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Erythema induratum associated with tuberculous lymphadenitis: analysis of a case using polymerase chain reactions with different primer pairs to differentiate bacille Calmette-Guérin (BCG) from virulent strains of Mycobacterium tuberculosis complex.

We retrospectively analyzed a bacille Calmette-Guérin (BCG) vaccinated female patient who developed erythema induratum in association with tuberculous lymphadenitis. The polymerase chain reaction (PCR) with two pairs of primers was performed. Only one pair was able to detect the myocobacterial DNA from the paraffin-embedded specimen of the erythema induratum (EI) lesion. However, both pairs showed positive results with the tuberculous lymphadenitis specimen. Sequence analysis of the PCR products excluded the possibility of BCG as the potential pathogen. Both lesions responded favorably to antituberculous therapy. Our study attests to the tuberculous nature of EI and demonstrates that BCG vaccination per se does not induce the lesion or interfere with the PCR result. Finally, using at least two pairs of primers targeting different genomic segments and possessing species-identification capability may raise the detection rates and solve some controversies about the nature of tuberculids.

Adult↗

Urticarial erythema associated with IgA myeloma.

We report a case of atypical urticaria associated with IgA multiple myeloma. A 79-year-old man presented with a two-month history of wheal-like erythema, which lasted approximately one week without any response to anti-histamines. Histological examination of a lesion revealed leukocytoclasia as well as perivascular leukocytic infiltration, being consistent with urticarial erythema. Laboratory investigation showed markedly elevated serum IgA concentration and M-protein in serum protein electrophoresis. A bone marrow examination led to a diagnosis of myeloma. An immunofluorescence study failed to detect any IgA deposit in the lesion. However, the wheal-like eruptions disappeared when the IgA myeloma was treated and reappeared when it relapsed. We conclude that this long lasting urticaria was the cutaneous manifestation of IgA myeloma.

Aged↗

Histopathological spectrum of erythema multiforme.

Lesions of erythema multiforeme from seventy-five patients have been studied histologically. In addition to peculiar intercellular epidermal oedema, subepidermal separation and a lymphohistiocytic inflammatory infiltrate in the papillary dermis, epidermal cell necrosis was observed in a variable percentage of the lesions. While dermal disturbance was a predominant finding in the macular lesions, focal or generalized keratinocytic necrosis was seen in the macular, papular, bullous and iris lesions in that order of frequency. Significant numbers of eosinophils were present in the inflammatory infiltrate in 60% of the bullous and 28% of the macular lesions. Our findings suggest that erythema nultiforme represents a tissue reaction with spectral expression, one end presenting as a predominantly dermal disturbance and the other merging into the adult type of toxic epidermal necrolysis. Yet, the histological features remain sufficiently characteristic for differentiation from other erythematous and vesiculobullous eruptions.

Edema↗

Erythema gyratum repens with pulmonary tuberculosis.

A 63-year-old man presented with erythema gyratum repens of 7 months' duration. A cavitating mass at the right lung apex was resected and proved to be tuberculous. Following the resection, the skin lesions cleared within a few days. Erythema gyratum repens has not previously been described in association with non-malignant visceral pathology. The pathogenesis remains obscure but cannot be related specifically to a response to tumour cells or their products in view of the association reported here. The condition bears no resemblance to any known tuberculide.

Erythema Multiforme↗

Reticulate erythema--a prodrome in hereditary angio-oedema.

A previously undescribed short-lived non-puritic reticulate erythema has been noted in several members of unrelated families with hereditary angio-oedema. The eruption which may be widespread can last from 1 to 4 days and usually immediately precedes an overt attack of hereditary angio-oedema although this is not invariable, and swellings may occur in areas not previously involved by the erythema. Histology including immunohistology probably shows no specific changes.

Adolescent↗

Hyperglucagonaemia and necrolytic migratory erythema in cirrhosis--possible pseudoglucagonoma syndrome.

