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PubMed2002

Solitary erythema migrans in children: comparison of treatment with azithromycin and phenoxymethylpenicillin.

OBJECTIVE: To compare clinical effectiveness and side effects of treatment with azithromycin or phenoxymethylpenicillin in children with solitary erythema migrans. METHODS: Consecutive patients younger than 15 years, referred to our institution in 1998 and 1999 with previously untreated typical solitary erythema migrans, were included in this prospective study. Basic demographic features and clinical data were collected by means of a questionnaire. The efficiency of treatment of acute disease, development of later major and/or minor manifestations of Lyme borreliosis and side effects of treatment were surveyed by follow-up visits during the first year. RESULTS: Forty-two patients received azithromycin 20 mg/kg/day for the first day followed by 10 mg/kg/day for a further four days and phenoxymethylpenicillin 100,000 IU/kg/day for 14 days. No differences in demographic and clinical pre-treatment characteristics were present in the two groups, with the exception of the duration of erythema migrans before treatment (3 days in the azithromycin group versus 4 days in the phenoxymethylpenicillin group; p = 0.0320). The clinical course during the post-treatment period revealed no significant differences between the two groups in the duration of EM (3 days versus 4 days; p = 0.2471), the appearance of minor manifestations of Lyme borreliosis (17.5% in the azithromycin group versus 24.4% in the phenoxymethyl-penicillin group; p = 0.6252), or in the emergence of major manifestations of Lyme borreliosis (one patient in each treatment group). One year after antibiotic treatment all patients were asymptomatic. Side effects of treatment were observed in 5.3% of patients treated with azithromycin and in 6% treated with phenoxymethylpenicillin. The appearance of "Herxheimer's reaction" at the beginning of treatment was recorded in 7 out of 42 patients (6%) in each treatment group. CONCLUSIONS: Azithromycin and phenoxymethylpenicillin are equally effective in treatment of children with solitary erythema migrans and have comparable side effects.

Adolescent↗
PubMed2002

Children with multiple erythema migrans: are there any pre-treatment symptoms and/or signs suggestive for central nervous system involvement?

OBJECTIVE: To establish eventual signs and symptoms suggestive for central nervous system involvement in children with multiple erythema migrans. METHODS: Patients younger than 15 years with multiple erythema migrans, diagnosed at our department from 1996 to 2000, were included in this prospective study. Demographic, clinical and laboratory findings were obtained and compared for a group of patients with pleocytosis (interpreted as a sign of central nervous system involvement) and a group of children with normal cerebrospinal fluid findings. RESULTS: Cerebrospinal fluid pleocytosis (cell counts > or = 5 x 10(6)/l) was detected in 55/214 (25.7%) children; it was lymphocytic in 94.5% of patients and ranged from 5 to 320 (median, 10 x 10(6)/l). Compared with the group with normal cerebrospinal fluid findings, patients with pleocytosis more often reported having had Lyme borreliosis in the past (8/55 versus 3/159; p = 0.0011), had longer incubation periods (25.5 versus 14 days; p = 0.0269), larger diameter of the largest erythema migrans at the time of first examination (10 versus 5.5 cm; p = 0.0055), higher frequency of associated systemic symptoms (45.5% versus 21.4%; p = 0.0011), positive meningeal signs (10.9% versus 1.9%; p = 0.0100), borrelial IgG antibodies in cerebrospinal fluid (3/49 versus 0/150; p = 0.0142) and B. burgdorferi s.l. isolated from cerebrospinal fluid (7/52 versus 1/147; p = 0.0004), but less often had mild initial disease (67.3% versus 88.7%; p = 0.0006). CONCLUSIONS: Cerebrospinal fluid pleocytosis was detected in 25.7% of children with multiple erythema migrans. Although several clinical and laboratory abnormalities were present significantly more often in patients with elevated cell counts than with normal cerebrospinal fluid findings, discriminatory significance for the majority of these abnormalities was low, particularly because of low negative predictive values. In more than 2/3 of patients with pleocytosis the initial disease was mild, fewer than 1/2 reported systemic symptoms, and meningeal signs were expressed in only 11%.

Adolescent↗
PubMed1975

Suprofen, a potent antagonist of ultraviolet-erythema in guinea-pigs.

