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[Erythema chronicum migrans with Bannwarth syndrome (Garin-Bujadoux-Bannwarth meningopolyneuritis)].

A 54-year-old male had erythema chronicum migrans (ECM), lymphocytic meningitis, and intense pain radiating along the distribution of the corresponding dermatomal segments. Neurologic involvement, described as Bannwarth syndrome or meningopolyneuritis Garin-Bujadoux-Bannwarth, is a typical late manifestation of ECM infection and requires high-dose intravenous penicillin therapy.

Diagnosis, Differential↗

[Anti-inflammatory effect and tachyphylaxis of systemic and combined systemic-topical treatment with corticosteroids in the pyrexal erythema test].

On account of clinical experience as well as experimental findings, we noticed subsiding anti-inflammatory and antiproliferative effects of topical corticosteroids after regularly repeated application. Following four-day's oral therapy with methylprednisolone 40 mg daily, the pyrexal erythema test did not reveal any decrease of anti-inflammatory effect in six volunteers. The efficacy of this therapy was similar to that of occlusive topical therapy with 0.25% desoxymethasone ointment. The anti-inflammatory effect of systemic steroid treatment could even be slightly increased by additional topical steroid therapy.

Administration, Topical↗

Polyethylene glycol precipitates in serum during and after erythema nodosum leprosum--study of their composition and anticomplementary activity.

Polyethylene glycol (PEG) precipitates obtained from sera were characterized and quantitated in 20 borderline lepromatous (BL) and polar lepromatous (LL) patients with moderate to severe erythema nodosum leprosum (ENL) before and four weeks after treatment with anti-ENL drugs, e.g., cortisone, clofazimine, chloroquine, or aspirin. Although the clinical severity of ENL subsided, there was no significant clearance of material that precipitates with PEG from the circulation. These precipitates had variable anticomplementary properties.

Antigen-Antibody Complex↗

Erythema nodosum. A review.

Erythema nodosum is not an uncommon dermatologic entity. Sarcoidosis and streptococcal infection have become the two most common causes, while tuberculosis was the predominant etiology prior to the use of isoniazid. Histoplasmosis and coccidioidomycosis are two important geographic considerations. Laboratory tests should include a PPD test, chest x-ray, throat culture for beta-streptococcus, and ASO titer determination as a minimum. Symptomatic treatment remains unsatisfactory in many cases, although recent success has been reported with oral potassium iodide.

Bacterial Infections↗

The ocular complications of erythema multiforme (Stevens Johnson syndrome) and their management.

Acute ocular complications of erythema multiforme such as infection causing conjunctivitis, suppurative keratitis or endophthalmitis are well recognized and usually easily managed. Late complications include disorders to tear production and drainage, position of lids, abberant or metaplastic lashes and metaplasia of the conjunctiva. Early detection and active management of these abnormalities greatly improves the long term prognosis. The techniques employed and the indications for their use in a recent series of 34 patients are presented.

Conjunctiva↗

Oral zinc in recurrent Erythema Nodosum Leprosum reaction.

Oral zinc sulfate was tried in Eight cases of recurrent Erythema Nodosum Leprosum. To control ENL, they required high dosage of clofazimine and steroids for prolonged periods. After instituting oral zinc, the dose of clofazimine could be reduced to 100 mg twice a week and steroids could be withdrawn completely. Four out of five patients who were not tolerating dapsone earlier, started tolerating dapsone. Incidence and severity of subsequent ENL was also reduced.

Administration, Oral↗

[Anthralin erythema: effect of concentration, contact time, oxidation products and corticosteroids. Clinical, reflection photometry and electron microscopy studies].

A comparative study on psoriatic patients and healthy volunteers demonstrated that short-term treatment with Anthralin shows significantly less side-effects on healthy skin than long-term therapy. We could also prove that the oxidation products Chrysazin and Bianthron do not cause any irritations, and that a combined therapy with Anthralin and corticoids does not reduce the development of erythema.

Adrenal Cortex Hormones↗

Lack of circulating immune complexes in uncomplicated erythema nodosum.

There is conflicting evidence in the literature concerning the role of circulating immune complexes (CIC) in the pathogenesis of erythema nodosum (EN). We investigated the possible involvement of CIC in 20 patients with EN, the majority of whom had idiopathic or uncomplicated disease. Immune complexes were detected by 3 complementary radioimmunoassays (the Clq, the mRF, and the anti-C3 solid phase assays). During the presence of the skin lesions, the only abnormalities noted were elevated concentrations of CIC detected by the anti-C3 assay in 5 of the 20 patients. None of the patients had elevated CIC by any of the 3 assays after resolution of skin lesions. These observations do not support a significant role for CIC in the pathogenesis of idiopathic or uncomplicated EN.

