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PubMed2001

Ultraviolet protection by summer textiles. Ultraviolet transmission measurements verified by determination of the minimal erythema dose with solar-simulated radiation.

BACKGROUND: Apart from sunscreen lotions, clothing provides protection from acute and chronic sun damage. Therefore, it is very important to know the ultraviolet (UV) protection factor (UPF) of textiles, in particular of lightweight summer clothing. Usually, the UPF of a textile is determined by spectrophotometric assessment of the UV transmission (in vitro method). OBJECTIVES: To compare the relationship between in vitro tests and in vivo tests of UPF using solar simulators for determination of the minimal erythema dose (MED), applied to 30 different summer textiles. METHODS: Thirty summer textiles were spectrophotometrically assessed, and UPFs were calculated with respect to the International Commission on Illumination (CIE) erythemal action spectrum.1 Based on the in vitro UPFs 'on skin' and 'off skin', in vivo testing was performed using a solar simulator for the determination of the MEDunprotected and MEDprotected. RESULTS: The UPFs obtained from in vivo 'on skin' testing were significantly (r = 0.95; P < 0.001) lower than the predicted in vitro UPFs. This disparity was also confirmed by chromometric assessment of the MED testing; the erythemal responses measured after textile protection were significantly (P < 0.001) higher than those obtained without protection. However, the in vivo 'off skin' UPFs did not significantly (r = 0.98; P > 0.05) differ from the in vitro UPFs; comparison of the chromometrically assessed erythemal responses was also insignificant (P > 0.05). CONCLUSIONS: The different correlation between in vitro and in vivo measurements of the UPF may be due to the optical-geometrical properties of textiles and the different amount of direct and diffuse radiation passing through the spaces between the yarns. As spectrophotometric measurements of a textile may generally yield lower UPFs than those obtained under average field conditions, the in vitro test method provides 'safe' UPF values representing a 'worst-case scenario'. In contrast to in vitro testing, in vivo methods are much more expensive and time-consuming. Thus, with respect to practicality, spectrophotometric measurements seem to be most suitable for the evaluation of UV protection of textiles.

Adult↗
PubMed1998

Sarcoidosis presenting as palmar erythema.

Sarcoidosis, a multisystem disease of unknown aetiology, is characterized by the formation of non-caseating granulomas which may involve any organ of the body. The commonest sites of predilection are the lungs, skin and lymph nodes. We now report a patient who presented with palmar erythema which on biopsy confirmed the presence of non-caseating granulomas and who responded to systemic corticosteroids. We are unaware of any previous report in the literature of sarcoidosis presenting in this way.

Erythema↗
PubMed1999

Erythema nodosum secondary to meningococcal septicaemia.

We report a case of erythema nodosum (EN) secondary to Neisseria meningitidis infection in a 77-year-old woman. Histology of two biopsy specimens from two different lesions showed characteristic features of EN. Blood culture showed Neisseria meningitidis group C.

Aged↗
PubMed1999

Leucocyte activation in erythema nodosum.

As a neutrophilic vascular reaction of small vessels in the subcutaneous tissue and a neutrophilic inflammatory infiltrate are common histopathological features found in initial erythema nodosum (EN) lesions, we asked the question whether activated polymorphonuclear neutrophils (PMN) might play a role in the pathogenesis of EN. We analysed the production of reactive oxygen intermediates (ROI) as a marker for activated neutrophils in the peripheral blood of patients suffering from EN (n = 10) and healthy volunteers (n = 10). FACS analysis of dihydrorhodamine 123-stained PMN was used to detect ROI production due to respiratory burst activity. Patients suffering from EN had a fourfold higher percentage of preactivated ('primed') ROI-producing PMN compared with healthy volunteers. Activation of PMN with formylated methionyl-leucyl-phenylalanine and phorbol 12-myristate 13-acetate led to an increase of ROI production per cell but had no influence on the percentage of activated cells. The percentage of ROI-producing cells in patients with EN correlated with the clinical severity. From these data, we conclude that ROI might play a role in the pathogenesis of EN. ROI might exert their effects by oxidative tissue damage and by promoting tissue inflammation.

