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At least 1,243 records · Page 69Linked to original sources
PubMed1980

Topically applied fluocinonide in an adhesive base in the treatment of oral vesiculoerosive diseases.

Patients with oral vesiculoerosive diseases frequently require corticosteroid treatment to induce healing and reduce pain. Because of the adverse effects associated with systemic use, topical application of 0.05% fluocinonide in an adhesive base was investigated. The study group was comprised of 89 patients with erythema multiforme, lichen planus, benign mucous membrane pemphigoid, or pemphigus. In the double-blind phase involving 15 patients, seven responded completely and eight partially to the topical ointment. In the open study that included 74 patients, 35 had complete disappearance of signs and symptoms, while 39 experienced partial benefit. There were no adverse side effects. All 89 patients were observed for three to 35 months and each patient's condition continued to respond to the treatment when its use was required.

Administration, Topical↗
PubMed1999

Critical overview: adverse cutaneous reactions to psychotropic medications.

BACKGROUND: Adverse cutaneous reactions (ACRs) are common, potentially life-threatening or symptomatically and cosmetically unappealing side effects of psychotropic drugs. DATA SOURCES: A MEDLINE search of the literature was employed to cite the association of various psychotropic drugs with specific cutaneous reactions. DATA SYNTHESIS: In addition to the common exanthematous eruption, we explore several serious reactions including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, angioedema, anaphylaxis, hypersensitivity syndrome, hypersensitivity vasculitis, erythroderma, and drug-induced lupus erythematosus. Other side effects such as alopecia, pigmentary disorders, photosensitivity, lichenoid lesions, fixed drug eruptions, and psoriasiform, acneiform, and seborrheic eruptions are discussed. Attention is paid to the morphology and distribution, systemic findings, diagnosis, and treatment of these conditions. CONCLUSION: Awareness of ACRs will allow psychiatrists to deter their continuation or recurrence, educate patients who have them, and diagnose serious instances of them.

Anaphylaxis↗
PubMed1977

Safety of influenza vaccination in allergic children.

One hundred forty-two allergic children aged three to 18 years were studied for evaluation of the usefulness of skin testing with influenza vaccine as a means of identifying those children who could be immunized safely despite their allergies to chickens, eggs, or feathers. One hundred twenty-eight children were fully immunized with bivalent influenza A/New Jersey/76-A/Victoria/75 vaccine. Twelve children had positive skin tests and were not immunized, and two developed positive skin tests after their first injection. One child had urticaria 8 hr later, one had a nonspecific reaction, and one had a self-limited erythema multiforme reaction eight days after the second injection. All others tolerated the procedure well. History of sensitivity to eggs was not as reliable an indication of vaccine sensitivity as skin testing with vaccine. A negative result of an intradermal skin test with a 1:100 dilution of the vaccine in saline appeared to be a reliable indicator of allergic subjects who could be immunized against influenza without fear of life-threatening acute allergic reactions.

Adolescent↗
PubMed1980

Cryoglobulinemia and decreased monocyte chemotaxis is malignant melanoma.

The sera fromm 13 patients with malignant melanoma were evaluated for immune complexes by cryoprecipitation and the 125I Clq binding assay. Cryoprecipitates were identified in 12/13 patients (92%) and cryoimmunoglobulins in 7/13 patients (54%). Either cryoimmunoglobulin or elevated Clq binding was identified in 8/13 patients (62%). Incubation of normal monocytes with the resuspended cryoimmunoglobulin of 7 melanoma patients produced greater than 50% reduction in the ability of th monocytes to respond to chemotactic stimuli (p < .01). Similar inhibition was seen with cryoimmunoglobulin from erythema multiforme patients, but not with 'medium alone, albumin, heat aggregated albumin or heat aggregated-IgG in similar concentrations. No soluble factors produced in vitro could be demonstrated to produce this inhibition. Inhibition of monocyte function by immune complexes may be an important component of impaired host response to malignant melanoma, or alternatively may represent an important mechanism for the accumulation of monocytes at sites of inflammation, analogous to migration inhibition factor.

Adolescent↗
PubMed1984

Glucocorticosteroids and oral medicine.

The article deals with the use of glucocorticosteroids in the treatment of the oral manifestations of Systemic Lupus Erythematosus (SLE), Discoid Lupus Erythematosus (DLE), Rheumatoid Arthritis (RA) in the temporomandibular joint, Pemphigus Vulgaris, Pemphigoid, Erythema Multiforme Exudativum (EME), Lichen Planus (LP), and Recurrent Aphthous Ulcerations (RAU). The benefit from steroids is discussed on the basis of current knowledge of etiology and pathogenesis of the various disorders. All of them are characterized by inflammation which appears secondary to a hypersensitivity reaction against autocomponents. Glucocorticoids do not interfere with the primary disease mechanisms. But it is concluded from the literature, that because of anti-inflammatory and immunosuppressive effects of the hormones, it seems reasonable to profit from steroids as palliatives in acute phases of the diseases and/or as long-term suppressors of the general host defense.

