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PubMed1998

Erythema dyschromicum perstans: report of a new case and critical review of the literature.

Erythema dyschromicum perstans (EDP), described by Convit et al. in 1961, is a rare dermatosis. Its relationship with ashy dermatosis (AD), described by Ramirez in 1957, is still a matter of debate. We report a typical case of EDP. The patient, of North African origin, had a dyschromic (hypo- and hyperpigmented) eruption on the chest and limbs for 2 years. The lesions were occasionally surrounded by a papular border which spread slowly and centrifugally. Histological examination showed a lichenoid infiltrate. A carcinoma of the lung was simultaneously discovered. No treatment was given, EDP is infrequent and often considered identical to ashy dermatosis in the literature. However, the clinical aspects of the two diseases differ. The main features of these two diseases are reviewed and compared on the basis of a literature review. We conclude that EDP and AD are distinct clinical entities.

Aged↗
PubMed1999

Erythema elevatum diutinum complicated by rheumatoid arthritis.

A 53-year-old female developed erythema elevatum diutinum (EED) twelve years after the onset of rheumatoid arthritis. The arthritis had been well controlled for the last several years. Annular purpuric macules were characteristically complicated by common nodular and plaque lesions. Both leukocytoclastic vasculitis and fibrosis were observed in the macular lesions, indicating that the lesions were a manifestation of an early phase of EED. Both types of skin lesions disappeared with treatment with dapsone. They have not relapsed for two years after stopping the dapsone. The leukocytoclastic vasculitis was thought to have developed independently of the rheumatoid arthritis. She had noticed sicca symptoms two years before the appearance of EED, but she did not satisfy the diagnostic criteria for Sjögren's syndrome.

Anti-Inflammatory Agents↗
PubMed1999

Erythema dyschromicum perstans in early childhood.

Erythema dyschromicum perstans (EDP) is a rare disorder characterized by asymptomatic, slowly progressive, ash-gray macular pigmentation of the skin which usually occurs from age 5 through adult life. We have experienced two cases of EDP in children aged 2 and 3, both exceptionally younger than the previously reported cases. We therefore suggest that EDP should be included in the differential diagnosis of pigmentary disorders occurring at an early age.

Age Factors↗
PubMed2002

Clinicopathologic analysis of 66 cases of erythema annulare centrifugum.

Erythema annulare centrifugum (EAC) denotes a group of eruptions characterized by slowly migrating annular or configurate erythematous lesions. It can be classified histopathologically as the deep or superficial type. Although there are many case reports of EAC associated with various underlying conditions, no recent clinicopathologic studies exist. The purpose of this study was aimed at analyzing the clinical and histopathologic features of EAC. Sixty-six patients who have been diagnosed as EAC by clinical and histopathological examination were collected. The medical records and skin biopsy specimens of these patients were reviewed retrospectively. There were 24 male patients and 42 female ones. The mean age was 39.7 years, and the mean durtion of the disease was 2.8 years. The lower extremities, particularly the thigh, were the most frequently involved locations. The most common clinical manifestation was large (>1 cm), scaly, erythematous, indurated plaques. Forty-eight patients (72%) had combined diseases including cutaneous fungal infection (48%), such as tinea pedis, other skin diseases (18%), internal malignancies (13%), and other systemic diseases (21%). By histopathologic examination, 33 of 42 patients (78%) were identified as superficial type, and 9 patients (22%) were deep type. Therapeutic trials with systemic or topical corticosteroid and oral antihistamine did not affect the chronic and recurrent course of these patients. EAC is a chronic and recurrent disease despite treatment. EAC is thought to be highly associated with internal disease as well as with superificial fungal infection. However, it was difficult to prove a causal association. The recognition and exact diagnosis of EAC is important, because it may be a quite stressful condition and lead to unnecessary over-treatments.

Adolescent↗
PubMed2002

Sweet's syndrome evolved from recurrent erythema nodosum in a patient with myelodysplastic syndrome.

A 63-year-old man had painful nodules on his lower legs. Microscopic examination showed septal and lobular panniculitis composed of lympho-histiocytic infiltrates. Based on the clinical and histopathological findings, the diagnosis of erythema nodosum (EN) was made. Nonsteroidal anti-inflammatory drugs were temporarily effective, but the eruptions had repeated to the present, and 16 months later, myelodysplastic syndrome (MDS) was diagnosed. Then, 6 months later, he developed a high fever and edematous fresh red-colored nodules on his neck, arm and upper trunk. Histopathologically, a diffuse, dense, dermal infiltrate of neutrophils was seen, and Sweet's syndrome (SS) was diagnosed. SS is known to develop in patients with MDS, and EN is one of the dermatoses that occur in conjunction with hematoproliferative disorders. Furthermore, SS evolving from recurrent EN and the simultaneous occurrence of SS and EN have been reported in some patients. In our case, we suggest that some mediators such as cytokines associated with MDS might have first induced EN, and then, as the MDS developed, they were replaced by others that caused SS.

Biopsy, Needle↗
PubMed2003

Painful indurated erythema suggestive of Kikuchi-Fujimoto disease in a patient with primary Sjögren's syndrome.