Adolescent↗
PubMed1999

Figurate erythema with bullous pemphigoid: a true paraneoplastic phenomenon?

There has been controversy about the possible link between bullous pemphigoid and underlying malignancy. We report a case of bullous pemphigoid with marked figurate erythema which arose shortly before the clinical presentation of colonic carcinoma and cleared completely 1 week after its resection. We review the literature and conclude that patients who present with clinically atypical bullous pemphigoid may warrant investigation for underlying neoplasia.

Colonic Neoplasms↗
PubMed2000

Chemotherapy-induced acral erythema: report of a case and immunohistochemical findings.

Chemotherapy-induced acral erythema (CAE) is an uncommon and distinct reaction seen in patients receiving high-dose chemotherapy. The exact pathogenic mechanisms of this disorder are still unknown. We report a 27-year-old woman who presented with red, swollen and painful macules on both palms, clinically consistent with this disease. Histological examination demonstrated vacuolar degeneration of the basal cell layer and spongiotic blisters in the epidermis, especially in the atrophied eccrine ducts and papillary oedema with mild perivascular infiltration of mononuclear and hypersegmented neutrophils. Immunohistochemistry showed that the infiltrating mononuclear cells were CD3-CD16+CD56+ leucocyte function antigen-1+, possibly natural killer cells. The eccrine ducts expressed HLA-DR and intracellular adhesion molecule-1 (ICAM-1). Our findings suggest that cell-to-cell interaction between NK cells and keratinocytes in the eccrine apparatus may induce CAE and may be involved in the pathogenesis of the skin reaction in our patient and possibly in this disease.

Adrenal Cortex Hormones↗
PubMed2000

Persistent annular erythema of infancy associated with intestinal Candida colonization.

We report a case of persistent annular erythema of infancy in a 4-month-old boy. Physical and laboratory parameters showed no sign of internal disease or specific infection except a massive Candida albicans colonization (> 103 organisms/mm3) of the lower gastrointestinal tract. Oral treatment with amphotericin B for 2 weeks resulted in a complete remission of the skin lesions indicating Candida colonization as a trigger.

Amphotericin B↗
PubMed2001

Erythema gyratum repens and acquired ichthyosis associated with transitional cell carcinoma of the kidney.

Both erythema gyratum repens (EGR) and acquired ichthyosis are distinctive dermatoses which have strong associations with internal malignancy. EGR usually precedes the diagnosis of malignancy whereas acquired ichthyosis commonly manifests after the detection of malignancy. We report a patient who initially presented with a figurate eruption of EGR which later developed into a widespread ichthyosis with disappearance of the serpiginous rash. Further investigations revealed an underlying transitional cell carcinoma of the kidney, an association which has not previously been reported with either EGR or acquired ichthyosis. The occurrence of two paraneoplastic skin disorders in the same patient may be explained by tumour cell secretion of transforming growth factor alpha, which has been shown to be mitogenic for keratinocytes.

Aged↗
PubMed1996

Erythema nodosum leprosum is associated with up-regulation of polyclonal IgG1 antibody synthesis.

Erythema nodosum leprosum (ENL) is a serious complication of lepromatous (L) disease in leprosy. We have previously shown that of the four IgG subclasses, IgG1 and IgG3 Mycobacterium leprae-specific antibodies are significantly lower in leprosy patients during ENL reaction compared with untreated L patients. To see if this decrease results from a down-regulation of antibody synthesis during ENL, the frequency of antibody-secreting B cells (ABSC) in the blood compartment was determined by ELISPOT and related to serum immunoglobulin concentrations (microgram/ABSC). Control groups consisted of 16 patients with stable L disease and 32 healthy endemic controls (EC). Paired samples were analysed during acute ENLS (n = 13) and after the reaction had subsided to identify changes associated with ENL. Polyclonal (PC) IgG1 was elevated in L patients compared with EC (325 micrograms versus 180 micrograms). Interestingly, patients during acute ENL showed concentrations higher than L patients (419 micrograms), which decreased after the reaction had subsided (260 micrograms), indicating the transient nature of the antibody response. IgG2 antibodies showed the reverse trend and were lower during ENL and increased after the reaction had subsided. The mean concentrations for PC IgG3 and IgG4 antibodies were similar during ENL and after the reaction had subsided. Thus, decrease in M. leprae-specific IgG1 and IgG3 antibodies is not related to down-regulation of B cell responses. Identification of factors which regulate PC IgG1 antibody synthesis may provide additional insights into determinants of ENL reactions.

