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PubMed2003

Clinical outcome of erythema migrans after treatment with phenoxymethyl penicillin.

In a 5 y retrospective follow-up study in southern Sweden of 708 adult individuals with erythema migrans as the single manifestation of Lyme borreliosis, the clinical outcome and the antibiotic treatment were studied. 80% were treated with phenoxymethyl penicillin, 15% with doxycycline and 5% with other antibiotics. Phenoxymethyl penicillin and doxycycline were extremely effective: 98 and 94% of the individuals reported complete recovery without complications. Few individuals reported the development of new symptoms following treatment and none developed any late manifestation of Lyme borreliosis during the observation period. Thus, in the area studied the treatment of the early localized manifestation of Lyme borreliosis (erythema migrans) with antibiotics was extremely successful. The current Swedish recommendation to use phenoxymethyl penicillin, when no sign of disseminated infection or coinfection with other tick-borne pathogens is present, seems excellent.

Adolescent↗
PubMed2004

Erythema multiforme minor following vaccination with paediatric vaccines.

We present 2 cases of erythema multiforme following a combined tetanus and diphtheria revaccination and a combined diphtheria, tetanus, acellular pertussis inactivated polio and Haemophillus influenzae type B vaccine respectively, suggesting vaccines containing diphtheria and tetanus toxoids as a potential precipitating factor to erythema multiforme.

Diphtheria-Tetanus-Pertussis Vaccine↗
PubMed2000

Intense pulsed light treatment for chronic facial erythema of systemic lupus erythematosus: a case report.

BACKGROUND: A 33-year-old woman, who had been diagnosed previously with systemic lupus erythematosus, presented with chronic erythema and rosacea of the face. The patient suffered from flushing and burning of the facial skin and sought prior treatment with anti-malarial drugs. METHOD: After various treatment options were discussed with the patient, she agreed to undergo intense pulsed light therapy. RESULTS: Improvement was noted after the first session and 75% clearance was observed at 1 month after a second session. There were no adverse effects associated with the treatment. One year later it was observed that the results of the two treatments had been maintained. CONCLUSION: This case report suggests that there is another safe and efficacious alternative for treatment of chronic erythema and rosacea.

Adult↗
PubMed2006

An outbreak of gastrointestinal illness and erythema nodosum from grated carrots contaminated with Yersinia pseudotuberculosis.

BACKGROUND: Outbreaks of Yersinia pseudotuberculosis infection have been epidemiologically linked to fresh produce, but the bacterium has not been recovered from the food items implicated. In May 2003, a cluster of gastrointestinal illness and erythema nodosum was detected among schoolchildren who had eaten lunches prepared by the same institutional kitchen. METHODS: We conducted a case-control study and trace-back, environmental, and laboratory investigations. Case patients had culture-confirmed Y. pseudotuberculosis O:1 infection, erythema nodosum, or reactive arthritis. Bacterial isolates from clinical and environmental samples were compared using pulsed-field gel electrophoresis (PFGE). RESULTS: Of 7392 persons at risk, 111 (1.5%) met the case definition; 76 case patients and 172 healthy control subjects were enrolled in the case-control study. Only raw grated carrots were significantly associated with illness in a logistic-regression model (multivariable odds ratio, 5.7 [95% confidence interval, 1.7-19.5]); a dose response was found for increasing amount of consumption. Y. pseudotuberculosis O:1 isolates from 39 stool specimens and from 5 (42%) of 12 soil samples that contained carrot residue and were obtained from peeling and washing equipment at the production farm were indistinguishable by PFGE. CONCLUSIONS: Carrots contaminated early in the production process caused a large point-source outbreak. Our findings enable the development of evidence-based strategies to prevent outbreaks of this emerging foodborne pathogen.

Adolescent↗
PubMed1998

Comparison of peripheral and central biopsy sites for the isolation of Borrelia burgdorferi sensu lato from erythema migrans skin lesions.

