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At least 739 records · Page 41Linked to original sources
PubMed1992

Elephantiasis nostras verrucosa: beneficial effect of oral etretinate therapy.

Elephantiasis nostras verrucosa is characterized by chronic secondary, non-filarial lymphoedema due to recurrent lymphangitis, dermal fibrosis, and epidermal changes consisting of hyperkeratotic, verrucous and papillomatous lesions. Histologically, there is pseudoepitheliomatous hyperplasia. Therapeutic efforts should aim to reduce lymph stasis, which will also lead to improvement of the cutaneous changes. In this study, rapid disappearance of the hyperkeratotic and verrucous lesions, remarkable flattening of the papillomatous nodules and improvement of lymphoedema occurred in three obese patients treated with etretinate in an initial dose of 0.6-0.75 mg/kg/day for 4-6 weeks. Monitoring of plasma concentrations of etretinate, acitretin and 13-cis-acitretin by HPLC revealed sufficient short-time absorption (4 h) and bioavailability of the drug (30 days; two out of three patients). Long-term maintenance therapy in one patient produced a remarkable improvement in the lymphoedema; another patient relapsed after discontinuation of the etretinate and responded again after this was reintroduced. In the third patient treatment was withdrawn because of an increase in triglycerides, but improvement persisted 6 months later. The clinical side-effects of oral retinoid therapy were moderate and well tolerated.

Administration, Oral↗
PubMed1993

Annular vasculitis associated with pregnancy.

A 29-year-old woman presented in the 31st week of pregnancy with an unusual bilateral, erythematous eruption on the posterior calves, which clinically resembled erythema annulare centrifugum. A biopsy showed features of a mild leucocytoclastic vasculitis. Within 2 days of delivery the rash had almost resolved, suggesting that its activity was related to the pregnancy. The diagnosis is consistent with 'annular vasculitis', which we suggest represents a distinct variant of leucocytoclastic vasculitis, and a distinct clinicopathological entity. We are not aware of any previous reports of an association between annular vasculitis and pregnancy.

Adult↗
PubMed1993

Reticulate purpura, cryoglobulinaemia and livedo reticularis.

Two patients with type I cryoglobulinaemia are described, both of whom presented with purpura in a reticulate distribution on the legs, resembling the pattern of physiological livedo. It appeared that increased cooling due to sluggish blood flow in areas of the skin corresponding to the blue areas of physiological livedo may have caused the localization of cryoprecipitate at these sites. To investigate the pathogenesis of the net-like pattern of purpura, three subjects with physiological livedo reticularis of the thighs were studied with a laser-Doppler velocimeter. In two subjects, mean blood flux in the blue areas was 21% (P < 0.01) and 26% (P < 0.02) lower than in adjacent white areas, whereas in the third there was no significant difference. The cutaneous features of cryoglobulinaemia, and the mechanism of the reticulate purpura in this condition, are discussed.

Aged↗
PubMed1994

Body site distribution of Bowen's disease.

Several studies of Bowen's disease suggest that most lesions occur on the head and neck, a finding which does not concur with observations in clinical practice in the U.K. In order to test the hypothesis that this reported distribution is due to an increased tendency of physicians to submit lesions of Bowen's disease occurring at these sites for histopathological examination, in comparison with lesions at other body sites, 52 cases of Bowen's disease identified from out-patient clinic diagnostic records were compared with 56 cases derived from pathology records. In both groups, the majority of lesions were on the lower leg; a greater number in the clinical cases group (45/52; 87%) than in the pathology cases (26/56;46%). The lower leg lesions were almost exclusively in women (96% of lower leg lesions occurred in women in each group). The pathology group contained more men (29%) than the clinical group (12%), and also more upper limb lesions (23% compared with 8% in the clinical group). There was no evidence that these differences were due to incorrect clinical diagnosis, and the likely explanation is that lesions diagnosed as Bowen's disease in men, or at sites other than the lower leg, are more likely to be biopsied than clinically typical lesions on the female lower leg. This type of bias is likely to affect larger series in which only biopsied cases are included, and may explain the discrepancy between observations reported in previous publications and the situation in routine clinical practice.

Aged↗
PubMed1994

Skin fibroblast activity in pretibial myxoedema and the effect of octreotide (Sandostatin) in vitro.

The accumulation of glycosaminoglycans in the skin in pretibial myxoedema appears to be a response by local fibroblasts to a stimulating factor in the patient's serum, but the identity of the factor, its ability to stimulate skin fibroblasts as opposed to cultured thyroid cells, and the specificity of its effect to pretibial skin fibroblasts, are all controversial. We have studied fibroblasts cultured from the lesional skin of two women with pretibial myxoedema, and compared their proliferation and secretion of glycosaminoglycans with those of fibroblasts from the patients' forearms and from the forearm skin of two normal subjects. We found that in the presence of the patients' sera all six lines of fibroblasts secreted more glycosaminoglycans [205 +/- 21% (SD)] than with normal human sera (147 +/- 19%), or fetal calf serum (100%). Fibroblast proliferation showed the same pattern of differences: patients' sera 142 +/- 22%; normal human sera 116 +/- 9%, and fetal calf serum 100%. These experiments confirm the presence of a serum factor in pretibial myxoedema which is capable of stimulating the activity of skin fibroblasts in vitro, and show that its effects are not restricted to fibroblasts from pretibial skin or to those grown from the skin of the patients. Proliferation of normal fibroblasts cultured in medium supplemented with fetal calf serum was reduced by Sandostatin (octreotide), but it failed to inhibit their secretion of glycosaminoglycans. In contrast, secretion of glycosaminoglycans by a patient's pretibial skin fibroblasts was almost completely inhibited by 1 mM minoxidil. In the presence of patients' sera Sandostatin (0.1-10 micrograms/ml) reduced secretion of glycosaminoglycans by about 50%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Late-onset focal dermal elastosis: clinical and histological features.

We describe two patients with lesions clinically resembling pseudoxanthoma elasticum and histologically exhibiting focal elastosis, with normal-appearing elastic fibres in the mid- and deep dermis. We consider that these skin lesions represent a previously undescribed entity, whose pathogenesis appears to be related to the ageing process.

Aged↗
PubMed1995

Successful surgical treatment of severe pretibial myxoedema.

We report a 46-year-old man with severe and long-standing pretibial myxoedema, who responded well to local surgical treatment. This improvement has been maintained over a 12-month period, perhaps because of concomitant treatment with octreotide.

Combined Modality Therapy↗
PubMed1995

Cutaneous protothecosis: report of a case in Hong Kong.

We report a patient who presented with recalcitrant ulcerated papules and plaques on both legs. Histopathology revealed protothecosis, and subsequent culture of the lesions grew Prototheca wickerhamii. Gradual resolution of the ulcers occurred on treatment with itraconazole.

Aged↗
PubMed1995

Erosive pustular dermatosis of the leg.

Two women with a distinctive rash on the legs are reported. The clinical features of erythema, erosions, crusting and pustular lakes, and the failure to respond to any treatment except very potent topical corticosteroids (Dermovate), are very similar to those of erosive pustular dermatosis of the scalp.

Administration, Topical↗