A standardized ultraviolet erythema test in guinea-pigs is described in detail. The erythema reaction to 120 sec of UV irradiation was assessed after 1, 2 and 4 h. A direct quantitative comparison of the anti-erythema effect was made between phenylbutazone, indometacin, tolmetin, ketoprofen and alpha-methyl-4-(2-thienylcarbonyl)benzeneacetic acid (suprofen) in a specially designed experiment. All compounds were given by oral gavage 1 h before irradiation. Among the compounds studied suprofen was the most potent antagonist of ultraviolet-induced erythema in guinea-pigs, i.e. about 45 times tolmetin, 25 times phenylbutazone, 10 times indometacin and 5 times ketoprofen activity.

Animals↗
PubMed2003

Methotrexate-induced acral erythema with bullous reaction.

Chemotherapy-induced acral erythema (CIAE), a toxic reaction to a number of different chomotherapeutic agents, causes a symmetrical, painful erythema of both the palms and soles which is self-limiting. The association of this syndrome with methotrexate is unusual; only nine cases have been reported in the literature. We describe the tenth case of this syndrome associated with methotrexate, which is also the third case of the bullous variant of methotrexate-induced acral erythema. Our case is unusual in that the acral erythema was present only on the soles of the feet and in that it was associated with the presence of diffuse maculopapular lesions over the legs and trunk.

Adolescent↗
PubMed2003

Annular erythema responding to tacrolimus ointment.

Annular erythema is an unusual, often idiopathic disorder that tends to respond poorly to topical therapy. Two patients with idiopathic, topical corticosteroid-resistant annular erythema showed prompt clearing of lesions treated with 0.1% tacrolimus ointment and persistence of untreated ones which themselves responded to subsequent treatment. These two cases demonstrate a clear-cut therapeutic response of chronic, topical corticosteroid-resistant annular erythema to topical tacrolimus ointment 0.1% BID. Additional experience with tacrolimus ointment, hopefully in controlled circumstances, should clarify its potential value in treating annular erythema.

Adult↗
PubMed1992

Vesicular erythema migrans.

BACKGROUND: Lyme disease is the most common vector-borne disease in the United States. The characteristic rash, erythema migrans, is an early sign of the disease. Clinical criteria remain the "gold standard" for diagnosis at this stage of illness. OBSERVATIONS: Five (8%) of 65 patients with erythema migrans seen in a Lyme disease diagnostic center in Westchester County, New York, had a lesion with vesicles. Borrelia burgdorferi was cultured from two of five. In one case the positive culture came from a swab of the blister fluid. CONCLUSIONS: Recognition of erythema migrans and its variants is important, since early treatment of Lyme disease may prevent late complications. Vesicular erythema migrans should be added to the differential diagnosis of inflammatory vesicular rashes in the appropriate clinical setting.

Adolescent↗
PubMed1992

The influence of pigmentation and illumination on the perception of erythema.

The visual assessment of erythema induced by ultraviolet radiation (UVR) involves a comparison of the irradiated site with surrounding nonirradiated skin. By viewing the skin through plastic filters of varying shades of brown to simulate different degrees of pigmentation and under either incandescent or fluorescent lighting, we were able to examine the influence of pigmentation and illumination on the perception of erythema. Illuminating the skin with either light source at the same illuminance did not affect the determination of the minimal erythema dose (MED). Likewise, the range of pigmentation that may occur in Caucasian skin had little or no effect on the perception of the MED compared with white, untanned skin. However, when the skin was viewed through dark brown filters that approximate the absorbance of Negro skin, erythema was only perceived at sites that had been irradiated with more than about twice the MED.

Erythema↗
PubMed1992

Use of a novel technique of cutaneous lavage for diagnosis of Lyme disease associated with erythema migrans.

OBJECTIVE: Determining the microbial cause of cellulitis is often difficult. In this study, a novel two-needle lavage technique was used to culture Borrelia burgdorferi from the skin of suspected erythema migrans lesions. DESIGN: The yield of lavage cultures for B burgdorferi was compared with that of a 2-mm skin biopsy sample. SETTING: A Lyme disease diagnostic center located in an area in which Lyme disease is epidemic. PATIENTS: Forty-five patients with suspected erythema migrans who had not been treated with antimicrobial agents. INTERVENTION: Cutaneous lavage of the advancing edge of a suspected primary erythema migrans lesion was done for all 45 participants, 33 of whom also had a skin biopsy of the same lesion at an identical (14) or an adjacent (19) site. MAIN OUTCOME MEASURES: Growth of B burgdorferi in in vitro culture. RESULTS: Lavage fluid cultures grew B burgdorferi in 13 (29%) of the 45 cases (95% confidence interval [CI], 16% to 44%). Among the 33 cases in which both lavage and skin biopsy cultures were done, the yield of lavage culture was less than that of biopsy culture (P less than .09, 12/33 vs 20/33). If contaminated cultures are excluded, this difference is significant (P less than .05, 12/30 vs 20/27). CONCLUSION: Cutaneous lavage is a new diagnostic technique for recovery of B burgdorferi from erythema migrans lesions that has potential applicability to other types of cutaneous infections.

