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PubMedDate not supplied

Chronic parastomal ulcers: spectrum of dermatoses.

Parastomal ulcers that develop after stoma surgery have reportedly been associated with recurrent inflammatory bowel disease and chronic infection. We report 13 patients with refractory parastomal ulcers, which occurred at a mean of 11 years after surgery. Parastomal ulcers in eight patients were the result of dermatologic conditions (e.g., contact dermatitis, bullous pemphigoid, lichen sclerosus et atrophicus, eczema, or psoriasis) or contact ulcers from dermatitis of the skin around the stoma and faceplate pressure. These ulcers healed after treatment with topical medications at a mean of 4 weeks. Five patients with inflammatory bowel disease had pyoderma gangrenosum ulcerations, which healed with systemic treatment at a mean of 25 weeks. Thus nonpyoderma gangrenosum parastomal ulcerations that occur late after stoma surgery require early enterostomal therapy nursing intervention and dermatologic evaluation, since they respond rapidly to appropriate local therapy.

Administration, Topical↗
PubMed1980

Behçet's disease and treatment with colchicine.

A case of Behçet's disease characterized by anterior uveitis, arthritis, oral, genital, and cutaneous lesions, as well as gastrointestinal involvement, all documented over a 10-month period, is presented. Less commonly appreciated complications, such as pyoderma gangrenosum, hidradenitis suppurativa, perianal fistula, and persisting leukocytosis, were among striking clinical features of the patient's history. Remission of cutaneous lesions and no recurrence of ocular or gastrointestinal manifestations occurred with 0.6 mg oral colchicine twice daily in a period of 5 weeks.

Adult↗
PubMed1990

Orange/black discolouration of the bowel (at laparotomy) due to clofazimine.

Clofazimine, a commonly used anti-lepromatous drug, is now being prescribed for the treatment of pyoderma gangrenosum, a complication of inflammatory bowel disease. This drug can cause an obstructive exacerbation of Crohn's disease. Surgeons should be aware of the orange/black discolouration of the bowel, which may mimic ischaemia macroscopically. A case, the first reported in Australia, is described and the literature discussed.

Adult↗
PubMed1987

Necrotizing dermatitis in patients receiving cancer chemotherapy.

Necrotizing dermatitis in patients being treated with cancer chemotherapeutic agents can be of several types. Microbial causes can include a variety of bacteria and fungi, the most common being Pseudomonas aeruginosa. Gangrene from occlusive causes is not uncommon among cancer patients with coexisting atheromatous, thromboembolic, or obliterative vascular disease. Toxic gangrene is most commonly caused by extravasation of intravenously administered cytotoxic antineoplastic drugs but has also been associated with the use of coumarin congeners and the bite of the brown recluse spider. Pyoderma gangrenosum is an idiopathic condition that has been reported in association with myeloproliferative disorders. Finally, necrosis can be caused by the neoplasm itself, when its growth is so great that blood vessels are compressed and ischemia of the surrounding tissue results.

Antineoplastic Agents↗
PubMed1991

Cutaneous manifestations of multiple myeloma.

We report the cutaneous manifestations of multiple myeloma, using a retrospective review of 115 patients' records obtained from tumor registry files. Five patients were found to have biopsy-proved extramedullary plasmacytomas without extension from an underlying bony focus. Twelve patients had ecchymoses without thrombocytopenia; two of them had biopsy-proved amyloidosis. One patient presented with pyoderma gangrenosum and was subsequently diagnosed with multiple myeloma. The last patient initially presented with what clinically appeared to be leukocytoclastic vasculitis, and, in the course of a standard workup, he was diagnosed with multiple myeloma. These findings are discussed with regard to the current literature on the cutaneous manifestations of multiple myeloma.

Adult↗
PubMedDate not supplied

[Cutaneous symptoms of ulcero-haemorragic rectocolitis and of Crohn's disease (author's transl)].

The association between ulcerative colitis, Crohn's disease and various abnormalities of the skin is reviewed. Erythema nodosum and pyoderma gangrenosum are the most specific external manifestations and thereby the ones of greatest diagnostic value. Erythema multiforme is probably a manifestation of drug hypersensitivity. Many other dermatosis have been observed in association with these gastrointestinal disorders. However, these associations are not statistically significant. A specific "aphtous colitis" may be observed in the course of Behçet's disease.

