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B Tebbe

Publications and source records attributed to B Tebbe.

At least 55 records · Page 3Linked to original sources
PubMed1997

Epidemiology and socioeconomic impact of skin disease in lupus erythematosus.

The prevalence rates of systemic lupus erythematosus (SLE) may vary within 17-48/100,000 population worldwide. Although population-based epidemiological studies are still missing, the cutaneous variants of lupus erythematosus (LE) are 2-3 times more frequent than SLE itself. The most common age of onset is 20-40 y. Overall, cutaneous LE is regarded as a variant with less severe course and better prognosis. However, CDLE and SCLE last for many years and may lead, like SLE, to severe disability for work and limited life quality; also, a small proportion of patients with cutaneous LE develops SLE during the course of their disease. This implies considerable amount of medical management and costs for the community. Early recognition of cutaneous LE patients at risk to develop SLE and preventive measures against disease triggering factors are important tasks for physicians attending with cutaneous LE patients. It seems that signs of nephropathy, elevated ANA-titers and arthralgias may serve as prognostic predictors for transition into SLE. Characteristic features of cutaneous LE are photosensitivity and female predominance. UV light is a major environmental triggering factor in cutaneous LE. Skin lesions may be induced or preexistent lesions may exacerbate due to UV light in up to 80-90% of all patients. Therefore, socioeconomic counseling of the young patients, for example choice of occupation and sun protection, are essentials in compliant patients. Also, since females are 3-6 times more frequently affected than males, the possibility of hormonal influences including pregnancy and estrogen-containing drugs should be discussed. Risk considerations for females wishing to become pregnant are required, and avoidance of estrogen-containing contraceptives should be recommended.

Adolescent↗
PubMed1997

Markers in cutaneous lupus erythematosus indicating systemic involvement. A multicenter study on 296 patients.

Lupus erythematosus (LE) is an autoimmune disorder, involving the skin and/or other internal organs. As cutaneous variants, chronic discoid LE (CDLE) and subacute cutaneous LE (SCLE) usually have a better prognosis, however, involvement of internal organs with transition into systemic disease may occur. The aim of this study was to assess the significance of some clinical and laboratory criteria that could serve as markers for early recognition of systemic involvement in cutaneous LE. Three hundred and seventy-nine patients with LE, seen in five cooperating Departments of Dermatology during the years 1989-1994, were documented by electronic data processing according to a common protocol. Two hundred and forty-five of these patients had cutaneous LE (CDLE or SCLE), and 51 had systemic LE (SLE) and were included in this study. Forty-nine patients with either CDLE/SCLE or SLE were not evaluated because of incomplete documentation; also, 34 patients suffered from other LE subsets and were likewise excluded from the evaluation. Multivariate statistical analysis was used to assess the value of seven selected variables for distinguishing between the CDLE/SCLE and SLE groups: ESR, titers of antinuclear antibodies, anti-dsDNA-antibodies, photosensitivity, presence of arthralgias, recurrent headaches and signs of nephropathy. Univariate and multivariate analysis of the obtained data showed that signs of nephropathy (proteinuria, hematuria) was the variable with the highest statistical relevance for distinguishing between patients with cutaneous (CDLE/SCLE) and with systemic LE (SLE) in all statistical models tested, followed by the presence of arthralgias and of high ANA titers (> or =1:320). In contrast, low ANA titers as well as anti-dsDNA antibodies showed little or no statistical relevance as a criterion for distinction. It seems, therefore, that cutaneous LE patients showing signs of nephropathy, presence of arthralgias and elevated ANA titers (> or =1:320) should be carefully monitored, because they may be at risk of developing systemic LE involvement.

Adolescent↗
PubMed1996

[Clinical fluconazole and itraconazole resistance of oro-gastrointestinal candidiasis in a patient with AIDS].