We report a patient with primary Sjögren's syndrome who developed pyrexia, cervical lymphadenopathy, and painful indurated erythema on the forehead, back, chest, abdomen, and limbs. Laboratory data showed an elevated erythrocyte sedimentation rate, C-reactive protein and CH50 in addition to existing autoantibodies including anti-nuclear antibody, anti SS-A antibody, and anti SS-B antibody. A skin biopsy specimen showed focal infiltration of histiocytes with non-neutrophilic karyorrhetic debris in the dermis and subcutaneous fat tissue. Immunohistochemically the infiltrated cells were stained for CD68, suggesting cutaneous involvement of Kikuchi-Fujimoto disease. All symptoms and laboratory data improved within three weeks after treatment with 20 mg/day of prednisolone. The present case suggests that a pathophysiological condition similar to Kikuchi-Fujimoto disease can develop during the long-term course of Sjögren's syndrome.

Adult↗
PubMed2004

Primary tuberculosis cases presenting with erythema nodosum.

Erythema nodosum (EN) is seen only in the primary tuberculosis (TB) form of tuberculous diseases. Among the etiologies of EN, TB is the most frequent disorder in developing countries. We aimed to assess our patients with EN in reference to primary TB. We evaluated 335 patients with the diagnosis of TB during last 20 years; retrospectively 61 (18%) of these cases had pulmonary and 274 (82%) had extrapulmonary TB. Ten (16%) of the pulmonary TB cases were primary. All 10 patients with primary TB presented with EN. Among 50 patients with EN diagnosed and followed during the last 10 years, the etiology was determined in 56%, and primary TB was the most frequent: 20%.

Adolescent↗
PubMed2004

Microscopic polyangiitis presenting urticarial erythema and Henoch-Schonlein purpura: two case reports.

Microscopic polyangiitis (MPA) is well known as a life-threatening member of a group of systemic vasculitis diseases. We report two cases of MPA. Case 1 was a 79-year-old-man who had been diagnosed with anti-neutrophil-cytoplasmic-antibody associated vasculitis (ANCA associated vasculitis) with alveolar hemorrhage and crescentric glomerulonephritis (CrGN). He presented with urticarial erythema in the abdomen, legs and back. The skin biopsy specimens showed leukocytoclastic vasculitis on the upper dermis. Case 2 was a 74-year-old-man, who presented with purpura on the abdomen, buttocks and legs that were similar to Henoch-Schonlein purpura (HSP). He also suffered from interstinal pneumonia. His renal biopsy specimens showed glomerulosclerosis and the peripheral pattern anti-neutrophil cytoplasmic antibody (P-ANCA) was positive. We reviewed the skin eruptions that had been reported with MPA, including our cases.

Abdomen↗
PubMed2004

Erythema nodosum and granulomatous lesions preceding acute myelomonocytic leukemia.

A 65-year-old female with a one-month history of painful eruptions on her lower extremities was admitted to our hospital. Histological examination revealed erythema nodosum (EN), and the patient was treated with oral prednisolone (PSL; 20 mg daily). The eruptions subsided in two weeks. One month later, painful reddish eruptions recurred on her upper limbs and abdomen in addition to her lower extremities. A skin biopsy from an abdominal erythematous plaque revealed a non-caseating granuloma without microorganisms or foreign-body materials. These eruptions also disappeared with treatment with oral PSL (20 mg daily). No underlying disease, including sarcoidosis, diabetes mellitus, or rheumatoid arthritis, was found. However, five months later, the patient developed conspicuous leukocytosis. She was diagnosed with acute myelomonocytic leukemia (M4) and treated with chemotherapy. After complete remission had been achieved, the EN reappeared, in association with an increase in blastic cells in the bone marrow. Serum levels of tumor necrosis factor-alpha and interleukin-1 beta, which are thought to be essential for granuloma formation and induction of EN, were markedly elevated. Physicians must remember that recurrent EN and granulomatous lesions can be a prodromal sign of leukemia.

Aged↗
PubMed2005

Trichophyton tonsurans infection manifesting as multiple concentric annular erythemas.

We report a case of dermatophytosis in a Judo wrestler caused by Trichophyton tonsurans (T. tonsurans) with clinical features that mimicked the concentric rings of tinea imbricata. Tinea imbricata is a unique dermatophytosis caused by Trichophyton concentricum (T. concentricum), observed endemically in subtropical to torrid zones and characterized by impressive concentric rings. We found three similar cases of the dermatophytosis in the literature that were reported as tinea pseudoimbricata or tinea indecisiva. All of these cases were associated with systemic or local immunosuppression, perhaps simulating the mechanism of tinea imbricata, which is known to involve the lack of delayed type hypersensitivity to T. concentricum. These cases imply that iatrogenic immunosuppression may perhaps play an important role in the development of the unique clinical features mimicking tinea imbricata. Furthermore, three of the four cases, including the presented case, were caused by T. tonsurans. It may be necessary to consider T. tonsurans infection when multiple concentric erythemas are encountered.

