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PubMed1986

Sorbic acid-induced erythema and edema.

Sorbic acid concentrations as low as 0.1% produced transient erythema with edema and flare after open or closed application to human skin. Multiple areas of the body were tested. Reactions were most intense on the face but also could be produced on the back, forearm, and deltoid areas. Sorbic acid-induced erythema, edema, and flare were not associated with mast cell degranulation. Pretreatment of skin with topical steroids to induce vasoconstriction resulted in a diminished response to sorbic acid. Aspirin blocked the erythematous component, suggesting that prostaglandins are important mediators. Systemic steroids, antihistamines, and hydroxyzine failed to influence sorbic acid-induced erythema and edema. The anti-inflammatory effect of topical steroids was not affected by sorbic acid-induced erythema.

Administration, Topical↗
PubMed1989

Effect of indomethacin on UVB- and UVA-induced erythema in polymorphic light eruption.

The effect of topical indomethacin on the intensity of UVB- and UVA-induced erythema was measured by reflectance spectrophotometry in 23 patients with polymorphic light eruption. Thirteen patients showed a response to indomethacin that was identical to that seen in normal subjects (i.e., inhibition of UVB-induced erythema; no effect on the intensity of UVA-induced erythema). In the remaining 10 patients indomethacin caused abnormal augmentation of UVB- and UVA-induced erythema. These results show for the first time that the term polymorphic light eruption embraces at least two disease states that have different mechanisms of photosensitivity and that can be distinguished on the basis of clinical features and results of photobiologic investigation.

Administration, Topical↗
PubMed1994

Cultivation of Borrelia burgdorferi from the blood of two patients with erythema migrans lesions lacking extracutaneous signs and symptoms of Lyme disease.

BACKGROUND: We recently demonstrated that cultivation of Borrelia burgdorferi from skin biopsy specimens obtained from erythema migrans lesions was an efficacious procedure to confirm the diagnosis of Lyme disease. OBJECTIVE: Our purpose was to investigate the efficacy of our microbiologic technique on blood samples obtained from patients with Lyme disease and erythema migrans. METHODS: Whole blood samples were obtained from 52 patients with erythema migrans and early localized or early disseminated Lyme disease and placed into polystyrene tubes containing 6 ml of modified Barbour-Stoenner-Kelly medium, processed, and examined for B. burgdorferi by dark-field microscopy. RESULTS: B. burgdorferi was cultured from the blood of two of our 52 patients (4%). Clinically, both of these patients were considered to have early localized Lyme disease. CONCLUSION: The culture of B. burgdorferi from the blood of patients with early Lyme disease does not appear to be an efficacious procedure to confirm the diagnosis of Lyme disease. However, the demonstration of spirochetemia in patients with erythema migrans without any extracutaneous evidence of disseminated illness does have therapeutic significance.

Adult↗
PubMed1997

Annular erythema associated with lupus erythematosus/Sjögren's syndrome.

BACKGROUND: Annular-polycyclic and papulosquamous lesions are associated with subacute cutaneous lupus erythematosus (SCLE). In some Asian cases, annular erythema has been associated with Sjögren's syndrome (SS). However, the relation between the two is unclear. OBJECTIVE: Our purpose was to clarify the clinical manifestations and immunologic features of patients with annular erythema. METHODS: This study included 15 patients with annular erythema. Systemic, serologic, and genetic findings were analyzed. RESULTS: Histologic examination showed perivascular and periappendageal lymphocytic infiltrates in all patients. However, LE-specific epidermal changes were observed in only three (20%). Although all patients at least partially demonstrated features of LE or SS, eight (53%) fulfilled the American Rheumatism Association criteria for systemic LE (SLE) and five (33%) were diagnosed with SS. Renal (20%) and central nervous system (7%) involvement was observed. Anti-Ro(SS-A) and anti-La(SS-B) antibodies were detected in nine (60%) and seven (47%) patients, respectively. There were no histocompatibility antigen (HLA) haplotype differences. CONCLUSION: Annular erythema in Asian patients is the counterpart of subacute skin lesions of LE in whites, except for the paucity of LE-specific histopathologic findings and HLA-DR3 tissue type.

Adolescent↗
PubMed2001

Solar ultraviolet-induced erythema in human skin and nuclear factor-kappa-B-dependent gene expression in keratinocytes are modulated by a French maritime pine bark extract.

