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PubMed1993

Unusual breast edema and erythema during radiotherapy in the conservative approach of breast cancer. A case report.

The appearance of breast edema in the conservative approach of breast cancer is correlated with axillary dissection, and it is worsened by radiotherapy. In rare cases there are serious edema and erythema of the breast at the beginning of radiotherapy. We present a patient with edema and erythema of the breast with an unusual evolution after conservative surgical treatment of the breast cancer. Possible etiologies and published data are reviewed.

Aged↗

PubMed1985

Drug-induced erythema multiforme: a possible immunologic pathogenesis.

A 37-year-old female developed erythema multiforme 17 days after beginning carbamazepine for complex partial seizures. The carbamazepine was discontinued and phenytoin begun. A new rash developed and phenytoin therapy was stopped. In vitro immunologic studies were conducted in an effort to understand the pathogenesis of the rashes. Enhancement of stimulated in vitro lymphocyte proliferation from the patient occurred in the presence of carbamazepine and phenytoin. Neither drug had an enhancing effect on lymphocyte proliferation from a control subject. These data, together with clinical data, strongly suggest an immunologic pathogenesis for drug-induced erythema multiforme.

Adult↗

PubMed1986

Effect of topically applied flurbiprofen on ultraviolet-induced erythema.

The effect of flurbiprofen, a nonsteroidal antiinflammatory agent, on ultraviolet B-induced erythema was studied in normal volunteers. The effect of various concentrations as well as the effect of multiple applications were evaluated at 4, 8, and 24 hours after irradiation with three MEDs of ultraviolet B. Repeated applications of flurbiprofen during the four- and eight-hour periods following ultraviolet B exposure did not increase the blanching response obtained following a single treatment. A concentration dependent effect of flurbiprofen on blanching was observed with suppression of erythema increasing with increasing concentration of flurbiprofen up to 3%. Further increase in concentration up to 5% offered no added advantage. Significant differences in blanching were also observed at different postirradiation time periods. No cutaneous or systemic complications were reported during the entire study.

Administration, Topical↗

PubMed1979

Production of ultraviolet-light-induced skin erythema in the hairless rat: a comparison with the haired rat in screening for anti-inflammatory drugs.

The onset of this erythema in response to different times of exposure corresponds closely to that in the haired animal. Orally administered phenylbutazone (30 mg/kg) or subcutaneously administered fluocinolone acetonide (10 mg/kg) have an equivalent antierythemic effect on haired and hairless animals. The hairless rat may therefore be an attractive alternative to its haired counterpart in this model since, prior to irradiation, it requires no depilation--which itself may affect subsequent erythema production.

Animals↗

PubMed1975

Comparison of skin erythemas under two different fractionation schemes.

This paper reports the results of a prospective clinical trial comparing 200 rads daily five times weekly for four weeks with 400 rads twice weekly for four weeks. Total dose in the first case was 4,000 rads and in the second 3,200 rads. Thirty patients threated palliatively for bronchial carcinoma are involved in this report. Treatment was given at 220 kV and the intensity of skin erythema at the end of the treatment was the measure of comparison. Generally 200 rads daily five times weekly for four weeks produced more intense erythema than the other scheme used.

Bronchial Neoplasms↗

PubMedDate not supplied

Miniature personal electronic UVR dosimeter with erythema response and time-stamped readings in a wristwatch.

Personal ultraviolet radiation (UVR) dosimetry is important because sunlight is the most important risk factor for skin cancer and a risk factor for some eye diseases and immunosuppression and related disorders. Integrating devices, such as polysulphone film dosimeters, are generally used. To measure the exact dose at specific times, we have developed a personal electronic UVR dosimeter that makes time-stamped measurements. It has a sensor with an erythema action spectrum response and a linear sensitivity (dose-response) with no offset. The sensor has cosine response, and the dosimeter can cope with environmental conditions such as rain, temperature and dirt. It can be programmed to measure with different time intervals and save the average of a specified number of measurements in the memory that can store 32 000 time-stamped measurements. It is small (36 x 28 x 13 mm), weighs 14 g and can work for 4 months without maintenance. It is worn on the wrist, is equipped with a watch showing the time and may thus be used in large-scale studies. The sensitivity can change by 10% due to temperature changes from -5 to 40 degrees C. The UVR dosimeter sensitivity is 0.09 standard erythema doses (SED)/h and the difference in total received dose during 7 days between a Solar Light 501 UV-Biometer (186 SED) and our UVR dosimeter was 3% and the median difference in daily total dose was 2.2%. The dosimeter provides unique possibilities. Examples of personal UVR measurements, data calculations and how they can be interpreted are given.

