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Necrolytic migratory erythema, presenting as candidiasis, due to a pancreatic glucagonoma.

A 54-year-old male with diabetes, weight loss, glossitis and Candidiasis presented with the typical cutaneous eruption of necrolytic migratory erythema. The suspicion of pancreatic glucagonoma was confirmed by an elevated plasma glucagon level. Surgical removal of the pancreatic alpha cell tumor resulted in a complete disappearance of all symptoms. The importance of the recognition of the skin eruption of necrolytic migratory erythema as a clue to the presence of pancreatic glucagonoma is emphasized.

Candidiasis↗

Erythema gyratum repens. A cutaneous marker of malignancy.

A patient with erythema gyratum repens in whom a bronchogenic carcinoma was found is described. Erythema gyratum repens is a cutaneous eruption with a unique morphology resembling a wood grain pattern. Its presence is almost always associated with serious systemic pathology, usually neoplastic, and thus should be considered a cutaneous marker of internal malignancy.

Aged↗

Effect of oral administration ofHypericum perforatum extract (St. John's Wort) on skin erythema and pigmentation induced by UVB, UVA, visible light and solar simulated radiation.

Hypericin from St John's wort (Hypericum perforatum L.) is a photosensitizing agent that may cause a severe photodermatitis when higher amounts of St John's wort are ingested by animals. Although Hypericum extracts are widely used in the treatment of depressive disorders, only a little information on the photosensitizing capacity of St John's wort in humans is available. In the present prospective randomized study we investigated the effect of the Hypericum extract LI 160 on skin sensitivity to ultraviolet B (UVB), ultraviolet A (UVA), visible light (VIS) and solar simulated radiation (SIM). Seventy two volunteers of skin types II and III were included and were divided into six groups, each consisting of 12 volunteers. In the single-dose study the volunteers (n = 48) received 6 or 12 coated tablets (5400 or 10 800 microgram hypericin). In the steady-state study the volunteers (n = 24) received an initial dose of 6 tablets (5400 microgram hypericin), and subsequently 3 x 1 tablets (2700 microgram hypericin) per day for 7 days. Phototesting was performed on the volar forearms prior to medication and 6 h after the last administration of Hypericum extract. The erythema-index and melanin-index were evaluated photometrically using a mexameter. After both single-dose and steady-state administration, no significant influence on the erythema-index or melanin-index could be detected, with the exception of a marginal influence on UVB induced pigmentation (p = 0.0471) in the single-dose study. The results do not provide evidence for a phototoxic potential of the Hypericum extract LI 160 in humans when administered orally in typical clinical doses up to 1800 mg daily. This is in accordance with previous pharmacokinetic studies that found hypericin serum and skin levels after oral ingestion of Hypericum extract always to be lower than the assumed phototoxic hypericin threshold level of 1000 ng/mL.

Administration, Oral↗

Influence of phospholipid liposomes (PLL) on UVB-induced erythema formation.

Application of liposomal phospholipids (Natipide II) caused a significant decrease in erythema induced by UVB (280-312 mm) in patients with skin types II and III (n = 31). In accordance with findings in other organs, e.g. liver, the present findings suggest that phospholipids are capable of reducing H2O2 formation and/or increasing glutathione synthesis in human skin, thus reducing erythema formation by preventing oxidative stress.

Adult↗

Modification of experimental UV erythema by external steroids--a reflex photometric study.

A method for reflex photometric detection of the modification of a model of inflammation (UV erythema) by external corticoids is presented. The steroids which most effectively suppress erythema formation are those which have the strongest vasoconstrictor potency also on unchanged skin. A tachyphylaxis phenomenon can also be demonstrated after several applications of a synthetic steroid to the inflammation model.

Adrenal Cortex Hormones↗

Measurements of the annual variation of the erythema dose of global radiation.

The share of erythema dose of global radiation (Der/G) shows significant diurnal and annual variations. This is the result of the dependence of the ratio Der/G on optical air mass. Maximum values of Der/G are found at times of low optical air mass, i.e., at noon and in summer, minimum values at sunrise and sunset hours as well as in winter. Another reason for the annual variation of the ratio Der/G is the changing amount of total atmospheric ozone. Therefore values of Der/G in fall are about 50% higher than in spring despite the same solar declination. Comparing measurements of erythema dose at two stations with different altitudes, a difference of 14% per 1,000 m is obtained.

Erythema↗

Reinfection in erythema migrans disease.

