Multiple miliary osteoma cutis consists of heterotopic foci of bone tissue in the dermis and subcutaneous tissue. Patients usually present with multiple, asymptomatic facial papules of several millimetres in diameter which cause distress regarding their cosmetic appearance. The condition is described as rare, as only a few cases have been reported since its first description in 1864 by Virchow. We therefore carried out a comprehensive literature search and review, in which 102 published cases were retrieved and analysed. The demographic and clinical aspects, as well as current therapy solutions, of this probably overlooked condition are discussed.

Most moderate-to-severe diabetic foot infections (DFIs) require hospitalization with urgent surgical approach and administration of empiric antibiotherapy. To ensure optimal antibiotic coverage, regular microbiological background updates are imperative. The purpose is to characterize the microbiological profile and the antibiotic sensitivity pattern of the DFI causative pathogens isolated within a specialized DFI unit of a tertiary hospital, in order to establish evidence-based policies regarding empirical antibiotic use. A cross-sectional study was conducted. Microbiological cultures and corresponding antibiotic sensitivity tests collected from moderate-to-severe DFIs as a first approach to the hospitalized patient were retrieved and analyzed during a 12-month period. Two groups were analyzed: inpatients that had been previously followed at the diabetic foot clinic of the hospital and inpatients without a previous contact with the hospital services. A total of 125 isolates obtained from 87 patients were deemed for analysis. Globally, a predominance of Gram-positive bacteria was observed (60%). Staphylococcus aureus was the most common pathogen. The global ratio of methicillin-sensitive S aureus to methicillin-resistant S aureus (MRSA) was 1.3:1, with similar findings in both groups. According to the antibiotic sensitivity test results, and within the recommended empiric antibiotic regimens for DFI, piperacillin/tazobactam seems to be the most suitable option. Gram-positive bacteria prevail as the main isolates in DFIs. Screening for MRSA-specific risk factors is mandatory. When going for a first empiric therapy, piperacillin/tazobactam is recommended in this institution, and an anti-MRSA agent should be added early, if necessary. We encourage continuous monitoring for the bacterial prevalence in Portuguese diabetic foot centers as it is paramount for the decision making regarding DFI protocols.

Dakin's solution (DS) is a time-honoured antiseptic that still remains part of the wound care armamentarium. In spite of its cytotoxicity, some question its use in the current era. We report the case of a 52-year-old diabetic woman who was admitted for sepsis because of a severely infected diabetic foot. Urgent surgical drainage and debridement left a 9 × 9-cm deep, complex, infected wound with both bone and tendon involvement. Treatment with local negative pressure was unsuccessful. DS was regularly instilled through a tube left in the wound dressing. A marked improvement was observed with this strategy as the wound bed was much cleaner and fully granulated after 6 weeks. No adverse effects were noted. This case debunks the myth that topical antiseptics necessarily impair wound healing. DS can still be considered an option for difficult-to-treat, complex and heavily infected wounds.

Summary Adult tinea capitis and tinea barbae are nowadays considered uncommon in developed countries. Despite their potential for morbidity and healthcare costs, few series have attempted to characterise these infectious disorders. We conducted a cross‐sectional study to analyse the epidemiological, clinical and mycological characteristics of adult tinea capitis and tinea barbae of a large tertiary centre in Southern Europe. All adult patients with a mycological‐confirmed tinea capitis or barbae over a 11‐year period (January 2008 to December 2018) were considered for the analysis. Concerning tinea capitis, 860 culture‐confirmed diagnoses were made during this 11‐year period, of which only 15 (1.5%) occurred in adults (15 patients). A disproportionately high number of patients were female and immunocompromised. Microsporum audouinii (20%) and Trichophyton rubrum (20%) were the most common isolates. Half of the cases were initially misdiagnosed. Regarding tinea barbae, 7 cases were diagnosed over this time period. Overuse of topical steroids was widespread in this population. Trichophyton rubrum was the infectious agent in all cases. Initial misdiagnosis was very common (43%). Adult tinea capitis and tinea barbae can still be observed in contemporary practice and remain a public health concern, with the immunosuppressed patient being particularly affected. Initial misdiagnosis is a common occurrence. Anthropophilic fungi are now the most common aetiologic agents of these infections, and they will probably continue to do so as the large urban centres expand peripherally. Awareness for this diagnosis is necessary to prevent unwarranted morbidity and costs.

men reporting 'immediate' pain after cryotherapy was greater than that of women [VAS 0 (v 2 = 3Á948; P = 0Á047)].Dermatologists advise patients that cryotherapy is painful, with little evidence to qualify or quantify that assertion. This study acknowledges the immediate moderate-to-severe pain experienced by a significant percentage of patients, but found that over half of patients reportat mostmild pain with cryotherapy. Additionally, 90% of the time, significant pain has largely resolved within 10 min.The tolerability of cryotherapy was independent of the number or size of lesion(s) treated. Patient age, skin type and sex did not impact on pain scores other than the significantly greater number of women who reported 'no immediate pain', suggesting that women have a higher pain threshold for cryotherapy. This result is contrary to some studies that have examined the impact of sex on pain tolerance and thresholds suggesting that men have a higher pain threshold than women for experimentally induced pain. 6 This study benefited from high follow-up rates, intentionto-treat analysis and lack of recall bias as a result of real-time data collection. A limitation of this study was the lack of treatment-na€ ıve patients and the effect of preconditioning on the experience of pain.While a comparison of pain scores between those who did and did not have prior treatment failed to reach significance, there was a trend toward significance. Further studies to validate our observations would benefit from larger patient populations, a treatment-na€ ıve population and repeat pain scores at 72 h or 1 week, to identify potential subsets of patients with persisting pain.Samimi and Kelleners-Smeets emphasize the role of established and new lesion-directed treatments for AKs. 7 Cryotherapy remains the gold standard, with > 100 years of clinical experience. 2 Documenting immediate and delayed pain associated with its delivery will allow for more informed consent and better facilitate comparisons.

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Dear Editors,Delayed local vaccination-induced reactions are rarely reported [ 1 ] , especially with recently introduced vaccines such as the quadrivalent human papillomavirus vaccine Gardasil ® [ 2 ] .A 28-year-old healthy female presented with a 9-month history of a painful plaque on her left arm, with limitation of motion. Five years before, she reported three intramuscular Gardasil injections on a 0-, 2-and 6-month schedule on that site, denying other local trauma.

Acute necrotising diabetic foot (DF) infections are common, costly, and do not infrequently result in debilitating major lower‐extremity amputations. Dakin's solution is a long‐standing topical antiseptic that has shown benefit in this clinical setting, but its use is undermined by a presumed risk of cytotoxicity. In this single‐centre case series, we retrospectively evaluated 24 patients with severe necrotising DF infections treated with a cyclical instillation of Dakin's solution at a referral multidisciplinary DF unit. Most patients achieved favourable outcomes in infection control and limb salvage, with only one patient (4.2%) requiring a major (at or above‐the‐ankle) amputation. The mean time to complete or near‐complete wound granulation was 5.4 weeks. Of the 12 patients who completed 12 or more months of longitudinal follow up, only 2 (12.2%) had a wound recurrence. In this severe DF infection patient cohort, Dakin's solution led to a clinically meaningful improvement. No remarkable impairment in the wound‐healing process was observed.