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Biomedical subjects

James A Yiannias

Publications and source records attributed to James A Yiannias.

16 recordsLinked to original sources
PubMed2006

The exanthem of acute pulmonary coccidioidomycosis: Clinical and histopathologic features of 3 cases and review of the literature.

BACKGROUND: Coccidioidomycosis may be associated with a reactive generalized cutaneous eruption early in the course of the illness. Detailed descriptions in the literature are scarce. OBSERVATIONS: We describe 3 patients with a florid eruption associated with pulmonary coccidioidomycosis. The exanthem mimicked erythema multiforme clinically but not histologically. In 2 of the patients, the eruption began before the presence of detectable antibodies in the serum. CONCLUSION: The presence of the exanthem, in combination with fever and/or pneumonia, was a helpful clue to the diagnosis of coccidioidomycosis.

Acute Disease↗
PubMed2006

Treatment of basal cell carcinoma with curettage alone.

BACKGROUND: Although curettage and electrodesiccation (C&E) is widely used to treat basal cell carcinoma, whether electrodesiccation improves outcome is unknown. OBJECTIVE: We sought to compare cure rates of curettage alone with those of C&E. METHODS: We conducted a retrospective records review of patients treated with curettage alone at 5-year follow-up or longer that extracted data about tumor location, size, histologic subtype, biopsy specimen margin involvement, and recurrence, as well as data about the medical history of patients treated in a dermatology clinic in a tertiary-care academic medical institution. RESULTS: Biopsy-proven tumors (302) amenable to treatment with C&E and treated by a single investigator with curettage alone had a 5-year cure rate of 96.03%, with minimal complications (hypopigmentation, scarring). Tumors involving more than 50% of the deep edge of the shave biopsy specimen had an increased risk of recurrence. LIMITATIONS: This is a retrospective study based on historic controls. CONCLUSION: For nonaggressive basal cell carcinoma, curettage alone has a cure rate similar to the published rates for C&E.

Aged↗
PubMed2006

Oral metal contact allergy: a pilot study on the cause of oral squamous cell carcinoma.

BACKGROUND: Intraoral metal contact allergy may result in mucositis that mimics lichen planus and the pathogenesis of squamous cell carcinoma. METHODS: Clinical records of all patients examined in the departments of dermatology and otorhinolaryngology at a tertiary-care academic medical center between June 1994 and June 2000 who had a diagnosis of intraoral squamous cell carcinoma adjacent to a metal dental restoration and who were patch tested with our metal series were reviewed retrospectively. Eleven patients met the inclusion criteria. RESULTS: Ten patients (91%) had positive patch tests to metals. In eight (73%), the oral cancer was adjacent to a dental restoration containing a metal to which the patient was allergic. Prevalence of gold, mercury, silver, and copper allergy among these patients was substantially higher than that reported in the available worldwide patch-test clinic population. CONCLUSION: Contact allergy to metal dental restorations may be a risk factor for development of intraoral squamous cell carcinoma.

Adult↗
PubMed2006

Scurvy: a disease almost forgotten.

BACKGROUND: Although much decreased in prevalence, scurvy still exists in industrialized societies. Few recent large studies have examined its pathogenesis, signs, and symptoms. METHODS: After we diagnosed scurvy in a 77-year-old female patient in 2003, we conducted a retrospective records review to identify patients with scurvy treated between 1976 and 2002 at Mayo Clinic (Scottsdale, Arizona; Rochester, Minnesota; or Jacksonville, Florida). We also searched the English-language medical literature for published reports on scurvy. RESULTS: In addition to our patient, seven of 11 patients whose records in the institutional database mentioned vitamin C deficiency were women. The age ranged from a neonate to 77 years (mean, 48 years). The most common associated causes were concomitant gastrointestinal disease, poor dentition, food faddism, and alcoholism. Vitamin or mineral deficiencies other than vitamin C deficiency were also found in our patients who had scurvy. The most common symptoms were bruising, arthralgias, or joint swelling. The most common signs were pedal edema, bruising, or mucosal changes. Four patients had vague symptoms of myalgias and fatigue without classic findings, and five had concomitant nutritional deficiencies. Follow-up available for six of 12 patients treated by vitamin C supplementation showed complete resolution of symptoms in five. CONCLUSIONS: Patients with scurvy may present with classic symptoms and signs or with nonspecific clinical symptoms and an absence of diagnostically suggestive physical findings. Concomitant deficiency states occur not uncommonly. Taking a thorough dietary history and measuring serum ascorbic acid levels should be considered for patients with classic signs and symptoms, nonspecific musculoskeletal complaints, or other vitamin or mineral deficiencies.

