Patient case (clinical description): A 27-year-old woman comes to the dermatology clinic with skin rash and oral ulcers.  The rashes are mildly itchy. The patient has no other medical conditions and takes no medications.  Vital signs are normal.  On examination, there are pink papules symmetrically distributed over the anterior surfaces of the shins and ankles. There are some white ulcerated papules on her buccal mucosa. She is in relationship with her boyfriend and has only one sexual partner. Her boyfriend uses condoms. She smokes 1 to 2 cigarettes a day and drinks a beer daily. Biopsy reveals prominent hyperkeratosis with a thickened granular layer.  There is an infiltration of mononuclear cells in the superficial dermis that involves the overlying epidermis. The rete ridges have a sawtooth appearance.

Patient's own account: I went to the dermatologist because I had rashes on my skin and ulcers in my mouth. The rashes were not that itchy. I don't get it! I'm 27, I don't take medication, nor I don't have any other illnesses. My vitals were normal. My doc told me there were pink spots on the back of my throat. I'm heterosexual and have been only with my boyfriend and he uses condoms. I smoke 1 or 2 cigarettes a day and I drink a beer to accompany it. I had a biopsy and it showed some thick and grainy skin texture. The doc said it's an immune reaction.

Clinical trial: Efficacy and Safety of Daptomycin Versus Vancomycin or Teicoplanin for Treatment of Complicated Skin and Soft Tissue Infections

Eligibility criteria:
Inclusion criteria:

          -  Subjects with a diagnosis of cSSTI

          -  Infection known or suspected (based on Gram's stain) to be due, at least partially, to
             Gram-positive bacteria.

          -  Hospitalised subjects with clinical evidence of at least one of the following:I
             infected ulcers , major abscess. deep or extensive cellulitis, post-surgical /
             post-traumatic wound infection

          -  Presence of at least two of the following: drainage and/or discharge from the
             infection site, redness, swelling and/or hardened skin, heat and/or localised warmth,
             pain and/or tenderness to touch, presence of pus.

        Exclusion criteria:

          -  cSSTIs of the following categories:

               -  Infected burns,

               -  Severely impaired arterial blood supply (such that the likelihood of amputation
                  of the infected anatomical site is likely),

               -  Decubitus ulcers,

               -  Infected diabetic foot ulcers associated with osteomyelitis,

               -  Infected human or animal bites, superficial infections or abscesses in an
                  anatomic site, such as the rectal area, where the risk of anaerobic or
                  Gram-negative pathogen involvement is high (e.g. perirectal abscess),

               -  Necrotising fasciitis or gangrene,

               -  cSSTI expected to require more than 14 days of intravenous antimicrobial therapy,

               -  Skin and/or skin structure infection that can be treated by surgery alone,

               -  Infections associated with a permanent prosthetic device that will not be removed
                  within 2 days of study randomisation

          -  Subjects with documented bacteraemia at Baseline or those with shock or hypotension

          -  Concomitant clinically suspected or confirmed other site of infection or disorder at
             study entry that may interfere with the evaluations in this protocol

          -  Treatment with vancomycin or teicoplanin within the past 48 hours, unless administered
             for less than 24 hours.

          -  Subjects admitted to the hospital for conditions associated with rhabdomyolysis or
             those with an infection due to an organism known prior to study entry to be resistant
             to daptomycin, vancomycin or teicoplanin.

          -  Previously diagnosed disease of immune function. Human Immunodeficiency Virus (HIV)
             infected subjects without Acquired Immune Deficiency Syndrome (AIDS) may be enrolled.

          -  Subjects receiving oral steroids or receiving immunosuppressant drugs after organ
             transplant.

          -  Absence of purulent material for initial culture and Gram's stain. Subjects with
             cellulitis may be enrolled in the absence of purulent material, provided that
             infection with a Gram-positive organism is suspected.

          -  Subjects who have received more than 48 hours of any systemic antibiotic or topical
             antibiotic at the infection site with activity against Gram-positive pathogens, unless
             there is clinical evidence of treatment failure OR documented resistance in the
             identified Gram-positive pathogen to the previous antibiotic therapy.

          -  cSSTI suspected or documented as being due exclusively to Gram-negative or anaerobic
             organisms based on epidemiology or on direct examination of a Gram-stained specimen.

          -  Subjects diagnosed with pneumonia or those with severe renal impairment or hepatic
             disease

          -  Previous history of hearing loss. Other protocol defined inclusion/exclusion criteria
             may apply.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.


Eligibility (NLI label): Contradiction