Colitis, Ulcerative↗
PubMed1983

Pyogenic granuloma-like acne lesions during isotretinoin therapy.

Three male patients with severe nodulocystic acne were treated with oral isotretinoin in a dosage of 0.5 to 1.0 mg/kg/day. A flare of their disease developed, characterized by an inflammatory, hemorrhagic, pyogenic, granuloma-like response of previously crusted acne lesions. This reaction occurred between the sixth and ninth weeks of treatment and was confined entirely to the chest and back. The severity of the reaction prompted the administration of oral prednisone and, in two cases, the discontinuation of isotretinoin therapy. In one patient, pyoderma gangrenosum developed on the thigh. The exact incidence of this pyogenic, granuloma-like reaction to isotretinoin is unknown, although we have seen it in three of 66 patients with nodulocystic acne treated with this drug. The cause of the reaction is unknown, but it may be due to the increased skin fragility and vascular proliferation known to be induced by isotretinoin.

Acne Vulgaris↗
PubMed1977

[Geometric phagedenism. Clinico-therapeutic experience].

A woman of 35 years old, in good physical condition, developed multiple lesions of Phagedenisme Geometrique (Pyoderma Gangrenosum) in the gluteal region and the thigh. Corticoids and antibiotics were used at high dosages resulting in healing of the center of the lesions but without any effect on the periphery. Plasma transfusions were then given, resulting in apparent amelioration of the peripheral abcesses. Her general condition was not altered during the entire course of the disease. Septic foci were not demonstrated and a minimal dysproteinemia was neither significant nor persistent.

Adult↗
PubMed1988

Selected rheumatologic and dermatologic manifestations of inflammatory bowel disease.

This review focuses on the behavior and pathogenesis of selected dermatologic and rheumatologic manifestations of inflammatory bowel disease. Erythema nodosum, the most common skin lesion, correlates with activity of the bowel disease but not with its duration or extent. Resolution occurs with therapy of inflammatory bowel disease. Pyoderma gangrenosum, the most severe skin lesion, bears little relationship to the activity or extent of the colitis. Therapy is usually supportive, but dapsone and steroids appear promising. Immune and vasculitic mechanisms have been postulated for both skin lesions. Peripheral arthritis usually has its onset with or after the development of colitic symptoms. It worsens with exacerbation of bowel inflammation and responds to treatment of the bowel disease. Immune mechanisms are likely. Spondyloarthropathy usually occurs before the onset of overt intestinal disease. Its course is unrelated to the bowel inflammation, it does not respond to treatment of bowel disease, and it is associated with HLA B27.

Colitis, Ulcerative↗
PubMed1988

Extraintestinal manifestations in patients with diverticulitis.

Three patients had diverticulitis and extraintestinal manifestations of arthritis and pyoderma gangrenosum. In each, a mistaken diagnosis of idiopathic inflammatory bowel disease was first made because of extraintestinal complaints associated with the gastrointestinal symptoms of diverticular disease. The joint and skin manifestations were refractory to various treatments, including oral and intradermal steroids, immunosuppressive agents, and hyperbaric oxygen. Segmental resection of the involved colon promptly and completely resolved all symptoms, without recurrence 26 to 38 months after surgery. Microscopic examination of the resected specimens showed only diverticulitis without any evidence of chronic idiopathic inflammatory bowel disease. Patients with diverticulitis may have extraintestinal manifestations as do patients with other inflammatory diseases of the colon. The failure to recognize this relationship may result in misdiagnosis and prolonged medical therapy, whereas segmental colonic resection may be curative.

Aged↗
PubMed2006

Effects of cyclosporine A in hyperzincaemia and hypercalprotectinaemia.