Adolescent↗
PubMed2006

Peripheral T-cell lymphoma presenting as lipoatrophy and nodules.

BACKGROUND: Cutaneous lymphomas have many morphologic forms and clinical features. Lymphoma presents rarely with a constellation of nodules, panniculitis, and localized lipoatrophy. The histopathologic similarities of lymphoma and connective tissue disease panniculitis may create a diagnostic challenge. METHODS: We retrospectively reviewed the case of a 47-year-old man who presented 15 years earlier with recurrent fevers, fatigue, tender subcutaneous nodules, and facial, trunk, and extremity lipoatrophy. RESULTS: Initial biopsy of a cutaneous nodule showed lymphohistiocytic panniculitis without atypical inflammatory cells. Serologic tests showed negative connective tissue serologies, yet the initial clinical impression was most consistent with lupus panniculitis. Initially, the patient was treated with oral prednisone; later, steroid-sparing agents were used with modest improvement evidenced by resolution of his systemic symptoms and stabilization of the cutaneous findings. A decade later, more pronounced facial lipoatrophy, new facial nodules, and posterior thigh pain developed. Laboratory testing showed leukopenia, elevated liver and muscle enzymes, hypertriglyceridemia, and a low level of high-density lipoprotein. Biopsy of a new chin nodule indicated peripheral T-cell lymphoma, whereas an evaluation for systemic malignant involvement was negative. The patient was started on chemotherapy, which resulted in stabilization of the lipoatrophy and decreasing size and frequency of the cutaneous nodules, but the posterior thigh pain persisted. CONCLUSIONS: We report a rare case of lymphoma presenting as nodules and profound lipoatrophy, which exemplifies the complexity of lymphomas. Profound lipoatrophy and panniculitis may be an unusual and diagnostically challenging presentation of cutaneous lymphoma.

Diagnosis, Differential↗
PubMed2006

Should macular erythema reactions be counted as positive allergic patch-test reactions?

BACKGROUND: Positive allergic patch-test results are generally described as erythematous papules, vesicles, or a spreading reaction with crust and ulceration. This description excludes milder reactions, including macular erythema. OBJECTIVE: Our aim was to investigate the prevalence and relevance of reactions graded as macular erythema at Mayo Clinic. METHODS: Between January 2001 and June 2004, patients suspected of having allergic contact dermatitis were patch-tested with our institution's standard patch test, a screening series of 68 to 72 allergens. In total, 2,823 patients were patch-tested with 193,530 allergen applications. Reactions were interpreted with the North American Contact Dermatitis Group scale, including and excluding reactions graded as macular erythema. Irritant reactions were excluded from calculations. For this study, scores for current, questionable, and past relevance were combined. RESULTS: On day 5, with the exclusion of reactions graded as irritant, 7,274 allergen applications were associated with reactions, including 3,082 (42.4%) that were graded as macular erythema. Of the macular erythema reactions, 2,430 (78.8%) were graded as relevant. The rate of reaction in our patients was 2.2% if macular erythema was excluded, 3.8% if all macular erythema reactions were included, and 3.4% if only those macular reactions deemed relevant were included. CONCLUSION: Patch-test reactions rated as macular erythema are common and may be of clinical relevance. For the purposes of patient education, they should not be disregarded. Consideration should be given to including these reactions when reporting patchtest results.

Allergens↗
PubMed2006

Allergic contact dermatitis to preservatives.

