169 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) ISSN (Print) 2313-4410, ISSN (Online) 2313-4402 © Global Society of Scientific Research and Researchers http://asrjetsjournal.org/ A Review: Dermal Ailments Causing Microbiota Anam Javed a* , Hira Jaffar b , Saira Mushtaq c a Assistant Professor of Zoology, School of Zoology, Minhaj University, Lahore, Pakistan b,c BS researcher, Department of Zoology, University of Sargodha (RCS campus), Narowal, Pakistan *a Email: dranam.zoology@mul.edu.pk b Email: hirajaffar16rcs@gmail.com c Email: sairamushtaqrcs62@gmail.com Abstract Though skin is protective shield of body still it is prone to not only wounds, burns but also to microbial invasion which may be mainly due to bacteria, fungi or various strains of viruses. Frequently reported dermal ailments are acne, measles, psoriasis, impetigo, cellulitis, molluscum contagiosum, tinea capitis, tinea pedis, atopic dermatitis, chronic wounds, ring worm, scabies, and onychomycosis which have broad spectrum pathophysiological effects. There are several root causes of the onset of development of infectious skin microbiota but major ones are intake of improper diet and lack of personal hygiene awareness and practice. To control these skin microbial diseases further research is required to find out low cost healthy food alternatives and programmed public awareness related to personal hygiene. Keywords: Skin; microbial invasion; dermal ailments; skin microbiota; personal hygiene. 1. Introduction Skin is a unique form of connective tissue which not only covers the body surface but also performs thermal and homeostatic regulations by providing a variety of microenvironments e.g., variation in UV contact, pH, moisture, sebum content and topography. But its broad spectrum functioning may disturb due to various factors like skin burns, cuts, growing age and many other dermal ailments [1, 2, 8, 10]. The skin texture may be of different types like sebaceous, moisture having and dry because it is influenced by activity of sweat and sebaceous glands and by growth of hair follicles. As sweat glands are thermoregulatory in nature which are connected to the hair follicles localized in oily sites, biochemically the secretion of sebaceous glands is lipid- rich sebum so serve as a hydrophobic, lubricating and antibacterial shield [2, 3]. ------------------------------------------------------------------------ * Corresponding author. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 170 But still there is risk of microbial invasion. The potent sources of microbial invasion may be either of bacterial, fungal or viral origin even sometimes algal too [4]. Moreover, in daily life another potent source of microbial exposure to skin is via various animals and their meat handling either in farms or at slaughter houses [6, 7]. These microbial dermal infections may become severe and can be converted into oncogenic disorders [9]. 2. Microbial dermal ailments Following are the commonly reported types of microbial skin diseases which occur either due to intake of infected diet or microbial exposure through other routes (Table.1): Table 1: Major skin microbial diseases and their pathophysiology Skin Disease Causative agent Pathophysiology Reference(s) Acne Cutibacterium acnes Corynebacterium Malassezia Staphylococcus epidermidis Severe inflammation and deep scars [11, 18-22, 23] Measles Measles virus Severe systemic viral disorder of approximately 9–19 days duration which initiates fever and malaise then cough, coryza and conjunctivitis. [12, 24-26] Psoriasis Corynebacterium Propionibacterium Staphylococcus Streptococcus Malassezia ovalis M. furfur M. restricta A chronic form of dermal thickening and inflammation which may lead to arthritis. [13-17,27-31] Impetigo Staphylococcus aureus Streptococcus pyogenes Mostly facial and rapidly spreading tiny thin walled blister. [32-41] Cellulitis S. pyogenes S. aureus Acute inflammation usually results from bacterial