The lepra reaction with necrotizing skin lesions. A report of six cases.
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Adult↗
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Results for “Erythema Multiforme”
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[Skin reactions to piroxicam (three cases) (author's transl)].
Three cases of skin reactions that occurred in patients under oral administration of Piroxicam are reported here: one erythema-multiforme-like reaction and two cases of acute, pruriginous erythemato-papulous dermatitis, one of which with intraepidermal blister formation. No past history of skin disease could be formed; lesions spontaneously improved when the drug was stopped. Only in one patient, receiving Piroxicam and Fenoprofene, an acute nephritis was observed. The role of Piroxicam, a new non-steroid antiinflammatory agent in the pathogenesis of the skin reactions observed is discussed. However, the renal involvement formed in one case is likely due to Fenoprofene, as in previously reported cases.
Aged↗
Determining the cause of drug eruptions.
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Alopecia↗
[Chronic atrophic polychondritis. Critical analysis of the therapeutic efficacy of dapsone. 2 cases].
Dapsone has been used since 1976 in the treatment of relapsing polychondritis. A critical analysis of its therapeutic effectiveness based on 2 personal cases and 14 cases reported in the literature, all treated with dapsone alone, showed that treatment had to be discontinued in 4 on account of side effects (haemolytic anaemia, erythema multiforme, somnolence, headache, nausea); 1 patient showed no improvement and 5 relapsed; 6 responded favourably and without relapse during a 3 months' to 4 years' follow-up. Considering the unpredictable course of relapsing polychondritis and the fact that some of its clinical manifestations, notably auricular chondritis, may spontaneously resolve, the response of the disease to dapsone is difficult to establish and requires to be confirmed by a controlled clinical trial.
Aged↗
Fatal disseminated cytomegalovirus infection in an apparently normal adult.
An ostensibly normal 43-year-old man had intermittent fever, erythema multiforme, and leukopenia that evolved into fulminant hepatic and bone marrow necrosis. The cause of his illness was compatible with cytomegalovirus (CMV) infection since there was a fourfold increase in immunofluorescent antibody titer. This report suggests that CMV can produce a rapidly progressive and overwhelming infection in an apparently healthy adult.
Adult↗
Mycoplasma pneumoniae infection detected by immunofluorescence in patients with certain skin diseases.
The presence of Mycoplasma pneumoniae and/or herpes antigens was investigated by indirect immunofluorescence (IF) reactions in exfoliated cells or biopsy specimens from 43 patients with different skin diseases (treatment-resistant cutaneous herpes, genital herpes, acne, urticaria, dermatitis, erythema multiforme, ecthyma contagiosum). Either M. pneumoniae or herpes antigen could be detected in 21 (55.26%) and 12 (31.57%) of the 38 IF-positive cases, respectively, while the associated occurrence of mycoplasma and herpes antigens was observed in 5 (13.15%) of the patients.
Adolescent↗
Epidemiologic aspects of M. pneumoniae disease complications: a review.
As early as the 1940s, erythema multiforme exudativum (Stevens-Johnson syndrome) and hemolytic anemia were associated with outbreaks of atypical pneumonia, a disease later found to be caused by Mycoplasma pneumoniae. Epidemiologic evidence has also associated neurological complications, especially aseptic meningitis and meningoencephalitis, with M. pneumoniae infections. Urticarial and morbilliform skin rashes often appear late in the course of M. pneumoniae pneumonia. A multitude of other complications have been ascribed to M. pneumoniae infections, often reported as case reports diagnosed by serologic antibody titers only. More systematic investigations are needed to assess the frequency of complications to M. pneumoniae infections. Isolation of the agent, not only serologic titer rises, should be required before a syndrome is attributed to M. pneumoniae infection.
Adult↗
Acute febrile neutrophilic dermatosis (Sweet's syndrome). Four case reports.
Four patients with unusual features of acute febrile neutrophilic dermatosis (Sweet's syndrome) are reported. This syndrome is more common than is apparent from the small number of case reports. It has well-defined clinical and histological criteria, but may be considered within the erythema multiforme spectrum of reaction patterns. The clinical presentation and course can vary, as illustrated by these 4 case reports.
Acute Disease↗
[Dermatoses with localization in the mucous membranes of the mouth and lips - various recommendations].
Review of some observations in the Department of Dermatology of the Medical-Stomatological Institute of the Ministry of Health, Moscow. From 1200 patients with lichen planus, 32% had lichen only on the mouth and lips. 5 types have been distinguished: the typical type, the exsudative hyperaemic type, the erosive ulcerous type, the bullous type and the atrophic type. In 55% of the patients with lupus erythematosus, only the lips were involved. A pemphigoid-like condition of the mucous membranes is mentioned, but without skin lesions and without scar formation. 33% of 100 patients with erythema multiforme had only lesions on the mucous membranes. In Behçet-disease, circulating IgE seems to be of importance. In cheilitis exfoliativa, physical factors are of importance. In Melkersson-Rosenthal-syndrome, the active-T-lymphocytes and the lymphocytes with staphylococci antigene receptors are elevated in the peripheral blood.
Cheilitis↗
Inflammatory bowel disease: cutaneous manifestations.
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Adult↗
A severe bullous eruption occurring in a patient with chronic active hepatitis and glomerulonephritis.
A patient with chronic active hepatitis and membranous glomerulonephritis acquired an acute, fatal illness characterized by a toxic erythematous desquamative dermatitis with bulla formation, fever, diarrhea, and hepatic and renal failure. The cutaneous histopathologic appearance resembled that found in erythema multiforme, toxic epidermal necrolysis, and the acute graft vs host reaction. The cutaneous eruption may have been part of a widespread atuoimmune reaction, possibly triggered by drugs or infection.