Two patients received oral penicillin for erythema migrans disease (EMD) in 1973 and 1977. Five and seven years later, respectively, they developed EMD for a second time after being bitten by ticks. The first and second erythema migrans lesions appeared in different places. Tests of sera evaluated for antibodies to Borrelia burgdorferi before (in one case), during and after the second episode of EMD remained negative (patient 1) or yielded an at least four-fold rise of IgG antibody titers, but did not become positive (patient 2). These cases provide evidence that reinfection in EMD may occur without a significant elevation of specific antibody titers.

Bites and Stings↗

Azithromycin and doxycycline for treatment of Borrelia culture-positive erythema migrans.

Adult patients with typical solitary erythema migrans, participating in prospective therapeutic studies on early Lyme borreliosis at the Lyme borreliosis Outpatient's Clinic, University Department of Infectious Diseases in Ljubljana, in 1991 to 1993, and followed up for 1 year, were included in the study. Only patients who were treated with azithromycin or doxycycline and in whom Borrelia burgdorferi was isolated from the border of the skin lesion prior to institution of antibiotic treatment were selected for presentation in this report. Fifty-eight patients received azithromycin (500 mg twice daily for the first day, followed by 500 mg once daily for 4 days) and 42 patients received doxycycline (100 mg twice daily for 14 days). The median duration of skin lesions after the beginning of treatment was 6.5 (2-30) days in the azithromycin group and 8 (2-35) days in the doxycycline group (non-significant difference). During the follow-up of 12 months one patient in each group developed major later manifestations of Lyme borreliosis and in 19 patients minor manifestations appeared: in nine (15.5%) treated with azithromycin and in ten (23.8%) receiving doxycycline. In one patient in the azithromycin group and in one patient in the doxycycline group B. burgdorferi was isolated from normal appearing skin at the site of previous erythema migrans 2 months after the institution of antibiotic therapy. Five (8.6%) patients receiving azithromycin and nine (21.4%) patients receiving doxycycline reported mild to moderate gastrointestinal discomfort. In addition, five patients treated with doxycycline developed photosensitivity.

Adult↗

Erythema migrans: three weeks treatment for prevention of late Lyme borreliosis.

An open, randomized, prospective study was carried out to compare the clinical efficacy and safety of phenoxymethylpenicillin with that of minocycline in the treatment of erythema migrans. Sixty patients (minocycline 30, penicillin 30) were enrolled in the study. The two groups of patients were statistically homogeneous regarding age and sex distribution. IgG and IgM antibodies against Borrelia burgdorferi were determined by ELISA before and after treatment and 1 year thereafter. Thirty-nine patients completed the study. All these patients (penicillin 21, minocycline 18) who received a 21-day course of treatment were free of clinical symptoms of late Lyme borreliosis after 1 year. Serum antibodies against B. burgdorferi could be detected before treatment in 6/21 patients treated with penicillin and 3/18 patients treated with minocycline. After 1 year 8/39 patients were seropositive without any evidence of ongoing disease. In the remaining 21 patients treatment could not be completed with the initial antibiotic due to side effects (penicillin 9/30, minocycline 12/30). One patient, who stopped penicillin treatment at day 14 and one patient who stopped minocycline at day 4, developed fatigue and memory impairment within the observation period. A 3-week course of treatment with penicillin or minocycline is equally effective in treating patients with erythema migrans and preventing late symptoms of Lyme borreliosis.

Adult↗

Erythema nodosum and giardia intestinalis.

We present the first report of erythema nodosum occurring in a woman with an intestinal infection due to giardia lamblia, an association not previously described. The authors suggest the possible role of giardia infection in the pathogenesis of erythema nodosum.

Adult↗

[Sweet syndrome and erythema nodosum in ulcerative colitis, refractory to steroids: successful treatment with tacrolimus].

BACKGROUND: Inflammatory bowel disease is accompanied by cutaneous manifestations in about 10% of cases. Erythema nodosum and pyoderma gangraenosum are most frequently observed, which often subside on treatment of the underlying disease. CASE REPORT: A 30-year-old male with a history of long-standing ulcerative colitis experienced an acute attack despite treatment with azathioprine. Further he noticed dull red, elevated and tender maculae on the forelegs. A disseminated and papulosquamous exanthema arose on the back of the trunk and the upper extremities without pruritus. Well-being was compromised and blood sampling revealed an inflammatory response. High-dose steroids with antibiotics were without benefit until they were combined with tacrolimus, an immunosuppressive agent acting similar to ciclosporin. Remission occurred rapidly and the skin lesions resolved. Six months later the patient is currently still in remission and developed no signs of recurrent exanthema. CONCLUSION: The cutaneous lesions are thought to be related to ulcerative colitis and were classified as erythema nodosum and Sweet syndrome. This is the first report on the successful use of tacrolimus in steroid-refractory ulcerative colitis with extraintestinal cutaneous involvement.