In summary, a wide variety of skin care products contain preservatives. Patients who are allergic to one of these preservatives may have either localized or widespread dermatitis. Affected patients may find it difficult to avoid thimerosal without the help of the health care provider because the use of these allergens is so widespread. Patch testing is an invaluable tool for patients who struggle with dermatitis. Antigen-avoidance lists that facilitate patient education about what products to avoid are available from the manufacturers of patch test allergens (for example, TRUE Test or Chemotechnique). These lists are helpful starting points for patients in that they provide general categories (for example, shampoos, soaps, or creams) of products that the patient should avoid. With these printed guidelines alone, patients must read skin care product labels carefully, looking for the names of their allergens as identified by patch tests as well as for any synonyms and cross-reactors of these allergens. Thus, patients may feel overwhelmed by hearing the names of allergens that are long and complex. After an allergen has been identified, the nurse can play a key role in helping patients understand their dermatitis and its management. Nurses are in a unique position to spend time educating patients about how to uncover the sources of specific allergens and, subsequently, how to avoid them. The Contact Allergen Replacement Database can help in this educational process by giving patients a shopping list of specific items that are free of the specific allergens causing their allergic contact dermatitis.

Causality↗
PubMed2005

Patch test results from the Mayo Clinic Contact Dermatitis Group, 1998-2000.

BACKGROUND: Patch testing is a diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. A standard series of allergens similar to that used by the North American Contact Dermatitis Group (NACDG) is used at Mayo Clinic. OBJECTIVE: Our aim was to report the results of patch testing with a standard series at Mayo Clinic from July 1, 1998, to Dec 31, 2000 and to compare our findings with those of the NACDG during the same period. METHODS: The results of patch testing with the standard series at Mayo Clinic were examined. Positive reaction rates were compared between Mayo Clinic and the NACDG. RESULTS: During the 30-month period, 1324 Mayo Clinic patients were patch tested with a standard series of allergens (mean, 60 allergens), whereas the NACDG standard series during this period included 50 allergens. Overall, 917 patients (69.3%) had at least one positive reaction and 606 patients (45.8%) had two or more positive reactions. The 10 allergens used both by Mayo Clinic and by the NACDG that most frequently caused positive reactions were nickel sulfate hexahydrate, balsam of Peru (Myroxylon pereirae), neomycin sulfate, cobalt chloride, fragrance mix, potassium dichromate (0.25%), thimerosal, bacitracin, formaldehyde, and glutaraldehyde. Statistically significant differences in positive reaction rates (P < .05) were observed for 12 of the 43 allergens common to both Mayo Clinic and the NACDG. CONCLUSION: With large standard patch test series, one can identify commonly encountered and potentially relevant contact allergens.

Adolescent↗
PubMed2005

Effectiveness of intravenous immunoglobulin therapy for skin disease other than toxic epidermal necrolysis: a retrospective review of Mayo Clinic experience.

OBJECTIVE: To examine retrospectively the use and effectiveness of intravenous immunoglobulin (IVIg) treatment of various skin diseases, primarily immunobullous disease. PATIENTS AND METHODS: We identified patients who had received IVIg therapy for skin disease between 1996 and 2003 at the Mayo Clinic in Rochester, Minn, Scottsdale, Ariz, and Jacksonville, Fla, and retrospectively reviewed their medical records. RESULTS: Eighteen patients were treated with IVIg for various skin diseases: immunobullous disease in 11 adults (pemphigus vulgaris [7 patients], bullous pemphigold [3], and cicatricial pemphigoid [1]); dermatomyositis (2); mixed connective tissue disease (1); chronic urticaria (1); scleromyxedema (1); leukocytoclastic vasculitis (1); and linear IgA bullous disease (1). Responses of patients by type of disease were as follows: pemphigus vulgaris, 1 partial response (PR) and 6 no response (NR); bullous pemphigoid, 1 complete response (CR) and 2 NR; cicatricial pemphigoid, 1 NR; dermatomyositis, 1 CR and 1 PR; mixed connective tissue disease, 1 CR; chronic urticaria, 1 CR; scleromyxedema, 1 CR; leukocytoclastic vasculitis, 1 PR; and linear IgA bullous disease, 1 CR. Six patients (33%) experienced CR, 3 (17%) had PR, and 9 (50%) had NR to IVIg therapy. All 9 nonresponders were adult patients with immunobullous disease. CONCLUSION: Although this was a retrospective study of a small cohort of a mixture of patients, the findings emphasize that our experience with IVIg treatment for skin disease, particularly immunobullous disease, is less favorable than that reported previously. Further studies are needed to verify the efficacy of IVIg for skin disease.