To compare peripheral and central biopsy sites for the isolation of Borrelia burgdorferi sensu lato from typical erythema migrans lesions, two biopsy specimens (one from the margin and the other from the center of the lesion) were taken from each of 53 adult patients. Thirty-four (32.1%) of the 106 biopsy specimens and 23 (43.4%) of the 53 patients were culture-positive. Spirochetes were isolated in 19 (35.9%) of the 53 central and 15 (28.3%) of the 53 peripheral biopsies (nonsignificant difference). In 8 cases only the central specimen, in 4 cases only the peripheral specimen, and in 11 cases both specimens were positive. In a comparison of 36 annular and 17 homogeneous lesions, borreliae were isolated from 15 (41.7%) of the former and 8 (47.1%) of the latter. In the annular-lesion biopsies, 11 central and 12 peripheral specimens were culture-positive. In the homogeneous-lesion biopsies, eight central and three peripheral specimens were culture-positive (nonsignificant difference); there were no culture-positive results solely for the margin of homogeneous lesions. This study demonstrates that B. burgdorferi sensu lato may be isolated from the central aspect of erythema migrans lesions as efficiently as from the peripheral aspect.

Adult↗
PubMed1997

Localization of the gene causing keratolytic winter erythema to chromosome 8p22-p23, and evidence for a founder effect in South African Afrikaans-speakers.

Keratolytic winter erythema (KWE), also known as "Oudtshoorn skin disease," or "erythrokeratolysis hiemalis," is an autosomal dominant skin disorder of unknown etiology characterized by a cyclical erythema, hyperkeratosis, and recurrent and intermittent peeling of the palms and soles, particularly during winter. Initially KWE was believed to be unique to South Africa, but recently a large pedigree of German origin has been identified. The disorder occurs with a prevalence of 1/7,000 in the South African Afrikaans-speaking Caucasoid population, and this high frequency has been attributed to founder effect. After a number of candidate regions were excluded from linkage to KWE in both the German family and several South African families, a genomewide analysis was embarked on. Linkage to the microsatellite marker D8S550 on chromosome 8p22-p23 was initially observed, with a maximum LOD score (Z(max)) of 9.2 at a maximum recombination fraction (theta(max)) of .0 in the German family. Linkage was also demonstrated in five of the larger South African families, with Z(max) = 7.4 at theta(max) = .02. When haplotypes were constructed, 11 of 14 South African KWE families had the complete "ancestral" haplotype, and 3 demonstrated conservation of parts of this haplotype, supporting the hypothesis of founder effect. The chromosome segregating with the disease in the German family demonstrated a different haplotype, suggesting that these chromosomes do not have a common origin. Recombination events place the KWE gene in a 6-cM interval between D8S550 and D8S552. If it is assumed that there was a single South African founder, a proposed ancestral recombinant suggests that the gene is most likely in a 1-cM interval between D8S550 and D8S265.

Chromosome Mapping↗
PubMed1993

Isolation of Borrelia burgdorferi from skin biopsy specimens of patients with erythema migrans.

Procedures for the cultural isolation and identification of Borrelia burgdorferi from skin biopsy specimens are described. B. burgdorferi was isolated from 24 of 34 skin biopsy specimens from patients with erythema migrans. Eight of the culture-positive patients had single, primary lesions and 16 had multiple, secondary lesions. The 17 male and 7 female patients were 2 to 70 years old. Biopsy samples were obtained from erythematous or normal-appearing skin within 1 cm of the peripheral aspect of the lesion. Twenty-three of the isolates were detected within 8 days of incubation in Barbour-Stoenner-Kelly medium with no antimicrobial agents. The identities of the isolates were determined by reactivity with monoclonal antibodies H9724 and H5332. Cultivation of B. burgdorferi from skin lesions suggestive of erythema migrans is a practical and clinically relevant procedure. Clinical isolates and corresponding patient sera and urine will contribute to efforts to improve existing immunoserologic testing methods and develop new assays to diagnose Lyme borreliosis.

Adult↗
PubMed1995

Persistence of Borrelia burgdorferi sensu lato in resolved erythema migrans lesions.

Erythema migrans skin lesions resulting from a tick bite and infection with Borrelia burgdorferi sensu lato eventually resolve, even without antibiotic therapy. The aim of the present study was to gauge the frequency of persistence of B. burgdorferi sensu lato in such lesions. Thus, the site of a previous lesion was biopsied and cultured in 48 patients: 39 with systemic or localized symptoms/signs and nine with no symptoms. B. burgdorferi sensu lato was isolated from biopsied skin from three symptomatic patients. Cultures of other tissues and fluids were negative. By genospecies-specific polymerase chain reaction (PCR) and pulsed-field gel electrophoretic (PFGE) analysis, two isolates were classified as Borrelia afzelii. The remaining isolate was a member of an unusual group of strains that type as B. burgdorferi sensu stricto by genospecies PCR but possess an atypical PFGE profile. All three patients had a dramatic clinical response to antibiotic treatment. These findings demonstrate the capacity of viable B. burgdorferi sensu lato organisms to persist in clinically normal-appearing skin at the site of a resolved erythema migrans rash for periods ranging from 2 months to 3.5 years. This observation may provide new insight into the organisms' ability to evade the host's immune response.

