Mycobacterium smegmatis is an acid-fast bacillus of rapidly growing mycobacteria (RGM) of nontuberculous mycobacteria (NTM). M. smegmatis was considered nonpathogenic to humans until 1986, when the first patient was linked to the infection. To date, fewer than 100 cases have been reported in the literature, mainly related to various surgical procedures. Herein, we report two immunocompetent patients who acquired M. smegmatis infection following cosmetic procedures. Due to the rarity of M. smegmatis infection in routine clinical practice, it is challenging for medical providers to diagnose and treat patients with M. smegmatis infection. M. smegmatis infection should be considered for patients with chronic skin and soft tissue infections at the injection site or surgical site following cosmetic procedures. Histological findings, pathogen identification by molecular testing or bacterial culture are required to make a definitive diagnosis. Medical providers should raise awareness of M. smegmatis infection for patients with chronic skin and soft tissue infections after cosmetic procedures. Stringent sterile procedures for surgical instruments, supplies, and environments should be enforced.
Background: Prurigo nodularis (PN) is a chronic pruritic skin disease which is difficult to treat. Current treatment options often lead to limited clinical benefit or severe side effects. Objective: To evaluate the efficacy and safety of dupilumab in the treatment of prurigo nodularis in adults. Method: This study is a retrospective cohort study. Twenty-four adult patients with prurigo nodularis were included and treated with dupilumab. The primary outcomes were the mean reduction in the Investigator’s Global Assessment (IGA) score, and pruritus numeric rating scale (p-NRS) score. Outcomes were assessed at baseline, week 4, week16, and week 36. Results: The study included 24 patients, while 9 (37.5%) were male, and the mean(SD) age of the enrolled patients was 49.88 ± 16.71 years. At the end of treatment, the mean p-NRS score decreased from 7.50 ± 2.21 to 1.41 ± 0.91 (P<0.001), sleeplessness numeric rating scale (s-NRS) score declined from 5.33 ± 3.29 to 0.18 ± 0.59(P <0.001), and Dermatology Life Quality Index (DLQI) score decreased from 13.32 ± 4.88 to 0.91 ± 0.81 (P<0.001). Fourteen (63.6%) patients achieved IGA 0/1 and 21 (95.4%) patients achieved IGA activity 0/1. Among 14 patients who achieved IGA 0/1,10 had an elevated serum IgE level, and patients with a high serum IgE level showed a more remarkable reduction in IGA (r=0.52, P=0.03). Patients with AD responded faster than those without AD (3.76 ± 1.71 weeks vs 6.40 ± 1.67 weeks, P=0.01). Adverse events were recorded in 4/24 (16.6%) patients, with conjunctivitis the most frequent. Conclusion: This study demonstrated that dupilumab is effective and safe for prurigo nodularis and could be a potential therapeutic option.
Lichen sclerosis (LS) is an insidious, chronic, relapsing skin disease characterized by atrophic, porcelain-appearing plaques. It usually arises in the anogenital area, but some cases can present in extragenital regions with a variety of presentations, including a bullous variant. Topical corticosteroids are a first-line therapy and are usually the most effective treatment to induce remission of LS. However, there is a subset of patients that does not respond well to topical steroids. Herein, we report an extragenital bullous LS case successfully treated with a fractional CO 2 laser (FxCO 2 ) and subsequent wet dressing of halcinonide solution.
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