P6838The biologic effects of adipose-derived stem cells on wound healing in amouse model

June Lee, MD, PhD, Eulji Medical Center, Seoul, South Korea; Chang Woo Lee,MD, PhD, Hanyang University Medical Center, Seoul, South Korea; Kwang HyunCho, MD, PhD, Seoul National University Hospital, Seoul, South Korea; Mi SunKim, MD, Eulji Medical Center, Seoul, South Korea

Background: Adipose tissueederived stem cells (ADSCs) are multipotent cells thatpresent a strong capacity to differentiate and proliferate to specific phenotypes.Although ADSCs are known to facilitate wound healing of grafted skin lesions, theirbiologic effects related to tissue remodeling are not yet understood.

Objective: The aim of this study was to investigate the potential of ADSCs inenhancing wound healing, a possible up-regulation of cellular proliferation, migra-tion, the expression of proliferating cell nuclear antigen (PCNA), and any possibleactivation of extracellular signal-regulated kinase (ERK) 1/2 pathway.

Methods: Wound closure was measured in ADSC-, fibroblast-, and PBS-treated nudemice, and was plotted by time after wounding. Collagen deposition and angiogen-esis were evaluated for histological study. In in vitro studies, collagen synthesis wasassessed by RT-PCR, Western blotting, and immunofluorescent analysis.

Results: ADSC-implanted mice had accelerated wound closure, with the closure rateincreasing as early as on day 3, and also showed more new collagen deposition andangiogenesis than fibroblast-implanted mice. ADSCs also increased the ability ofmigration, perhaps, via activation of ERK1/2 signaling, and increased the prolifer-ation, and for the expression of PCNAwhen compared to those of fibroblasts. ADSCsalso showed higher levels of type I collagen expression than fibroblasts, asconfirmed by RT-PCR, Western blot analysis, and immunofluorescence.

Conclusion: In this study, cell implantation experiments revealed that ADSCs canaccelerate the wound healing process, increasing by not only migration andproliferation but also neocollagenosis and angiogenesis. This suggests that theADSC could be an up-coming biologic tool for improving wound healing physiology.

AB10

cial support: None identified.

Commer

PD06—INFECTIOUS DISEASE

P7052A systematic review of systemic antifungals to treat onychomycosis inchildren

Aditya Gupta, MD, PhD, Mediprobe Research Inc, London, Ontario, Canada;Maryse Paquet, Mediprobe Research Inc, London, Ontario, Canada

Background: Because of the low prevalence of onychomycosis in children, little isknown about the efficacy and safety of systemic antifungals in this population.

Methods: Pubmed and Embase databases, as well as the references section of relatedpublications, were searched in March 2012 for clinical trials (CTs), retrospectiveanalyses (RAs), and case reports (CRs) on the use of systemic antifungals foronychomycosis in children (\18 years old). English-language publications onmonotherapy as well as combined therapy with topical antifungals were included.The efficacy data were extracted, converted to complete cure rate when possible,and pooled together. The data from systemic antifungals alone and combinedsystemic and topical antifungals were analyzed separately. The safety data forsystemic antifungals therapies with or without concomitant use of topicals wereseparated into clinical and hematologic adverse events and the laboratory monitor-ing was recorded.

Results: Twenty-six studies, including 5 CTs, 3 RAs, and 18 CRs, were publishedbetween 1976 and 2011. Most of these studies were published between 1991 and2006 and reported the use of systemic terbinafine and itraconazole for the treatmentof onychomycosis in children. Monotherapy with systemic antifungals in childrenaged 1 to 17 years old resulted in a complete cure rate of 70.8% (107/151), whereascombined systematic and topical antifungals therapy in one infant and 19 childrenover 8 years old resulted in a complete cure rate of 80.0% (16/20). The efficacy andsafety profiles of terbinafine, itraconazole, griseofulvin, and fluconazole in childrenwere similar to the those previously reported for the adult population. There wasevidence of scheduledmonitoring in only 75% (3/4) of the CTs, 67% (2/3) of the RAs,and 39% (7/18) of the CRs.

