Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of

Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.

Although transmission is often attributed to the ingestion of infective eggs by nail biting and inadequate hand washing, inhalation and ingestion of airborne eggs also occur. The female Enterobius vermicularis migrates nightly to the perianal area to deposit her eggs, but some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing an array of symptoms. More consideration of this entity is justified in patients presenting with genitourinary complaints not responding to normal therapies. In the treatment of pinworms affecting genitourinary organs, treatment with possibly two oral agents, namely mebendazole and ivermectin, and a topical therapy for the eggs may be warranted.

The dosing regimen used in the present study is considerably higher than that used in previous studies of isotretinoin. At 1 year after completion of isotretinoin treatment, we found that patients receiving 220 mg/kg or more had a significantly decreased risk of relapse. Rash was the only adverse effect that was significantly more common in the high-dose group during treatment. This study suggests that significantly higher doses of isotretinoin are effective for treating acne and decreasing relapse rates without increasing adverse effects.

SummaryAcne vulgaris is a self-limiting skin disorder seen primarily in adolescents, whose aetiology appears to be multifactorial. The four main aetiological factors are hypercornification of the pilosebaceous duct, increased sebum production, colonization with Propionibacterium acnes, and subsequently the production of inflammation. Considerable investigation has addressed the immunologic reaction to extracellular products produced by the acne-causing organism, P acnes. The immunologic response involves both humoral and cellmediated pathways. Further research should clarify the role of complement, cytotoxins, and neutrophils in this acne-forming response. Keywords: acne vulgaris; Propionibacterium acnesAcne vulgaris, the most common cutaneous disorder, is manifested by comedones, papules, pustules, and cysts. The aetiology of acne appears to be multifactorial. The exact mechanism triggering the development of the comedone and the stimuli causing the non-inflamed lesion to become inflamed are poorly understood. The microbiology of acne vulgaris and its immunologic ramifications constitute the major thrust of present research in the elucidation of the pathogenesis of the inflammatory acne lesion.The microbiology of the pilosebaceous unit involves three coexisting groups of microorganisms: Gram-positive, coagulase-negative cocci (staphylococci and micrococci); anaerobic diphtheroids (Propionibacterium acnes and Propionibacterium granulosum); and lipophilic yeasts (Pityrosporum species). The microflora of comedones is qualitatively identical to that of the normal sebaceous follicle.The staphylococci and micrococci are aerobes; therefore, their site of growth within the sebaceous unit is superficial, and these organisms are unable to reside in the anaerobic conditions of the infra-infundibulum where the inflammatory reaction occurs in acne. Antibiotics that selectively eliminate these organisms do not aVect the clinical response of patients, 1 and their role in acne pathogenesis is negligible.The lipophilic yeasts that reside in hair follicles have been divided morphologically into Pityrosporum ovale and Pityrosporum orbiculare. These represent a complex of organisms and have been reclassified as Malassezia furfur as well as other Malassezia species.2 The filamentous forms that are usually associated with a pathologic condition are not seen in acne lesions and, save for tinea versicolor, these organisms appear not to play a significant aetiologic role in any disease state.If the microbial flora is significant in the pathogenesis of acne, the most likely organism to blame is P acnes, a strict anaerobe that has been shown serologically and biochemically to be identical to Corynebacterium parvum, a potent stimulator of the reticuloendothelial system. 3 This organism has been used as an immunostimulatory adjunct in chemotherapy of numerous tumours.3-6 P acnes is overwhelmingly the predominant microorganism in the normal pilosebaceous follicle, as well as in the acne state, and has been divided into two serotypes and fiv...

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Atopic dermatitis is a chronic inflammatory skin condition with drastic impacts on pediatric health. The pathogenesis of this common disease is not well understood, and the complex role of the skin microbiome in the pathogenesis and progression of atopic dermatitis is being elucidated. Skin commensal organisms promote normal immune system functions and prevent the colonization of pathogens. Alterations in the skin microbiome may lead to increased Staphylococcus aureus colonization and atopic dermatitis progression. Despite the evidence for their important role, probiotics have not been deemed efficacious for the treatment of atopic dermatitis, although studies suggest that probiotics may be effective at preventing the development of atopic dermatitis when given to young infants. This review will cover the most recent published work on the microbiome and pediatric atopic dermatitis.

Biomarkers capable of predicting disease progression will be needed to advance new therapeutic strategies. Importantly, how to deal with the emotional and psychological effects of Sturge-Weber syndrome and its impact on quality of life is a clear unmet need.