Adolescent↗
PubMed1992

Erythema migrans: comparison of treatment with azithromycin, doxycycline and phenoxymethylpenicillin.

Azithromycin, doxycycline and phenoxymethylpenicillin were compared in a prospective, randomized study of 64 patients with typical erythema migrans. Twenty patients were treated with oral azithromycin, 250 mg bd for two days followed by 250 mg od for eight days, 21 patients were given phenoxymethylpenicillin 1 million IU tds for 14 days and 23 patients received doxycycline, 100 mg bd for 14 days. All patients were followed up for 24 months. There were no significant differences between the groups with respect to the persistence of cutaneous lesions after starting treatment; the mean durations were 10.5 days in the penicillin group, 8.8 days in the doxycycline group and 8.6 days in the azithromycin group. There were statistically significant differences in terms of the resolution of associated local and/or systemic symptoms. The response time was shortest in patients treated with azithromycin. Two patients who received phenoxymethylpenicillin and two given doxycycline subsequently developed major manifestations of Lyme borreliosis; these did not occur in patients receiving azithromycin. Although azithromycin has been shown to be effective in the treatment of erythema migrans, further studies will be needed to determine the optimal dosage and duration of therapy.

Adolescent↗
PubMed1978

Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector.

Forty-three residents of 12 contiguous Connecticut communities were identified who had the onset of erythema chronicum migrans, Lyme arthritis, or both during the summer and fall of 1977. Nine of them (21%) remembered having been bitten by a tick at the site of the initial skin lesion a median of 12 days (range 3-20) before onset; one patient brought in the tick for identification (Ixodes scapularis). Compared to 64 of their neighbors, significantly more patients had cats and farm animals, and had noted ticks on their pets and tick bites on themselves. The incidence of the illness during 1977 was 2.8 cases per 1000 residents in the three communities on the east side of the Connecticut River, compared to 0.1 cases per 1000 residents in the nine communities on the west side, a difference of almost 30-fold. Taken with the results of a concomitant acarological study on both sides of the river, these findings support the hypothesis that erythema chronicum migrans and Lyme arthritis are tick-transmitted, specifically by I. scapularis.

Adolescent↗
PubMed1997

Neutrophilic figurate erythema of infancy.

We describe a transient figurate erythema in an 11-month-old female infant with a 2-month history of arcuate and annular erythematous lesions localized on the face, trunk, and limbs. Constitutional symptoms were absent. Previous medical history was unremarkable. Full blood examination, erythrocyte sedimentation rate, antistreptolysin-O titer, anti-Ro, and anti-La antibodies were within normal limits or negative. Histologic examination revealed a superficial and deep perivascular and interstitial dermatitis constituted mostly of neutrophils and abundant nuclear dust. The lesions resolved spontaneously within a few months without scarring or atrophy. Recurrence has not occurred. This case suggests that figurate erythemas in infants rarely may disclose a neutrophilic histologic pattern, which must be differentiated from that of other neutrophilic dermatoses.

Antibodies, Antinuclear↗
PubMed1989

Chemotherapy-induced acral erythema: desquamating lesions involving the hands and feet.

Patients receiving very high doses of chemotherapeutic drugs, particularly cytarabine (cytosine arabinoside, ara-C, Cytosar), may develop chemotherapy-induced acral erythema, a painful toxic rash of the palmar surfaces of the hands that progresses to edema, blister formation, and desquamation. In more severe cases, the feet are involved, and they show similar changes. Plastic surgeons may be consulted because of the hand involvement and the clinical resemblance, after desquamation, to a very superficial second-degree burn. In patients who have had bone marrow transplantation, this diagnosis must be distinguished from graft-versus-host reaction--a desquamating skin lesion that can affect a similar anatomical area but that is progressive and productive of serious consequences. Acral erythema appears to be self-limited and requires only supportive treatment.

Adolescent↗
PubMedDate not supplied

Painful red leg nodules and syphilis: a consideration in patients with erythema nodosum-like illness.