Necrolytic migratory erythema is the distinctive cutaneous eruption seen with glucagon-producing tumours of the pancreas. Recognition of this eruption is important because it may lead to the early diagnosis of a glucagonoma. Recently, we saw a patient who had necrolytic migratory erythema, hyperglucagonaemia, and cirrhosis of the liver with no evidence of pancreatic tumour while alive or at autopsy. Serum glucagon levels during the period of observation and during an oral glucose tolerance test suggested that the hyperglucagonaemia was not due to an occult glucagon-producing tumour but may have been the result of advanced hepatic cirrhosis.

Adolescent↗

Salmonella gastroenteritis--another cause of erythema nodosum.

Although there are many causes and associations of erythema nodosum, it remains a useful sign often giving a clue to the diagnosis of a puzzling illness. It is therefore important for clinicians to be aware of all the possible causes and associations. The following report is of a patient in whom typical erythema nodosum developed during the course of severe salmonella gastroenteritis.

Adult↗

Kinetics of UV-erythema in normal subjects.

In the expanding field of clinical dermatopharmacology we standardized an erythema model for testing drugs with effects on UV-induced inflammation in normal male Caucasian subjects. Using a light source with fibre-optic transmission and precise radiation characteristics, some of the shortcomings of conventional UV-application could be overcome. The radiation geometry during the various experiments was kept constant by a tube, permitting a defined area of exposure. Up to eight skin areas of the backs of normal volunteers were radiated with 86.2% UV-A and 13.8% UV-B. After exclusion of hyporeactive and hyperreactive subjects a good intrasubject reproducibility was obtained repeatedly over at least 3 months. According to the definition of bioavailability, our method allows the measurement of the rate and extent of UV-induced erythema. This model has been used for testing topical steroids, non-steroidal antiphlogistics in a variety of pharmaceutical formulations.

Dose-Response Relationship, Radiation↗

Thirteen British cases of erythema chronicum migrans, a spirochaetal disease.

Thirteen British cases of erythema chronicum migrans are reported. An antibody to the Lyme disease spirochaete was found in three of five recent cases, but Lyme disease was not seen. The distribution and life cycle of the tick Ixodes ricinus is described and related to the occurrence of erythema chronicum migrans in Great Britain.

England↗

A portable instrument for quantifying erythema induced by ultraviolet radiation.

The design and performance of an instrument for quantifying ultraviolet-induced cutaneous erythema are discussed. If the instrument is used to record an 'erythema index' at a site on the skin before and after irradiation, the difference between those two readings is essentially related to an increase in vasodilation and is largely independent of the melanin content of the epidermis.

Dermatology↗

Quantitative studies on UVA-induced erythema in human skin.

The erythemal response of normal human skin to UVA and UVB radiation was measured objectively using a reflectance instrument in seven subjects, and a laser Doppler velocimeter in two subjects. UVA radiation was produced using a newly-developed high-intensity UVA lamp. The slope of the log dose-erythemal response curve for UVA at 24 h after irradiation was found not to differ significantly from that for UVB. The time course of UVA erythema was biphasic; erythema was present immediately after irradiation, fell to a minimum at about 4 h and then rose to a broad plateau between 6 and 24 h. The intensity of the early phase was dose-rate dependent, whereas that in the later phase depended on dose only.

Adult↗

Erythema multiforme due to griseofulvin.

Three patients are reported who developed erythema multiforme during treatment with griseofulvin. To our knowledge there have been no previously documented reports of this drug causing erythema multiforme in either the English or American literature.

Adult↗

The relationship between plasma psoralen concentration and psoralen-UVA erythema.