Biopsy↗
PubMed1992

Necrolytic migratory erythema: unresolved problems in diagnosis and pathogenesis. A case report and literature review.

Necrolytic migratory erythema is a distinctive cutaneous eruption that occurs in patients with malignant glucagon-secreting tumors of the pancreas. Recognition of this erosive dermatitis as a cutaneous manifestation of an internal malignancy can result in tumor detection and surgical removal prior to metastasis. The case history of a forty-year-old diabetic woman with necrolytic migratory erythema associated with a metastatic glucagon-secreting islet cell tumor of the pancreas is presented. Prior to diagnosis, she had been treated with topical steroids and Mycostatin powder for a recurrent perioral, acral, and intertriginous dermatitis. Because of apparent responsiveness to these medications, the diagnosis of necrolytic migratory erythema was not considered, and the diagnosis of pancreatic carcinoma was delayed for over one year. Wider recognition of the distinctive clinical and histopathologic features of necrolytic migratory erythema should result in earlier detection and possible surgical cure of the associated glucagonoma.

Adult↗
PubMedDate not supplied

Necrolytic migratory erythema with myelodysplastic syndrome without glucagonoma.

Necrolytic migratory erythema is a cutaneous paraneoplastic manifestation, which is usually associated with a glucagon-secreting pancreatic tumor. However, it also may occur in other circumstances in which serum glucagon is elevated, as in hepatic cirrhosis. Rarely, necrolytic migratory erythema is reported in association with a jejunal and rectal adenocarcinoma or villous atrophy of the small intestine without any evidence for increased serum glucagon levels. In this context we report the case of an 85-year-old male with myelodysplastic syndrome who developed typical necrolytic migratory erythema without glucagonoma syndrome or evidence for other pancreatic or liver disease. We suggest that, in addition to the diseases listed, myelodysplastic syndrome might be able to cause necrolytic migratory erythema.

Aged↗
PubMed1992

Concurrent Sweet's syndrome and erythema nodosum: a report, world literature review and mechanism of pathogenesis.

Sweet's syndrome (acute febrile neutrophilic dermatosis) and erythema nodosum are reactive dermatoses whose pathogenesis is currently undefined. Although there are several associated conditions that both of these disorders have in common, the appearance of Sweet's syndrome and erythema nodosum in the same person is rare. Only 8 individuals with biopsy confirmed lesions of both dermatoses were described in the world literature. We describe a 30-year-old woman with biopsy confirmed lesions of Sweet's syndrome on her hand and erythema nodosum on her legs. She had been taking an oral contraceptive and an appetite suppressant during the 5 months before these dermatoses appeared. Both cutaneous lesions rapidly responded to topical corticosteroid ointment and have not recurred since her medications were discontinued. The association of Sweet's syndrome and erythema nodosum is reviewed, their similarities discussed, and a pathogenesis is proposed.

Adult↗
PubMed2006

Gyrate erythema associated with metastatic tumor of gastrointestinal tract.

Figurate or gyrate erythemas are group of skin conditions that present as annular or figurate erythematous papules and plaques with peripheral spreading. Several diseases are included in this group but only two of them are associated with underlying malignancy, erythema annulare centrifugum and erythema gyratum repens. We present a 58-year-old woman with simultaneous presentation of gyrate erythema and skin metastasis from a gastrointestinal tumor that was diagnosed by histopathology and immunohistochemistry as a leiomyogenic gastrointestinal stromal tumor.

Carcinoma↗
PubMed1989

Meclofenomate inhibition of UV-induced erythema--a randomized, placebo-controlled, double-blind study.

Systemic intradermal and topical inhibitors of eicosanoid synthesis have been shown to decrease the intensity delay the onset of erythema produced with a single exposure to ultraviolet (UV) light. We studied the effect of single and multiple doses of meclofenomate on erythema induced by single and multiple doses of UV light. Thirty Caucasian subjects took either meclofenomate 100 mg t.i.d. or matching placebo for 5 days, crossing over to the alternative for 5 more days after a 2-day washout period. A statistical analysis was made of erythema response immediately prior to the study and then on 8 successive days during the study. Analysis of single and multiple exposure data revealed a statistically significant inhibition of erythema from meclofenomate therapy as compared with placebo.

