Significance of renal brush border antibodies in skin immune complex-related diseases.
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Adult↗
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Results for “Erythema Multiforme”
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Atypical cases of Microsporum canis infection in the adult.
Eleven adult patients (7 males, 4 females) were found to be infected with Microsporum canis. There was involvement of the scalp in three patients: in one male and one female there were kerion-like lesions and in one male the lesions resembled seborrheic dermatitis. There were three cases of tinea barbae, males aged 28, 65 and 82 years, in the first resembling an infected single lesion of granuloma annulare, the second with a kerion-like lesion and the third with an abscess-like tumor. There were five patients with lesions in glabrous areas: one male with a lesion of the palm resembling erythema multiforme and one with an infection of the auricular lobe resembling a seborrheic dermatitis or otitis externa; of three females with tinea faciei one had a lesion simulating granuloma faciale, one simulating lymphocytic infiltration and one simulating discoid lupus erythematosus. A cat was the source of infection in three cases; in the remainder it could not be determined with certainty. It is of note that a continuous increase in infection with M. canis has been observed in Israel during the past five years.
Adult↗
The increasing role of Microsporum canis in the variety of dermatophytic manifestations reported from Israel.
During a period of 8 years 300 cases of dermatophytoses involving both hairy areas and the glabrous skin were found to be caused by M. canis. There was scalp involvement in 60%, including 8 infants and 27 adults; most of the adults presented Kerion-like lesions and presented various clinical aspects such as seborrhea capitis, folliculitis and discoid lupus erythematosus. In the 21 patients showing invasion of the beard the clinical manifestations included superficial erythemato-squamous patches with hyperemic slightly elevated margins, folliculitis or abscess-like lesions and Kerion-like lesions. Among the lesions found on the glabrous skin there were unusual aspects of tinea faciei in 19 adults, mimicking lymphocytic infiltration, granuloma faciale or discoid lupus erythematosus. Some of the cases of tinea corporis found in 70 patients also had lesions simulating various other dermatological entities, including erythema multiforme, psoriasiform eruption, pityriasis rosea and seborrheic dermatitis. The hands were invaded in 5 adults patients, with involvement of the finger nails in one. Repeated mycologic examinations were necessary to establish the true etiology in many of these cases.
Adult↗
Ecological and epidemiological studies of histoplasmosis in the United States of America.
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Animals↗
Common skin problems.
Dermatological problems manifesting as primary and secondary cutaneous complaints, constitute at least 30% of all outpatient visits to a pediatrician and 30% of all visits to dermatologists involve patients of pediatric age group. There is, however, a paucity of data about pediatric dermatoses in India, which has been reviewed to the extent possible. A brief account of common dermatological problems in India mainly infestations (pediculosis capitis, scabies) and infections (pyoderma, molluscum contagiosum, warts, herpes simplex infection, varicella, herpes zoster, tinea capitis and corporis, tinea versicolor, and candidiasis) has been given. At the end, common pediatric dermatological emergencies have been short-listed. Erythema multiforme and its variants and acrodermatitis enteropathica are discussed briefly.
Child↗
[Pemphigoid gestationis without blisters].
BACKGROUND AND OBJECTIVE: Pemphigoid gestationis (PG) is a rare pregnancy-associated autoimmune bullous disease characterized by autoantibodies to the 180 kD bullous pemphigoid antigen (BP180). The clinical spectrum of PG is polymorphic and for diagnostic purposes, a skin biopsy is usually taken demonstrating the deposition of autoantibodies. PATIENTS AND METHODS: From 2 patients, skin biopsies were obtained for histopathologic and immunofluorescence studies. Circulating autoantibodies were characterized by immunoblotting and ELISA using a recombinant form of the immunodominant BP180 NC16 A domain. RESULTS: The 2 PG patients described here did not show blisters but complained about severe itching. In the first case, PG presented in the first trimester of the second pregnancy as an erythema-multiforme-like disease. The second patient developed urticarial plaques a few days after delivery. PG was diagnosed by the detection of autoantibodies against recombinant BP180 NC16 A by immunoblot and ELISA analysis and confirmed by linear deposits of C3 at the cutaneous basement membrane zone on direct immunofluorescence microscopy. Skin lesions healed with oral prednisolone. CONCLUSIONS: In our two patients, non-bullous PG could be diagnosed by serological tests. Immunoblotting and ELISA might be sensitive and specific tools when screening sera of patients with pruritic skin lesions in pregnancy for the presence of autoantibodies to BP180. In some cases, these newer techniques may make a skin biopsy unnecessary.
Adult↗
[Paraneoplastic pemphigus. Induction of autoantibodies against structural proteins in the skin].
