Polylactic Acid Membranes, a Novel Adjunct Treatment for Bullous Impetigo

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript entitled “Polylactic Acid Membranes, A Novel Treatment for Bullous Impetigo” presents three case reports highlighting the potential use of a Suprathel® membrane as a supplementary treatment for adult patients with bullous impetigo who are also receiving antibiotic therapy. While this study offers novel and compelling data, several points should be addressed before publication:

1. Since the PLA membrane was used in conjunction with antibiotics, it served as an adjunct rather than a standalone treatment. The title should therefore be revised to clarify its supportive role and to emphasize the unique clinical aspects of the cases.
2. A control group is lacking. If feasible, please provide data from cases treated solely with antibiotics. Alternatively, compare your findings with those reported in previous case studies; as of now, no such literature is cited (lines 176–191).
3. Ensure that all Latin names are written in italics.
4. Each figure reference should appear immediately after the relevant patient description (lines 111–117).
5. The discussion section should cite more references pertinent to the issues raised (e.g., lines 181–183, 184–186, 190–191, 192–193, 222–224).
6. In the discussion and conclusion, underline the fact that the PLA membrane functions as an adjunct to antibiotic therapy. Without comparing to a control group treated exclusively with antibiotics, the membrane alone cannot be conclusively deemed a standalone treatment.

Author Response

Comments 1: . Since the PLA membrane was used in conjunction with antibiotics, it served as an adjunct rather than a standalone treatment. The title should therefore be revised to clarify its supportive role and to emphasize the unique clinical aspects of the cases.

Response 1: Thank you for pointing this out. We agree with this comment. Therefore, we have adapted the title to be more clear by adding the word Adjunct Treatment. […a Novel Adjunct Treatment for…]

Comments 2: A control group is lacking. If feasible, please provide data irom cases treated solely with antibiotics. Alternatively, compare your findings with those reported in previous case studies; as of now, no such literature is cited (lines 176-191).

Response 2: Agree. We have, accordingly,  added a control group of 5 patients treated with antibiotic and topical mupirocin as the adjunct therapy and compared results to emphasize this point. This information can be found on page 5, lines 194-199 highlighted for easier localization [As a control group, we included 5 patients with similar…]. Additionally we have added a Figure [4] to represent one of these patients, this can be found as well on page 5 with the figure description on lines 153-159.

Comments 3: Ensure that all Latin names are written in italics.

Response 3: Thank you for reminding us about it. We checked and made sure all Latin names were in italics and modified the ones needed [et al.], you can find these changes in the reference sections highlighted in yellow [lines 308, 330, 334, 338, 341, 343, 347, 356]

Comments 4: Each figure reference should appear immediately after the relevant patient description (lines 111-117).

Response 4: Completely agree, we made the modifications noted and will be found highlighted in yellow in page 3, lines 114-116.

Comments 5: The discussion section should cite more references pertinent to the issues raised (e.g., lines 181-183, 184-186, 190-191, 192-193, 222-224).

Response 5:   Agree, we have included more references that support the topic being discussed. This will be found highlighted in yellow in pages 6 and 7, lines 222, 225, 229, 231, 234.

Comments 6: In the discussion and conclusion, underline the fact that the PLA membrane functions as an adjunct to antibiotic therapy. Without comparing to a control group treated exclusively with antibiotics, the membrane alone cannot be conclusively deemed a standalone treatment.

Response 6:    Yes, thank you. We have underlined the text specifying this is working as an adjunct treatment for this group of patients to make it clear for our readers. These changes will be highlighted in yellow on page 6, lines 216-218 and page 7, line 280.

Reviewer 2 Report

Comments and Suggestions for Authors

Major points:

1) Please enlist the two first authors according to their surname alphabetical order.

2) Please compile a table summarizing the patient demographics.

3) Please introduce either a new graphical abstract or a new concluding figure to symbolically express the main message in an illustrative and easy-to-digest manner.

Minor points:

1) Please change "A" to "a" (line 2).

2) Please translate "Hospital Regional de Alta Especialidad" into English language (lines 6, 8).

3) Please replace "Potosí, S.L.P., México" with "Potosí (SLP), Mexico" (lines 6, 9).

4) "Several images of a person's leg AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 1. Please disable this feature.

5) "A close-up of a leg AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 2. Please disable this feature.

6) "Several images of a person's foot AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 3. Please disable this feature.

7) Please change "supervision" to "supervision," (line 246).

8) Please replace "Martinez-Jimenez MA" with "M.A.M-J." or "M.A.M.J." (line 246).

9) Please change "Ramirez-GarciaLuna JL." to "J.L.R-G.L.", "J.L.R.G.L.", "J.L.R-G.", or "J.L.R.G." (lines 247, 249).

10) Please replace "Novoa-Moreno AL." with "A.L.N-M." or "A.L.N.M." (line 248).

11) Please change "Loza-González VM." to "V.M.L-G." or V.M.L.G. (line 248).

12) Please replace "Sanchez-Olivo N." with "N.S-O." or "N.S.O." (line 248).

13) Please change "Ortiz-Alvarez A" to "A.O-A." or "A.O.A." (line 249).