We report on a 32-year-old male patient with advanced acquired immunodeficiency syndrome (AIDS), who had severe candidiasis of the gastrointestinal tract. Treatment with fluconazole, 200 mg/day, was introduced. After oral intake of fluconazole over 5 months itraconazole 200 mg/day was given for 1 month. However, fungal infection still persisted. The antifungal activity of fluconazole, itraconazole and ketoconazole against Candida albicans was evaluated by means of the microdilution test by determining the 90% inhibitory concentration of each drugs. A high minimal inhibitory concentration (MIC) was detected for fluconazole (50 micrograms/ml) revealing fluconazole resistance. The susceptibility to itraconazole was borderline (MIC 0.125 micrograms/ml) and that to ketoconazole was markedly lowered (MIC 0.25 micrograms/ml). Plasma levels of itraconazole were also found to be lowered. In HIV patients the gastrointestinal absorption of azole derivatives is often reduced. Therefore, the clinical resistance of Candida albicans to itraconazole can be explained by reduced susceptibility after azole therapy and also by the decreased absorption of the drug in HIV patients.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Detection of Helicobacter pylori in dermatoses. Clinical incidental finding or pathogenetic association?].

Recently, several reports have been describing a possible relation between Helicobacter pylori infection of the gastric mucosa and dermatological diseases. Associations have been reported for urticaria, roascea, Sjögren's syndrome and Schönlein-Henoch purpura. In this paper we review the current knowledge on Helicobacter pylori infection and its relevance for skin diseases, especially its clinical and pathophysiological aspects.

Gastritis↗
PubMed1996

Absence of human T-lymphotrophic virus type I in patients with systemic lupus erythematosus.

The role of the human T-cell lymphotropic/leukaemia virus type I (HTLV-I) in the pathogenesis of autoimmune diseases of unknown cause, such as systemic lupus erythematosus (SLE), multiple sclerosis (MS) or Sjögren's syndrome (SS) has been discussed extensively. We have investigated whether SLE is in any way associated with exogenous HTLV-I. Using enzyme immunoassay (EIA), we found no seroreactivity against HTLV-I antigens in any of 24 SLE patients under investigation. Using a radioimmunoprecipitation assay (RIPA), there was also no expression of retroviral tax-protein demonstrable in 24 individuals with SLE. DNA preparations of peripheral blood cells, as well as isolated CD4- and CD8-positive cells, were examined for HTLV-I sequences (pol-, env-, gag-, LTR- and tax-region) using polymerase chain reaction (PCR). We were unable to demonstrate any specific HTLV-I PCR products in SLE specimens. Our data suggest that exogenous HTLV-I is not involved in the pathogenesis of SLE. Systemic lupus erythematosus (SLE) is a multisystem disease of unknown cause characterized by B-cell hyperactivity with hypergammaglobulinaemia and the formation of pathogenic autoantibodies. Patients may also show altered suppressor/helper T-cell ratios. Abnormalities in T-cell function include T-cell lymphopenia, expression of activation antigens and alteration of responses to mitogens and lymphokines. Human retroviruses are known to cause immune aberrations, such as diminished T-cell function and polyclonal B-cell stimulation, which are observed in patients with leukaemias, lymphomas and the acquired immunodeficiency syndrome (AIDS). Human T-cell lymphotropic/leukaemia (HTLV-I) is aetiologically linked with adult virus type I T-cell leukaemia (ATL) and tropical spastic paraparesis. A common feature of the HTLV family is an LTR encoded protein (tax protein, p40tax) which triggers viral protein production in the early stages of a retroviral infection. Detection of p40tax may indicate transcriptional activity of a provirus. Several investigators have examined the possible involvement of HTLV-I in SLE and have produced conflicting results, especially so far as seroreactivity against HTLV-I antigens is concerned. The discovery of HTLV-I like particles in murine lupus might also indicate an important role of exogenous viruses in SLE. Olsen and colleagues describe a high seropositivity to anti-HTLV-I- and anti-HTLV-III antibodies and evidence of viral replication in patients with SLE. Lin et al. also demonstrated anti-HTLV-I antibodies in SLE patients. However, other authors failed to detect anti-HTLV-I antibodies, proviral structures or viral transcripts in SLE. We investigated whether or not there are any indications of the presence of the exogenous retrovirus, HTLV-I, in patients with SLE, at immunological and genetic levels. We found neither immunological nor molecular biological evidence for the existence of HTLV-I in SLE patients. There were some weak suggestions of the presence of possibly endogenous retroviral sequences.

Antibodies, Viral↗
PubMed1996

Remission of scleromyxoedema following treatment with extracorporeal photopheresis.

