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PubMedDate not supplied

[The use of sorption therapy in the combined treatment of exudative erythema multiforme].

Polymethylsiloxan, a sorbent, was used in combination with enterosorption with thermal alkaline mineral water in a complex treatment of patients (n = 37) with multiform exudative erythema. During the 45-min therapeutic session the sorbent-applicator was changed three times. The above therapy makes for rapid healing of erosions, reduces treatment time periods, prevents recurrences irrespective of the causative factors of inductors of the disease under study.

Combined Modality Therapy↗
PubMed1999

Risk factors for erythema nodosum leprosum.

A retrospective study of new borderline lepromatous and lepromatous patients reporting for multidrug therapy (MDT) for leprosy at the Anandaban Leprosy Hospital, Kathmandu, Nepal, over an 8-year period was conducted to determine the prevalence of erythema nodosum leprosum (ENL), the time and frequency of reactions, and clinical and laboratory parameters associated with ENL. An overall prevalence of ENL in this cohort of 19% was found. One third of these reactions occurred in patients before MDT was given, one third in the first 6 months and one third after 6 months of treatment. Nearly 1 in 10 of the ENL reactions occurred in patients who had completed 2 years of MDT; 45% of patients with ENL had more than one episode. Data collected at the patients' first presentation was used to identify four major risk factors. Patients with lepromatous disease, skin infiltration or a bacterial index (BI) of > 4+ were at significantly increased risk. Patients older than 40 were at significantly decreased risk of ENL. There was a linear relationship in the risk of ENL with an increasing BI and an inverse relationship to increasing age. These observations should enable clinicians to recognize patients at first presentation who will be likely to develop ENL.

Adolescent↗
PubMed1999

Erythema migrans in the immunocompromised host.

From 1990 to 1996 a total of 67 adult patients with typical erythema migrans (EM) and a previously identified immunocompromised condition were investigated at the University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia. The course and outcome of borrelial infection were compared with 67 previously healthy age and sex-matched individuals with EM who were examined at our institution in the same year. Clinical characteristics of Lyme borreliosis before treatment and the duration of EM after the institution of therapy with antibiotics including amoxicillin, azithromycin, cefuroxime-axetil, doxycycline, and ceftriaxone were comparable in both groups. The occurrence of early disseminated borrelial infection before treatment and the frequency of treatment failure (defined as the onset of severe minor or major manifestations of Lyme borreliosis, persistence of B. burgdorferi sensu lato in the skin and/or persistence of EM after treatment) were found significantly more often in immunocompromised patients than in the control group (16/67 versus 6/67, respectively; p = 0.0358). Re-treatment was required in 13 (19.4%) patients of the immunocompromised group and only in five (7.5%) patients of the control group (p = 0.0762). However, in spite of the more severe course and the more frequent need for re-treatment among patients whose immune system was impaired, the outcome of borrelial infection after one year was favourable in both groups.

Adolescent↗
PubMedDate not supplied

Ectopic erythema migrans in an adolescent with a skin disorder.

Red and white circular lesions of the buccal and labial mucosa were observed in an adolescent. Periodically, these nontender patches would resolve and move to other oral sites. Detection of ectopic erythema migrans aided in the diagnosis of a bothersome skin condition.

Adolescent↗
PubMed2000

Erythema nodosum in Israeli children.

BACKGROUND: Erythema nodosum, although uncommon in children, is the most frequent form of panniculitis in pediatrics. EN has been associated with various infections and chronic inflammations, and its course varies with age, gender, and racial and geographic factors. There is no information on EN in Israeli children. OBJECTIVES: To examine the clinical course of EN and the conditions with which it is associated in Israeli children. METHODS: We conducted a retrospective study of 24 children with a diagnosis of EN who presented at our Center over a 10 year period (1989-98). RESULTS: EN was more frequent in females than males (ratio 2:1) due to a cluster of adolescent girls. The mean duration of the skin manifestation was 18 days. The course was benign in all patients. Streptococcal infection was the most common cause (25%), followed by Epstein-Barr virus infection (18%) and inflammatory bowel disease (13%). In one-third of cases, no specific cause could be identified. Tuberculosis, an important cause of EN in the past, was not found in our patients. CONCLUSIONS: Most cases of EN in Israeli children are related to streptococcal and EBV infections or to chronic inflammatory conditions. Despite the increase in tuberculosis morbidity in Israel during recent years, we found no association of EN and tuberculosis in our study.