The procyanidin-rich French maritime pine bark extract Pycnogenol (PBE) has been investigated for its effect in protecting human skin against solar UV-simulated light-induced erythema. Twenty-one volunteers were given an oral supplementation of Pycnogenol: 1.10 mg/kg body weight (b. wt.)/d for the first 4 weeks and 1.66 mg/kg b. wt./d for the next 4 weeks. The minimal erythema dose (MED) was measured twice before supplementation (baseline MED), once after the first 4 weeks of supplementation, and a last time at the end of the study. The UVR dose necessary to achieve 1 MED was significantly increased during PBE supplementation. Since the activation of the pro-inflammatory and redox-regulated transcription factor NF-kappaB is thought to play a major role in UVR-induced erythema, the effect of PBE was also investigated in the human keratinocyte cell line HaCaT. PBE, added to the cell culture medium, inhibited UVR-induced NF-kappaB-dependent gene expression in a concentration-dependent manner. However, NF-kappaB-DNA-binding activity was not prevented, suggesting that PBE affects the transactivation capacity of NF-kappaB. These data indicate that oral supplementation of PBE reduces erythema in the skin. Inhibition of NF-kappaB-dependent gene expression by PBE possibly contributes to the observed increase in MED.

Administration, Oral↗
PubMed1999

Diagnosis: erythema nodosum or not?

Erythema nodosum is the final common pathway to a myriad of insults and is thought to be a hypersensitivity reaction centered in the subcutis. To recognize the histological spectrum of erythema nodosum, one must be aware of the morphologic chronology of the disease (early, fully developed, late) and its clinical variants (erythema nodosum migrans). This article reviews the range of changes that can be seen in this prototype of a septal panniculitis and describes the diversity that may be accepted in the diagnosis. Differential diagnoses at each stage of disease development are discussed. The criteria elaborated should assist the pathologist in answering the clinician's query, "Erythema nodosum, or not?"

Diagnosis, Differential↗
PubMed2005

Supplementation with tomato-based products increases lycopene, phytofluene, and phytoene levels in human serum and protects against UV-light-induced erythema.

Carotenoids are suitable photoprotectants, and beta-carotene supplements are used for protection against ultraviolet (UV) light-induced erythema. Protective effects are also observed when carotenoids are provided with the diet. Here, we investigated the photoprotective effects of synthetic lycopene in comparison with a tomato extract (Lyc-o-Mato) and a drink containing solubilized Lyc-o-Mato (Lyc-o-Guard-Drink). With these different sources, the volunteers ingested similar amounts of lycopene (about 10 mg/day). After 12 weeks of supplementation, significant increases in lycopene serum levels and total skin carotenoids were observed in all groups. Significant increases in the serum levels of phytofluene and phytoene occurred in the Lyc-o-Mato and the Lyc-o-Guard-Drink group. At weeks 0, 4, and 12 an erythema was induced with a solar light simulator. Dorsal skin of each subject was irradiated with 1.25 minimal erythemal dose (MED). Reddening of the skin was evaluated before and 24 hours after irradiation by chromametry and expressed as positive a-values (red/green-axis). delta a-values (difference of a-value before irradiation and after 24 hours) were used as an index of erythema intensity. A decrease in the delta a-value from week 0 to week 12, indicating prevention of erythema formation, was observed in all groups. Compared to week 0, the delta a-value at week 12 was 25% lower in the synthetic lycopene group. The protective effect was more pronounced in the Lyc-o-Mato (38%) and Lyc-o-Guard-Drink (48%) groups. In the two latter groups, phytofluene and phytoene may have contributed to protection. Both of these carotenoids exhibit absorption maxima at wavelengths of UV light. Absorption of UV light protects skin from photodamage and might explain the differences observed between groups.

Adult↗
PubMed2003

Accuracy of annual erythema exposure estimation using different numbers of ambient exposure fractions in the human exposure model.

BACKGROUND: The aim was to determine the optimum number of ambient exposure fractions required in the human exposure model for accurate computation of annual erythema effective solar exposure. METHODS: Ambient exposure fractions were determined on a daily basis over a period of a year in the Rockhampton region using ambient exposure measurements and erythema effective solar exposure measurements at selected body sites of Australia post mail delivery personnel (APMDP). Several values of annual erythema effective exposure for the same body sites were computed using different combinations of ambient exposure fractions on a monthly, seasonally and half-yearly basis in the human exposure model and compared with the measured values. RESULTS: This method enabled a check on the accuracy of annual erythema effective solar exposure estimation using the different combinations of ambient exposure fractions in the human exposure model. In the worst case there was approximately 35% difference between the measured value and the computed value. CONCLUSION: The best accuracy was obtained with the use of ambient exposure fractions on a monthly basis where most of the estimated values for the different body sites were within 20% of the measured values.

