Prolonged pruritus and bullous pemphigoid.
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Biomedical subjects
Publications and source records attributed to D Burrows.
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An outbreak of dermatitis occurred in an aircraft factory using epoxy resin composite material. Of 25 operatives, 14 gave positive patch test reactions to the composite material and/or diglycidylether of bisphenol A (DGEBA), tetraglycidyl-4,4'-methylene dianiline (TGMDA), and o-diglycidyl phthalate. This report seems to be the first to demonstrate contact allergy to the two last mentioned epoxy resins. The diglycidylether of bisphenol A used in routine test series picked up only 3 cases of 12 tested.
Test on 100 consecutive patients, 59 with a suspected allergen and 41 with eczema or contact dermatitis without a suspected allergen, yielded 23 unsuspected positives in 17 patients. The clinical diagnosis was not confirmed in 27 of the 59 cases with suspected allergens.
We report a fatal case of drug toxicity associated with torsade de pointes following an overdose of the tetracyclic antidepressant, maprotiline (Ludiomil). Tissue and plasma levels were obtained at autopsy and are noted. In addition, the cardiovascular effects, pharmacokinetics, and toxicity of maprotiline are reviewed and compared with that of tricyclic antidepressants.
In Northern Ireland, with a population of 1.5 million, thirteen cases of Letterer-Siwe disease have been diagnosed over the past 21 years. The average age of onset was 10.5 months. There was a 69% mortality with an average survival time from diagnosis to death of 3.3 months. Four children survived with no morbidity. All deaths were from pulmonary complications, but two cases with pulmonary infiltration responded to treatment with quadruple chemotherapy. There were no familial cases in this study.
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Thirty-one liver biopsies were performed on twenty-two psoriatics on treatment or considered for treatment with methotrexate. Three developed serious morbidity after biopsy. Of twenty-one attempted pre-methotrexate biopsies, four were abnormal, and one failed. Five of ten post-methotrexate biopsies were abnormal. Histological abnormalities were mild and cirrhosis was not seen. Liver function tests were not found to be a reliable indicator of hepatic damage and it is felt that in spite of our relatively high complication rate, liver biopsy is a useful method for monitoring liver damage due to methotrexate and should be performed.
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Fifty-two patients with severe and resistant psoriasis were treated with 8-methoxypsoralen followed by high intensity long wave ultraviolet light over a 12-month period at the Royal Victoria Hospital, Belfast. One hundred per cent clearing of the plaques of psoriasis was obtained with an average dose of energy of 53.5 joules in 43 (96 per cent) of 45 patients and the other two materially improved. Seven are still in the clearing phase. Early side effects were uncommon. There was no clinically significant change in laboratory or ophthalmological findings. Of the nine patients who complained of arthritis, four had radiological evidence and one showed radiological improvement after PUVA. In this study all seven patients who had been using large doses of topically applied steroid cream (up to 200 g Dermovate per week for two years) did not show adrenal suppression.
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