Adult↗
PubMed1989

Annular erythema in identical twins.

A case of superficial gyrate erythema that was indistinguishable from erythema annulare centrifugum occurred in identical twins. We propose to include a familial cause among the known causes of erythema annulare centrifugum rather than considering this a separate entity, "familial annular erythema."

Biopsy↗
PubMed1986

Toxic erythema of palms and soles associated with high-dose mercaptopurine chemotherapy.

We encountered a case of distinctive palmar-plantar erythema with desquamation of the fingers in a patient receiving high-dose mercaptopurine combined with allopurinol. He was receiving 400 mg/d of mercaptopurine with 200 mg/d of allopurinol when a painful, livid erythema involving his hands and feet developed. Over the ensuing 24 hours, desquamation of the distal fingertips was noted. The mercaptopurine was discontinued and the patient was treated with topical fluocinonide ointment under occlusion. Over the next 96 hours, the erythema and pain resolved entirely. To date, this is the eighth case of a painful desquamating erythema of the palms and soles occurring as a complication of chemotherapy. We suggest that high-dose mercaptopurine combined with allopurinol that blocks xanthine oxidase, a necessary enzyme in the catabolism of mercaptopurine, was responsible for our patient's clinical presentation.

Adult↗
PubMed1985

[Infrared erythema].

This article deals with the immediate effect of infra-red (IR) irradiation on human skin. The cutaneous response to IR significantly differed from that to polychromatic UV rays. The IR erythema showed a reticular pattern and was monophasic. Minimal erythema (ME) appeared without latency and faded a few minutes later. Induction of IR-ME required a radiation doses about 15,000 times higher (187-295 J/m2) than was needed for UVB erythema. The maximum erythema also occurred immediately after exposure to IR and faded away within one to four hours. The response was biphasic in only one of 28 test persons. Histological studies revealed dilated vessels and perivascular accumulation of degranulated mast cells.

Adult↗
PubMed1979

Dissociation of erythema and basophil accumulation in Jones-Mote type hypersensitivity in the guinea-pig.

Relationship between delayed-in-onset erythema and infiltrating leucocytes in the skin reaction site of Jones-Mote type hypersensitivity was observed in guinea-pigs. Guinea-pigs were immunized with formalin-fixed (F-SRBC) or native form (N-SRBC) of sheep red blood cells in incomplete Freund's adjuvant (IFA). Elicitation was carried out with intradermal injection of F-SRBC or N-SRBC in saline 1 or 3 weeks after immunization. One week after immunization with F-SRBC or N-SRBC in IFA, erythema accompanied by basophil infiltration was detected, but antibody production was negative. Erythema reached a peak at 24 h, but basophil infiltration reached a peak at 48 h or later. In the skin reaction site elicited with N-SRBC, high levels of basophil infiltration were detected persistently even after erythema had disappeared. Three weeks after immunization, low titres of PCA (passive cutaneous anaphylaxis) were detected in guinea-pigs immunized with F-SRBC in IFA. At that time erythematous skin reaction was detected, but the level of basophil infiltration was lower than that of 1 week after immunization. In guinea-pigs immunized with N-SRBC in IFA, skin reaction of the Arthus type accompanied by haemorrhage was observed at the site elicited with N-SRBC.

Animals↗
PubMed1984

[Erythema nodosum and Crohn's disease].

Erythema nodosum was found on 11 out of 106 patients with Crohn's disease (10.4%), being the most common skin complication after the perianal ones. Women were affected more often than men (2.7:1) and most of the patients were above 15 and below 40 years of age. Patients with ileocolic lesions were more often affected than those with lesions confined to the small bowel. No cases of erythema nodosum were found in association with granulomatous colitis, as opposed to other authors experience. The eruption was usually related to the periods of active inflammatory bowel disease but not to the administration of salazopyrine. The morphology and evolution of the lesions was typical of erythema nodosum and joint involvement was almost constant. The differential diagnosis with other nodular eruptions that can occur in association with Crohn's disease are discussed and hypothetical common etiopathogenic factors to both Crohn's disease and erythema nodosum are briefly considered. The relevant literature is reviewed and commented upon.

Adolescent↗