Adult↗

[Persistent erythema and edema of the face associated with rosacea and lymph vessel dysplasia].

A 24-year-old woman with lymph vessel dysplasia had experienced a progressive edema of her legs since her second year of life and progressive facial edema for the past year. She also had telangiectasias and papules on the background of a diffuse erythema as well as marked seborrhea on her face. Histopathological examination of a representative facial lesion revealed a granulomatous dermatitis with periadnexal distribution mainly consisting of lymphocytes and histiocytes. In addition, there was a moderate fibrosis of the dermis with numerous mast cells. By duplex ultrasound, a diagnosis of a massive edema of the legs without evidence for chronic venous insufficiency was made. The clinical and histopathological findings were consistent with solid persistent erythema and edema of the face associated with rosacea and lymph vessel dysplasia. The chronic course, absence of serological abnormalities and nonspecific histopathological features as well as resistance to therapy are the most important diagnostic criteria of this disease also known as Morbihan's disease.

Adult↗

[Palpable migratory acriform erythema and lymphocytic infiltration of the skin--different presentations of the same entity?].

Palpable arciform migratory erythema of Clark (PAME) has been described as a rare member in the group of T-cell pseudolymphoma. The clinical picture of infiltrated annular erythema developing into large migrating lesions with the trunk as predilection site is distinctive from other pseudolymphomas. Because of the very similar histology and immunohistochemistry in comparison to the more frequent lymphocytic infiltration of the skin of Jessner and Kanof (LIS) doubts have been raised about the existence of PAME as an unique entity. A 46-year old patient presented with the typical picture of PAME on his trunk while showing typical lesions of LIS on his neck and face. Both diseases showed synchronous intermittent remissions in response to different therapeutic modalities. Multiple biopsies were subsequently performed and histological, immunohistochemical and molecular biological examinations did not reveal relevant differences between PAME and LIS in this patient. We conclude that the findings in this key case suggest that the T-cell pseudolymphoma PAME is not an unique entity, but a special clinical presentation of LIS.

Cell Movement↗

[Squamous epithelial carcinoma in erythema ab igne].

Erythema ab igne (EAI) is a red-brown net-like hyperpigmentation due to repetitive exposure to submaximal heat over a long period of time. This rash is typically seen on the anterior lower legs of people who sit in front of open fireplaces or coal stoves and on the trunk of patients with chronic disorders who seek pain relief by long-term use of hot-water bottles or heating pads. EAI can not only be a diagnostic sign for underlying internal diseases including malignant tumors but can also give rise to cutaneous malignancies. We report on a 75-year-old female patient who developed several thermal keratoses and squamous cell carcinomas at the site of erythema ab igne caused by chronic heat exposure over several years.

Abdominal Neoplasms↗

[Chemotherapy-induced erythema nodosum leprosum: successful treatment with thalidomide].

The severity and outcome of a chronic granulomatous infection caused by M. leprae depend on the cell-mediated immunity towards the pathogen. The disease classification is based on the host's response to M. leprae ranging from high to low resistance (polar tuberculoid leprosy to polar lepromatous leprosy). The host's position in the spectrum is not stable; leprosy reactions reflecting changed immune status may occur spontaneously or during chemotherapy. The type II reaction or erythema nodosum leprosum can most often be seen in patients with lepromatous leprosy, a multiorgan disease characterized by an unrestricted bacillary replication. Clinically, this reaction is characterized by crops of painful bright pink, dermal and subcutaneous nodules arising in clinically normal skin, in association with fever, malaise, glomerulonephritis and arthralgias. Therefore, prompt institution of immunosuppressive therapy with corticosteroids or thalidomide is recommended. This case report describes the development of erythema nodosum leprosum during chemotherapy treated successfully with thalidomide. Furthermore, immunologic effects and potential side effects of this drug are discussed.

Adult↗

Late-onset erythema along a sterile functioning ventriculoperitoneal shunt: case report and review of the literature.

CASE REPORT: A 6-year-old boy presented with erythema along the tract of his ventriculoperitoneal shunt 6 years after its insertion; there was no associated CSF infection or shunt malfunction. DISCUSSION: The question of what to do in such a situation is addressed. The possible causes of the erythema are discussed, as well as its management, and the literature is reviewed.

Brain↗

Arthritis associated with recurrent erythema multiforme responding to oral acyclovir.

Erythema multiforme is a skin condition frequently associated with herpes simplex virus and has a tendency to recur. Oral acyclovir has been successful in suppression of the disease. Here we report a patient who had recurrent erythema multiforme associated with recurrent polyarthritis that responded to oral acyclovir suppression therapy.

Acyclovir↗