The plasma 8-methoxypsoralen (8-MOP) concentration was measured in 60 patients commencing psoralen photochemotherapy (PUVA). At the time of blood sampling each patient was phototested using a series of 10 exposures to UVA. The resulting erythema was measured objectively 72 h after irradiation and dose-response curves for psoralen-UVA erythema were constructed. Although the dose of 8-MOP was calculated according to body weight, patients receiving 30 mg of 8-MOP had a significantly lower mean plasma concentration than those receiving higher doses. There was no significant correlation between plasma 8-MOP concentration and minimal phototoxic dose, either estimated visually or calculated from the dose-response curves. However the slope of the dose-response curve showed significant correlation with plasma 8-MOP concentration. The variation between patients in the rate of increase of the erythemal response, but not the variation in threshold sensitivity, can be explained by difference in plasma psoralen concentration.

Adolescent↗

Recurrent annular erythema associated with anti-SS-B/La antibodies: analysis of the disease-specific epitope.

We have found that anti-SS-B/La antibodies are present in a group of patients with a characteristic recurrent annular erythema, and immunological abnormalities. The presence of a disease-specific epitope for this entity has been examined by comparing immunological reactivity of anti-SS-B/La antibodies between these patients and patients with classical Sjögren's syndrome who have anti-SS-B/La antibodies but do not have this characteristic erythema. In immunoblotting using three different antigen sources, all the sera from both groups exhibited the same reaction patterns. V8 protease mapping showed that the sera could be divided into three groups by the difference in reactivity to two main digested peptide fragments. However, no significant relationship of the reactivity in peptide mapping between the two patient groups was observed. Further studies are necessary to elucidate the role of anti-SS-B/La antibodies in disease pathogenesis in these patients, in particular by more precise peptide mapping using recombinant SS-B/La antigen proteins.

Adult↗

Differences in phototoxic potency should be considered when tetracyclines are prescribed during summer-time. A study on doxycycline and lymecycline in human volunteers, using an objective method for recording erythema.

In order to test the phototoxic potency of the two tetracyclines most frequently prescribed in Sweden, a double-blind cross-over study using a double-dummy technique with doxycycline 0.1 g twice daily, lymecycline 0.6 g twice daily, and placebo, was performed in 15 healthy volunteers. Drugs were given for 3 consecutive days, and on the third day volunteers were tested with 25, 50, 75 and 100 J/cm2 of artificial long-wave ultraviolet radiation (UVA), and assessed 6 h later for erythematous photoreactions. Objective readings were made using skin reflectance spectrophotometry. All three substances were tested in each individual at weekly intervals. Within 50, 75 and 100 J/cm2 of UVA, lymecycline showed a slight increase in erythema compared with placebo, but this was not significant (50 and 100 J/cm2), or was of low significance (75 J/cm2). However, with the same doses, doxycycline showed a substantial increase in erythema compared with placebo, which was highly significant. We conclude that doxycycline has a higher phototoxic potency than lymecycline, and this is in agreement with earlier in vitro experimental data. We recommend that therapy with doxycycline is avoided during summer-time, and during holidays in a sunny climate.

Adult↗

Anti-Ro/SSA-associated annular erythema in childhood.

We report four children with anti-Ro/SSA positive who presented with an annular erythema as a manifestation of Sjögren's syndrome. One patient had an aseptic meningoencephalitis as well as cutaneous lesions. Children with annular erythema should be carefully followed for features of Sjögren's syndrome, which is believed to be a rare condition in children.

Adolescent↗

Autoimmune thyroid disease in anti-Ro/SS-A-positive children with annular erythema: report of two cases.

Anti-Ro/SS-A-associated recurrent annular erythema is a rare disorder, and represents a cutaneous manifestation of primary Sjögren's syndrome (SS). We report two childhood cases complicated with autoimmune thyroid disease, one with Graves' disease and the other with autoimmune thyroiditis. Both children were positive for anti-Ro/SS-A and anti-La/SS-B antibodies. One patient was lacking clinical SS with objective evidence of salivary gland involvement, while the other was diagnosed with primary SS. Our observation suggests that autoimmune thyroid disease in the subset of anti-Ro/SS-A-positive children with annular erythema might occur with similar frequency to that in adult primary SS.

Adolescent↗