Paraneoplastic pemphigus (PP) is a newly reported autoimmune disease, which is always associated with an underlying neoplasia. It is characterized by painful mucosal erosions and ulcerations, and by polymorphous skin lesions reminiscent of erythema multiforme, pemphigus vulgaris and lichen planus pemphigoides. These patients have autoantibodies that bind to a distinct complex of epidermal proteins, including desmoplakin I (250 kD), major bullous pemphigoid antigen (230 kD), desmoplakin II (210 kD) and a 190-kD and a 170-kD protein, neither of which has yet been further characterized. Histological findings include acantholysis, epidermal cell necrosis, vacuolar interface changes and, sometimes, lichenoid infiltrates of the upper dermis. Direct immunofluorescence shows an intercellular deposition of immunoreactants in the epidermis and granular deposits at the dermal-epidermal junction. Indirect immunofluorescence with rodent bladder as substrate shows an intercellular pattern. This method is the most convenient and cost-effective method of screening for PP, since antigens of both pemphigus vulgaris and pemphigus foliaceus are not expressed in this tissue.
Adolescent↗
[An unusual hemorrhagic variant of Stevens-Johnson syndrome in an HIV-infected patient].
Cutaneous adverse drug reactions in HIV-positive patients with their wide spectrum of manifestations remain a diagnostic and therapeutic challenge. Skin diseases as erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis belong to this group. The typical primary lesions are erythematous macules and papules, which rapidly extend to the entire body and may be accompanied by a extensive epidermal detachment. Diagnosis and immediate therapy is indispensable because of the possible fulminant course of the disease. We report a HIV-positive patient with a cutaneous adverse drug reaction showing predominantly hemorrhagic lesions.
AIDS-Related Opportunistic Infections↗
[Acral necroses after therapy with quinine sulfate for calf cramps].
The most common cause of acral cyanosis is vascular spasm which can be induced by several drugs. An 87-year-old woman developed red and livid skin lesions on the fingers of both hands and several toes one month after beginning treatment with quinine sulfate 200 mg daily. The skin lesions progressed to necrosis in some areas. Quinine sulfate is a widely prescribed drug for nocturnal cramps. The following side effects may develop, particularly in the elderly: exanthems, pruritus, urticaria, erythema multiforme, purpura and photosensitivity. Our case points to the possibility of acral necrosis and demonstrates the efficacy of vasodilator treatment.
Acrodermatitis↗
Idiopathic palmoplantar eccrine hidradenitis in children.
Idiopathic palmoplantar eccrine hidradenitis (IPPH) is a recently described disorder characterized by painful erythematous plantar nodules and in three cases, showed a typical neutrophilic infiltrate around and within the eccrine sweat apparatus. Five cases of IPPH on the soles of the feet in healthy children are reported. The disorder presented after intense physical activity in four cases. The course was benign and self-limiting. Complete bed rest for several days without any medical therapy led to alleviation of the pain and disappearance of all the lesions. Conclusion. Idiopathic palmoplantar eccrine hidradenitis may be more common than reported. Paediatricians should be aware of it in order to avoid unnecessary diagnostic tests and treatments.
Chilblains↗
A case of paraneoplastic syndrome mimicking adult-onset Still's disease.
A 49-year-old woman was admitted to our hospital because of fever of unknown origin. The patient had long-lasting spiking fever, hepatosplenomegaly, pleural effusion, and skin rash. Laboratory tests showed marked leukocytosis and an extremely high serum ferritin level (240 000 ng/ml) accompanied by disseminated intravascular coagulation and hemophagocytic syndrome. Most of the patient's features were compatible with a diagnosis of adult-onset Still's disease (AOSD), the rash, however, was not a typical rheumatoid rash but multiforme erythema. Biopsy of a breast nodule revealed breast cancer, leading us to a diagnosis of paraneoplastic syndrome mimicking AOSD. Although this is a rare disorder, cases resembling the present one have been reported, indicating the importance of including paraneoplastic syndrome in the differential diagnosis of AOSD.
Journal Article↗
Herpes Simplex Virus in Children.