Electronics↗

PubMedDate not supplied

Reference limits for erythema-effective UV doses.

Diagnostic phototesting, including the determination of the minimal erythema dose (MED), is a useful procedure to detect abnormal sensitivity to UV radiation. We aimed to estimate the reference limits (RLs) of the MED in a reasonably large reference sample of white individuals. Skin phototypes and MED values for broadband UVB and for UVA were determined in 461 white subjects. When appropriate, the 95% reference intervals, including the 0.025 fractile and 0.975 fractile, were computed for the MED-UVB reference values (by means of parametric methods) and the MED-UVA reference values (by means of nonparametric methods). MED data were also converted to standard erythema doses (SEDs). As described elsewhere we observed a considerable overlap of MED values for all skin phototypes and confirmed that age and sex do not substantially influence the MED. The lower RLs observed for MED-UVB were 33 mJ cm(-2) (0.5 SEDs) and for MED-UVA 12.6 mJ cm(-2) (1.2 SEDs). The MED and SED findings from this investigation may serve as reference data for white individuals and give support to the clinician in differentiating between normal and pathologically abnormal photosensitivity. Although the MED data given here are limited to the phototest device used in the present study, the SED results establish comparability between our data and phototest results obtained from laboratories using different UV sources.

Adolescent↗

PubMed1996

[Histopathologic findings for the research of acid-fast bacilli in erythema nodosum].

It was possible to prove, by means of retrospective histopathological studies of 51 glass slides of common erythema nodosum (EN) and 39 glass slides of erythema nodosum leprosum (ENL), that the histopathological features of the two groups differed in several ways. It was found that the most prominent divergent findings between these two diseases was the presence of a lepromatous granulomatous infiltrate in the ENL; the predominant location of the inflammatory infiltrate was derma-hypodermal in ENL and hypodermal in common EN; there was a preferential septa attack in common EN and lobular in ENL; foreign giant cells occurred only in common EN; the lymphocyte cell infiltration in common EN and of neutrophils in ENL and the presence of inflammatory infiltrate around nerves in ENL. Our study has proved that the search for M. leprae does not have to be made in all cases of EN as there are histological differences in the routine histopathological exam between common EN and ENL that can alert to the real need for this procedure. This search must be performed when during the routine histopathological exam of sections stained by hematoxilin-eosin the ENL histopathological characteristics delineated herein are observed.

Bacteriological Techniques↗

PubMed2004

Erythema induratum of Bazin and renal tuberculosis: report of an association.

Erythema induratum of Bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the posterior part of the lower extremities, some of which ulcerate. In many countries, tuberculosis is still the main etiologic factor. We report a case of a 40-year-old woman who presented a course of protracted and recurrent episodes over five years of cutaneous lesions on her legs. These tend to involute, but new crops appear at irregular intervals. It was painful, erythematous-violaceous nodules, some of which drained a reddish secretion. The histopathologic features of the lesions demonstrated inflammatory infiltration, with predominance of neutrophils in dermis and hypodermis, necrotizing vasculitis in the arterioles and septal fibrosis. There was no granuloma. The Ziehl-Neelsen stain did not revealed acid-fast bacilli, and the culture of biopsy specimen was negative. The tuberculin skin test was strongly positive (17 mm). The chest X-ray was normal. Few months later she presented adynamia and urinary complaints, such as polacyuria and dysuria. It has been done an urynalysis, which demonstrated acid pH urine, sterile pyuria and microscopic hematuria. It was then raised the diagnostic hypothesis of renal tuberculosis. The urine culture for M. tuberculosis was positive in two out of ten samples. The treatment was instituted with rifampin, isoniazid and pyrazinamide, with complete regression. This case illustrates a clear association between erythema induratum and renal tuberculosis, demonstrated by the remission of the cutaneous lesions after the treatment of the renal tuberculosis.