exposure via various skin wounds and may also results in pain, swelling, erythema and fever. [42-48] Molluscum contagiosum Molluscipox Dermal lesion mainly on the palms and around the lips. [49-59] Tinea capitis Trichophyton tonsurans A commonly reported fungal infection of the scalp, hair shaft and hair follicles which often results in patchy hair loss, scaling and serious scalp inflammation. [60-66] Tinea pedis Trichophyton rubrum T. interdigitale Epidermophyton floccosum An inflammatory and ulcerative infection of feet which occurs not only on soles of feet but in different pattern in interdigital spaces. [67-68] Atopic dermatitis S. aureus Inflammation associated with severe rashes mainly on scalp, facial and other extremities. [69-73] Chronic wounds Major microbial causative agents are: Staphylococcus sp. Serratia sp. Clostridium sp. Various fungal, protozoan and viral strains Usually lasts for more than three months with prolonged severe inflammation, persistent infection, and drug-resistant microbial behavior. [74-82] American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 171 Ring worm Trichophyton mentagrophytes T. rubrum Microsporum canis Candida albicans This infection usually spreads on nail bed, scalp and skin due to exposure of already infected items e.g., clothing, utensils, furniture and even via pets etc. The characteristic features of its pathology are the occurrence of gradually growing diameter reddish circular swollen dermal scars. [83-85, 89] Scabies S. aureus S. pyogenes Dermal itching which may convert into diverse severe forms like cellulitis abscesses, necrotizing fasciitis or it may result into renal impairment and septicemia. [86-88] Onychomycosis Dermatophytes Yeasts Non-dermatophytes molds Frequently reported fungal infection of nails which may occur on superficial, distal, lateral and proximal subungual sides and also in candidal form. [5] 3. Control of microbial dermal disorders Following preventive measures should be adapted to control commonly occurring skin microbial diseases (Figure 1): Figure 1: Control of Microbial skin diseases 4. Conclusion Lack of general public awareness about personal hygiene is a major global problem especially of developing countries. Another factor is economic crisis as an outcome huge population has poor living standards and is more prone to skin infectious microbiota due to intake of improper and unhealthy diet, untidy living environment and inability to avail proper dermal treatment due to financial constraints. To control such skin disorders of microbial origin suitable remedies either apitherapy based, herbal or synthetic antibiotics should be utilized [4, 5, 90]. Moreover, personal hygiene based general public awareness programs should be introduced at national and international levels. Protect your skin from exposure of dust and pollutants Protect your skin from acute thermal & UV exposures On exposure of skin microbes, take proper antibiotics, herbal & apitherapy based remedies Requirement of general public awareness related to healthy diet intake and personal hygiene American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 172 5. Future perspective Future researchers should introduce better ideas of low cost alternatives of junk and staple food for common man at global level. Similarly, formation of side effects free skin care and dermal ailments’ recovery products are also required, in this regard publicity of natural produce based items either of herbal, apiculture or other animals based which should also be ethically allowed, is need of current era. All such efforts will be more effective, if they are monitored and delivered globally to general public via electronic media which is currently accessible at individual level. Acknowledgements Funding support was not received by any authority or organization. This collaborative scientific effort was solely performed by Anam Javed, Hira Jaffar and Saira Mushtaq. References [1]. A. Javed, M. Usman, S.M. Haider, B. Zafar, and K. Iftikhar. Potential of indigenous plants for skin healing and care. Am. Sci. Res. J. Eng., Technol. Sci., vol. 51(1): 192-211, 2019. [2]. E. A. Grice & J. A. Segre. The skin microbiome. Nat. Rev. Microbiol., vol. 9: 244–253, 2011. [3]. A. L. Byrd, Y. Belkaid & J. A. Segre. The human skin microbiome. Nature reviews microbiology, vol. 16: 143–155, 2018. [4]. A. Javed, G. E. Zahra, M. Amjad. Feet Microbial Infections. American Scientific Research Journal for Engineering, Technology, and Sciences, vol. 70 (1): 172-183, 2020. [5]. A. Javed, S.M. Haider, N. Akram and M. Usman. Epidemiology of onychomycosis in Gujranwala division-Pakistan. American Scientific Research Journal for Engineering, Technology, and Sciences, vol. 58(1): 113-117, 2019. [6]. A. Javed, A. Zulfiqar, T. Irum and T. Asalm. Microbial infections transmission through meat intake in Pakistan. American Scientific Research Journal for Engineering, Technology, and Sciences, vol. 59(1): 93-104, 2019. [7]. A. Chmielowiec-Korzeniowska, B. Trawińska, L. Tymczyna, H. Bis-Wencel and Ł. Matuszewski. Microbial contamination of the air in livestock buildings as a threat to human and animal health– review. Annals of Animal Science, vol. 1: xxx-xxx, 2020. [8]. A. Javed. Edge of herbal preparations for skin regeneration over synthetic ointments. IJRSR, vol. 7(8): 13012-17, 2016. [9]. A. Javed, G. E. Zahra and A.M. Qureshi. Epidemiology of oral cancer in Pakistan. American Scientific Research Journal for Engineering, Technology, and Sciences, vol. 72(1): 118-127, 2020. [10]. A. Javed and J.I. Qazi. Efficacy of Azadirachta indica and Solanum nigrum for skin regeneration in mice. Pakistan journal of life & social sciences, vol. 14(3): 158-166, 2016. [11]. S. Ramasamy, E. Barnard, T.L. Dawson and H. Li. The role of the skin microbiota in acne pathophysiology. British Journal of Dermatology, vol. 181: 691–699, 2019. [12]. P. Strebel and W.Orenstein. Measles. The New England journal of medicine, vol. 381(4): 349-57, American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 173 2019. [13]. F. Benhadou, D. Mintoff, B. Schnebert and H. B. Thio. Psoriasis and microbiota: a systematic review. Diseases, vol. 6 (47): 1-9, 2018. [14]. A.V. Alekseyenko, G.I. Perez-Perez, A. De Souza, B. Strober, Z. Gao, M. Bihan, K. Li, B.A. Methé and M.J. Blaser. Community differentiation of the cutaneous microbiota in psoriasis. Microbiome, vol. 1: 31, 2013. [15]. C.W. Lober, P.W. Belew, E.W. Rosenberg and G. Bale. Patch tests with killed sonicated microflora in patients with psoriasis. Arch. Dermatol., vol. 118: 322–325, 1982. [16]. N. Kanda, K. Tani, U. Enomoto, K.Nakai and S. Watanabe. The skin fungus-induced Th1-and Th 2-related cytokine, chemokine and prostaglandin E2 production in peripheral blood mononuclear cells from patients with atopic dermatitis and psoriasis vulgaris. Clin. Exp. Allergy, vol. 32: 1243–1250, 2002. [17]. Y.S. Liang, H.Q. Wen and R. Xiao. Serum levels of antibodies for IgG, IgA, and IgM against the fungi antigen in psoriasis vulgaris. Bull. Hunan Med. Univ., vol. 28: 638–640, 2003. [18]. E.A. Grice. The intersection of microbiome and host at the skin interface: genomic- and metagenomic-based insights.Genome Res., vol. 25: 1514–20, 2015. [19]. E.A. Grice and J.A. Segre. The skin microbiome. Nat Rev Microbiol., vol. 9: 244–53, 2011. [20]. E.A. Grice and T.L. Dawson. Host-microbe interactions: Malassezia and human skin. Curr. Opin. Microbiol., vol. 40: 81–7, 2017. [21]. B. Heelen, C. Cafarchia, G. Gaitanis, I. D. Bassukas, T. Boekhout, T. L. Dawson. Malassezia ecology, pathophysiology, and treatment. Med. Mycol., vol. 56 (1): 10–25, 2018. [22]. G.J. Christensen and H. Bruggemann. Bacterial skin commensals and their role as host guardians. Benef. Microbes, vol. 5: 201–15, 2014. [23]. K. Yazici, K. Baz, A.E. Yazici, A. Köktürk, S. Tot, D. Demirseren and V. Buturak. Disease-specific quality of life is associated with anxiety and