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PubMedDate not supplied

Nodular tuberculid: a report of four patients.

The tuberculids are hypersensitivity reactions to Mycobacterium tuberculosis (MTB) and include papulonecrotic tuberculid (PNT), lichen scrofulosorum, erythema induratum of Bazin (EIB), and phlebitic tuberculid. Papulonecrotic tuberculid displays papulonecrotic lesions mostly on the extensor surfaces of the limbs. Histopathology shows necrosis, granulomatous inflammation (GI), and occasionally vasculitis, usually in the superficial dermis. Erythema induratum of Bazin shows nodulo-ulcerative lesions on the posterior aspect of the legs. Histopathology reveals a septolobular panniculitis, necrosis, GI, and vasculitis. The Mantoux test is strongly positive and associated tuberculosis (TB) may be present in both conditions. MTB cannot be demonstrated with a Ziehl-Neelsen (ZN) stain or cultured. The polymerase chain reaction has demonstrated MTB DNA in PNT (50%) and EIB (25%). The tuberculids respond to full anti-TB treatment. We document four patients with nodules on the legs in whom the pathologic changes were situated in the deep dermis and adjacent subcutaneous fat. Nodular tuberculid (NT) is regarded as a suitable term for these lesions. All patients were female. Their ages were 19 months, 12 years, 17 years, and 5 years. All patients presented with nodules on the limbs. These nodules were approximately 1 cm in diameter, dull red or bluish-red, and nontender. Ulceration was not present. The number of nodules varied from a few to many. The Mantoux test was strongly positive in all the patients. Associated pulmonary TB was present in two patients. Histopathology showed GI (n = 4), vasculitis (n = 2), and coagulative necrosis (n = 2). A ZN stain was negative in each case. All patients received anti-TB treatment for 6 months [rifampicin (n = 4), isoniazid (n = 4), pyrazinamide (n = 4), and ethambutol (n = 2)]. At 12 months follow-up, skin and pulmonary lesions had resolved in all. Nodular tuberculid should be distinguished from arthropod bites and papular urticaria, dermal erythema multiforme, evolving vasculitis, evolving folliculitis, and erythema nodosum. Histopathologically NT should be distinguished from other causes of granulomatous vasculitis and GI with or without necrosis. In children with nodules on the limbs unresponsive to routine treatment, skin biopsy should be done to exclude NT. Nodular tuberculid represents a hybrid between PNT and EIB with characteristic clinicopathologic features and should be included in the classification of cutaneous TB.

Adolescent↗
PubMed1977

Oral manifestations of herpes simplex virus infections.

Most individuals are infected with Herpes Simplex in childhood usually suffering a mild febrile illness of no consequence. Later some individuals suffer recurrent infections which appear as cold sores on the lip while others intermittently shed virus in the oro-pharygeal secretions. Adults uninfected in childhood may be exposed to viruses for example by kissing and develop an acute primary herpes with fever and gingivo-stomatitis occasionally requiring hospital admission. Awareness of this condition is required for diagnosis after which the majority of patients seen in otolaryngological practice need only supportive therapy, explanation and reassurance. Recurrent cold sores are no more that a nuisance in most patients, but occasionally they are severe and in others the cold sore may precipitate oral erythema multiforme. Unfortunately the treatments available for recurrent cold sores are rather unsatisfactory.

Erythema Multiforme↗
PubMed1994

Oral presentation and management of vesiculobullous disorders.

Vesiculobullous diseases are frequently encountered by the practicing dermatologist. However, these disorders are often difficult to diagnose and manage. The oral cavity may be overlooked as a source of diagnostic information. Oral manifestations of vesiculobullous diseases may occur independently or precede cutaneous involvement by a year or more. Maintenance of oral hygiene, discomfort that results in poor hydration and nourishment, and secondary infection must be addressed to assure disease control and patient comfort. The three vesiculobullous disorders that occur most commonly in the oral cavity are pemphigus vulgaris, cicatricial pemphigoid, and erythema multiforme. This article will discuss their oral presentation, diagnosis, and management.