Enzyme-Linked Immunosorbent Assay↗
PubMed2002

Peripheral amino acid and fatty acid infusion for the treatment of necrolytic migratory erythema in the glucagonoma syndrome.

Necrolytic migratory erythema (NME), the characteristic rash associated with the glucagonoma syndrome, is a cause of substantial morbidity among patients with this rare malignancy. Treatment options are suboptimal, and often useful for only short or moderate durations. We report the effective, long-term (> 1 year) use of intermittent infusions of amino acids (AA) and fatty acids (FA) administered via peripheral intravenous access for the treatment of NME in the glucagonoma syndrome. Despite resolution of the NME, serum amino acid (initially subnormal) and fatty acid (initially normal) levels remained unchanged. Tumour growth and other symptoms related to the glucagonoma syndrome appear unaffected by such infusions.

Amino Acids↗
PubMed1997

Nodular erythema elevatum diutinum mimicking cutaneous neoplasms.

AIMS: We describe the cutaneous pseudoneoplastic lesions in two patients with nodular erythema elevatum diutinum, a rare chronic disorder in which polymorph nuclear fragmentation (leukocytoclasis) is present within dermal nodules showing spindle cells and fibrosis. In both cases diagnostic difficulty was encountered clinically and pathologically and various benign and malignant neoplasms were considered in the differential diagnosis. METHODS AND RESULTS: Immunohistochemically the spindle cells were negative for CAM5.2, AE1/3, S100 protein and desmin (D33). They were positive for vimentin and focally positive for CD34 and alpha-smooth muscle actin. Some of the spindle cells were positive for Mac 387 and KP1(CD68). By electron microscopy, the lesions were shown to consist of fibroblasts/myofibroblasts and fusiform macrophages. CONCLUSIONS: Increased awareness of the features described will help to avoid misdiagnosis as a neoplastic process.

Adult↗
PubMed1998

Recurrent herpes simplex virus-induced erythema multiforme: different HLA-DQB1 alleles associate with severe mucous membrane versus skin attacks.

In some individuals a local herpetic lesion precipitates a generalized inflammation of the skin, designated as erythema multiforme (EM). We determined the frequencies of the immune response genes of the HLA system by molecular HLA class II typing in 46 patients with EM and in many of their family members. Allele frequencies were correlated with disease form and disease-inducing factors. We found that specific complications of HSV infection occur preferentially in patients with certain HLA-DQB1 alleles. In 21 of the 46 patients EM was induced by recurrent HSV infection. Thirteen of these patients showing only minor or no involvement of mucous membranes had the HLA allele DQB1*0302 (phenotype frequency 61.9% versus 18.8% in controls, p corr = 0.0008) and all three patients with major involvement of mucous membranes had the rare HLA allele DQB1*0402 (phenotype frequency in controls 6,4%, p corr = 0.017).

Alleles↗
PubMed1998

Erythema nodosum and associated diseases. A study of 129 cases.

BACKGROUND: Erythema nodosum (EN) is associated with many infectious diseases. The purpose of this study was to evaluate the relative prevalence of associated diseases in a large series of EN, and to review the previously described causes of EN. MATERIALS AND METHODS: A total of 157 inpatients with a diagnosis of EN made in Strasbourg, France between 1960 and 1995 were studied retrospectively, but only 129 patients with confirmed EN were evaluated. A biopsy was taken in 30 patients with atypical clinical symptoms. Chest radiography, blood cell count, throat swab, and anti-streptolysin dosage were performed systematically. Viral investigations and serodiagnoses for various bacterial infections were carried out in approximately half of the patients. All investigations were analyzed retrospectively and compared with the world literature. RESULTS: The female: male ratio was 5 : 1 and the mean age was 31 years. We found 28% confirmed streptococcal infections, 11% sarcoidosis, 1.5% enteropathies, 1.5% Chlamydia infections, 0.8% Mycoplasma infections, 0.8% Yersinia infections, 0.8% hepatitis B, and 0.8% tuberculosis (one case). The causative factor could not be determined in 55% of patients. CONCLUSIONS: Our data confirm the predominance of streptococcal infections and sarcoidosis among patients with EN. Tuberculosis has virtually disappeared, since the last case was observed in 1962. Various viral or bacterial diseases are rarely associated with EN, but all patients were not thoroughly investigated. A large and prospective study should be performed in order to determine the true prevalence of associated diseases in EN. In the absence of specific symptoms, exhaustive investigations are not cost-effective.