An adolescent girl presented with the classical physical findings of painful red nodules on the legs; the lesions were suggestive of erythema nodosum. The usual underlying causes were explored and found to be absent. Because she was sexually active, the patient was also routinely screened for sexually transmitted diseases. A rapid plasma reagin test was performed and found to be strongly positive. The confirmatory fluorescent treponemal antibody test was also positive. A diagnosis of syphilis was made, and she was treated with benzathine penicillin G (2.4 X 10(6) units). This report is a reminder that when a patient is suspected of having erythema nodosum, the physician should check for syphilis as well as for tuberculosis, sarcoidosis, reaction to a drug, and streptococcal disease. Panniculitis can be an important clinical sign of secondary syphilis that should never be overlooked.

Adolescent↗
PubMed2004

Erythema multiforme associated with candesartan cilexetil.

Candesartan cilexetil is an angiotensin II receptor antagonist that is widely used in the treatment of hypertension. It is generally well tolerated and rarely has adverse effects. We report the case of a 50-year-old man with a 3-year history of hypertension that was difficult to manage because of intolerance to multiple medications. Treatment with candesartan cilexetil was initiated, and blood pressure control improved markedly. Five weeks later, the patient presented with a 2 x 3-cm ulcerative plaque covered with a fibrinous exudate on the right upper lip. Findings from a biopsy of the upper lip were diagnostic for erythema multiforme. Treatment with candesartan cilexetil was discontinued, and the lesions resolved completely within a few weeks. To our knowledge, this is the first report of erythema multiforme induced by the antihypertensive medication candesartan cilexetil.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2005

Long-pulsed dye laser treatment for facial telangiectasias and erythema: evaluation of a single purpuric pass versus multiple subpurpuric passes.

BACKGROUND AND OBJECTIVE: Subpurpuric treatments with the pulsed dye laser can be effective for treatment of vascular lesions, although less so than when purpuric fluences are used. Increased efficacy may be achieved by performing multiple passes at the time of treatment. We performed a split-face bilateral paired comparison of multiple low-fluence subpurpuric passes compared with a single high-fluence purpuric pass in the treatment of facial telangiectasias. MATERIALS AND METHODS: Nine patients were included in the study. One cheek was chosen to be treated with four passes of a nonpurpuric fluence, and the contralateral cheek was treated with a single purpuric pass. Reductions in vessel density, diameter, arborization, and background erythema were evaluated 3 weeks after treatment. RESULTS: We found a 43.4% reduction in surface area covered by telangiectasias on the cheek treated with a single purpuric pass compared with 35.9% on the cheek treated with four subpurpuric passes. The purpuric fluences produced greater reduction in vessel diameter and arborization, whereas the subpurpuric protocol was more effective in reducing background erythema. Purpuric fluences were also noted to produce more significant edema and transient hyperpigmentation in one patient. CONCLUSION: The multipass subpurpuric approach to treatment with the pulsed dye laser is both cosmetically acceptable and effective, although purpuric treatments may be required to effectively eliminate larger-caliber, more highly networked vessels.

Erythema↗
PubMed1995

Comparison of melanocytes and keratinocytes in ultraviolet-induced DNA damage per minimum erythema dose sunlight: applicability of ultraviolet action spectra for risk estimates.

Action spectra are being used in risk estimates for ultraviolet (UV) damage. The purpose of our investigation was to compare the susceptibility of cultured melanocytes and keratinocytes to UV-induced DNA damage per minimum erythema dose (MED) and to determine whether the predictions made with action spectra agree with the damage actually induced. Genetic damage was measured as the number of T4-endonuclease V-sensitive sites (ESS). Predictions made with the action spectrum for the induction of DNA damage in melanocytes after irradiation with sunlight and a solar simulator were 15.9 and 13.2 ESS per 10(8) daltons per MED, respectively; with the action spectrum for the induction of DNA damage in keratinocytes the predictions were 12.1 and 9.8 ESS per 10(8) daltons per MED, respectively. To determine the actual damage per MED, cultured cells were irradiated with sunlight or a solar simulator, and MED was determined with an erythema UV meter. The induction of DNA damage in melanocytes after sunlight and solar simulator irradiation was 8.01 and 6.7 ESS per 10(8) daltons per MED, respectively, and in keratinocytes 7.49 and 7.12 ESS per 10(8) daltons per MED, respectively. This was considered to be in agreement with the predicted data. The use of action spectra for risk estimates in melanocytes appears justified.

Animals↗