Adolescent↗
PubMed2004

The contact allergen replacement database and treatment of allergic contact dermatitis.

OBJECTIVE: To determine whether the Contact Allergen Replacement Database would improve clinical outcomes for patients with allergic contact dermatitis associated with topical skin care products by helping patients avoid known allergens. DESIGN: This study was a randomized, single-blind, controlled trial. SETTING: The study was conducted at the outpatient facilities at Mayo Clinic, Scottsdale, Ariz, and Rochester, Minn. PARTICIPANTS: Of the 29 patients enrolled, 21 completed the study. INTERVENTION: All patients were randomly assigned to either a Contact Allergen Replacement Database group or a traditional therapy group. Patients in the database group received an individualized list of topical skin care products free of the antigens identified by the results of their individual patch tests. Otherwise, the 2 groups received identical therapy. MAIN OUTCOME MEASURES: To evaluate erythema, scale, and pruritus at 3-month follow-up, each variable was given a severity score from 0 to 3. A 1-point change was considered clinically notable. We also evaluated total physician-patient counseling time and patient satisfaction. RESULTS: We found no statistically significant differences (P>.05) between the 2 treatment groups on measures of disease activity and counseling time. However, 91% of the database group reported the allergen-free product list to be either somewhat helpful or very helpful in managing contact dermatitis. All the patients without access to the database said it would have been helpful. CONCLUSIONS: Although this small study, with its limited follow-up, did not yield objective evidence supporting the use of the Contact Allergen Replacement Database, the database-generated product lists were favorably received by patients. We anticipate an expanded clinical role for this database as an Internet-based resource.

Administration, Topical↗
PubMed2004

A new patient education approach in contact allergic dermatitis: the Contact Allergen Replacement Database (CARD).

BACKGROUND: When a patient is identified by patch testing as being sensitive to a specific contact allergen, he or she is generally advised to read the product labels and avoid products that contain the specific allergen. Patients are often confronted with difficult chemical names, synonyms, and cross-reactants for individual allergens. At the same time, dermatologists may spend a considerable amount of time trying to educate their patients about the avoidance of these allergens and explaining which products may contain them. METHODS: We applied a new educational approach to inform patients about products that are free of their allergens. RESULTS: We present a patient with multiple contact allergens in whom the Contact Allergen Replacement Database was used to educate about specific allergens. This approach has proved to be an invaluable tool for both physicians and their patients in contact allergy counseling.

Allergens↗
PubMed2004

Contact dermatitis to cosmetics, fragrances, and botanicals.

Cosmetics, fragrances, and botanicals are important causes of allergic contact dermatitis. Identifying and avoiding the causative allergens can pose a challenge to both the patient and the dermatologist. The site of involvement can give the investigator clues to the cause of the eruption in many cases. Fragrances and preservatives are the two most clinically relevant allergens in cosmetics. Botanicals are being added to cosmetics because of consumer demand and are now being recognized as sources of allergy as well. Patch testing allows for the detection of allergens that are potentially relevant in the genesis of the patient's eczema. Common skin-care product allergens, including fragrances and botanicals as well as those found in sunscreen, nail, and hair-care products, are reviewed. Practical methods of allergen avoidance are also discussed.

Allergens↗
PubMed2003

Contact stomatitis.

Contact stomatitis is inflammation or pain of the oral mucosa due to both irritant and allergic substances. Irritants include heat, frictional trauma, and chemicals. Oral flavorings, preservatives, and dental materials are common allergens. Simplification of oral care and avoidance of contactants is the primary mode of therapy. Patch testing to a broad series of antigens may be required to identify specific causes of allergic contact stomatitis.

Allergens↗
PubMed2002

Allergic contact dermatitis to epoxy resin in immersion oil for light microscopy.

Allergic contact dermatitis caused by immersion oil used for microscopy is a recently recognized phenomenon. We report a case with characteristic findings of periorbital erythema and edema in a cytogenetics technician. Positive patch test responses to epoxy resin, epoxy acrylate, and the immersion oil were noted. This case represents yet another contact allergic reaction, possibly airborne, to epoxy resin present in immersion oil used for microscopy.

Administration, Topical↗