Adolescent↗
PubMed2000

Annular erythema of Sjögren's syndrome in a white woman.

Annular erythema of Sjögren's syndrome (AE-SS) is believed to be the Asian counterpart of subacute cutaneous lupus erythematosus (SCLE) in white persons. We report the second case of a white person with AE-SS, diagnosed by clinical and serologic findings, as well as the absence of histologic criteria for SCLE. The diagnosis of AE-SS was established by symptoms of xerophthalmia and xerostomia, as well as by examination of skin and salivary gland biopsy specimens. Evaluation showed the presence of anti-Ro(SS-A) and anti-La(SS-B) autoantibody, with the presence of anti-Ro(SS-A) antibody against the 60-kd, but not the 52-kd, epitope, a pattern frequently seen in both the Asians with AE-SS and in white patients with SCLE. Both skin and sicca symptoms were alleviated with combination antimalarial therapy, which included hydroxychloroquine and quinacrine. This case demonstrates that AE-SS can occur in white patients and that the autoantibody profile is similar to that described in Asians with this disease.

Aged↗
PubMedDate not supplied

Clinical observations of erythema multiforme in children.

Erythema multiforme (EM), a cutaneous or mucocutaneous disorder, occurs primarily in young adults. To evaluate the precipitating factors, clinical courses, and treatment of this disease in children, 30 cases aged from 1 month old to 15 years of age were studied retrospectively from Jan 1988 to Aug 1998. Twenty-three cases were diagnosed as minor type; the other 7 were of major type (Stevens-Johnson syndrome). Mycoplasma infection was identified in 4 patients, and adenovirus in one patient with EM minor. Cytomegalovirus was found in one EM major patient. Anticonvulsant administration before the skin lesions were recorded in 5 EM major patients and 2 EM minor patients. All cases received supportive treatment during admission. Besides, 6 of 7 patients with EM major, and 11 of 23 EM minor (Group A) received systemic corticosteroid at a dose equal to prednisolone 1-2 mg/kg/day for 3-14 days. One EM major patient and 11 patients with EM minor (Group B) received supportive care only. One EM minor patient with acute idiopathic thrombocytopenia purpura was treated with intravenous immunoglobulin. The mean duration of course of EM minor was 11.8 +/- 2.9 days, and it was 25.1 +/- 9.8 days for EM major. No mortality and no sequelae were noted. The average disease course and hospitalization time were not significantly different between Group A and B: (11.4 +/- 3.1 days vs 12.4 +/- 2.9 days, p = 0.45); (5.4 +/- 2.0 days vs 6.3 +/- 3.1 days, p = 0.47). This study demonstrated that infections, especially mycoplasma, and anticonvulsants play important roles in childhood EM. The skin lesions of EM minor subsided within 2 weeks, and EM major recovered completely within 6 weeks. Systemic corticosteroid may be beneficial to EM major, but probably is unnecessary for patients with EM minor.

Adolescent↗
PubMedDate not supplied

Lipoatrophic lesions preceded by pain and erythema - a new clinical entity?

A 46-year-old female patient presented with deeply depressed lesions on the abdominal wall after slight pain and erythema, without a history of trauma or injection. No general symptoms were noted. There was a marked decrease of subcutaneous fatty tissue with minimal inflammatory cell infiltration. We found three similar cases in the literature. Differential diagnoses were performed, but our case and the other three cases do not fit any of the heretofore described lipoatrophic diseases, and might be a new clinical entity.

Abdominal Muscles↗
PubMed1975

Erythema nodosum leprosum in a general hospital.

We report 32 patients with erythema nodosum leprosum (ENL). Twenty-two patients developed ENL before beginning chemotherapy. The recognition that ENL in the absence of chemotherapy is not an uncommon event is of importance, not simply as a fact in and of itself, but because this observation raises provocative questions when placed in the context of current ideas concerning ENL. ENL should be regarded as a manifestation of leprosy, not necessarily as a complication of its therapy.

Adolescent↗
PubMed2000

["Deep" figurate erythema].