Back↗
PubMed1999

The relationship between facial annular erythema and anti-SS-A/Ro antibodies in three East Asian women.

A distinct annular erythema developed on the cheeks of three East Asian women who had anti-SS-A/Ro (SSA) antibodies. The erythema was characterized by a wide, elevated border and central pallor. Histologically, there was a coat-sleeve-like infiltration of lymphocytes around the blood vessels, appendages, and secretory gland cells in the dermis. Immunohistological analysis clarified that the majority of infiltrating lymphocytes were CD4-positive T cells. Abnormal expression of HLA-DR antigens in the perivascular, appendage, and secretory gland cells in the dermis was also observed. The differential diagnosis of the three patients lay between Sjögren syndrome (SjS), Sjögren/systemic lupus erythematosus overlap syndrome and an asymptomatic clinical state. These results are consistent with recent findings of major histocompatibility complex class II expression on target organs in various autoimmune diseases. Based on these findings, erythema appears to represent a broad cutaneous manifestation of these diseases. Furthermore, the presence of SSA antibodies, aberrant HLA-DR expression, and sun exposure may be responsible for the development of erythema.

Adult↗
PubMed2002

Long-term prognosis of patients treated for erythema migrans in France.

BACKGROUND: The long-term prognosis of patients treated for erythema migrans has only rarely been assessed. OBJECTIVES: To evaluate the clinical characteristics and long-term prognosis of patients treated for erythema migrans in the region of Alsace, France. METHODS: In a prospective study, 56 consecutive patients presenting with erythema migrans at the Strasbourg University Hospital between 1995 and 1999 were examined and a Borrelia burgdorferi enzyme immunoassay was performed. Patients were treated with tetracyclines or amoxycillin. Patients were re-examined 6 weeks later and a telephone interview was performed in summer 2000 to evaluate the long-term outcome. RESULTS: There were 25 women and 31 men of mean age 49 years presenting with single (n = 54) or multiple (n = 2) erythema migrans lesions. At the time of diagnosis, 30% of the patients had systemic signs, myalgias or arthralgias and only 36% of 50 patients were seroreactive against B. burgdorferi. None of the 51 patients evaluated at 6 weeks and none of the 37 patients interviewed after a median delay of 3 years had developed complications attributable to Lyme borreliosis. CONCLUSIONS: The prognosis of patients treated for Lyme borreliosis in this part of France is excellent. Therefore, a complete clinical examination is sufficient as an initial evaluation and long-term follow-up is not necessary.

Adolescent↗
PubMed1997

Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases.

BACKGROUND: Chemotherapy-induced acral erythema is a distinct localized cutaneous response to certain systemic chemotherapeutic agents. METHODS: Between January 1990 and December 1994, from a total of 76 leukemic patients who have received combination chemotherapy consisting of cytosine arabinoside and anthracycline antibiotics, 15 patients developed chemotherapy-induced acral erythema. Fourteen of the patients had acute myelocytic leukemia, and one of them had chronic myelogenous leukemia in blast phase. Clinical features of these 15 patients have been analysed. Biopsy specimens obtained from eight of the patients were also evaluated for histopathologic alterations. RESULTS: The overall incidence of this reaction was found to be 19.7% in our group of patients receiving this chemotherapy protocol. The onset of reaction varied from the fourth to the seventeenth days of the chemotherapy and resolved within 2 weeks in most of the patients. Lesions appeared as well-defined erythema and edema involving the palmar surfaces in all of the patients. In nine of the patients the reaction recurred with subsequent chemotherapies. Scattered necrotic keratinocytes, vacuolar alterations of the basal layer, and mild to moderate perivascular lymphocytic infiltration in the dermis were the histopathologic findings observed in the biopsy specimens. CONCLUSIONS: Chemotherapy-induced acral erythema is a frequent reaction in patients who are receiving high-dose chemotherapy. For patients in whom this self-limited condition develops, reassurance is the mainstay of therapy. Awareness of this reaction is also important to be able to differentiate it from acute graft versus host disease in patients who receive bone marrow transplants.

Adolescent↗
PubMed2001

The effect of methoxsalen dose on ultraviolet-A-induced erythema.