Conclusion: Based on the limited information available for onychomycosis inchildren, systemic antifungals therapies in children are safe and their cure ratesare similar to the rates achieved in adults.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P6421Antibiotic resistant Staphylococcus aureus and group B streptococcus inpediatric patients with atopic dermatitis

Tinatin Gotsiridze, MD, Saint Louis University, Saint Louis, MO, United States;Elaine Siegfried, MD, Cardinal Glennon Children’s Hospital, Saint Louis, MO,United States

Infection and/or colonization with Staphylococcus aureus (SA) or Streptococcusin children with atopic dermatitis (AD) may exacerbate skin flares. Topicalmupirocin is commonly used to treat skin infection and control mucosalcolonization. We investigated the incidence of SA and group B Streptococcuscolonization of skin, throat, nares, and perianal mucosa in pediatric patients withAD, to determine the prevalence of mupirocin resistance, to correlate this withoxacillin, clindamycin, erythromycin and tetracycline resistance, and to compareclinical characteristics of AD patients with resistant SA to those without resistantSA and patients with Streptococcus to those without Streptococcus. We reviewedall bacterial culture results from skin, throat, nares, and perianal mucosa swabsamples taken from patients with AD seen in the CGCH Pediatric Dermatologyclinics over a 12-month period. We analyzed the percentage of isolates positivefor SA and Streptococcus, determined susceptibility of the isolated SA organismsto mupirocin, oxicillin, clindamycin, erythromycin, and tetracycline, and com-pared isolates for similar resistance patterns. We compared AD patients harboringmupirocin-resistant SA to AD patients without mupirocin resistance for severityof disease, history of hospitalizations, number of mupirocin used, prior oral andtopical antibiotic use, and bleach bath use. We performed the similar analysis forpatients with and without Streptococcus. We collected 169 isolates betweenOctober 2009 and October 2011 from AD patients between 0 and 21 years old.136/172 (79%) of the patients were found to have SA colonization. 17/124 (10%)of the patients were found to have Streptococcus colonization. Out of thepatients with SA colonization of skin 23%, 35%, 25%, 48%, and 5% weremupirocin, oxacillin, clindamycin, erythromycin, and tetracycline resistant re-spectively. Disease severity did significantly affect SA colonization status. Patientswith SA were more likely to use bleach baths. Prior mupirocin use didsignificantly affect SA resistance status. There was no association betweencolonization with Streptococcus and mean age, bleach bath use, disease severity,and number of hospitalizations or antibiotics used. The incidence of SAcolonization is higher in AD patients compared to Streptococcus colonization.Mupirocin resistance was noted to be higher than previously reported literature.Previous use of mupirocin was associated with antibiotic resistance status.

cial support: None identified.

Commer

P7080Molecular determination of nondermatophyte mold infections and mixedinfections containing dermatophytes in putative onychomychosis pa-tients referred to a dermatologist

Aditya Gupta, MD, PhD, Mediprobe Research Inc, London, Ontario, Canada;Kerry-Ann Nakrieko, PhD, Mediprobe Research Inc, London, Ontario, Canada

Nondermatophyte mold infections (NDMs) account for a significant proportion ofonychomycosis worldwide, with the majority of cases caused by dermatophyte andyeast infections. Since the occurrence of NDM onychomycosis accounts forapproximately10% of cases, studies describing the associated clinical presentations,epidemiology, and treatment strategies are limited. Evenmore limited is data relatingto the occurrence of mixed infections of dermatophytes and NDMs. This studyfocuses on determining the prevalence of bona fide NDM infections (ofAcremonium spp., Fusarium oxysporum, Scopulariopsis brevicaulis, andScytalidium spp.) and mixed infections of dermatophytes with the NDM(s) ofinterest. In order to avoid the complications involved in the culture and identifica-tion of NDMs, polymerase chain reaction (PCR)-restriction fragment length poly-morphism (RFLP) analyses and nested PCR were used to determine the occurrenceof NDM and mixed infections directly from nail samples. Our brief survey of n ¼ 56patients that were referred to a dermatologist in Canada yielded 11% (6/56) mixedinfections and 7% (4/56) NDM infections. Acremonium spp. accounted for 9%(5/56) of the infections of interest with 5% (3/56) single infections and 4% (2/56)mixed infections. F oxysporum accounted for 4% (2/56) of the infections of interest,with 2% (1/56) mixed, and 2% (1/56) mixed with a dermatophyte and another NDM(S brevicaulis); and S brevicaulis accounted for 8% (4/56) of the infections ofinterest with 2% (1/56) single infections, 4% mixed (2/56), and 2% (1/56) mixedwith a dermatophyte and another NDM (F oxysporum). Samples were also tested forthe presence of Scytalidium spp., but none were positive. These findings providevaluable insight into the occurrence of NDM onychomycosis and may help torationalize treatment strategies.

cial support: None identified.

Commer

APRIL 2013