Deep figurate erythema is a rare dermatologic disease of unknown etiology. Early onset is exceptional. We report a clinical observation of neonatal onset, which serves to confirm the characteristic presentation of this disease, its benign nature and lack of response to different therapeutic attempts.

Erythema↗
PubMed1975

Erythema gyratum repens with metastatic adenocarcinoma.

A patient with Erythema Gyratum Repens (EGR) had a marked increase of his eruption, with uncontrollable pruritus that was unresponsive to steriod therapy. This culminated in an exfoliative dermatitis. A metastatic, undifferentiated adenocarcinoma was removed following a right-sided craniotomy. The patient then had complete cessation of his pruritus, with moderate improvement of his eruption. All the reported cases of EGR were reviewed in terms of the source of the malignant disorder. The relationship between the time of onset of the EGR and the discovery of the malignant disorder, as well as the effect of treatment of the malignant condition on the course of the EGR, was studied. The data suggest a highly probable relationship between the two.

Adenocarcinoma↗
PubMedDate not supplied

Erythema induratum in a patient with active tuberculosis of the axillary lymph node: IFN-gamma release of specific T cells.

A 57-year-old woman with tender nodular lesions on her legs, arms, buttocks and face is reported as a case of erythema induratum (EI) with active tuberculosis of axillary lymph nodes. Both skin nodular lesions and lymph nodes responded positively to antituberculous therapy. The patient's peripheral blood mononuclear cells showed a high proliferation and produced interferon-gamma (IFN-gamma) in response to purified protein derivative (PPD). These findings indicate the possibility that PPD-specific T cells, capable of producing IFN-gamma, are likely to be involved in the formation of EI as a type of delayed-type hypersensitivity response to mycobacterial antigens at the site of skin lesions.

Axilla↗
PubMed2001

Demographic features, clinical characteristics and laboratory findings in children with multiple erythema migrans in Slovenia.

OBJECTIVE: To identify demographic, clinical and laboratory characteristics of children with multiple erythema migrans (EM) in Slovenia. METHODS: We prospectively studied patients aged 15 years and less, examined at our department for multiple EM in 1996 and 1997. Demographic and clinical data were collected by means of a questionnaire. In addition, basic haematological and biochemical investigations, serologic testing, and Borrelia cerebrospinal fluid and blood cultures were performed. RESULTS: Ninety-five children (44 girls, 55 boys) aged 1 to 13.5 (median, 4.5) years fulfilled the inclusion criteria. A tick bite was recalled by 23%. The incubation period was 10.5 (range, 1 to 150) days, the duration of skin lesions before the initial examination 4 (range, 1 to 54) days, and the median number of skin lesions, 4.5 (range, 2 to 35). The initial disease was mild in 81% of patients. Local and systemic symptoms were reported by 11% and 30% of children, respectively. Clinical signs accompanying EM lesions were found in 42%. Cerebrospinal pleocytosis (predominantly lymphocytic) was seen in 18% of patients; none of them had frank clinical evidence of central nervous system involvement. Serum IgM and IgG antibodies were detected in 28% and 22% of children, respectively. In 3/79 (4%) patients, Borreliae were isolated from the blood and in 2/83 (2%) from the cerebrospinal fluid. In 2/81 (2%) children, borrelial IgG intrathecal antibody production was demonstrated. CONCLUSIONS: Multiple EM in Slovene children is a mild disease. However, some patients had an associated, usually asymptomatic, infection of the central nervous system.

Adolescent↗
PubMed2001

[Diffuse plane xanthoma with arthritis, serositis, erythema nodosum, vasculitis and myelomonocytic leukemia. Description of a case with autopsy].