INTRODUCTION: Hyperzincaemia and hypercalprotectinaemia with systemic inflammation, recurrent infections, hepatosplenomegaly, arthritis, anemia, cutaneous inflammation, and failure to thrive is an extremely rare disease and no therapy is reported. AIM: To evaluated the effects of cyclosporine A in hyperzincaemia and hypercalprotectinaemia in terms of serum cytokine level changes before and after treatment. METHODS: A 10-year-old girl was admitted suffering from pyoderma gangrenosum, hepatosplenomegaly, anemia that was unresponsive to iron supplementation, persistent inflammation, arthritis, and increased serum zinc. The level of serum calprotectin was extremely high; therefore, we diagnosed hyperzincaemia and hypercalprotectinaemia and started cyclosporine A treatment. Twelve cytokines in serum were measured before and one year after treatment. RESULTS: Cyclosporine A was very effective. Her skin lesion and joint pain were alleviated and quality of life was markedly improved. C-reactive protein had decreased and anemia had improved. While zinc levels had fallen, calprotectin remained at an extremely high level. Of the cytokines examined, interleukin -6 serum levels had fallen and interleukin -8 showed a marked reduction after treatment. CONCLUSION: Cyclosporine A is effective for hyperzincaemia and hypercalprotectinaemia. Serum interleukin -8 may be useful in assessing the therapeutic effects of cyclosporine A in hyperzincaemia and hypercalprotectinaemia.

Child↗
PubMed1990

Oral cyclosporine in the treatment of inflammatory and noninflammatory dermatoses. A clinical and immunopathologic analysis.

Cyclosporine is known to be effective in the treatment of psoriasis. In this study, we have used oral cyclosporine (6 mg/kg per day) given for 5 to 30 weeks to 24 patients for the treatment of 12 different dermatoses. Patients with the following diseases demonstrated a marked response or total clearing: 1 patient each with pyoderma gangrenosum, pityriasis lichenoides chronica, and psoriasis of the acrodermatitis continua of Hallopeau type. Moderate to marked response occurred in both patients with epidermolysis bullosa acquisita and the patient with hidradenitis suppurativa. Minimal to moderate responses were obtained in both patients with granuloma annulare, 1 of 2 with acrodermatitis continua of Hallopeau, both patients with Darier's disease, and 1 of 6 patients with vitiligo. Little or no response was noted in both patients with sarcoidosis, all 3 patients with pityriasis rubra pilaris, 5 of 6 patients with vitiligo, 1 patient with pemphigus foliaceous, and 1 with pemphigus vulgaris. Clinical side effects were mild and transient and included dysesthesia, fatigue, hypertrichosis, nausea, and flushing. The most frequent clinically significant abnormalities were hypertension and renal dysfunction, with all factors normalizing within 1 month of discontinuation of cyclosporine therapy.

Administration, Oral↗
PubMed1984

[Plasmapheresis in extra-intestinal manifestations of Crohn's disease].

An assessment was undertaken of the value of plasmapheresis in patients with circulating immune complexes and/or extraintestinal manifestations of Crohn's disease (arthritis, iridocyclitis, erythema nodosum, pyoderma gangrenosum, stomatitis, fever). In 17 patients aged 20 to 50 years (median 34 years) 46 plasmaphereses were performed using a continuous flow-cell separator. Before and after plasmaphereses the concentrations of circulating immune complexes, of complement C4, of the immunoglobulins IgG and IgM and of the proteins alpha-1-antitrypsin, CRP, prealbumin and beta-lipoprotein were determined. 71% of patients given plasmaphereses showed clinical remission of the extraintestinal manifestations and 85% demonstrated a reduction of circulating immune complexes. Clinical follow-up of the patients was documented by the Crohn's Disease Activity Index (CDAI), which was reduced by plasmaphereses to a highly significant degree (p less than 0.005). For patients displaying an acute phase of Crohn's disease with extraintestinal manifestations and/or circulating immune complexes plasmapheresis represents an effective mode of therapy, which, moreover, lacks serious side effects.

Adult↗
PubMedDate not supplied

[Detection of circulating immune complexes using polyethylene glycol. Its value in the therapy of phlebology patients].