Scleromyxoedema, a disseminated papular and sclerotic variant of lichen myxoedematosus, is a rare disease with a chronic progressive course, and little tendency towards spontaneous remission. The treatment of scleromyxoedema has been largely ineffective. Aggressive chemotherapeutic agents have been used, often leading to therapy-related morbidity and mortality. We report a 41-year-old woman with scleromyxoedema, associated with a monoclonal gammopathy of IgG-kappa type, whose condition almost completely cleared with 12 monthly sessions of extracorporeal photopheresis. The patient had previously not responded to isotretinoin, and chlorambucil with prednisolone.

Adult↗
PubMed1995

Cutaneous metastatic angiosarcoma with a lethal outcome, following radiotherapy for a cervical carcinoma.

A cutaneous metastatic angiosarcoma was diagnosed in a 79-year-old woman 19 years after radiotherapy for a carcinoma of the uterine cervix. The diagnosis was confirmed by immunohistochemical staining (factor VIII-related antigen and BMA 120) and electron microscopic examination. Surgical treatment of the large tumour, which was situated in the gluteal region, was not feasible, but electron beam therapy resulted in complete remission. However, a further metastasis occurred in the inguinal region, and management by total excision, radiotherapy, and interferon-alpha treatment was unsuccessful. The patient died 28 months after the initial diagnosis of the neoplasm.

Buttocks↗
PubMed1995

Immunohistochemical analysis of chronic discoid and subacute cutaneous lupus erythematosus--relation to immunopathological mechanisms.

An immunohistochemical analysis of skin biopsies was performed in 18 patients with cutaneous lupus erythematosus (LE), using the alkaline phosphatase and monoclonal anti-alkaline phosphatase method (APAAP). The study group was subdivided on the basis of clinical criteria into 10 patients with chronic discoid LE (CDLE) and eight patients with subacute cutaneous LE (SCLE). Using a panel of monoclonal antibodies the following results were obtained: (i) ICAM-1 was expressed on epidermal keratinocytes, dermal inflammatory cells, and endothelial cells in most biopsies, whereas LFA-1 was confined to the dermis. Attachments between keratinocytes or endothelial cells and activated T lymphocytes via ICAM-1/LFA-1 may be a possible mechanism of target/effector recognition in cutaneous LE. (ii) HLA-DR was expressed on epidermal keratinocytes and cells of the dermal infiltrate, but not on endothelial cells. HLA-DR+ cells probably function as antigen-presenting cells, leading to major histocompatibility complex-restricted cellular cytotoxicity in cutaneous LE. (iii) Interleukin 2 receptor expression on dermal inflammatory cells was weak, indicating non-specific activation of T lymphocytes. (iv) The dermal inflammatory cells were T lymphocytes, mainly of the helper/inducer subtype. B lymphocytes were rarely found in the dermis. In general, no significant immunohistochemical differences were found between CDLE and SCLE, suggesting that these variants represent clinical subtypes rather than different pathogenetic entities.

CD8 Antigens↗
PubMed1994

[Cutaneous drug reaction caused by suramin in 4 patients with metastatic prostate cancer].

Suramin has long been used in the treatment of onchocerciasis and trypanosomiasis. Recent investigations showed an antiproliferative effect of suramin on prostate carcinoma cell lines. Ongoing clinical trials have confirmed the effect of suramin on metastasizing prostate carcinoma. Five patients with metastatic prostate carcinoma resistant to classic hormonal therapy were treated with high-dose suramin. Four of the five developed a papulovesicular or maculopapular rash within 2-4 weeks of starting therapy. The rashes disappeared after discontinuation of suramin within 10 days. In tumour therapy, high dosages of suramin are used to achieve a serum level of 200-300 micrograms/ml. Therefore, a toxic reaction to suramin is suspected as the explanation for the skin rashes.

Aged↗
PubMed1994

[Long-wave ultraviolet radiation (UVA) and skin cancer].

Ultraviolet light is frequently used for cosmetic tanning of the skin. UV light is known to be carcinogenic, but this is attributed predominantly to short-wavelength UV radiation (UVB). However, new data indicate a carcinogenic role for long wavelength ultraviolet light (UVA) also. In vitro studies have demonstrated DNA-damaging effects of UVA. In animals squamous cell carcinomas and melanomas were induced by UVA alone or in combination with UVB. Reference to a possible carcinogenicity of UVA may also be derived from the therapeutic application of UVA together with psoralens (PUVA). In addition, recent epidemiological studies have associated the use of sunbeds with the development of malignant melanoma. In conclusion, the carcinogenicity of UVA in humans cannot be ruled out, but requires further validation. Long and repeated UVA exposure should be discouraged, because of the far-reaching risks involved.

