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Biomedical subjects

A W du Vivier

Publications and source records attributed to A W du Vivier.

At least 19 recordsLinked to original sources
PubMed2001

Neutrophilic eccrine hidradenitis in two neutropaenic patients.

We describe two patients, who presented with erythematous facial plaques, in keeping with neutrophilic eccrine hidradenitis, during chemotherapy for acute myeloid leukaemia. Both patients were neutropaenic and febrile. Histology showed a dermal neutrophilic infiltrate around the eccrine glands with gland destruction. The importance of recognizing this disorder is to prevent the inappropriate use of antibiotics as it is self limiting.

Acute Disease↗
PubMed2000

Coexistence of acanthosis nigricans and the sign of Leser-Trélat in a patient with gastric adenocarcinoma: a case report and literature review.

The association of acanthosis nigricans (AN) with the sign of Leser-Trélat (LT) and gastric carcinoma is rare. Our patient was a 69-year-old man, who presented with hematemesis; a stage-IV poorly differentiated, diffuse-type, adenocarcinoma of the gastric antrum was diagnosed. The AN was striking, with florid cutaneous papillomatosis that also involved the mucous membranes of the mouth and eyelids, and keratoderma. AN and the sign of LT predated tumor detection by 6 months and regressed after chemotherapy in parallel with reduction of the tumor load, demonstrating the dermatoses as paraneoplastic phenomena. The patient died 7 months after completion of chemotherapy. The coexistence of AN and the sign of LT should prompt a search for underlying malignancy. The pathogenesis of both dermatoses is discussed.

Acanthosis Nigricans↗
PubMed1999

Analysis of Chinese herbal creams prescribed for dermatological conditions.

OBJECTIVE: To determine whether Chinese herbal creams used for the treatment of dermatological conditions contain steroids. DESIGN: 11 herbal creams obtained from patients attending general and paediatric dermatology outpatient clinics were analysed with high resolution gas chromatography and mass spectrometry. SETTING: Departments of dermatology and clinical biochemistry. MAIN OUTCOME MEASURE: Presence of steroid. RESULTS: Eight creams contained dexamethasone at a mean concentration of 456 micrograms/g (range 64 to 1500 micrograms/g). All were applied to areas of sensitive skin such as face and flexures. CONCLUSION: Greater regulation needs to be imposed on Chinese herbalists to prevent illegal and inappropriate prescribing of potent steroids.

Administration, Topical↗
PubMed1999

Topical immunotherapy in dermatology.

Topical immunotherapy of skin diseases has been used since the 1970s to treat conditions thought to result from an altered immunological state, mainly extensive alopecia areata and resistant viral warts. Despite its effectiveness, only a handful of dermatology departments in the UK currently provide such treatment. Any of three universal contact sensitisers may be used for topical immunotherapy; but diphencyprone (DCP) has advantages over dinitrochlorobenzene (DNCB) and squaric acid dibutyl ester (SADBE). Sensitisation of medical, nursing and pharmacy staff may be avoided by careful handling of the solutions. Local blistering and eczematous eruptions are the most common risks in patients undergoing treatment; vitiligo and erythema multiforme-like reactions are rare complications. Topical immunotherapy using DCP with close supervision is a useful option for severe alopecia areata and resistant viral warts.

Administration, Topical↗
PubMed1997

Psychiatric illness in patients referred to a dermatology-psychiatry clinic.

