Biomedical subjects
Publications and source records attributed to A Ingber.
We present 2 sibs with a local junctional type of epidermolysis bullosa associated with enamel defect of the teeth, dystrophic nails of the feet, and mental retardation. Subluxation of the lenses was evident in 1 of them. This combination found in a brother and a sister seems to represent a distinct autosomal recessive type of epidermolysis bullosa.
OBJECTIVE: To report smoking intolerance that occurred in two patients while they were treated with minoxidil. DATA SYNTHESIS: Minoxidil is a potent vasodilator useful in treating severe hypertension. Topical minoxidil was approved as a treatment for androgenital alopecia. Only few side effects have been reported during treatment with topical minoxidil, most of them localized skin reactions. Two of our patients developed smoking intolerance during treatment with topical minoxidil for androgenital alopecia. The relation between treatment with minoxidil and smoking intolerance was emphasized by stopping treatment and the disappearance of the smoking intolerance, and then by rechallenge in both patients. CONCLUSIONS: Topical minoxidil may cause smoking intolerance; further studies are needed to evaluation this side effect.
Forty-four patients with seborrhea and seborrheic dermatitis of the scalp were treated with either bifonazole shampoo (22 patients) or the vehicle shampoo (22 patients) in a randomized, double-blind vehicle-controlled study. The patients were instructed to wash their scalps 3 times weekly for 6 weeks and were examined every 3 weeks. Responses were evaluated by clinicians using a clinical grading of scaling, erythema and overall improvement, and also by the patients, who assessed pruritus and overall improvement, using a scale of 0 to 3. The improvement following the bifonazole shampoo was found to be significantly greater than that achieved with the vehicle shampoo in regard to the clinical evaluation of scaling (p = 0.01) as well as patient evaluation of pruritus (p = 0.008) and overall improvement (p = 0.03). No major adverse side effects were recorded.
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A retrospective review was made of 35 cases of Brown Recluse spider bites treated during a period of 21 years. The most common location of the bite was on the lower limbs, particularly the thigh. The main systemic manifestations were fever, malaise and maculopapular rash, but there were no cases of hemolysis, coagulopathy, or of renal or neurologic involvement. Signs indicating a poor prognosis appeared to be lymphangitis, generalized maculopapular rash and location of the bite on the thigh or abdomen. Most cases were treated effectively by rest, elevation of the affected part of the body, local cleansing, and prophylactic antibiotics. On the basis of this experience it was concluded that only when lesions show a necrotic area measuring 2 to 3 cm should patients be treated with systemic corticosteroids. In most such cases, administration of corticosteroids for 14-21 days proved sufficient to avoid the need for surgery. Only 5 cases required surgical intervention.
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A young patient developed an acute self-limited bullous eruption shortly following ampicillin ingestion, with histopathological and immunofluorescent features fulfilling the criteria of bullous pemphigoid. A review of the relevant literature is made with special emphasis on the heterogenous and sometimes misleading faces of drug-induced bullous pemphigoid.
Two new cases of neutrophilic bullous disease exhibiting bound and circulating intercellular IgA in vivo in both direct and indirect immunofluorescence (IF), for which the term IgA-pemphigus was recently proposed, are presented. The first case showed a unique constellation of clinical and histopathological features not previously described for IgA-pemphigus, resembling both dermatitis herpetiformis and pemphigus, for which the designation IgA-herpetiform pemphigus seems most appropriate. The second case showed clinical and histopathological features mimicking subcorneal pustular dermatosis for which the previously used term IgA-pemphigus foliaceus seems most appropriate. The previously reported 11 cases showing similar direct IF findings, as well as our two patients, illustrate the main differences between IgA-pemphigus and classic forms of this condition: (a) different clinical manifestations with the absence of Nikolsky's sign; (b) scanty acantholysis; an abundance of neutrophils, with occasional neutrophilic spongiosis; (c) absence of C3 on direct IF; (d) the lower sensitivity of indirect IF and low levels of circulating antibodies; (e) the relatively benign course of the disease; (f) the apparent responsiveness to sulphones in many cases. It is suggested that IgA pemphigus should be considered as an entity separate from, but closely related to, classic pemphigus.
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From 1 November 1984 to 1 November 1989. 3075 patients (1949 female and 1126 male) were patch tested with the European standard series, including primin 0.01% pet. 57 positive reactions were obtained (1.8%). About 95% of the patients with positive patch tests were female. 60% of the patch-test-positive patients were above age 60 and 35% above 70 years. The test was negative in all under the age of 20 and rarely positive under the age of 35 years. Only 2 patients had probable patch test sensitization observed 8 and 14 days after application of the test material. 41% of the patients with positive reactions had current primula dermatitis at the time of patch testing. The frequency and high degree of current relevance justify inclusion of primin in the standard series, at least in certain geographical regions. The patch test concentration of 0.01% pet. seems to be correct.
A 69-year-old man developed a generalized pustular drug rash 2 weeks after starting on hydroxychloroquine sulfate (HCQ) medication. This form of drug eruption had not previously been attributed to HCQ, although a diagnosis of pustular psoriasis cannot be ruled out.
A search for possible lithogenous factors was under-taken in a group of 42 lichen planus (LP) patients (15 with urolithiasis and 27 without). Normal mean values of calcium, phosphorus, uric acid and creatinine were found in the serum and in the 24-hour urine collection. However, 9 patients (21%) manifested laboratory deviations consisting of hyperuricemia, hyperuricosuria or hypercalciuria, or combinations of the three. The prevalence of hyperuricemia among LP patients was greater than in matched controls and vis-à-vis the recorded prevalence of hyperuricemia in the general population and in other calcium stone formers. These findings may suggest involvement of metabolic defects in LP.