Arthritis, Rheumatoid↗
PubMed1977

[Therapy with transfer factor in a case of recidivating herpes with polymorphous erythema].

A young woman had recidivating herpes with erythema multiforme for several years. When conventional therapy failed to correct this condition she was treated with Transfer Factor (TF). Immunologic anomalies which had been registered previously became normal after the first application of TF. The skin lesions disappeared after the fourth dose. Six months later a new skin manifestation with immunologic alterations became apparent. They disappeared after two doses of TF. A year and a half later the patient has no lesions and the immunologic parameters, which were monitored throughout this period, are normal.

Adult↗
PubMed1979

Mucocutaneous eruptions due to antiepileptic drug therapy in children.

Three children with bullous erythema multiforme and 1 with toxic epidermal necrolysis associated with antiepileptic drug therapy are described. One patient is unique because of seven mucocutaneous eruptions caused by three classes of antiepileptic drugs. Lymphocyte stimulation by antiepileptic drugs could not be demonstrated in the 2 patients in whom appropriate studies were performed, and no precipitating antibodies to antiepileptic drugs were found. Observation of four diagnostic and therapeutic principles, which are illustrated by the course of our patients, may reduce the incidence of life-threatening mucocutaneous eruptions and simplify the long-term management of individuals in whom such reactions occur.

Anticonvulsants↗
PubMed1982

[Adverse effects of drugs on the oral mucosa--incidence and clinical picture in clinical patients].

The medical documents of 17.250 inpatients admitted to the Dermatological Department between 1970 and 1980 have retrospectively been examined concerning the frequency and clinical types of drug-induced side effects on the oral mucosa. Among 4.766 inpatients with registered side effects (27.63% to the total) there were 187 (3.92%) exhibiting drug-induced oral lesions. These conditions included, with decreasing prevalence rates, various types of enanthemas, mucosal oedemas, and erythema multiforme exsudativum, whereas other side effects (denture sore mouth, allergic contact stomatitis, lichenoid lesions, etc.) have been observed less frequently. Among the drugs involved analgetics, antiphlogistics and anti-infective ones prevailed being followed by psychopharmaca and dental materials. In 91 our of 121 inpatients, the causative allergen(s) could be ascertained by allergologic examinations (mostly by epi- or intracutaneous testing, or controlled drug exposition). Middle-aged inpatients, in comparison to the total of inpatients, suffered overproportionally from drug-induced oral side effects.

Adolescent↗
PubMed1980

Diagnosis and management of long-standing benign oral ulceration.

The authors formed a Mouth Clinic at Sunnybrook Hospital in 1973 since when there have been 3025 patient visits. Those patients with chronic ulceration present a challenge, the diagnosis sometimes being difficult and therapy not rapidly effective. The differential diagnosis includes lichen planus, pemphigus vulgaris, benign mucous membrane pemphigoid, discoid lupus erythematosus, erythema multiforme, aphthous ulcers, Behcets disease, periadenitis mucosa necrotica recurrens, specific infections and iatrogenic causes. It is possible to reach a definite diagnosis in virtually every case by means of a good history and careful clinical examination supplemented by biopsies and in some cases direct and indirect immunofluorescent studies. Treatment emphasizes scrupulous attention to oral hygiene with baking soda mouthwashes and careful teeth cleaning to minimize the accumulation of dental plaque. Specific therapy includes topical steroids in lichen planus, intra muscular gold in benign mucous membrane pemphigoid, a previously unreported treatment which considerably improved seven out of ten patients, and tetracycline mouthwashes in aphthous ulcers.

Behcet Syndrome↗
PubMed1993

Non-infectious diseases of the oral soft tissue: a new approach.

A significant proportion of the non-infectious diseases of oral mucosa are either auto-immune in nature or have lesions which are the result of immunologically-mediated events. These include pemphigus, benign mucous membrane pemphigoid, linear IgA bullous dermatosis, dermatitis herpetiformis, epidermolysis bullosa acquisita, erythema multiforme, and lichen planus. Although each of these has certain specific characteristics, all may produce bullae, erosions, and ulcers on the oral mucosa, resulting in confusingly similar clinical presentations. With careful clinical, histological, and immunofluorescence examination, it is possible to establish a definitive diagnosis in a high proportion of cases. However, one of the most exciting developments which has emerged from recent research into these diseases is their precise molecular characterization. This raises the prospect of accurate, highly specific diagnostic tests which would provide the basis for sound clinical management, with original approaches replacing the somewhat unsatisfactory symptomatic treatment which is often all that is available.