Adolescent↗

Erythema infectiosum: an epidemic with a probable posterythema phase.

An outbreak of erythema infectiosum occurred in an Ontario school in the spring of 1983. This benign disease ran a 19-day course in the index case and appeared in most of the child's grade 1 classmates. A few adults were also affected. In eight children flu-like symptoms persisted or occurred suddenly and lasted for several days after the rash had vanished. A plan of management that involves communication with parents, teachers and the public health service is outlined for the general practitioner.

Child↗

Drug-induced oral erythema multiforme. Results of a long-term retrospective study.

As reliable data on prevalence rates of drug-induced oral mucosa side effects are scarce in the medical literature, a retrospective analysis of drugs as possible inducers in 173 in-patients with either minor or major type of erythema multiforme (EM) admitted to the Erlangen University Department of Dermatology from 1970 through 1981 was carried out. In 62 of these cases precipitation by drugs was suspected by history, in 31 of them with oral mucosa involvement. In 11 out of 19 patients with mucocutaneous EM drug testing either in vivo or in vitro provided evidence for drug induction of EM.

Adolescent↗

Serum immunoglobulins an autoantibodies during and after erythema nodosum leprosum (ENL).

Sera from 20 patients with lepromatous leprosy complicated by erythema nodosum leprosum (ENL) were collected at the time of acute reaction and then after clinical cure four weeks later. Anti-ENL drugs used were: prednisolone (11 patients), chloroquin (6 patients), and clofazimine (3 patients). Immunoglobulins M, G, and A and autoantibodies, namely, antithyroglobulin antibody (ATA), antinuclear antibody (ANA), and rheumatoid factor (RF), were measured in these 20 paired serum samples. The mean serum concentration of IgG showed a significant elevation after clinical subsidence of the reaction, mainly in the prednisolone treated group; while those of IgM and IgA varied only marginally. Autoantibodies were detected in nine patients. Of these, three patients developed these antibodies only after remission of the reaction. Treatment with prednisolone and chloroquin, although causing subsidence of ENL, resulted in an increased incidence of ATA and/or ANA. Furthermore, it was observed that longer duration of illness, higher age group, and history of repeated attacks of ENL predisposed these patients to enhanced autoantibody formation.

Adult↗

Ultrastructure of skin in erythema nodosum leprosum.

The ultrastructural changes observed in erythema nodosum leprosum lesions were gross damage to blood vessels, particularly the endothelial cells, and deposition of immune complexes in vessel walls. Infiltrating cells and alteration of the ground substance formed a constant feature of the reaction. These changes are characteristic of an immune complex reaction.

Blood Vessels↗

Influence of UV- and capsaicin-induced erythema as well as of acetylsalicylic acid on the urinary excretion of vanilmandelic acid and homovanillic acid in man.

In the present study we investigated whether by means of urinary excretion of vanilmandelic acid (VNA) and homovanillic acid (HVA), resp., the two main metabolites of adrenaline, noradrenaline and dopamine, informations could be obtained on synthesis and release of catecholamines in inflammation. UV- and capsaicin-induced erythema, resp., were used as the inflammatory models. The urinary excretion or both VMA and HVA were found to be decreased after UV irradiation. Administration of acetylsalicylic acid during UV irradiation inhibited the decrease of VMA excretion whereas HVA excretion remained low. The application of capsaicin as a plaster failed to influence the urinary VMA and HVA excretion. Our results could be explained on the basis of the interrelationship between catecholamines and prostaglandins. Other possible mechanisms are discussed.

Adult↗

Arthritis, hilar adenopathy, erythema nodosum complex.

Sarcoidosis may be associated with an arthritis primarily of the legs, usually accompanied by hilar adenopathy and marked systemic symptoms. We retrospectively reviewed 16 Caucasian patients referred because of rheumatologic complaints with an associated asymptomatic hilar adenopathy in 8 (50%) and the presence of erythema nodosum in 12 (75%). Investigations, including pulmonary function tests and angiotensin converting enzyme, were normal. Clinical course was generally benign and self-limited with median duration of 3 months for the hilar adenopathy and arthritis. HLA typing revealed a significant increased prevalence of HLA A1 B8 haplotype.

Adult↗