Adult↗

PubMed1997

Photochemistry and photobiology of actinic erythema: defensive and reparative cutaneous mechanisms.

Sunlight is part of our everyday life and most people accept it as beneficial to our health. With the advance of our knowledge in cutaneous photochemistry, photobiology and photomedicine over the past four decades, the terrestrial solar radiation has become a concern of dermatologists and is considered to be a major damaging environmental factor for our skin. Most photobiological effects (e.g., sunburn, suntanning, local and systemic immunosuppression, photoaging or dermatoheliosis, skin cancer and precancer, etc.) are attributed to ultraviolet radiation (UVR) and more particularly to UVB radiation (290-320 nm). UVA radiation (320-400 nm) also plays an important role in the induction of erythema by the photosensitized generation of reactive oxygen species (singlet oxygen (1O2), superoxide (O2.-) and hydroxyl radicals (.OH)) that damage DNA and cellular membranes, and promote carcinogenesis and the changes associated with photoaging. Therefore, research efforts have been directed at a better photochemical and photobiological understanding of the so-called sunburn reaction, actinic or solar erythema. To survive the insults of actinic damage, the skin appears to have different intrinsic defensive mechanisms, among which antioxidants (enzymatic and non-enzymatic systems) play a pivotal role. In this paper, we will review the basic aspects of the action of UVR on the skin: a) photochemical reactions resulting from photon absorption by endogenous chromophores; b) the lipid peroxidation phenomenon, and c) intrinsic defensive cutaneous mechanisms (antioxidant systems). The last section will cover the inflammatory response including mediator release after cutaneous UVR exposure and adhesion molecule expression.

Antioxidants↗

PubMed2002

Celecoxib-induced erythema multiforme with glyburide cross-reactivity.

Erythema multiforme is an acute inflammatory skin reaction that often is caused by drugs, especially sulfonamides and their derivatives. Celecoxib, a cyclooxygenase-2 inhibitor, is a sulfonamide derivative commonly prescribed to treat arthritis in patients who cannot tolerate or who have a contraindication for taking traditional nonsteroidal antiinflammatory agents. A 57-year-old man with a previously undocumented sulfa allergy experienced an allergic skin reaction and had difficulty breathing secondary to throat swelling. His condition was believed to be erythema multiforme associated with the introduction of celecoxib into his drug regimen. His drug therapy was discontinued, but a subsequent reaction occurred when the sulfonamide derivative glyburide was reintroduced. It is important for clinicians to obtain a careful history and perform a thorough medical evaluation in all patients receiving sulfonamides and their derivatives, as a potentially life-threatening allergic reaction may be prevented.

Celecoxib↗

PubMed1993

Erythema multiforme involving gingiva.

Erythema multiforme is a vesiculobullous condition that may affect skin and/or mucosa. Oral lesions are characterized by hemorrhagic crusting of the lips and ulceration mainly of the non-keratinized mucosa. This paper describes a patient who presented with gingival lesions as well as the more typical oral signs of erythema multiforme.

Adult↗

PubMed2001

Erythema multiforme secondary to herpes simplex infection: a case report.

BACKGROUND: Erythema multiforme (EM) is a complex disease that may have cutaneous and/or mucosal involvement. The severity may range from mild to severe and potentially life threatening. The literature cites many factors including viruses, infections, and medications as causes. This report documents a patient who developed EM secondary to a herpes simplex viral (HSV) infection. METHODS: Two weeks following an eruption of herpes labialis, a 20-year-old white female patient developed acutely painful oral and labial ulcers accompanied by target skin lesions. A diagnosis of erythema multiforme (EM) was made. The patient was treated with antivirals, analgesics, and symptomatic therapy. RESULTS: Nine days after the onset of symptoms, the oral and cutaneous lesions had started to heal and the patient no longer required pain medication. CONCLUSIONS: Although the etiology of EM is still often unknown, infections with herpes simplex virus have been implicated as a possible precipitating factor. This case illustrates the association of the occurrence of EM with an HSV infection.

