Dermatologic diseases encompass a broad category of pathologic situations. Infection remains a significant aspect of the pathology faced in patient encounters, and it is natural to expect that anti-infectives play a major element in the armamentarium utilized by dermatologists. Aside from the treatment of the classic bacterial and fungal infections, there are now new uses for antiviral agents to help suppress recurrent disease, such as herpes simplex. There is also the novel approach of using anti-infectives, or agents that have been thought to have antimicrobial activity, to treat inflammatory diseases. This review describes anti-infectives, beginning with common antibiotics used to treat bacterial infections. The discussion will then cover the current use of antivirals. Finally, the description of antifungals will be separated, starting with the oral agents and ending with the topical antimycotics. The use of anti-infectives in tropical dermatology has been purposefully left out, and perhaps should be the subject of a separate review. Cutaneous bacterial infections consist chiefly of those microorganisms that colonize the skin, such as species of staphylococcus and streptococcus. Propionibacterium acnes and certain other anaerobes can be involved in folliculitis, pyodermas and in chronic conditions such as hidradenitis suppurativa.
Currently, clinicians face a wide gamut of challenges in the treatment of infectious conditions of the skin. Economic factors generated by healthcare management agencies and beyond the control of the clinician may serve to restrict access to specific medications and indirectly restrict patient access to appropriate care. An area of very recent concern is centered on the growing prevalence of methicillin-resistant Staphylococcus aureus. Herpes simplex type 2 prevalence has shown for the first time a surprising downward trend, offsetting the expected continuation in upward escalation observed in previous decades. Newer pharmacological agents have facilitated control of fungal and parasitic infections. More dermatologists are becoming involved in the field of wound care, where appreciation of microbial colonization may play an equally important role to that of frank wound infection. The novel use of biologicals for the treatment of psoriasis heralds the need for constant vigilance for the potential emergence of granulomatous infections, such as TB.
Acne therapy often requires continuous treatment with a combination of agents. Patient satisfaction with treatment ensures proper compliance, which ultimately leads to a successful outcome. The BenzaClin (benzoyl peroxide/clindamycin topical gel) Efficacy and Satisfaction Trial (BEST) was conducted to determine changes in the degree of satisfaction after using benzoyl peroxide/clindamycin topical gel in patients with mild to moderate acne who were not satisfied with their current therapy. Reported in this subanalysis are results stratified according to selected patient demographic subsets (18 years and younger, 21-30 years; male, female; white, black, Hispanic, and Asian; and patients with mild acne). Efficacy variables included patient satisfaction, acne condition and severity, quality of life (QOL), and physician assessment of treatment response. Significant increases in patient satisfaction and improvement in acne condition were demonstrated with the use of benzoyl peroxide/clindamycin topical gel by male and female patients of the ages and races evaluated, as well as by patients with mild acne (P < or = .0001 for all patient subsets). Patients across genders and the specified age groups and races, as well as patients with mild acne, reported significant (P < .05) improvements in QOL following treatment with benzoyl peroxide/clindamycin topical gel. The majority of patients in most subsets, including those with mild acne, demonstrated marked improvements as measured by Physician Global Assessment (PGA) in response to treatment. In summary, patients who have been dissatisfied with their treatment regimen may be more satisfied with the use of this benzoyl peroxide/clindamycin topical gel regardless of age, gender, or race.
Although the precise pathogenesis is not known, vitiligo appears to be an autoimmune disease involving T cell-mediated melanocyte destruction. Efalizumab, a recombinant, humanized monoclonal antibody, targets T cells, the key mediators of the immunopathogenesis of psoriasis. Although a concomitant presentation of vitiligo with psoriasis is uncommon, several cases have been reported previously in the literature. A case of a patient with vitiligo and psoriasis who was treated with efalizumab to alleviate the symptoms of psoriasis is described. Over the course of the diseases, the patient had been treated unsuccessfully with numerous therapies. The patient initiated efalizumab with a 0.7 mg/kg conditioning dose and then continued on 1 mg/kg weekly. After 2 months of efalizumab therapy, the psoriasis symptoms were reduced, and the vitiligo had visibly improved in some areas. The patient has remained on efalizumab therapy with no evidence of an exacerbation of vitiligo. The management of acute flares is also discussed. This case is illustrative of a patient with psoriasis and vitiligo who was treated successfully with efalizumab.
