency (PD) is a rare inborn error of metabolism causing ulcers and other skin disorders, splenomegaly, developmental delay, and recurrent infections. Most of the literature is constituted of isolated case reports. It occurs due to the mutations in the prolidase gene (PEPD) that result in loss of prolidase activity. We reported here a child who had presented with features compatible with hyper-immunoglobulin E syndrome (HIES) like recurrent skin ulcers, recurrent infections, facial dysmorphism, retained primary teeth, and elevated levels of immunoglobulin E levels but with normal flow cytometric assays, which was later diagnosed as PD.

Case Report: Local Treatment of a Leishmania tropica Infection in a Syrian Child with a Novel Filmogenic Preparation of Pharmaceutical Sodium Chlorite (LeiProtect®)

Cutaneous leishmaniasis (CL) frequently entails chronic skin lesions that heal only slowly. Until now, the available therapeutic options are very limited. Here, we present a case of a 5½-year-old Syrian refugee with two progressive lower-leg skin ulcers caused by Leishmania tropica. The patient received topical treatment with LeiProtect®, a newly developed, hydroxypropylcellulose-based, filmogenic gel containing nontoxic concentrations of pharmaceutical sodium chlorite. The skin lesions completely healed within 8 weeks and did not relapse during 1 year of follow-up, underlining the efficacy of this novel local therapy of CL.

Stasis Ulcers – The Unifying Concept

Chronic stasis dermatitis, usually confined to the lower legs, is a complication of longstanding interstitial edema and inflammation, due either to venous hypertension or disorders having in common excessive lymph overload. Heart failure, renal failure, liver cirrhosis, secondary and primary diseases of lymph vessels may complicate with stasis dermatitis. The same mechanisms causing stasis dermatitis can also generate skin ulcers superimposed on stasis dermatitis. In the appropriate context such skin ulcers are called "venous ulcers" or, in different situations, “stasis ulcers”. The distinction between venous and other stasis ulcers is usually possible at the bedside. Also, some general measures of therapy are similar for venous and other stasis ulcers: such are elastic compression, topical skin care and ulcer care. In having in common the pathophysiological mechanisms, in bearing clinical resemblance, and responding to similar therapies, a unifying concept may be opportune to comprise the spectrum of stasis dermatitis, venous and other stasis ulcers. The present work is an appeal to this aim.

MEILIODOSIS - AN ENIGMA WITH VARYING ANTIBIOTIC RESPONSE

Melioidosis or Whitmore's disease is an infection of humans and animals caused by aerobic gram negative bacillus Burkholderia pseudomallei. This infection with a wide clinical spectrum is predominantly present in tropical climates, mainly Southeast Asia and Northern Australia. The clinical manifestations include pneumonia, skin ulcers or abscesses, osteomyelitis, prostatitis, encephalomyelitis and fulminant septic shock. The denitive diagnosis is made by a positive culture of Burkholderia pseudomallei. The bacteria is innately resistant to 6 classes of commonly used antibiotics. CDC recommends an intensive phase of intravenous antibiotics for 10 to 14 days followed by eradication therapy with oral antibiotics for 3 – 6 months. The intravenous agents effective against the bacteria are meropenem and ceftazidime. Trimethoprim sulfamethoxazole and amoxicillin/clavulanic acid are the oral antimicrobial agents used. Here we present two cases of Melioidosis, at opposite ends of the spectrum with varying antibiotic response. One patient is a young non immunocompromised female and the second an elderly immunocompromised (T2DM) male, both presented with skeletal melioidosis.

New Monoterpenoid Indoles with Osteoclast Activities from Gelsemium elegans

The well-known toxic medicine Gelsemium elegans is widely and historically used to treat bone fracture and skin ulcers by the folk people of China. Two new monoterpenoid indole alkaloids, gelselegandines D and E, together with the known analogue gelegamine A were isolated from G. elegans. Their structures were elucidated by means of spectroscopic techniques and quantum chemical calculations. All isolated compounds were tested for the effects on RANKL-induced osteoclast formation. Interestingly, gelselegandine E and gelegamine A, respectively, showed significant promoting and inhibitory activities on osteoclastogenesis, while gelselegandine D had no activity under the same concentration. This work suggested the different configurations for the carbons near the C-19/20 oxygen rings of the isolated compounds may be the key active groups on osteoclast formation and provided the evidence for the rationality as the traditional treatment for bone-related diseases of G. elegans.

MACROSCOPIC AND MICROSCOPIC LESIONS CHANGE OF DERMATITIS DOG WITH TRIGONA SP HONEY TREATMENT

Dermatitis is a term used to describe inflammation and damage of the layers of the skin. The causative agents are bacterial, fungal, mold, and parasitic infestations. Dermatitis has become problems in various regions in Indonesia and some other countries. Dermatitis often causes an unpleasant and disgusting feeling for the owner. Skin damage occurs to the dermis, thus showing clinical symptoms of hair loss, itching, redness of the skin, skin ulcers, and a bad smell of the animals. This study aims to determine the effect of giving honey from Trigona bees to improve the skin layer structure of patients with dermatitis in dogs and to see the development of skin lesions macroscopically. Research method: 10 dogs diagnosed with complex dermatitis were given fresh honey of 5 ml/day/dog. The treatment is given orally once a day for 35 days. Clinical observation of the wound healing process on the skin was observed every week for 5 weeks, and histopathological observations of the skin were carried out on the 0, 7, and 21 days. The results showed that giving fresh honey was able to repair skin damage with dermatitis lesions. It could be seen from the decrease in symptoms of erythema and the start of hair growth at the site of alopecia lesions. Histologically there was a decrease in the number of inflammatory cells (p<0.05) in the administration of honey. We concluded that Trigona's honey could be used as an herbal ingredient for treating dermatitis in dogs