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Biomedical subjects

A G Franks

Publications and source records attributed to A G Franks.

9 recordsLinked to original sources
PubMed2004

Dermatology position paper on the revision of the 1982 ACR criteria for systemic lupus erythematosus.

The 1982 ACR classification criteria have become de facto diagnostic criteria for systemic lupus erythematosus (SLE), but a review of the criteria is necessary to include recent diagnostic tests. The criteria were not developed with the help of dermatologists, and assign too much weight to the skin as one expression of a multiorgan disease. Consequently, patients with skin diseases are classified as SLE based mostly on skin symptoms. We discuss specific problems with each dermatologic criterion, but changes must await a new study. We suggest the following guidelines for such a study, aimed at revision of the criteria. 1) The SLE patient group should be recruited in part by dermatologists. 2) The study should evaluate an appropriate international ethnic/racial mix, including late onset SLE as well as pediatric patients. 3) All patients should have current laboratory and clinical evaluations, as suggested in the paper, to assure the criteria can be up-to-date. This includes anti-SS-A and anti-SS-B antibodies and skin biopsies for suspected cutaneous lupus erythematosus except for nonscarring alopecia and oral ulcers. 4) The study should be based on a series of transparent power calculations. 5) The control groups should represent relevant differential diagnoses in numbers large enough to assess diagnostic problems that might be specific to these differential diagnoses. In order to demonstrate specificity of the criteria with a 95% confidence interval between 90 and 100%, each control group of the above should have at least 73 patients.

Classification↗
PubMed1998

Six-hour versus 48-hour patch testing with varying concentrations of potassium dichromate.

This study examines the possibility of using patch contact times shorter in duration than the standard 48 hours. Using varying concentrations of potassium dichromate (K2Cr2O7), this study analyzed results from two sets of patches applied to the backs of 11 subjects for durations of 6 and 48 hours, respectively. Results showed that after the 48-hour application period, all subjects reacted to K2Cr2O7 at some concentration. For the patches applied for 6 hours, 7 of the 11 subjects (64%) reacted to K2Cr2O7 at some concentration. Minimum elicitation thresholds (METs), the lowest concentration at which a reaction was observed, were established for both the 6-hour and 48-hour application times. The ratio of an individual's 6-hour MET to their 48-hour MET was calculated to evaluate the feasibility of patch testing with a higher concentration of an allergen for a shorter time period. Although the results clearly indicated that a higher concentration of allergen is required in order to elicit a reaction at 6 versus 48 hours, a fair amount of interindividual variability is exhibited by these 6-hour to 48-hour MET ratios. This observed variability would seem to preclude the use of 6-hour duration patch contact times for routine patch testing with K2Cr2O7.

Dermatitis, Contact↗
PubMed1992

Incidence of alopecia areata in lupus erythematosus.

BACKGROUND: A small percentage of patients with alopecia areata have connective diseases such as systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, and scleroderma. Lupus erythematosus is associated with a number of different types of alopecia, but the incidence of alopecia areata in lupus erythematosus has not been examined. OBSERVATIONS: Of our cohort of 39 patients with lupus erythematosus, alopecia areata developed in 10% (four patients), in contrast to 0.42% of general dermatologic patients. Biopsy specimens of alopecia areata lesions in each of our patients showed continuous granular deposition of IgG at the dermoepidermal junction, a finding usually found in only a minority of alopecia areata cases. Intralesional injections of corticosteroids were effective treatment. CONCLUSIONS: The incidence of alopecia areata in patients with lupus erythematosus is increased. Recognition of this form of alopecia allows for specific therapy with intralesional corticosteroids.

Adult↗
PubMed1988

Resistant discoid lupus erythematosus of palms and soles: successful treatment with azathioprine.

We present the case of two patients with an unusual form of discoid lupus erythematosus that was confined almost exclusively to the palms and soles. In both patients this form of discoid lupus erythematosus did not respond to conventional therapies, which included topical steroids, intralesional steroids, prednisone, quinacrine hydrochloride, hydroxychloroquine sulfate, colchicine, and dapsone. Both patients were then treated with azathioprine. One patient dramatically improved with azathioprine, worsened each time the azathioprine was stopped or reduced, and responded again to the reinstitution of therapy. The other patient began taking azathioprine 8 months ago and has also experienced relief of her symptoms. These cases suggest that discoid lupus erythematosus principally involving the palms and soles is difficult to treat with conventional medication and that azathioprine, which appears to be useful, should be tried after the failure of other therapies.

Adult↗
PubMed1982

Topical glyceryl trinitrate as adjunctive treatment in Raynaud's disease.

The effects of topical glyceryl trinitrate in Raynaud's disease were compared with those of placebo in a double-blind, crossover trial in 17 patients with bilateral Raynaud's disease and an associated collagen disease, who were receiving oral sympatholytic agents at the maximum levels they could tolerate. 1% glyceryl trinitrate ointment or a placebo of lanolin was applied to one hand only for 6 weeks, then patients changed to the other preparation for 6 weeks. The results were evaluated every 2 weeks. The frequency of attacks, severity of attacks, and size of ulcers in the treated hand were significantly lower when the patients were using glyceryl trinitrate ointment than when they were using placebo. The treatment of Raynaud's disease may be improved by using topical glyceryl trinitrate ointment as an adjunct to a basic regimen of oral sympatholytic agents. Glyceryl trinitrate ointment may obviate the need for more aggressive treatment, such as intraarterial reserpine, in selected patients.

Administration, Topical↗
PubMedDate not supplied

Carbohydrate metabolism in porphyria cutanea tarda.

Porphyria cutanea tarda (PCT) has a known increased incidence of diabetes mellitus and hepatic involvement. We investigated glucose tolerance and glucoregulatory hormone alterations in seven patients with PCT and correlated these results with hepatic histology by percutaneous liver biopsy. Abnormal glucose tolerance was observed in six of the seven patients (87%). Fasting serum insulin levels were normal range, and normal glucose and growth hormone responses to standard, exogenous intravenous insulin were observed. Fasting serum glucagon and urine free cortisol levels were normal in those patients in whom they were measured. While varying degrees of abnormalities were found on histopathologic exam of the liver biopsies, no patient met the criteria for cirrhosis, and none of the patients demonstrated abnormal levels of insulin counterregulatory hormones commonly seen in cirrhosis. Thus, liver disease may not be the sole cause of the observed glucose intolerance and hyperinsulinemia in PCT patients.

Adult↗