depression in patients with acne. Jr. Eur. Acad. Dermatol. Venereol., vol. 18: 435-439, 2004. [24]. B. M. Laksono, R. D. de Vries, S. McQuaid , W. P. Duprex and R. L. de Swart. Measles virus host invasion and pathogenesis. Viruses, vol. 8(8): 210, 2016. [25]. Y. Yanagi, M. Takeda and S. Ohno. Measles virus: Cellular receptors, tropism and pathogenesis. J. Gen. Virol., vol. 87: 2767–2779, 2006. [26]. D.E. Griffin. Measles virus. In Fields Virology, 6 th ed.; Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2013. [27]. A. Ogdie and P. Weiss. The epidemiology of psoriatic arthritis. Rheum. Dis. Clin. N. Am., vol. 41: 545–568, 2015. [28]. F.O. Nestle, D.H. Kaplan and J. Barker. Psoriasis. N. Engl. J. Med., vol. 361: 496–509, 2009. [29]. N. Ayala-Fontánez, D.C. Soler and T.S. McCormick. Current knowledge on psoriasis and autoimmune diseases. Psoriasis, vol. 6: 7–32, 2016. [30]. D.J. Veale and U. Fearon. The pathogenesis of psoriatic arthritis. The Lancet, vol. 391(10136):2273-84, 2018. [31]. A. Pal, U. Garain, A. Chandra, R. Chatterjee and S. Senapati. Psoriasis skin biopsy image American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 174 segmentation using Deep Convolutional Neural Network. Computer methods and programs in biomedicine, vol.159: 59-69, 2018. [32]. J. Brown, D.L. Shriner, R.A. Schwartz and C.K. Janniger. Impetigo: an update. Int. J. Dermatol., vol. 42(4): 251-255, 2003. [33]. T. Feaster and J.I. Singer. Topical therapies for impetigo. Pediatr Emerg Care, vol. 26(3): 222-231, 2010. [34]. M.J. Sladden and G.A. Johnston. Common skin infections in children. BMJ, vol. 329:95–99, 2004. [35]. S. Koning, R. van der Sande, A.P. Verhagen, L.W. van Suijlekom‐ Smit, A.D. Morris, C.C. Butler, M. Berger, J.C. van der Wouden. Interventions for impetigo. Cochrane Database Syst. Rev., vol. 1: CD003261, 2012. [36]. M.L. O'Dell. Skin and wound infections: an overview. Am. Fam. Physician, vol. 57: 2424–2432, 1998. [37]. E.A. Morell and D.M. Balkin. Methicillin-resistant Staphylococcus aureus: a pervasive pathogen highlights the need for new antimicrobial development. Yale J. Biol. Med., vol. 83: 223–233, 2010. [38]. K. Becker, A. Podbielski, C. Sunderkötter, et al. Mikrobiologisch-infektiologische Qualitätsstandards (MiQ 6a). 2nd ed. München: Elsevier Urban and Fischer, 2013. [39]. Becker K, Podbielski A, Sunderkötter C et al. Infektionen der Haut und der subkutanen Weichteile Teil II. In: Podbielski A, Herrmann A, Kniehl E et al. Mikrobiologisch-infektiologische Qualitätsstandards (MiQ 6b). München: Elsevier Urban and Fischer 2013. [40]. K. Becker and C. Sunderkötter. Hautinfektionen durch MRSA – Epidemiologie und Klinik. Hautarzt, vol. 63: 371–80, 2012. [41]. K. Becker, A. Kriegeskorte, C. Sunderkötter et al. Chronisch rezidivierende Infektionen der Haut und Weichgewebe durch Staphylococcus aureus. Klinische Bedeutung des Small-colony-variant (SCV)-Phänotyps und von Panton-Valentine-Leukozidin (PVL) - positiven S. aureus- Isolaten. Hautarzt, vol. 65: 15–25, 2014. [42]. D.L. Stevens, A.L. Bisno, H.F. Chambers, E.D. Everett, P. Dellinger, E.J. Goldstein, S.L. Gorbach, J.V. Hirschmann, E.L. Kaplan, J.G. Montoya and J.C. Wade. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis., vol. 41(10):1373-1406, 2005. [43]. K.L. Christensen, R.C. Holman, C.A. Steiner, J.J. Sejvar, B.J. Stoll and L.B. Schonberger. Infectious disease hospitalizations in the United States. Clin Infect Dis., vol. 49: 1025-1035, 2009. [44]. T. Duvanel, R. Auckenthaler, P. Rohner, M. Harms, J.H. Saurat. Quantitative cultures of biopsy specimens from cutaneous cellulitis. Arch Intern Med., vol. 149(2): 293-296, 1989. [45]. S. Chira and L.G. Miller. Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiol. Infect., vol. 138(3): 313-317, 2010. [46]. D.L. Stevens, A.L. Bisno, H.F. Chambers, E.P. Dellinger, E.J. Goldstein, S.L. Gorbach, J.V. Hirschmann, S.L. Kaplan, J.G. Montoya and J.C. Wade. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical infectious diseases vol. 59(2): e10-52, 2014. [47]. C.G. Gunderson, R.A. Martinello. A systematic review of bacteremias in cellulitis and erysipelas. J. Infect., vol. 64(2):148-155, 2012. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 175 [48]. C.G. Gunderson. Cellulitis: definition, etiology, and clinical features. Am. J. Med., vol. 124: 1113- 1122, 2011. [49]. H.C. Dillon. Treatment of staphylococcal skin infections: a comparison of cephalexin and dicloxacillin. J. Am. Acad. Dermatol., vol. 8: 177-181, 1983. [50]. A.K. Leung and H.D. Davies. Molluscum contagiosum. Curr. Pediatr. Rev., vol. 8(4): 346-9, 2012. [51]. A.K. Leung. Molluscum Contagiosum. In: Leung AK, Ed. Common problems in ambulatory pediatrics. New York: Nova Science Publishers, Inc.; 917-22, 2011. [52]. J. Coloe, C.N. Burkhart and D.S. Morrell. Molluscum contagiosum: What’s new and true? Pediatr. Ann., vol. 38(6): 321-5, 2009. [53]. S.J. Ferns and P.A. Noronha. Picture of the month. Molluscum contagiosum. Arch Pediatr Adolesc Med., vol. 163(4): 383-4, 2009. [54]. R. Husak, C. Garbe and C.E. Orfanos. Mollusca contagiosa bei HIV-Infektion. Hautarzt, vol. 48:103– 109, 1997. [55]. S.J. Ha, Y.M. Park, S.H. Cho, B.K. Cho and K.Y. Song. Solitary giant molluscum contagiosum of the sole. Pediatr. Dermatol., vol. 15: 222–24,1998. [56]. J.A. Svirsky, D.R. Sawyer and D.G. Page. Molluscum contagiosum of the lower lip. Int. J. Dermatol., vol. 24: 668–9, 1985. [57]. L.M. Solomon and P. Telner. Eruptive molluscum contagiosum in atopic dermatitis. Can. Med. Assoc. J., vol. 95: 978–79, 1966. [58]. V.A. Moye, S. Cathcart and D.S. Morrell. Safety of cantharidin: a retrospective review of cantharidin treatment in 405 children with molluscum contagiosum. Pediatr. Dermatol., vol. 31: 450–454, 2014. [59]. J. Coloe and D.S. Morrell. Cantharidin use among pediatric dermatologists in the treatment of molluscum contagiosum. Pediatr. Dermatol., vol. 26:405–408, 2009. [60]. R.F. Martın-Garcıa, M.E. Garcıa, A. Rosado. Modified curettage technique for molluscum contagiosum. Pediatr. Dermatol., vol. 24:192–194, 2007. [61]. M. Mohrenschlager, H.P. Seidl, J. Ring and D. Abeck. Pediatric tinea capitis: recognition and management. Am. J. Clin. Dermatol., vol.6: 203–13, 2005. [62]. M. Blaithin, H. Roderick and M. Racheal. The diagnosis and management of tinea. BMJ, vol. 10(345): e4380, 2012. [63]. I. Fathi and A.G.M. al-Samarai. Prevalence of tinea capitis among school children in Iraq. East Mediterr. Health J., vol. 6(1):128–37, 2000. [64]. V. Sharma, J.C. Hall, J.F. Knapp, S. Sarai, D. Galloway and D.E. Babel. Scalp colonization by Trichophyton tonsurans in an urban pediatric clinic. Asymptomatic carrier state? Arch. Dermatol., vol.124: 1511–3, 1988. [65]. S.M. Abdel-Rahman, N. Farrand, E. Schuenemann, T.K. Stering, B. Preuett, R. Magie, A. Campbell. The prevalence of infections with Trichophyton tonsurans in school children: the CAPITIS study. Pediatrics, 12: 966-73, 2010. [66]. L.C. Fuller, R.C. Barton, M.F. Mohd Mustapa, L.E. Proudfoot, S.P. Punjabi and E.M. Higgins British Association of Dermatologists’ guidelines for the management of tinea capitis, published 8 June 2014. [67]. K.J. McClellan and S. Noble. Topical metronidazole: A review of its use in rosacea. Am. J. Clin. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 176 Dermatol., vol. 1(3): 191-99, 2000. [68]. S. Kumar & A. B Kimball. New antifungal therapies for the treatment of onychomycosis. Expert Opinion on Investigational Drugs, vol. 18: 6, 727-734, 2009. [69]. S.E. Bell‐ Syer, S.M. Khan and D.J. Torgerson. Oral treatments for fungal infections of the skin of the foot. Cochrane Database of Systematic Reviews, vol.10: 1-52, 2012. [70]. E. K. Costello, C. L. Lauber, M. Hamady, N. Fierer, J. I. Gordon & R. Knight. Bacterial community variation in human body habitats across space and time. Science, vol. 326(5960): 1694–1697, 2009. [71]. T.E. Shaw, G.P. Currie, C.W. Koudelka, E.L. Simpson. Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J. Invest. Dermatol., vol. 131(1):67–73, 2011. [72]. I. Jakasa, E.S. Koster, F. Calkoen, W.H.I. McLean, L. Campbell, D. Bos, M.M. Verberk, S. Kezić. Skin barrier function in healthy subjects and patients with atopic dermatitis in relation to filaggrin loss- of-function mutations. J. Invest. Dermatol., vol. 131(2): 540–542, 2011. [73]. L.F. Eichenfield, W.L. Tom, S.L. Chamlin, S.R. Feldman, J.M. Hanifin, E.L. Simpson, T.G. Berger, J.N. Bergman, D.E. Cohen, K.D. Cooper, K.M. Cordoro. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J. Am. Acad. Dermatol., vol. 70(2): 338–351, 2014. [74]. S. Illi, E. von Mutius, S. Lau, R. Nickel, C. Grüber, B. Niggemann and U. Wahn. Multicenter Allergy Study Group. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. Journal of Allergy and Clinical Immunology, vol. 113(5): 925-31, 2004. [75]. R. Zhao, H. Liang, E. Clarke, C. Jackson and M. Xue. Inflammation in Chronic Wounds, Published: 11 December 2016. [76]. K. McKelvey, M. Xue, K. Whitmont, K. Shen, A. Cooper, C. Jackson. Potential anti-inflammatory treatments for chronic wounds. Wound Practice & Research: Journal of the Australian Wound Management Association, vol. 20(2): 86, 2012. [77]. L.B. Price, C.M. Liu, J.H. Melendez, Y.M. Frankel, D. Engelthaler, M. Aziz, J. Bowers, R. Rattray, J. Ravel, C. Kingsley, P.S. Keim. Community analysis of chronic wound bacteria using 16S rRNA gene- based pyrosequencing: impact of diabetes and antibiotics on chronic wound microbiota. PloS one, vol. 4(7):e6462, 2009. [78]. R. Nunan, K.G. Harding and P. Martin. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity. Dis. Model Mech., vol. 7:1205-1213, 2014. [79]. K. Woo, E.A. Ayello and R.G. Sibbald. The edge effect: current therapeutic options to advance the wound edge. Adv. Skin Wound Care, vol. 20: 99– 117, 2007. [80]. A. Stojadinovic, J.W. Carlson, G.S. Schultz, T.A. Davis and E.A. Elster. Topical advances in wound care. Gynecol. Oncol., vol. 111: S70–S80, 2008. [81]. C.E. Attinger, J.E. Janis, J. Steinberg, J. Schwartz, A. Al-Attar and K. Couch. Clinical approach to wounds: debridement and wound bed preparation including the use of dressings and wound healing adjuvants. Plast. Reconstr. Surg., vol. 117: 72S–109S, 2006. [82]. T.N. Demidova-Rice, E.V. Salomatina, A.N. Yaroslavsky, I.M. Herman and M.R. Hamblin. Low-level light stimulates excisional wound healing in mice. Lasers Surg. Med., vol. 39: 706–715, 2007. [83]. B.K. Sun, Z. Siprashvili and P.A. Khavari. Advances in skin grafting and treatment of cutaneous American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 76, No 1, pp 169-177 177 wounds. Science, vol. 346:941–945, 2014. [84]. O. Schwandner and A. Fürst. Assessing the safety, effectiveness, and quality of life after the starr procedure for obstructed defecation: results of the german starr registry. Langenbeck’s archives of surgery, vol. 395(5):505–513, 2010. [85]. R. Kreston. Blood & fog: The militarys germ warfare tests in sf. Educate, 2015. [86]. Y. Y. Janjigian, F. Sanchez-Vega, P. Jonsson, W. K. Chatila, J. F. Hechtman, G. Y. Ku, J. C. Riches, Y. Tuvy, R. Kundra, N. Bouvier, et al. Genetic predictors of response to systemic therapy in esophagogastric cancer. Cancer discovery, vol. 8(1):49–58, 2018. [87]. J. Heukelbach and H. Feldmeier. Scabies. Lancet, vol. 367: 1767–74, 2006. [88]. A.C. Steer, A.W. Jenney, J. Kado, et al. High burden of impetigo and scabies in a tropical country. PLoS Negl. Trop. Dis., vol. 3: e467, 2009. [89]. D.L.Á. Mosquera, T. Tayupanta, S.E.A. Valarezo, T.A.V. Villareal and M.B.M. Álvarez. In vitro evaluation of the antifungal activity of Marco (Ambrosia arborescens Mill.) and Matico (Aristeguietia glutinosa Lam.) on the pathogenic fungi that cause dermatomycosis (ringworm). F1000Research, vol. 7: 559, 1-12, 2018. [90]. A. Javed. Efficacy of apitherapy for skin regeneration. American Scientific Research Journal for Engineering, Technology, and Sciences, vol. 75(1):80-5, 2020.