Erythema Multiforme↗
PubMed1979

Urticarial vasculitis: report of a case and review of the literature.

A woman with cutaneous vasculitis had a severe bullous eruption that was suggestive of erythema multiforme. The patient also had a history of recurrent urticaria that continued intermittently for over a year of follow-up examination. Skin biopsy specimens of both urticarial and erythema and multiforme lesions showed leukocytoclastic vasculitis. An illness resembling systemic lupus erythematosus (SLE) is suggested by transient, low-titer, positive antinuclear antibody tests, persistent deposits of immunoglobulin and complement in normal skin, arthralgias, circulating immune complexes, and chronic hypocomplementemia. This case is similar to cases previously reported as "hypocomplementemic vasculitis," an "unusual SLE-related syndrome," and "urticaria with vasculitis."

Adult↗
PubMed1998

Herpes. Vaccines for HSV.

Herpes simplex viruses type 1 (HSV-1) and 2 (HSV-2) are ubiquitous human pathogens capable of producing primary, latent, and recurrent infections. These viruses cause a variety of clinical illnesses including genital herpes, oral-facial infections, cutaneous infections, ocular infections, neonatal herpes, herpes encephalitis, disseminated infection, and erythema multiforme. This article summarizes the past and current efforts to develop both prophylactic and therapeutic HSV vaccines.

Encephalitis, Viral↗
PubMed2000

The bullous desquamative lesions of oral mucosa.

The most common of the bullous/desquamative diseases that affect the mouth include the erosive form of lichen planus, erythema multiforme, pemphigoid, and pemphigus. This overview looks at the clinical features and diagnosis of these diseases. In addition, treatment options are discussed.

Epithelium↗
PubMed1993

How frequent are notified severe cutaneous adverse reactions to Fansidar?

An attempt was made to estimate the risk of severe cutaneous adverse reactions (SCARs) to Fansidar (sulfadoxine plus pyrimethamine). Cases were identified through a spontaneous reporting system. Persons exposed were estimated using sales data of 27 countries reporting one SCAR case for either Fansidar or a related product, Bactrim (cotrimoxazole; sulfamethoxazole plus trimethoprim). Between 1974 and 1989, 126 cases were notified for Fansidar: 87 cases of erythema multiforme or Stevens-Johnson syndrome, and 39 cases of toxic epidermic necrolysis. 86% of cases were reported in Europe or North America. In 116 cases with use known, prophylaxis was the reason in 103, and treatment in 13. Toxic epidermolysis and erythema multiforme/Stevens-Johnson syndrome had case fatalities of 36 (95% confidence intervals 21 to 53%) and 9% (4 to 18%), respectively. Fansidar users were estimated at 117 million, and the overall SCAR risk to be 1.1 (0.9 to 1.3) per million. For developing countries with mainly single dose use, the risk was estimated to 0.1 (0.0 to 0.1) per million. For Europe and North America with mainly prophylactic use, the risk was 10 (8 to 12) and 36 (23 to 48) per million, respectively. Prophylactic use had a 40 times higher risk than single dose therapeutic use. The aggregated risk peaked in 1984-1985, with global and North American SCAR frequencies of 3.4 (2.4 to 4.3) and 72 (41 to 102) per million, respectively. After 1985, North America reported only one further case despite continued use by an estimated 0.3 million persons.(ABSTRACT TRUNCATED AT 250 WORDS)

Adverse Drug Reaction Reporting Systems↗
PubMed1985

Immune complexes in the reactive inflammatory vascular dermatoses.

Immune complexes are formed by the interaction of antigen and antibody. When these complexes are deposited in tissue, they activate complement that is chemotactic to neutrophils. Neutrophil release of lysozymal enzymes results in destruction of tissue. In the skin this destruction manifests itself clinically as vasculitic lesions. Occasionally other clinical lesions, such as urticaria, erythema multiforme, and so forth, may be a manifestation of immune complex disease.