Animals↗
PubMed1994

[Course and prognosis of subacute cutaneous lupus erythematosus. A prospective study of 34 patients].

34 patients with subacute cutaneous lupus erythematosus (SCLE) were prospectively followed up and examined twice in 1986-1989 and 1990-1991, with a minimal interval of 2 years. The findings obtained were documented in a computerized registry and were evaluated by computer-assisted analysis. Thirty-one women and three men aged 23-66 years at the time of the first documentation (FD) were included in the study. The disease had lasted an average 6.5 years (from a few months to 39 years). Prominent cutaneous manifestations of SCLE were shown by 79.4% of the patients at the first visit compared to 58.8% at the second documentation (SD), whereas the incidence of acrolocalized vasculitis increased (FD 20.6%, SD 41.2%), as did that of Raynaud phenomenon (FD 20.6%, SD 26.5%). Mild extracutaneous symptomatology was found in 70.6% (FD) and in 85.3% (SD) of the SCLE patients. Arthralgia (FD 47%, SD 61.8%) and symptoms suggesting some involvement of the peripheral or central nervous system (FD 29.4%, SD 50%) were noted most frequently. Overall, during the follow-up there was a quantitative mild increase of extracutaneous symptomatology; a significant correlation between the presence of acrolocalized vasculitis and arthralgia was found. In conclusion, the prognosis of SCLE appears rather benign; fulminant courses were not observed. However, the risk of mild systemic involvement clearly increases during the prospective course of the disease, whereby acrolocalized vasculitis can be regarded as a cutaneous marker for extracutaneous manifestations.

Acrodermatitis↗
PubMed1993

Anticardiolipin antibodies in Adamantiades-Behçet's disease.

Moderately raised levels of circulating anticardiolipin antibodies were found in 14 of 30 patients with active Adamantiades-Behçet's disease (46.7%) who were not receiving treatment. Three patients showed the IgG isotype, nine the IgM isotype, and two had both IgG and IgM isotypes. Statistical analysis, to determine possible correlations between anticardiolipin antibodies and clinical features, and meta-analysis of the data available, were performed. A positive correlation between erythema nodosum and histologically confirmed cutaneous vasculitis and the presence of circulating anticardiolipin antibodies of the IgM isotype was found (P = 0.017 and 0.018, respectively), whereas the IgG isotype did not correlate with any clinical feature. Evaluation of data on other clinical manifestations showed no correlation, either with the IgG or IgM isotypes. In particular, there was no association of circulating anticardiolipin antibodies with the incidence of thrombosis, systemic vasculitis, retinal involvement or neurological features. These results suggest that anticardiolipin antibodies do not play a major pathogenetic role in Adamantiades-Behçet's disease, but they may serve as an additional marker for a risk of the development of cutaneous vasculitis such as erythema nodosum.

Adolescent↗
PubMed1993

[Alopecia areata and diffuse hypotrichosis associated with Ullrich-Turner syndrome. Presentation of 4 patients].

Gonosomal aberrations such as Turner's syndrome are frequently associated with autoimmune diseases or with serological markers for autoimmune diseases. An autoimmune origin has been suggested for alopecia areata. The simultaneous occurrence of alopecia areata and Turner's syndrome has not formerly been reported. We present here four female patients with Turner's syndrome, who also developed typical alopecia areata. In three of these cases alopecia areata first appeared during adolescence, whilst the fourth patient showed an early manifestation at the age of 10. Two of the patients had alopecia areata of the ophiasis type, while the condition was localized in one and diffuse in the fourth. In addition, two of the patients had diffuse hypotrichosis of the scalp and reduced sweat gland activity, with no other signs of ectodermal dysplasia. The third patient had not develop body hair after her childhood, except for some sparse thin hair in the axilla and in the genital area. The coincidence of alopecia areata and Turner's syndrome may indicate some genetic relationship between the two entities.

Adult↗