Gram-negative folliculitis without systemic antibiotics?
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Biomedical subjects
Publications and source records attributed to H I Maibach.
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This review of black and white human skin differences emphasizes the alleged importance of factors other than the obvious, i.e., skin color. Physicochemical differences and differences in susceptibility to irritants and allergens suggest a more resistant black than white skin. Differences appear to exist in the frequency of which several skin diseases occur among blacks and whites. A striking feature in this literature is the disagreement between authors. Common for much of this information is difficulty of interpretation, because of socioeconomic influences and other environmental factors.
Scabies, caused by the itch mite and transmitted by skin-to-skin contact, is being seen in pandemic proportion. In the United States this infestation is seen in patients of all ages and socioeconomic levels. Scabies is often misdiagnosed, and the classic form occurs less frequently in the current cycle. Differential diagnosis includes most pruritic dermatoses. Diagnosis should be made with certainity, preferably by identification of the mite, before therapy is begun. Modern scabicides are high effective.
Relative evaporation and penetration of the insect repellent, N,N-diethyl-m-toluamide, has been measured by 3 methods, 2 in vivo and 1 in vitro. The evaporation rate 30 min after application was found to be similar by all 3 methods. At an applied dose of 0.25 microgram/cm2, 9.6% in vivo and 9.7% in vitro evaporated from the skin in the first hour after application. Although the techniques used produced similar results in vivo and in vitro for diethyltoluamide, studies are being conducted to further elucidate kinetics of loss by evaporation.
The microbial flora of the vulva is described and compared with the flora of the forearm by utilizing the detergent scrub method. Microbial counts were higher on the vulva (2.8 x 10(6)/cm2) than on the forearm (6.4 x 10(2)/cm2). Lipophilic diphtheroids, coagulase negative staphylococci, micrococci, non-lipophilic diphtheroids and lactobacilli formed the dominant flora of the vulva. Streptococci, Gram negative rods and yeasts were also noted. The highest incidence of S. aureus was noted on the vulva (67%) followed by perianal (30%), nose (30%), and the forearm (11%).
A laboratory technician developed allergic contact dermatitis to hydroxyethylmethacrylate associated with nausea, diarrhoea and persistent paresthesiae of the fingertips. The gastrointestinal symptoms were reproduced by patch testing. Hydroxyethylmethacrylate was demonstrated to pass through vinyl gloves. Cross reactions occurred to methyl-, ethyl-, propyl- and isopropylmethacrylate but not to butyl- or isobutylmethacrylate.
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We systematically screened the depigmenting capacity of several phenols, catechols and organic antioxidants. Clear-cut depigmentation was achieved with monomethyl ether of hydroquinone (MMH) and tertiary butyl catechol (TBC) using black guinea pigs and black mice as animal models. A goal was to establish a reliable in vivo method to demonstrate or to predict the depigmenting action of chemicals on mammalian melanocytes. There was no universal solvent or optimal body site, although all tested areas could be depigmented. Irritation induced by some vehicles and test materials produced false positive responses. False negative responses with known depigmenting chemicals were observed. Utilizing these observations, we propose a model for screening medicinal and industrial chemicals for depigmenting capacity.
A sugar refinery worker developed allergic contact dermatitis of his feet secondary to rubber accelerators in his work boots. The dermatitis resolved when polyvinyl chloride work boots were substituted. The importance of controlling hyperhidrosis in the management of foot dermatitis in workers is discussed.
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To better understand the cutaneous reactivity of vulvar skin, two chemical irritants were applied topically to 21 subjects. The forearm of each subject served as a comparative control. Test sites remained open and were read at 24 hours. A significantly increased response to the irritants was noted on the vulvar skin.
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A gloved-hand wash method was used to compare the antimicrobial effect of chlorhexidine gluconate alcohol emollient hand wash (HIBISTAT) with that of 70% isopropyl alcohol on the normal flora of the hands (81 subjects) under conditions designed to mimic use by surgeons. Results of the immediate postwash effects on the bacterial counts for all 3 tests days showed that chlorhexidine significantly reduced the normal flora of the hands. When compared with the base line bacterial counts, there was 85, 96, and 98% reduction with chlorhexidine treatment and 84, 93, and 90% reduction with alcohol treatment on days 1,2, and 5, respectively. The difference between chlorhexidine and alcohol treatments was not statistically significant on days 1 and 2, but was significant on day 5 (P less than 0.01). For delayed postwash bacterial counts (for persistent antimicrobial effects), the overall log means were 4.9943 and 5.4684 for chlorhexidine and alcohol treatments, respectively. The difference between the two treatments was significant (P less than 0.01). After the chlorhexidien treatment, there was no significant growth of bacteria over a period of 6 h when compared with the base line bacterial counts.
Transepidermal water (TEW) loss of normal vulvar and flexor forearm skin was measured in 12 subjects. A significantly elevated vulvar TEW loss was demonstrated. Depsite subcutaneous administration of atropine in seven subjects to eliminate eccrine sweating, no alteration in the elevated TEW loss was found. A significant anatomic and/or physiologic uniqueness of vulvar skin is demonstrated and warrants further investigation.
A widely used technique for the quantitative removal of bacteria from the skin uses a detergent, Triton X-100 (p, t-octylphenoxynonaethoxyethanol), to remove and suspend the bacteria. We determined the half-life for the survival of five common skin bacteria suspended in the solution. The shortest-lived was Streptococcus pyogenes with a half-life of 0.9 hours. All of the others (Propionibacterium acnes, Staphylococcus epidermidis, Staphylococcus aureus, and Klebsiella pneumoniae) had half-lives of 1.5 hours or longer. K. pneumoniae, the only Gram-negative species tested, had a half-life of more than 30 hours. Thus, a one hour delay in plating and incubation of samples suspended in this detergent solution inhibits quantitation of most species tested.
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