Antibodies, Anti-Idiotypic↗
PubMed1997

William Osler and development of the concept of systemic lupus erythematosus.

OBJECTIVE: This historical review summarizes the understanding of lupus erythematosus (LE) during the time of the career of William Osler and analyzes factors that may have retarded the clinical identification of this disease. METHODS: All of Osler's writings related to diseases that he defined as the "erythema group" were studied, in conjunction with relevant writings on Schönlein-Henoch purpura and erythema multiforme. RESULTS: Osler did not knowingly describe cases of LE, nor did he discuss the disease in general. He proposed that a primary skin disease, which in some cases has visceral manifestations, may develop as a purely visceral disease, using cases from his "erythema group" cohort as evidence. CONCLUSIONS: The reluctance into the 1940s to diagnose systemic LE was primarily a consequence of the erroneous belief that a skin eruption was required to establish the diagnosis. Osler's teaching the possible dissociation of visceral from cutaneous symptoms with regard to the erythema group was not analogized to LE. The interpretation that Osler had elucidated aspects of LE has developed since 1937 and attributes insights to Osler that his writings do not substantiate.

Erythema Multiforme↗
PubMed1983

Ceftazidime in the treatment of lower respiratory tract infection.

Forty patients with acute lower respiratory tract infection requiring hospital admission were treated with ceftazidime. One patient developed acute dyspnoea after the first dose of the drug which was considered to be drug related and treatment was discontinued. All remaining patients were clinically assessed as being either cured or improved. In all cases that were bacteriologically assessable the pathogens were eradicated. One patient developed erythema multiforme after the end of ceftazidime treatment; this was considered to be possibly drug related.

Adolescent↗
PubMed1992

Dermatitis caused by dimethyl cyanocarbonimidodithioate.

Dimethyl cyanocarbonimidodithioate (CAS No. 10191-60-3) a raw material for cimetidine synthesis, is labelled as an irritant on its storage tank. There is no information available regarding the toxic effects of human exposure. We report a case of severe dermatitis clinically resembling erythema multiforme following an accidental exposure to dimethyl cyanocarbonimidodithioate in an occupational setting. A clerk sifted a handful of dimethyl cyanocarbonimidodithioate from an unlabelled bucket through his bare hands during an inspection prior to customs clearance. Five hours later, while he was washing his hands, pruritus, erythema and vesicles developed over the exposed area. The skin condition worsened within two weeks, extending to his whole body with generalized erythema and vesicles of various sizes. Some vesicles became confluent with ruptured bullae, resembling a second degree burn over 40% of the body. Elevation of the serum IgE (705 mu/mL, normal less than 300 mu/mL) and lymphocyte activation with an increased 3H-thymidine uptake by the patient's mononuclear cells suggested that this episode resulted from a cell-mediated allergic skin reaction. The skin lesions improved progressively after systemic steroid therapy for about two weeks. Dimethyl cyanocarbonimidodithioate is used as a raw material for cimetidine synthesis by some pharmaceutical manufacturers. Our experience suggests that a severe reaction similar to that caused by another H2-blocker, ranitidine and its intermediate may be caused by dimethyl cyanocarbonimidodithioate in occupational exposures. Systemic steroid administration is beneficial in treatment.

Adult↗
PubMed1986

[Physiology of Langerhans cells and their potential role in oral pathology].