There is considerable interindividual variation in bioavailability of Methoxsalen (8-methoxypsoralen) after ingestion of the standard dose used in photochemotherapy (psoralen plus ultraviolet A). A dose change may be used to alter the degree of photosensitivity, although there is limited information on the effect of 8-methoxypsoralen dose alterations on phototoxicity within individuals. We studied the effect of changes of 8-methoxypsoralen dose over a narrow range in 15 subjects with psoriasis. Two hours after ingestion, serum 8-methoxypsoralen concentration was determined and phototesting was performed at 350 +/- 30 nm (0.45-14 J per cm2). The minimal phototoxic dose at 72 h was recorded, erythema was measured using a reflectance instrument, and dose-response curves were constructed. Each subject was tested on three occasions using doses of 25 mg per m2 (conventional dose) or conventional dose +/- 10 mg. Median serum 8-methoxypsoralen concentration increased from 96 to 143 to 229 ng per ml with dose increases from conventional dose - 10 mg to conventional dose and conventional dose + 10 mg, respectively (p < 0.001). The median minimal phototoxic dose and D0.025 (the objective equivalent of the minimal phototoxic dose derived from the dose-response curve) were significantly reduced with increasing 8-methoxypsoralen dose from conventional dose minus 10 mg (minimal phototoxic dose 1.7 J per cm2; D(0.025) 2.8 J per cm2) to conventional dose (1.2; 1.4 J per cm2) and conventional dose plus 10 mg (0.9; 1.0 J per cm2) (p < 0.001). Change in 8-methoxypsoralen dose had no detectable effect on the maximum slope of the psoralen plus ultraviolet A erythema dose-response curve. Thus, 8-methoxypsoralen dose changes within individuals, over a narrow but clinically relevant range, significantly altered the threshold response to psoralen plus ultraviolet A erythema but not the rate of increase in erythema with increasing ultraviolet A dose.

Adult↗
PubMed1999

Prolonged erythema after facial laser resurfacing or phenol peel secondary to corticosteroid addiction.

BACKGROUND: Prolonged persistent erythema postprocedure using phenol or carbon dioxide (CO2) lasers occurs frequently and the reasons have not been fully ascertained. OBJECTIVE: To describe patients whose postoperative care consisted of prolonged use of topical corticosteroids and to assess the outcome of cessation of this medicine. METHODS: Twelve patients who underwent CO2 laser resurfacing or phenol peels to their face are presented. All patients were seen between 3 and 30 months after the procedures were performed. All dressings, wound care, and other medicaments had been stopped prior to being seen. Most were patch tested to a wide variety of chemicals including corticosteroids, topical medications, and preservatives. They were observed during the poststeroid cessation period and the clinical response is described. RESULTS: All patch testing showed insignificant results. All postpeel patients cleared within 6 months of steroid cessation, experiencing several flares of erythema before the end result. Three of the six laser resurfacing patients cleared fully within 12 months and three are still being followed. The erythema and severe burning in the patients that cleared stayed clear during long-term follow-up. No scars or atrophy were seen. CONCLUSION: The use of topical corticosteroid preparations postoperatively in peel and resurfacing patients is believed to be a major cause of prolonged erythema, dermatitis, burning, and telangiectasias in these patients. The mechanism is believed to be one of vasoconstriction/vasodilatation secondary to the corticosteroids through a nonintact barrier.

Administration, Topical↗
PubMed2000

Carotenoid supplementation reduces erythema in human skin after simulated solar radiation exposure.

Excessive exposure to solar radiation, especially ultraviolet A (UVA: 320-400 nm) and ultraviolet B (UVB: 290-320 nm) radiation, may induce UV-carcinogenesis and erythema in the skin. Although the protective effects of carotenoids against skin lesions are still unclear, beta-carotene has been proposed as an oral sun protectant. The purpose of this study was to determine the magnitude of the protective effects of oral alpha- and beta-carotene supplementation for 24 weeks on UVA- and UVB-induced erythema in humans. While being exposed to UVA and UVB radiation, 22 subjects (11 men and 11 women) were supplemented with natural carotenoids for 24 weeks. Each day for the first 8 weeks, subjects were given 30 mg of natural carotenoids containing 29.4 mg of beta-carotene, 0.36 mg of alpha-carotene, and traces of other carotenoids in vegetable oil. The natural carotenoid dose was progressively raised by 30-mg increments, at every 8 weeks, from 30 mg to 90 mg. Small areas (1 cm2) of the skin were exposed to increasing doses of UV light (16-42 mJ/cm2) to determine the minimal erythema dose (MED). MED was defined as a uniform pink color with well-defined borders. MED readings were obtained by visual inspection 24 hr postirradiation. Blood samples taken during supplementation were used to determine alpha- and beta-carotene serum levels and for a lipid peroxidation analysis. During natural carotenoid supplementation, the MED of solar simulator radiation increased significantly (P<0.05). After 24 weeks of supplementation, serum beta-carotene levels were increased from 0.22 microg/ml (95% CI; 0.16-0.27) to 1.72 microg/ml (95% CI;1.61-1.83). Similarly, alpha-carotene serum levels increased from 0.07 microg/ml (95% CI;0.048-0.092) to 0.36 microg/ml (95% CI; 0.32-0.40). Serum lipid peroxidation was significantly (P<0.05) inhibited in a dose-dependent manner during natural carotenoid supplementation. The present data suggest that supplementation with natural carotenoids may partially protect human skin from UVA- and UVB-induced erythema, although the magnitude of the protective effect is modest.