14) Please remove bold formatting from "N" in "Novoa-Moreno" (line 251).

15) Please replace "JRG" with "J.L.R-G.L.", "J.L.R.G.L.", "J.L.R-G.", or "J.L.R.G." (line 258).

16) Please change "Aureus" to "aureus" in the Abbreviations section.

Author Response

1. Major points:

Comment 1: Please enlist the two first authors according to their surname alphabetical order.

Response 1: Thank you for highlighting this, we have made the corresponding changes and will be found highlighted in yellow on line 4 of the first page.

Comment 2: Please compile a table summarizing the patient demographics.

Response 2: We appreciate your suggestion and have incorporated a table summarizing our patients demographics from both groups and specified the treatment used as well as the outcomes. This table will be found on page 6 along with its description in lines 211, 212.

Comment 3: Please introduce either a new graphical abstract or a new concluding figure to symbolically express the main message in an illustrative and easy-to-digest manner.

Response 3: We agree this would be a valuable resource and have made a graphical abstract to be added to this work. This will be found on a separate document in PNG format.

2. Minor points:

Comment 1: Please change "A' to "a" (line 2).

Response 1: Thank you for taking the time to give us such detailed feedback. This change has been made and highlighted in page 1, line 2

Comment 2: Please translate "Hospital Regional de Alta Especialidad" into English language (lines 6, 8).

Response 2:   Yes, thank you. We have modified the name to be written correctly into the English language and such changes will be highlighted in page 1, lines 6 and 8.

Comment 3: Please replace "Potosí, S.L.P., México" with "Potosi (SLP), Mexico (lines 6, 9).

Response 3:  No problem, this has been corrected and highlighted on said lines.

Comment 4: A “Several images of a person's leg Al-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 1. Please disable this feature.

Response 4: While we appreciate this comment, we couldn’t find the option to disable this feature as we did not add them in our manuscript. We would greatly appreciate if you could indicate to us how to do so and will gladly make the pertinent changes.

Comment 5: “A close-up of a leg Al-generated content may be incorrect." an appear when hovering the mouse cursor over Figure 2. Please disable this feature.

Response 5: Same response as the previous comment.

Comment 6: "Several images of a person's foot Al-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 3. Please disable this feature.

Response 6: Same response as the comment 4, thank you.

Comment 7: Please change "supervision" to "supervision," (line 246).

Response 7: Noted, the change made will be highlighted and found on page 8, line 287.

Comment 8: Please replace "Martinez-Jimenez MA" with "M.A.M-J." or "M.A.M.J." (line 246).

Response 8: Got it, we adjusted the name to “M.A.M-J.”. This changes will be found highlighted on page 8 line 287, 288.

Comment 9: Please change "Ramirez-GarciaLuna JL." to "J.L.R-G.L.", "J.L.R.G.L.", "J.L.R-G.", or "J.L.R.G." (lines 247, 249).

Response 9: Yes, this change will be found highlighted in yellow on page 8, lines 288, 289.

Comment 10: Please replace 'Novoa-Moreno AL." with "A.L.N-M." or "A.L.N.M." (line 248).

Response 10: Of course, this change will be highlighted in yellow on page 8, line 288

Comment 11: Please change 'Loza-González VM." to "V.M.L-G." or V.M.L.G. (line 248).

Response 11: No worries, this change has been made and found highlighted in yellow as well on page 8, lines 288, 289.

Comment 12: Please replace 'Sanchez-Olivo N." with "N.S-O." or "N.S.O.' (line 248).

Response 12: All set, this change will be highlighted on page 8, line 289.

Comment 13: Please change "Ortiz-Alvarez A' to "A.O-A." or "A.O.A." (line 249).

Response 13: We have taken care of this changes and will be highlighted on. page 8, line 289.

Comment 14: Please remove bold formatting from "N" in "Novoa-Moreno" (line 251).

Response 14: Thank you for noticing, the modification will be highlighted and found on line 291.

Comment 15: Please replace "JRG" with *J.L.R-G.L.", "J.L.R.G.L.", "J.L. R-G.", or "J.L.R.G." (line 258).

Response 15: Thanks for the reminder. All fixed and highlighted in line 298.

Comment 16: Please change 'Aureus" to "aureus" in the Abbreviations section.

Response 16: Done! Thank you again so much for taking the time to provide us with such a detailed revision. This change will be highlighted as well and found on the Abbreviations section.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Major point:

Please convert Table 1 into a text format.

Minor points:

1) From "Clinical examination revealed signs of advanced local inflammatory response, including extensive erythema, edema, warmth, tenderness, and/or regional lymphadenopathy" (line 84) is not unequivocally clear whether the authors mean to say "extensive erythema, edema, warmth, tenderness, and regional lymphadenopathy"" or "extensive erythema, edema, warmth, tenderness, or regional lymphadenopathy"? Please fix in the text.

2) Please change "Staphylococcus" to "S." (line 86).

3) "Several images of a person's leg AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 1. Please disable this feature.

4) Please replace "Initial Presentation" with "Initial presentation" in Figures 1–3.