Antigen-Antibody Complex↗
PubMed1998

Autoimmune progesterone dermatitis and stomatitis.

Autoimmune progesterone dermatitis is a rare clinical condition associated with variable cutaneous and mucosal eruptions such as urticaria, erythema multiforme, and eczema. Exacerbation is influenced by hormonal changes of the menstrual cycle. The patient described in this report had recurrent cyclic lesions on the skin, oral mucosa, and lips that appeared just before regular menstruation and persisted until a few days after. During each cycle, the eruptions appeared at the previously affected sites, mimicking the clinical feature of a fixed drug eruption. This rare phenomenon is attributed to an autoimmune reaction to female sex hormones. The condition failed to respond to therapy with prednisone, but improved with the use of an antiestrogen drug, tamoxifen. This medication suppresses ovulation and the post-ovulation rise in endogenous progesterone levels.

Adult↗
PubMed1984

Drug-induced skin disease.

Drug-induced cutaneous reactions encompass a wide variety of rashes that depend in part on route of administration (e.g., contact versus systemic) as well as type of cutaneous response and molecular mechanism underlying the reaction. One such reaction is a type IV immunologic reaction (delayed hypersensitivity) manifest as contact dermatitis and commonly elicited by drugs such as antihistamines, antibiotic ointments, local anesthetics, and paraben esters in cosmetic creams and lotions. A generalized eruption of this sort will occasionally occur with systemic administration of a drug to someone previously sensitized by topical application. Systemic administration of agents can cause nonspecific pruritus or maculopapular eruptions that resemble visual exanthemas. The pathogenesis is unclear and no immune mechanism has been demonstrated. If the drug is continued, exfoliative dermatitis can result. Other types of reactions are urticarial in nature and include acute urticaria/angioedema, erythema multiforme (bullous and nonbullous), Stevens-Johnson syndrome, urticaria in association with serum sickness-like reactions, and urticaria associated with anaphylactoid reactions. In many of these, an allergic reaction in which there is an immunoglobulin (Ig) E-dependent release of mediators in the skin causes hives or swelling. In others, circulating immune complexes may be present, often involving IgG antibody complexed with drug and complement fixation; hives may then be caused by anaphylatoxin release or a concomitant IgE-mediated reaction. In some instances, a cellular reaction may augment the aforementioned inflammatory reactions, perhaps as part of a late-phase reaction or a true delayed hypersensitivity component.

Angioedema↗
PubMed1997

Allergy testing in serious cutaneous drug reactions--harmful or beneficial?

We report on 3 cases of adverse cutaneous drug reactions of erythema multiforme type. Despite the serious previous clinical conditions, patch tests with the possible causative drugs have been performed in all our patients, because of multiple candidate drugs and the need of the patients for further treatment with at least some of the agents. We demonstrate that patch tests are a good and safe approach to initial evaluation of the nature of a cutaneous drug reaction. In the case of a positive patch test reaction to one of the substances, re-exposure to the non-reactants in a clinical setting is recommended. If a one-side-blinded placebo-controlled challenge test is well tolerated, then the clinician should be able to reintroduce drugs previously suspected as causing the allergy.

Adult↗
PubMed1986

Acute generalized exanthematous pustular dermatitis and viral infection.

Three patients with acute generalized exanthematous pustular dermatitis (AGEPD) are presented. This new clinical entity comprises generalized erythema, erythema multiforme, amicrobial pustules, fever and spontaneous healing over a 10-day period. Histologically, there are a mixed neutrophilic and eosinophilic vasculitis and an eosinophilic subcorneal and spongiform pustule. All the patients experienced pharyngitis 1 week before the onset of the rash. Two of them had high-titered IgM-neutralizing antibodies to enteroviruses and 1 had an enterovirus in stool and urine. AGEPD may be related to a viral infection and may occur in patients with a genetic predisposition to psoriasis. The diagnosis of AGEPD should be made early enough so that the patients are not given the often aggressive therapy of pustular psoriasis.

Adolescent↗
PubMed1996

Case report: diclofenac-induced rhabdomyolysis.