After a short exposition of the meaning and the technique for determination of immune complexes in circulating blood (after Hashkova, with polyethylene glycol) our first experience with phlebological patients is exposed. Positive reactions in a variety of cases (N = 122) includes atypical ulcus cruris, ulcerated vasculitis, Pyoderma gangrenosum, discoid lupus erythematodes, chronic rheumatoid polyarthritis (with, or without ulcus cruris), monoarthritis of the knee, pernicious anemia, chronic lymphedema (elephantiasis), some cases of sclerosis multiplex. In such positive cases the sedimentation rate of citrate blood may, or may not be elevated. Negative or uncertain reactions (below 10) were seen in 141 cases, in common's ulcus cruris cases, in vasculite nodulaire, in discopathy and most spondylarthroses and other arthrosis cases, in vasculite nodulaire, in discopathy and most spondylarthroses and other arthrosis cases, in various patients with rheumatoid complaints in coxarthrosis, osteoporosis and in a group of healthy young persons. Negative reactions were the rule in atherosclerotic and diabetic old persons with claudication or gangrene, in most dermatological cases, in necrobiosis lipoidica, in psoriasis, in postthrombotic phlebitis and in chronic rheumatism in a quiet stage. In vasculitis cases the reaction is often only slightly positive (between 10 and 20) but should be repeated as the values may vary. The determination of circulating immune complexes with polyethylenglycol is a useful screening method in the policlinic. Treatment is often directed in the right way sometimes prednisone, more often nivaquin (chloroquin) or other anti-inflammatory drugs and in pernicious anemia hepatotherapy can be of great help in the healing of complicated phlebological cases.

Adult↗
PubMed1987

Postgranulomatous anetoderma associated with Takayasu's arteritis in a child.

Takayasu's arteritis (TA) is a rare chronic inflammatory arteriopathy affecting mainly the aorta and its branches. Many skin manifestations have been reported in association with this disease. Pyoderma gangrenosum and subcutaneous inflammatory lesions of the leg are the most frequent. We studied a boy with TA in whom a papular rash of the trunk preceded the onset of vascular symptoms by many years. Histologically, the lesions were superficial and consisted of middermal noncaseating tuberculoid granulomas, which progressed to atrophy and anetoderma because of elastic network disruption. Granulomas were also found in synovial tissue but not in a temporal artery biopsy specimen, which showed only intimal hyperplasia. Our observations suggest that vascular and skin lesions with elastic tissue may both result from a common granulomatous hypersensitivity process.

Aortic Arch Syndromes↗
PubMed2001

Identification of mesoderm development (mesd) candidate genes by comparative mapping and genome sequence analysis.

The proximal albino deletions identify several functional regions on mouse Chromosome 7 critical for differentiation of mesoderm (mesd), development of the hypothalamus neuroendocrine lineage (nelg), and function of the liver (hsdr1). Using comparative mapping and genomic sequence analysis, we have identified four novel genes and Il16 in the mesd deletion interval. Two of the novel genes, mesdc1 and mesdc2, are located within the mesd critical region defined by BAC transgenic rescue. We have investigated the fetal role of genes located outside the mesd critical region using BAC transgenic complementation of the mesd early embryonic lethality. Using human radiation hybrid mapping and BAC contig construction, we have identified a conserved region of human chromosome 15 homologous to the mesd, nelg, and hsdr1 functional regions. Three human diseases cosegregate with microsatellite markers used in construction of the human BAC/YAC physical map, including autosomal dominant nocturnal frontal lobe epilepsy (ENFL2; also known as ADNFLE), a syndrome of mental retardation, spasticity, and tapetoretinal degeneration (MRST); and a pyogenic arthritis, pyoderma gangrenosum, and acne syndrome (PAPA).

Abnormalities, Multiple↗
PubMed1997

Cutaneous necrotizing vasculitis after low dose methotrexate therapy for rheumatoid arthritis: a possible manifestation of methotrexate hypersensitivity.

Large haemorrhagic and necrotic cutaneous lesions developed after two low dose (5 mg) methotrexate injections in a patient suffering from long standing rheumatoid arthritis. Differential clinical diagnosis included factitia dermatitis, infectious processes, pyoderma gangrenosum, rheumatoid neutrophilic dermatitis, necrotizing arteritis and vasculitis. Histological and direct immunofluorescent examinations of skin biopsies supported the diagnosis of leucocytoclastic vasculitis. We discuss the respective roles of methotrexate and rheumatoid arthritis in the outbreak of leucocytoclastic vasculitis. Hypersensitivity is strongly suspected.

Antirheumatic Agents↗
PubMed2000

[High dosage steroid pulse therapy. Is there an indication in dermatology?].

In recent years, high-dose steroid pulse therapy has been considered an effective treatment regimen in a number of non-dermatological diseases. This review addresses in the first part the pharmacological basics and mechanisms of action of high-dose glucocorticosteroid therapy. In the second part, we discuss the clinical experience using this treatment for dermatological diseases including pemphigus vulgaris, pyoderma gangrenosum, alopecia areata, and dermatomyositis.

Autoimmune Diseases↗