There is a recognized psychiatric morbidity among those who attend dermatology clinics. We aimed to determine the pattern of psychological and social problems among patients referred to a liaison psychiatrist within a dermatology clinic. Notes from 149 patients were reviewed and more detailed assessments performed in a subgroup of 32 consecutive referrals. All but 5% merited a psychiatric diagnosis. Of these, depressive illness accounted for 44% and anxiety disorders, 35%. Less common general psychiatric disorders included social phobia, somatization disorder, alcohol dependence syndrome, obsessive-convulsive disorder, posttraumatic stress disorder, anorexia nervosa, and schizophrenia. Classical disorders such as dermatitis artefacta and delusional hypochondriasis were uncommon. Commonly, patients presented with longstanding psychological problems in the context of ongoing social difficulties rather than following discrete precipitants. Psychiatric intervention resulted in clinical improvement in most of those followed up. Of the dermatological categories 1) exacerbation of preexisting chronic skin disease; 2) symptoms out of proportion to the skin lesion; 3) dermatological nondisease; 4) scratching without physical signs, the commonest were dermatological nondisease and exacerbation of chronic skin disease. Anxiety was common in those from all dermatological categories. Patients with dermatological nondisease had the highest prevalence of depression. Skin patients with significant psychopathology may go untreated unless referred to a psychiatrist. The presence of dermatological nondisease or symptoms out of proportion to the skin disease should particularly alert the physician to the possibility of underlying psychological problems.

Adolescent↗
PubMed1996

Evaluation of the 2-mm punch biopsy in dermatological diagnosis.

This prospective study was undertaken to determine whether the 2-mm punch biopsy technique yields specimens of sufficient size and quality to allow a reliable histological diagnosis to be made. A histopathological comparison was made between tissue obtained from a 2-mm punch biopsy and a standard ellipse biopsy taken from a wide range of dermatoses and benign and malignant skin tumours. In 79 of the 84 cases studied, the same histopathological diagnosis was reached with the 2-mm punch biopsy and the standard ellipse. Use of the 2-mm punch biopsy technique produces specimens which allow an accurate histological diagnosis to be made in a wide range of dermatological conditions. Skin biopsy techniques should ideally be quick and easy to perform, yielding specimens of high quality and adequate size while leaving the smallest possible tissue defect and a good cosmetic result. The aim of this study was to compare the effectiveness of the 2-mm punch biopsy with that of the standard ellipse biopsy technique in providing skin specimens which permit an accurate pathological diagnosis to be made.

Biopsy↗
PubMed1994

Cutaneous disease and alcohol misuse.

Certain skin disorders have now been demonstrated to be affected by alcohol misuse, in particular psoriasis and discoid eczema. The pattern of involvement in psoriasis differs from psoriasis vulgaris in character and distribution, and tends to be more difficult to treat. Discoid eczema appears to be specifically related to alcohol excess and is associated with deranged liver function tests. Rosacea, post-adolescent acne, superficial infections and porphyria cutanea tarda may also be markers of alcohol misuse. These disorders occur early and are quite distinct from the traditional cutaneous stigmata of established liver disease. The association between alcohol and skin disease is under-reported, as alcohol misuse may go undetected in a general clinic unless specifically sought. Alcohol has a profound influence on immune function and induces changes in the cutaneous vasculature. The relevance of these effects to the pathophysiology of alcohol-related skin disease is discussed.

Alcohol Drinking↗
PubMed1992

Alcohol and the skin.

The cutaneous stigmata of chronic alcoholic liver disease have been well recognised since the nineteenth century. However, it is now clear that the skin may be affected as an early feature of alcohol misuse. In particular, psoriasis, discoid eczema and superficial infections are more common in heavy drinkers. Awareness of these early associations can alert physicians to patients at risk of future complications of alcoholism. Great advances have been made in the understanding of the physiological and pathological effects of ethanol. The implications of these changes in the skin are discussed with reference to both the new and established cutaneous signs of alcohol misuse.

Alcoholism↗
PubMed1991

Angina bullosa haemorrhagica--a possible relation to steroid inhalers.

Angina bullosa haemorrhagica (ABH) is a recently recognized condition, characterized by benign subepithelial blood-filled blisters in the mouth. The history is characteristic and distinction from other causes of oral blistering can be made by simple clinical signs or on histological grounds. This condition does not appear in standard dermatology texts, yet patients with ABH usually present to a dermatology clinic. A case with typical history is reported in an asthmatic patient who very regularly used a steroid inhaler. The possible aetiological role of such steroid-based inhalers is discussed.

Adult↗