Skin Abscesses and Antibiotics

The incidence of skin and soft-tissue infections has dramatically increased in the USA during the last decade and most of these infections have been caused by a methicillin-resistant Staphylococcus aureus (MRSA). Even if the drainage of abscess infections is the most indicated treatment, someone also considers the adding of antibiotics, which are instead not advised by other physicians dealing with infectious diseases. In order to clear up the matter, a double-blind trial has been performed on children treated for skin abscesses in an Emergency Department in Missouri: participants were randomized to receive for 10 days after drainage a treatment with TMP-SMX (trimetoprim-sulphametoxazole) or placebo. The cohort was made up of 149 children. The germ involved in skin abscesses, isolated in cultures, was Staphylococcus aureus in 80% of cases and the percentage of therapeutical failure was of 5.3% and of 4.1% respectively with placebo and antibiotics. Even if the rate of formation of new abscesses was higher in the placebo group, at a control after 10 days (26.4% vs. 12.9%), after 3 months the percentage between the two groups was in practice the same (28.8% vs. 28.3%).

The conclusion is easy: the adding of an antibiotic adds very little to the result obtainable with the drainage of skin abscesses. It is necessary to continue limiting the use of antibiotics to cases where their use is really justified, since we are living a historical moment where bacteria acquire every day more and more capabilities to resist antibiotic treatments.

Acne

Even if acne represents one of the most spread diseases, we still known very little on its cause, pathogenesis and therapy. With the support of pharmaceutical industry, the members of Global Alliance to Improve Outcomes in Acne have updated their recommendations, dating back to 2003, on the management of this disease, updating it with new medical and surgical therapies. The concept of acne deriving from it is that of a chronic disease with spontaneous remissions implying permanent psychological and physical scars. That’s the reason why an aggressive therapy and a long-term maintenance are proposed. Four primary factors, determining the onset of the disease, are presented: sebum production, bacterial colonization of follicles by Propionibacterium acnes, the alteration of keratinization and the release of inflammatory substances at the skin level. Each of these processes seems more complex than it was thought (for example, sebaceous glands regulate endocrine function and directly and indirectly influence the skin anti-bacterial defenses). Both according to evidence and following experts’ advice, recommendations on treatment include the invitation not to use an antibiotic monotherapy because of bacterial resistances, but to exploit also antibiotic anti-inflammatory action. Topical retinoids are above all useful during maintenance, given their anticomedonic and anti-inflammatory action. Benzoyl peroxide, even being not an antibiotic, has anti-bacterial and keratolitic properties, so treatment must be a combination of antibiotics, benzoyl peroxide, retinoids and azelaic acid. Recommendations do not imply any consideration about isotretinoin.

The document is up to date and sharable, even if incomplete, and it ranges from medical to surgical therapies. Unfortunately, acne, which is a big problem for many young people, is still today without a definitive eradicating therapy, but treatment must be based on multiple approaches, identified case by case.

Famciclovir in herpes labialis

Herpes labialis is a common problem in many young people and various, more or less empirical, therapies were adopted to put down starting manifestations. Most treatments are however ineffective, so a multinational study was realized to evaluate the efficacy of a single-dose famciclovir on 701 immunocompetent adults. The requisite to enter the study was the presence of at least three episodes of herpes labialis in the previous year, with the presence of symptoms in at least half cases and the evolution towards vesicular stage in at least half episodes. Within an hour from symptoms appearance and before the appearance of any lesion, the subjects were administered placebo or 1500 mg famciclovir (in a single dose or in two doses within 24 hours). Both with placebo and with famciclovir, the duration of recovery was reduced of 2 days, while the use of famciclovir reduced of 1 day the duration of pain and of mucous hypersensitiveness. Famciclovir was not able, however, to prevent the viral manifestation and the evolution towards the vesicular stage.

Considering the poor clinical outcome and the cost of such a therapy, to turn towards a simple anesthetic cream (reducing recovery times of 2 days) continues to be the most acceptable therapeutical solution.