Langerhans cells represent a minor epidermal cell population in mammals. They are also observed in squamous epithelia of the oesophagus, vagina and cervix, as well as in oral epithelia. They occur in higher density in the non keratinized epithelium. These cells are characterized by a dendritic pattern, a clear cytoplasm and ultrastructurally by the presence of Birbeck granules. They are usually located in a suprabasal position. Their bone marrow origin is now well established. Surface markers and functional properties identify them as belonging to the macrophage/monocyte lineage. Langerhans cells can be identified in tissue sections by immunofluorescence or immunoperoxidase techniques using monoclonal antibodies directed against surface antigens such as class II histocompatibility antigens, T6 marker, or possibly T4 marker. There is also a cytoplasmic marker, the S-100 protein. A renewed interest in Langerhans cells comes from evidence of their role in the cutaneous immune response. At present these cells are considered as dendritic cells expressing a high density of class II histocompatibility antigens and behave as very potent antigen presenting cells that activate mainly helper T lymphocytes. However, experimental data on antigen processing and interleukin 1 secretion are still lacking. This review also examines the oral pathology literature with respect to modifications in the number or localization of Langerhans cells and their proximity to T lymphocytes, for example in lichen planus, Behcet's syndrome, erythema multiforme, gingivitis and oral carcinoma. Histiocytosis X represents a particular case in which the Langerhans cell itself is affected.

Behcet Syndrome↗
PubMed2002

Local erythematous dermatitis after intravenous docetaxel.

We report the case of a patient who developed a local skin eruption over the vein following intravenous infusion of docetaxel at 4-week intervals. The skin lesions were limited to an area of the forearm proximal to the site of infusion. They appeared 1 week after the infusion and were diagnosed as erythema multiforme (mixed-type) based on the histological findings.

Aged↗
PubMed2002

[Toxic dermatitis caused by pseudoephedrine: apropos of a case].

Allergy to pseusoephedrine seems to be rare and has been described as responsible of urticaria, contact dermatitis, fixed non-pigmenting erythema or pseudoscarlatina. We report the case of a male patient who presented a recurrent erythema after administration of different treatments including pseudoephedrine. A cutaneous biopsy was compatible with erythema multiform. Patch tests confirmed the diagnosis of allergy to pseudoephedrine but resulted in a reappearance of symptoms.

Adult↗
PubMedDate not supplied

Miscellaneous diseases affected by pregnancy.

Miscellaneous groups of dermatoses are associated with pregnancy and affected by gestation, but they do not coincide with any known classifications. They are inflammatory in nature and include psoriasis, acne, hidradenitis suppurativa, atopic dermatitis, and erythema multiforme. Such dermatoses can either improve or worsen during pregnancy. This review focuses on the changes that can occur during the pregnant state.

Acne Vulgaris↗
PubMed2002

Acute necrotizing dermatitis and septicemia after application of a d-limonene-based insecticidal shampoo in a cat.

A 2-year-old female spayed domestic shorthair cat was examined because of lethargy, inappetance, vocalization, and abnormal aggressive behavior of 1 day's duration. The cat had been groomed the previous day with a d-limonene-based insecticidal shampoo. Skin lesions consisted of coalescing erythematous patches. Despite supportive care, the cat's condition deteriorated. Dermatohistopathologic changes included multifocal areas of acute coagulative epidermal necrosis. The dermis was infiltrated by a dense population of bacilli. d-Limonene toxicosis has been rarely described in dogs and cats. Toxic effects such as hypersalivation, ataxia, shivering, hypothermia, scrotal irritation, hypotension, and erythema multiforme major have been reported. Treatment for septicemia and disseminated intravascular coagulation, along with intensive supportive care, may be necessary.

Acute Disease↗
PubMed1990

The photoaggravated dermatoses.

The photoaggravated dermatoses are diverse diseases adversely affected by sunlight or artificial ultraviolet (UV) exposure. The role of UVR is often well-recognized, as in lupus erythematosus (LE) and bullous pemphigoid (BP). Immunologic theories for the cause of the photosensitivity in lupus erythematosus are the production of UV-DNA antibodies with subsequent immune complex formation, a partial defect in DNA repair following UV exposure, and the release or stimulation of potent cutaneous immunologic mediators. However, mechanisms are still not fully elucidated. Photosensitivity has also been described in erythema multiforme, actinic lichen planus, viral exanthems, cutaneous T-cell lymphoma, eczema, and psoriasis. Treatment is restriction of light exposure, use of high protection sunscreens, and treatment of the underlying disorder.

Animals↗