A case is described in which, after administration of diclofenac for 13 days for arthritis attributed to gout, the patient experienced erythema multiforme followed by muscle weakness, elevation of serum creatine phosphokinase (CPK) level from 101 to 83,770 U/L, 100% muscle isoenzyme, blood urea nitrogen (BUN) level from 15 to 87 mg/dL, creatinine level from 1.0 to 2.1 mg/dL and urine myoglobin level to 1,190 micrograms/dL (N < 1.2). The diagnosis was rhabdomyolysis due to diclofenac, with myoglobinuria resulting in mild renal failure. Treatment consisted of discontinuing diclofenac and administering sufficient fluids to prevent progression of myoglobinuric renal failure. Serum CPK level gradually returned to normal by day 50, BUN and creatinine levels by day 28, and muscle strength between day 90 and 180. Rhabdomyolysis due to diclofenac or to other nonsteroidal antiinflammatory drugs has not been reported.

Adult↗
PubMed1976

Fibrinoid necrosis of the epithelial cells of the skin.

It has been shown in previous studies that fibrinoid necrosis not only occurs in connective tissue and in vessel walls, but can also be observed in the liver cells under special conditions and can also be provoked experimentally. It was observed in the present study that certain dermatoses (cases of the herpes group, erythema multiforme, drug eruptions, Lyell's toxic epidermal necrolysis, pityriasis lichenoides acuta, and skin affected by UV-rays) were associated with "eosinophilic necrosis" in the epithelial cells which morphologically corresponded to the fibrinoid necrosis of the connective tissue and of the liver cells described previously. Besides toxic, infectious and septic conditions, circulatory disturbances (hypoxia, anoxia) appear to have a special significance. Observations by way of the light and fluorescence microscope revealed the characteristics of keratin variants and precursors in some necrobiotic cells which influence the peculiar properties of fibrinoid necrosis of the skin epithelia. The role of the mixed paraproteins is emphasized and reference is made to the role of a mixed paraprotein ("keratofibrinoid") which is formed in the course of the regressive process and to which the morphological changes may be attributed.

Drug Eruptions↗
PubMed1993

Rheumatologic manifestations of pediatric human immunodeficiency virus infection.

OBJECTIVE: Multiple rheumatologic signs and symptoms have been described in adult human immunodeficiency virus (HIV) infection. Our goals were to determine the incidence and characteristics of rheumatologic manifestations in HIV infected children, and to examine their relationship to laboratory evidence of autoimmunity. METHODS: Forty HIV infected children were studied by means of a questionnaire, history, examination, and serologic testing including determination of concentrations of immunoglobulin, C3, C4, and of presence of antinuclear antibodies (ANA), rheumatoid factor (RF), and circulating immune complexes (CIC). RESULTS: Rheumatologic manifestations included arthralgia (15%), myalgia (8%), erythema multiforme (3%), and parotitis (20%). Hypergammaglobulinemia (98%), hypocomplementemia (25%), RF (10%), ANA (3%), and CIC (82% of patients studied) were also found. Patients with or without rheumatologic manifestations did not differ significantly in any laboratory variable measured. CONCLUSIONS: In contrast to HIV infected adults, HIV infected children, do not display serious rheumatologic manifestations. Mild rheumatologic symptoms are common, but there is little evidence that these are immune mediated. Parotid enlargement occurs and must be differentiated from Sjögren's syndrome. Differences between rheumatologic manifestations of HIV infection in children and adults may reflect host factors such as the immaturity of the pediatric immune system, or environmental factors such as modes of acquisition of HIV, duration of HIV infection, or exposure to other sexually transmitted organisms.

Adolescent↗
PubMed1986

Severe cutaneous reactions among American travelers using pyrimethamine-sulfadoxine (Fansidar) for malaria prophylaxis.

In 1982, the fixed combination of pyrimethamine and sulfadoxine (Fansidar) became available in the United States, and was recommended for use in travelers at risk of acquiring chloroquine-resistant Plasmodium falciparum. Prior to that time, no reports of severe cutaneous reactions had appeared in the medical literature despite widespread use for more than 8 years in both Europe and malarious areas of the developing world. In the fall of 1984, the Centers for Disease Control received reports of 4 cases of toxic epidermal necrolysis (including 3 fatalities) among Americans who had used pyrimethamine-sulfadoxine (PYR/SDX) for the prevention of malaria. Subsequent investigation into severe cutaneous reactions associated with the use of this drug by American travelers detected 24 cases of erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis. Twenty-three of the 24 patients concurrently used chloroquine. Seven patients died. No risk factors in the development of these reactions other than the use of PYR/SDX could be identified. Among American travelers, we estimate that these reactions occur in 1 per 5,000-8,000 users, and that fatal reactions occur in 1 per 11,000-25,000 users. This higher than expected incidence necessitates that the use of PYR/SDX for the prevention of malaria be reconsidered. In the United States it is now recommended that the routine weekly use of the drug be reserved for those travelers at highest risk of acquiring chloroquine-resistant P. falciparum, when alternate prophylactic regimens are not deemed appropriate.

Adolescent↗