5) Please change "61-year-old" to "61 year old" (line 61).

6) Please remove italics formatting from "dorsum" (line 62).

7) "A close-up of a leg AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 2. Please disable this feature.

8) Please replace "50-year-old" with "50 year old" (line 129).

9) Please remove italics formatting from "stasis" (line 130).

10) Please change "7-day" to "7 day" (line 133).

11) "Several images of a person's foot AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 3. Please disable this feature.

12) Please replace "90-year-old" with "90 year old" (line 141).

13) Please remove italics formatting from "pruritus" (lines 144, 181).

14) Please change "Diabetes Mellitus" to "diabetes mellitus" (line 154).

15) Please replace "insufficiency" with "insufficiency," (line 154).

16) Please change "(right panel)" to "(right panel)," (line 157).

17) Please replace "Coli" with "coli" (lines 157, 199).

18) Please change "5" to "five" (line 194).

19) Please replace "3" with "three" (lines 197, 198).

20) Please change "1" to "one" (line 199).

21) Please replace "Diabetes Mellitus" with "diabetes mellitus" in Table 1.

22) Please change "TMP-SMX:" to "TMP-SMX," (line 211).

23) Please replace "polylactic acid (PLA)-based" with "PLA-based" (line 215).

24) Please remove underline formatting from "adjunctive therapy" (line 216).

25) Please remove underline formatting from "Suprathel® in combination with oral antibiotics" (line 217).

26) Please remove underline formatting from "adjunctive therapy" (line 280).

27) Please add "TMP-SMX" to the Abbreviations section.

28) Please sort the abbreviations section alphabetically.

Author Response

Thank you very much for yur comments. Please find below our point-by point answers:

 

Major point: Please convert Table 1 into a text format.

• We believe that Table 1 offers a good insight into the demographic and clinical characteristics of the patients, so we decided to keep it in its current format. However, following your suggestion, we have updated the text in the Case Description and Results sections to present these patients' data.

Minor points:

1) From "Clinical examination revealed signs of advanced local inflammatory response, including extensive erythema, edema, warmth, tenderness, and/or regional lymphadenopathy" (line 84) is not unequivocally clear whether the authors mean to say "extensive erythema, edema, warmth, tenderness, and regional lymphadenopathy"" or "extensive erythema, edema, warmth, tenderness, or regional lymphadenopathy"? Please fix in the text.

• We have modified the text to read "Clinical examination revealed signs of advanced local inflammatory response, including extensive erythema, edema, warmth, and tenderness, with or without regional lymphadenopathy."

2) Please change "Staphylococcus" to "S." (line 86).

• This has been changed

3) "Several images of a person's leg AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 1. Please disable this feature.

• This is a feature of the MDPI platform and is not related to the Word file manuscript.

4) Please replace "Initial Presentation" with "Initial presentation" in Figures 1–3.

• This has been replaced

5) Please change "61-year-old" to "61 year old" (line 61).

• This has been replaced

6) Please remove italics formatting from "dorsum" (line 62).

• This has been removed

7) "A close-up of a leg AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 2. Please disable this feature.

• This is a feature of the MDPI platform and is not related to the Word file manuscript.

8) Please replace "50-year-old" with "50 year old" (line 129).

• This has been replaced

9) Please remove italics formatting from "stasis" (line 130).

• This has been removed

10) Please change "7-day" to "7 day" (line 133).

• This has been replaced

11) "Several images of a person's foot AI-generated content may be incorrect." sign appear when hovering the mouse cursor over Figure 3. Please disable this feature.

• This is a feature of the MDPI platform and is not related to the Word file manuscript.

12) Please replace "90-year-old" with "90 year old" (line 141).

• This has been replaced

13) Please remove italics formatting from "pruritus" (lines 144, 181).

• This has been removed

14) Please change "Diabetes Mellitus" to "diabetes mellitus" (line 154).

• This has been changed

15) Please replace "insufficiency" with "insufficiency," (line 154).

• This has been replaced

16) Please change "(right panel)" to "(right panel)," (line 157).

• This has been changed

17) Please replace "Coli" with "coli" (lines 157, 199).

• This has been replaced

18) Please change "5" to "five" (line 194).

• This has been changed

19) Please replace "3" with "three" (lines 197, 198).

• This has been changed

20) Please change "1" to "one" (line 199).

• This has been changed

21) Please replace "Diabetes Mellitus" with "diabetes mellitus" in Table 1.

• This has been changed

22) Please change "TMP-SMX:" to "TMP-SMX," (line 211).

• This has been changed

23) Please replace "polylactic acid (PLA)-based" with "PLA-based" (line 215).

• This has been replaced

24) Please remove underline formatting from "adjunctive therapy" (line 216).

• This has been removed

25) Please remove underline formatting from "Suprathel® in combination with oral antibiotics" (line 217).

• This has been removed

26) Please remove underline formatting from "adjunctive therapy" (line 280).

• This has been removed

27) Please add "TMP-SMX" to the Abbreviations section.

• This has been added

28) Please sort the abbreviations section alphabetically.

• This has been done

Author Response File: Author Response.pdf