Adolescent↗
PubMed1998

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in northeastern Malaysia.

BACKGROUND: Previous studies have reported that drugs and infections are common causes of erythema multiforme (EM) and Stevens-Johnson syndrome (SJS). Toxic epidermal necrolysis (TEN) is mainly related to drugs. No study has been conducted in Kelantan, the northeastern state of Malaysia, to assess these cutaneous reactions. METHODS: A retrospective study of all hospitalized cases of EM, SJS, and TEN was conducted covering an 8-year period from 1987 to 1994. RESULTS: There were four cases (13.8%) of EM, 22 cases (75.9%) of SJS, and three cases (10.3%) of TEN. Drugs as a definitive cause was observed in one case (25%) of EM, 12 cases (54.5%) of SJS, and two cases (66.7%) of TEN. Drugs as a probable cause was observed in seven cases (31.8%) of SJS and one case (33.3%) of TEN. The male to female ratio was equal in EM and SJS. Antiepileptics were the commonest culprits, followed by antibiotics. One patient died of SJS and one patient died of TEN, giving mortality rates of 4.5% and 33.5% respectively. Fever was noted in 18 patients (62.1%). Leukocytosis was noted in 10 patients (34.5%), and nine patients (31.0%) had elevated liver transaminase enzymes. No significant correlation was noted between these biochemical changes and cutaneous eruption. Secondary infections were observed in 11 patients (37.9%): Staphylococcus aureus was the commonest isolated organism. CONCLUSIONS: This study shows that drugs remain the commonest culprit in SJS and TEN. Despite adequate treatment, the mortality rate remains high, especially in TEN. These findings are similar to those of other reported studies.

Adolescent↗
PubMed2003

Correlating skin phototype and minimum erythema dose in Arab skin.

Skin typing, as proposed by Fitzpatrick, has been used for estimating the initial dose in phototherapy.1 However, several reports have questioned the reliability of the method.2-4 It has been suggested that skin typing should not be the sole basis for starting UV-B phototherapy, and that determining the minimum erythema dose (MED) is a more reliable method of estimating the UV-B dosage.5 There is little published data with respect to skin types and MED values in Arab skin. In this review, we present our experience on the subject with Bahraini patients.

Arabs↗
PubMed1999

Corneal laceration and forehead erythema: a syndrome in infants.

PURPOSE: To illustrate a syndrome of transient erythema in the first division of the fifth cranial nerve caused by minor corneal laceration, occurring in infants. METHODS: Case reports are presented, together with photographs. These must, of necessity, usually be obtained by the general practitioner because of the short duration of the signs. RESULTS/CONCLUSIONS: Opinion is sought as to whether other practitioners have recognized this association and whether it has been described elsewhere.

Corneal Injuries↗
PubMed2000

Erythema multiforme along Blaschko's lines.

A case of erythema multiforme along Blaschko's lines is reported in a 20-year-old female suffering from recurrent herpes labialis. Histological examination was compatible with the clinical features. Spontaneous resolution followed in 4 weeks without therapy.

Adult↗
PubMed2001

Tinea barbae associated with erythema nodosum in an immunocompetent man.

We describe the case of a 45-year-old man with atopy who developed marked inflammatory lesions on the bearded area of the face caused by Tricophyton rubrum, an anthropophilic fungus not frequently correlated with kerion of the face. After starting therapy with griseofulvin, he developed typical lesions of erythema nodosum on both legs. We discuss how these lesions could be correlated with the kerion of the face.

Antifungal Agents↗