Acyclovir↗

PubMed1987

Electron microscopic observation on dark endothelial cells in erythema nodosum-like lesions of Behçet's disease with ultrastructural X-ray spectroanalysis.

We used electron microscopy and electron microscopic X-ray spectroanalysis to examine the biopsies taken from erythema nodosum-like lesions of 20 patients with Behçet's disease. Electron-dense degenerated endothelial cells were found in the microcirculatory beds of the dermis and subcutaneous fat. However, electron microscopic X-ray spectroanalysis failed to demonstrate the localization of either chlorine or base metals in those degenerated endothelial cells. Moreover, neither in ultrastructurally normal endothelial cells, nor in infiltrating macrophages of erythema nodosum-like lesions the positive deposit of chlorine or base metals could not be detected. The results of this analysis suggest that environmental factors do not play an etiologic role in this disease. Significance of the degeneration of endothelial cells is not clear present.

Behcet Syndrome↗

PubMed1994

Erythema multiforme during GM-CSF therapy.

A 52-year-old Caucasian man treated with granulocyte-macrophage colonystimulating factor (GM-CSF) developed a cutaneous eruption on legs and ankles with clinical and histologic features of erythema multiforme. Laboratory studies indicated that the eruption occurred at the time of peripheral blood lymphocyte recovery and that it was coincidental with serum peaks of interleukin-1 (IL-1), interleukin-2 (IL-2), interleukin-6 (IL-6) and tumour necrosis factor-alpha. We postulate that GM-CSF provoked erythema multiforme in a predisposed individual as a consequence of either an inappropriate cytokine secretion or of an abnormal amplification mechanism following lymphocyte recovery.

Erythema Multiforme↗

PubMed1994

Toxic epidermal necrolysis and erythema multiforme following therapy with terbinafine.

We report two cases with severe skin reactions following oral terbinafine (Lamisil) therapy. The first case was a 49-year-old woman with onychomycosis of the toe nails. She had suffered from diabetes for 3 years, but it was well controlled on insulin. Five days after start of terbinafine 250 mg once daily she developed erythema. The treatment was continued for 2 days, but the skin eruption progressed, and a clinical diagnosis of toxic epidermal necrolysis was confirmed histologically. The second case was a 51-year-old woman with dermatomycosis on the right foot. She developed a papular eruption in the second week after taking terbinafine 250 mg once daily. Despite this eruption she continued treatment for 6 days. Generalized erythema multiforme developed in the following days. Terbinafine is a recently introduced efficacious fungicidal drug. This is the first report of toxic epidermal necrolysis following terbinafine.

Administration, Oral↗

PubMed2006

Polyhexamethylenebiguanide hydrochloride exposure and erythema multiforme in a physician.

A 52-year-old woman physician developed recurrent erythema multiforme. Occupational and environmental exposure assessment suggested a disinfectant containing polyhexamethylenebiguanide hydrochloride (PHMB), Phagosept. Elimination of the product was followed by disappearance of symptomatology. Literature search revealed cases of sensitization and anaphylaxis due to contact with PHMB, but to our knowledge, this is the first report on PHMB-induced erythema multiforme.

Biguanides↗

PubMed1993

An unusual manifestation of Chlamydia pneumoniae infection: meningitis, hepatitis, iritis and atypical erythema nodosum.

A 37-year-old man was admitted to hospital with fever, muscle tenderness, headache and mild exanthema on the right thigh. During his hospital stay, the headache worsened and aseptic meningitis was diagnosed. A bilateral iritis developed, and the exanthema developed into an atypical erythema nodosum. In liver function tests, pathological results were recorded. Vasculitis was suspected but could not be confirmed. All serological tests proved negative except for a fourfold titre rise to Chlamydia pneumoniae. We concluded that the meningitis, hepatitis, iritis and atypical erythema nodosum were most probably due to a C. pneumoniae infection.

Adult↗