Adult↗
PubMed2005

A case of bleomycin-induced acral erythema (AE) with eccrine squamous syringometaplasia (ESS) and summary of reports of AE with ESS in the literature.

Chemotherapy-induced acral erythema (AE) is primarily induced by hydroxyurea, methotrexate, and cytarabine, although there are rare reports of AE induced by combination chemotherapy containing bleomycin. It is thought that the accumulation of chemotherapeutic drugs in eccrine glands may cause eccrine squamous syringometaplasia (ESS), which is characterized by metaplasia and focal necrosis of the epithelium of the eccrine duct. ESS is occasionally detected in conjunction with AE, but such occurrences are relatively uncommon. This is the first report of AE with ESS induced by the administration of bleomycin alone. We also provide a summary of past cases of AE with ESS in the literature.

Antimetabolites, Antineoplastic↗
PubMed2006

Erythema induratum of Bazin in an infant after Bacille Calmette-Guerin vaccination.

We report the first case of erythema induratum of Bazin (EIB) after Bacille Calmette-Guerin (BCG) vaccination in an infant. The patient developed recurrent multiple erythematous and subcutaneous nodules on his legs 2 months after a BCG vaccination. He had no other symptoms or family history of tuberculosis (TB). Histopathological findings revealed a granulomatous lobular panniculitis. EIB often appears as a chronic, nodular eruptions that frequently occur on the lower legs of females with tuberculin hypersensitivity. To date, only a few cases of infants with EIB have been reported. There have been no clinical reports of EIB after BCG vaccination. Our case suggests that Mycobacterium bovis in the BCG vaccination may have caused EIB.

Adjuvants, Immunologic↗
PubMed1994

In vitro antibiotic susceptibilities of Borrelia isolates from erythema migrans lesion of Lyme disease patients in Japan.

Antibiotic susceptibilities of twelve borrelial isolates from skin of patients with erythema migrans (EM) and ticks (Ixodes persulcatus and I. ovatus) in Japan were examined by in vitro microdilution MIC method and macrodilution MBC method. Nine EM isolates and 3 tick isolates were susceptible to amoxicillin, erythromycin, and minocycline. MICs for Japanese isolates were 0.038-0.30 microgram/ml, < 0.012 microgram/ml, and < 0.012-0.05 microgram/ml, respectively. MBCs were as follows: 0.038-0.88 microgram/ml, < 0.012-0.10 microgram/ml, and < 0.025-0.78 microgram/ml, respectively. These antibiotics could be recommended for treatment of patients in early stage of Lyme disease in Japan.

Amoxicillin↗
PubMed1983

Arachidonic acid and prostaglandin levels in dithranol erythema: time course study.

Arachidonic acid and prostaglandins were measured in uninvolved psoriatic skin before and after treatment for up to 24 h with dithranol. Prior to treatment, skin exudate contained 2744 ng ml-1 arachidonic acid and 26.4 ng ml-1 PGE2. After treatment with dithranol, the arachidonic acid concentration increased to a maximum of 5556 ng ml-1 at 48 h whilst PGE2 increased to 93.4 ng ml-1 at 12 h and then declined. The erythemal response was apparent at 6-12 h and maximal at 72 h. These results suggest that PGE2 mediates the early development of dithranol erythema.

Adult↗
PubMed1975

Unusual cutaneous associations of a malignant carcinoid tumour of the bronchus--erythema annulare centrifugum and white banding of the toe nails.

The case history of a patient who presented with erythema annulare centrifugum and white banding of the toe nails is recorded. On investigation for an underlying malignancy the patient was found to have an opacity in the lower lobe of the right lung. Subsequently lobectomy was performed and histology of the operative specimen revealed a malignant carcinoid tumour of the bronchus.

Back↗
PubMed1976

Treatment of erythema nodosum and nodular vasculitis with potassium iodide.

Twenty-four of twenty-eight patients with erythema nodosum and sixteen of seventeen patients with nodular vasculitis responded to treatment with potassium iodide. Relief of symptoms occurred within 2 days. The average duration of treatment was 3 weeks and the lesions took an average of 2 weeks to resolve. The possible mode of action of potassium iodide is discussed and an immunosuppressive effect mediated by heparin is suggested.

Adolescent↗
PubMed1977

The wages of warmth: changes in erythema ab igne.

Biopsies from 20 patients with erythema ab igne (EAI) were examined and compared with biopsies from the legs of 7 elderly control subjects. Epidermal thinning and flattening of the dermo-epidermal junction were seen in most of the tissues examined but were more prominent in the EAI biopsies. Basal cell degenerative change with vacuolation was frequently observed in the EAI specimens. Epidermal atypia amounting to preneoplastic change was observed in 4 EAI biopsies. The dermis was thinned and showed (a) marked oedema and connective tissue disruption and (b) accumulation of elastic staining material. Both haemosiderin and melanin were found within the dermis. The small blood vessels showed a striking abnormality in 7 patients and 2 control biopsies in that the endothelial cells were enlarged and the nuclei were hyperchromatic and irregular in size and shape. This change may be due more to stasis than to chronic heating.

Aged↗