Herpes simplex virus (HSV) infections are ubiquitous. Children are infected with HSV resulting in totally asymptomatic acquisition to life-threatening disease. Therapy of HSV diseases of children can be considered according to severity and time of acquisition. Neonatal herpes simplex virus infections take one of three forms--disease localized to skin, eye, or mouth (SEM), encephalitis, or multiorgan disseminated disease. Treatment consists of intravenous (IV) administration of acyclovir. Supportive care for patients with life-threatening disease is an integral component of patient management. Mucocutaneous HSV infections in the immunocompromised host can be treated with either intravenous acyclovir or one of the orally bioavailable antiviral therapies. For hospitalized patients, therapy consists of IV acyclovir at 5 mg/kg every 8 hours for 7 to 14 days. For ambulatory patients, therapy is tailored according to age. For children less than 12 years of age, oral acyclovir is administered at a dosage of 20 mg/kg every eight hours. Although no controlled studies have been performed with valaciclovir or famciclovir, the pharmacokinetics of these medications would suggest superiority over acyclovir. Dosage recommendations have not been established for young children. For postpubertal children, dosage should mirror that of adults. Valaciclovir is administered at 500 mg twice daily. Famciclovir is administered at 125 mg three times daily. Herpes simplex keratoconjunctivitis is treated with topical triflurothymidine. Two drops are applied to the infected eye five times daily until resolved. Recurrences are managed in a similar manner. Some physicians administer oral acyclovir at the doses noted above in order to prevent frequent recurrences. Genital HSV infections can be treated with acyclovir, valaciclovir, or famciclovir. Episodic treatment of recurrent episodes is usually not necessary in childhood. Importantly, all data on the use of these compounds for these conditions have been generated in adults. Physician judgment is required for the management of recurrent herpes labialis, erythema multiforme, and herpes gladitorum. No controlled studies have been performed in children, although experience with acyclovir, valaciclovir, and famciclovir have resulted in their use.
Journal Article↗
Paraneoplastic vasculitis. Unique syndrome of cutaneous angiitis and arthritis associated with myeloproliferative disorders.
Six patients are described whose myeloproliferative disorders were complicated by inflammation in small, predominantly cutaneous blood vessels. The clinical manifestations of the vasculitis included palpable purpura, urticaria, maculopapular lesions, and erythema multiforme. Vascular inflammation was confirmed by skin biopsy. Two patients experienced fleeting, asymmetrical nondestructive arthritis. Transient proteinuria complicated one case and was the only suggestion of visceral vasculitis. The clinical features of cutaneous vasculitis antedated bone marrow deterioration in four patients and diminished as bone marrow function worsened in all patients. Oral corticosteroids or chemotherapy for the underlying disorder inconsistently affected the clinical course of the cutaneous vasculitis. Myeloproliferative disorders should be considered among disorders that are complicated by inflammation in small blood vessels.
Adult↗
Orofacial herpes simplex virus infections: current concepts in the epidemiology, pathogenesis, and treatment, and disorders in which the virus may be implicated.
Herpes simplex virus (HSV) is the causal agent of herpetic stomatitis, recurrent herpes labialis, and the recurrent intraoral infections seen particularly in the immunocompromised patient. HSV has also been implicated in some erythema multiforme, cranial neuropathies, Behçet's syndrome, and oral squamous carcinoma. Recent advances in understanding of HSV, epidemiology, pathogenesis, and treatment are reviewed because there have been numerous advances over the past 5 years.
Humans↗
Open preliminary clinical trial of clobetasol propionate ointment in adhesive paste for treatment of chronic oral vesiculoerosive diseases.
Clobetasol propionate (Temovate), a novel high-potency topical corticosteroid, was used in open trial from 1987 to 1988 on 24 patients with persistent oral vesiculoerosive disease of at least 1 month's duration. Fourteen women and 10 men, ranging in age from 27 to 76 years (mean 48 years), participated. Nine patients had erosive lichen planus, one had benign mucous membrane pemphigoid, three had pemphigus vulgaris, seven had persistent major recurrent aphthous stomatitis, and four had chronic oral erythema multiforme. Fifteen patients had complete remission of signs and symptoms, seven had excellent response of signs and complete remission of symptoms, and two failed to respond. All other topical therapy was suspended before and during the study. All patients responded to two or three applications daily of medication. Side effects were minor and reversible, and included localized candidiasis (three patients), stomatopyrosis (two), and hypogeusia (one). Clobetasol propionate ointment in adhesive paste (Orabase) thus seems to be an effective topical steroid alternative to other less potent topical and systemic drugs for recalcitrant oral vesiculoerosive disease.
Adult↗
Viruses and chronic disorders involving the human oral mucosa.
Viruses have been implicated in the etiology of several chronic disorders of the oral mucosa. Most of these associations have been with DNA viruses, particularly certain herpesviruses, which are associated, for example, with some cases of erythema multiforme and with hairy leukoplakia. Papillomaviruses are associated with various papillomatous lesions, focal epithelial hyperplasia, and possibly with some carcinomas. Viruses may possibly be associated with recurrent aphthae, Behçet's syndrome, and some dermatoses. The literature concerning these possible associations is reviewed. However, much more research needs to be done before the full story of viral associations with oral mucosal disorders can be written.
Burkitt Lymphoma↗
Detection in vitro of cellular hypersensitivity to drugs.
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Adult↗
Widespread dermatophyte infections that mimic collagen vascular disease.
This article reports the cases of two patients in whom a widespread dermatophyte infection mimicked the cutaneous lesions of their underlying collagen vascular disease. Griseofulvin may be associated with an increased incidence of adverse cutaneous reactions in patients with systemic lupus erythematosus. One patient with systemic lupus erythematosus developed erythema multiforme after taking griseofulvin.
Adult↗