A 57-year-old woman consulted for a severe xanthelasma followed by a severe and complex systemic disease and died ten years later with xanthomas extended to the face and trunk. Her lipid and cholesterol levels were normal but HDL was below normal values. Diabetes as well as amyloidosis, paraproteinemia and Bence Jones protein in urine were not found. Three years after her initial consultation monocytosis appeared in most but not all of her hemograms. Soon after her spleen was palpable and became very large. She had three bone marrow biopsies showing progressive white cell hypercellularity that was considered as possibly reactive. During her long illness she had recurrent conjunctivitis and systemic complications such as arthritis, pleural and pericardial effusions, vasculitis, sudden deafness with Ménière-like vertigo, erythema nodosum and myositis that responded, at least partially, to steroid treatments though she remained corticoid dependent in order to control her more severe symptoms. Those complications were considered to be probably due to vasculitis or immune phenomena. After a long follow up it was clear that her disease was better classified as diffuse plane xanthoma (DPX) related to a myeloproliferative syndrome and vasculitis. Her final hospitalization was due to a severe esophageal moniliasis and she died a few days later. An autopsy was performed and a chronic myelomonocytic leukemia was the final diagnosis. The ultimate cause of death was a perforated acute duodenal ulcer with peritonitis. Possible relations between DPX, immunologic reactions and myelomonocytic leukemia are discussed.

Arthritis↗
PubMed2001

Erythema induratum: a clinicopathologic and polymerase chain reaction study.

BACKGROUND: In Taiwan, cutaneous lesions with granulomatous lobular panniculitis, with or without vasculitis, are usually diagnosed as erythema induratum (EI), a common form of tuberculid associated with tuberculosis. However, there has been no study to elucidate the extent of this association in Taiwan. The aim of this study was to document the spectrum of the pathologic findings in EI and its association with Mycobacterium tuberculosis. METHODS: The diagnostic/inclusion criteria for EI were recurrent tender subcutaneous nodules on the legs, histopathologic findings of granulomatous lobular or septolobular panniculitis plus necrosis or vasculitis, and positive response to antituberculosis therapy. The clinicopathologic findings in the 12 cases that fulfilled these criteria were analyzed, and nested polymerase chain reaction (PCR) was used to identify M. tuberculosis complex DNA from formalin-fixed, paraffin-embedded sections. RESULTS: Eleven women and one man were included in the study, ranging from 18 to 70 years old (mean, 40.6 yr). The duration of the disease ranged from 10 days to 10 years (mean, 2.1 yr). Histopathology revealed granulomatous panniculitis; a diffuse lobular pattern was observed in nine cases and a focal lobular/septolobular pattern in three. Vasculitis was found in nine cases, four affecting an artery or vein, with three occurring in the patients with focal panniculitis. Ten cases showed various degrees of caseous necrosis. Eosinophils or focal eosinophilia were fairly common (10 patients). From PCR, nine patients were positive for M. tuberculosis complex DNA. CONCLUSIONS: Type III and IV hypersensitivity reactions to M. tuberculosis complex were involved in the pathogenesis of EI. Our results suggest that approximately half of the cases with pathologic findings consistent with EI or nodular vasculitis in Taiwan are associated with M. tuberculosis.

Adolescent↗
PubMedDate not supplied

Chronic heat-induced skin lesions (erythema ab Igne): ultrastructural studies.

Erythema ab igne (EI) is an uncommon skin lesion caused by mild and repeated exposure to infrared sources. The aim of this study was to investigate the ultrastructural alterations in this condition. The ultrastructural study was carried out on 5-outpatients who presented typical EI of their exposed sites. Skin punch biopsies were processed for standard electron microscopy. The epidermis was hyperpigmented, with focal regressive changes of basal keratinocytes. An apparent functional activation of melanocytes with numerical increase of dendritic processes was also observed. The dermis showed abundant melanophages and occasional elastic fiber alterations similar to actinic elastosis. No alterations consistent with preneoplastic skin conditions were observed. The ultrastructural findings associated with EI seem to be nonspecific and consistent with moderate regressive changes of keratinocytes as well as a consensual melanocytic activation and elastic fiber modifications. Similar alterations can be observed in chronic actinic skin damage. This condition is presumably more benign than the ultraviolet exposure. The association of EI and premalignant skin lesions, though occasionally described, seems relatively infrequent.

Adult↗
PubMed2001

Erythema dyschromicum perstans: a case report and review.

Erythema dyschromicum perstans (EDP) is an acquired ashy dermatosis characterized by patches of blue-gray pigmentation over the trunk, extremities, and neck. These pigmentary changes may become chronic and disfiguring. At present, the etiology of EDP remains unclear, and there is no single established therapy. We describe a 21-year-old Hispanic man with extensive patches of EDP who improved with oral corticosteroid therapy.

Adult↗