Adolescent↗
PubMedDate not supplied

A case of herpetic whitlow associated with erythema multiforme.

We report a 6-month-old girl with erythema multiforme minor occurring during the course of a herpetic whitlow. Erythema multiforme minor is unusual in infants, and in this population herpes simplex virus has not been reported as a significant etiologic factor. The clinical coexistence of erythema multiforme minor and the herpetic lesion is also atypical. To our knowledge, this is the first report of erythema multiforme minor associated with a concomitant HSV infection in an infant.

Erythema Multiforme↗
PubMedDate not supplied

Acral erythema in children receiving high-dose methotrexate.

Scant information is available concerning the occurrence and evolution of chemotherapy-induced acral erythema in children receiving intravenous high-dose methotrexate (MTX). Among 50 children with acute lymphoblastic leukemia or lymphoblastic lymphoma receiving a total of 203 courses of high-dose MTX (3-8 g/m2), 3 cases of acral erythema were observed. Painful erythema of finger and toe pads was noted in three children 3 days to 2 weeks after MTX infusion. The lesions resolved completely after blister formation and desquamation. These patients subsequently received high-dose MTX therapy without cutaneous problems. The present work points out that the chemotherapeutic schedule need not be modified in selected patients who develop acral erythema following high-dose MTX infusion.

Adolescent↗
PubMedDate not supplied

Erythema nodosum induced by kerion celsi of the scalp.

A 5-year-old girl presented with a 2-week history of a sharply demarcated, inflammatory, granulomatous lesion on the right side of her scalp. Shortly afterward, painful, subcutaneous nodules developed on her shins and thighs. Trichophyton mentagrophytes was isolated from the scalp lesion and a diagnosis of erythema nodosum induced by kerion of the scalp was made. The patient was started on oral therapy with 18 mg/kg/day griseofulvin, associated with topical crystal violet. Her erythema nodosum regressed in 10 days, while the kerion healed 6 weeks later, leaving residual scarring alopecia. Erythema nodosum represents a reaction pattern to a wide variety of inflammatory stimuli. The interest of this case lies in the unusual association of kerion erythema nodosum, of which only nine cases have been reported in the international literature.

Antifungal Agents↗
PubMedDate not supplied

Erythema toxicum neonatorum: an immunohistochemical analysis.

Erythema toxicum neonatorum is a benign rash of unknown etiology, present to various degrees in most term newborns and characterized by an accumulation of eosinophils in dermal lesions. The recruitment of leukocytes to tissues implicates the involvement of adhesion molecules, cytokines, and chemokines. We therefore performed immunohistochemistry on punch biopsy specimens from cutaneous lesions of ten 1-day-old infants with erythema toxicum using specific monoclonal antibodies directed against a variety of adhesion molecules, cytokines, chemokines, and cell type-specific membrane markers. Biopsy specimens of noninflamed skin from four matched newborns and four adults served as controls. The immunohistologic features of erythema toxicum in all 10 infants included a strong staining of the adhesion molecule E-selectin in the vessel wall and the presence of numerous inflammatory cells that were identified as dendritic cells (CD1a, CD83, HLA-DR, CD40, and ICAM-1 positive), eosinophils (EG2 positive), neutrophils (CD15 positive), macrophages (CD14, CD68, and Mac387 positive), and E-selectin-expressing cells. Furthermore, the lesions showed a high incidence of the proinflammatory cytokines interleukin (IL)-1alpha and IL-1beta and of the chemokines IL-8 and eotaxin. This immunologic activity was reduced or absent in noninflamed skin from newborn controls and adults. We conclude that there is an accumulation and activation of immune cells in the lesions of erythema toxicum, also present in noninflamed skin of 1-day-old infants, but to a lower level. The physiologic significance of the rash remains to be elucidated.

Adult↗