Adult↗
[Acute generalized exanthematic pustuloses (four cases) (author's transl)].
Acute generalized exanthematic pustuloses supervening without a genetic psoriatic predisposition are not exceptional if the literature over the last few years is taken into account. Such observations are published under a wide range of names. Beside exanthematic pustular psoriasis as defined by Baker and Ryan, there exists in fact a whole scale of amicrobial pustulosis: acute generalized pustular bacterid; acute generalized pustulosis manifestation of leukocytoclastic vasculitis; pustular necroziting angeitis; pustular eruption with eosinophilic abscesses; generalized pustular drug rash; subcorneal pustules in erythema multiforme and in Sweet's syndrome. Thus, it appears that pustuloses exist in many forms, although they have certain common points that justify a synthetic perspective:--their occurrence, after a bout of infection and/or after taking drugs in subjects with no previous known psoriasis;--a single outbreak occurring spontaneously or with corticoid therapy and which heals by itself;--the existence of a marked vasculitis which occurs before the epidermal pustules. Sometimes this takes the form of a leucocytoclastic vasculitis or a polymorphic infiltrate which is rich in intact eosinophils. Direct immunofluorescence shows deposits of C3 and occasionally IgM at the vascular wall. The circulating antibody-antigen complex produced by an infection and/or by a drug may be responsible of the pustulosis by a hypersensibility mechanism (type Arthus phenomen). From the existing literature and the personal observations of four cases, the authors have made a general review of these pustuloses. They believe that in the majority of cases, pustulosis should not be considered as being psoriatic. However, the authors discuss the rare but possible occurrence of such a pustulosis in patients with a genetic psoriatic predisposition. They feel it would be preferable to avoid the publication of observations under a too wide a range of names, and propose the common heading of "acute generalized exanthematic pustulosis".
Acute Disease↗
[Hand, foot and mouth disease. Report of 10 cases].
Ten children with hand-foot-and-mouth disease are described and their clinical manifestations reported in detail. It is a benign, minor viral disease of childhood, but in our country its real incidence is unknown. Diagnosis in the clinical practice is based on the recognition of typical and atypical localizations of the vesicular eruption, as well as on the identification of extracutaneous and extrabuccal manifestations. The differential diagnosis includes herpangina, aphthous stomatitis, dyshidrosis and erythema multiforme.
Child↗
[Stevens-Johnson syndrome and toxic epidermal necrolysis following intake of sulfonamides].
Sulfonamides, particularly in combination with trimethoprim, are among the most commonly prescribed antimicrobial chemotherapeutic agents since they are generally well tolerated and have a broad antibacterial spectrum. However, they are the most common cause of adverse cutaneous drug reactions, the most serious of which are the major variant of erythema multiforme, i.e. Stevens-Johnson-syndrome, and toxic epidermal necrolysis. In eight of 11 patients with Stevens-Johnson syndrome or toxic epidermal necrolysis seen in our department over a period of 4 years, sulfonamides were the most probable causative agent. The present report describes these eight patients and discusses the potential risks of sulfonamide therapy.
Aged↗
Ethambutol-induced toxic epidermal necrolysis.
Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that most commonly is related to drug exposure and that clinically can be confused with other bullous dermatoses, particularly staphylococcal scalded skin syndrome (SSSS) and erythema multiforme major (the Stevens-Johnson syndrome). We report the first case, to our knowledge, of TEN associated with ethambutol hydrochloride administration. Toxic epidermal necrolysis can be partially differentiated from other bullous dermatoses by history and clinical presentation. Microbiological results (eg, the isolation of Staphylococcus aureus in SSSS) and immunological studies (eg, the demonstration of immune complexes in the Stevens-Johnson syndrome) may aid in differentiation, but ultimately the diagnosis depends on histopathological examination of involved skin.
Aged↗
Prostaglandin E2 in blister fluid of bullous diseases and experimental suction blisters.
Prostaglandin(PG)-like activity in the fluid of spontaneous and suction blisters was measured by bioassay on isolated guinea-pig colon after acidic lipid extraction. The fluid from spontaneous blisters in 15 patients with various bullous dermatoses, such as pemphigoid, porphyria cutanea tarda, erythema multiforme, contact dermatitis, X-ray dermatitis, all contained measurable amounts of activity, varying from 0.4 to 54 ng/ml, expressed as PGE2-activity. From 4 patients with pemphigoid, samples of fluid were collected, adequate to permit of analysis regarding the identity of the spasmogenic material. In silicic acid column chromatography, thin-layer chromatography, and in reversed phase partition chromatography, the major part of the biological activity co-chromatographed with 3H-PGE2. In one patient part of the activity coincided with PGF2alpha. The PG-like activity of experimental suction blisters was found to be significantly higher in patients with dermatitis herpetiformis than in control and psoriasis patients. The appearance of PGs in blister fluid is compatible with a role as chemical mediator involved in blister formation.
Adult↗
Multinucleated epidermal giant cells in inflammatory skin diseases.
The occurrence of multinucleated epidermal giant cells (MEGCs) with more than three clumping nuclei has been considered an episodic and exceptional phenomenon in inflammatory skin diseases. However, we have found them in 97 histologic specimens obtained from inflammatory lesions. They appeared in 88 of 196 biopsy specimens from a group of patients with chronic eczema or prurigo. In pruriginous lesions alone, they were found in 67 (74%) of 90 specimens. On the other hand, MEGCs were found rarely in lichen amyloidosus (2/11), dermatitis herpetiformis (1/6), erythema multiforme (1/11), pustular psoriasis (1/17), lichen planus (1/29), lupus erythematosus (1/30), and pustulosis palmaris et plantaris (1/41), probably representing just a chance occurrence in these dermatoses.
Cell Nucleus↗