Intralesional steroid injection after nerve-block in orofacial granulomatosis.
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Biomedical subjects
Publications and source records attributed to C M Lawrence.
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Three cases of allergy to rubber are described, in which the patients exhibited peri-oral rashes following dental treatment by personnel wearing latex rubber gloves. Two of the patients were aware of possible allergy to domestic rubber products but did not reveal this as part of their medical history. With the increase in numbers of dentists wearing rubber gloves it is probable that there will be many more such cases reported in the future. Rubber products must then be added to the list of potential allergens which may be of some import to the practice of dentistry.
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The effect of terfenadine, an H1-receptor antagonist, on anthralin inflammation was studied in 12 subjects. Subjects were randomised to receive terfenadine 60 mg or placebo b.d. in a double-blind, cross-over study. Anthralin 5, 10 and 20 micrograms in 10 microliters chloroform was pipetted onto flexor forearm skin. Anthralin inflammatory oedema and erythema were measured using Harpenden calipers and a reflectance photometer, 48 h after anthralin application. After a 3-day washout period, placebo and terfenadine were restarted and the procedures repeated on the opposite arm. Anthralin erythema and oedema increased with dose but the dose-response curves showed no significant difference with or without terfenadine (p greater than 0.05). This study shows that H1-receptor blockade does not inhibit anthralin inflammation.
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Three methods of measuring the surface area of the involved skin were compared in 10 patients with psoriasis. Using the rule of nines, four untrained observers estimated the average extent of psoriasis as 20, 14, 23 and 33% of the body surface area. Measuring the area of tracings of plaque outlines using image analysis gave a mean involved surface area of 9% and image analysis of whole body photographs gave a mean value of 7%. We conclude that untrained observers using the rule of nines will overestimate the extent of psoriasis and that image analysis of whole body photographs is comparable to that of traced outlines.
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We describe a patient with halo eczema around a benign pigmented compound naevus. The eczema resolved after excision of the central naevus alone; this allowed histological assessment of the naevus without the need for a large excision or for additional topical therapy.
Granuloma annulare may be recurrent and various precipitating factors have been described but seasonal cases have not been previously reported. We describe two patients with granuloma annulare on the elbows which developed in spring and resolved spontaneously in October each year. We believe that this type of seasonally recurrent granuloma annulae has not been previously described.
Fifty-eight patients with chondrodermatitis nodularis on the antihelix in 24 ears (16 women and eight men) and the helix in 40 ears (six women and 34 men) were studied. Twelve ears responded to intralesional steroid therapy. Under local anesthetic, 46 operations were performed to remove cartilage without skin excision. On the helix, a longitudinal incision was made; on the antihelix, a flap was raised and the underlying cartilage was excised, taking care to leave no rough cartilage edges. Follow-up (mean, 16 months; range, 4.5 to 34 months) showed that 10 of 17 antihelix lesions and 24 of 29 helix lesions healed completely with excellent cosmetic results. Recurrences, requiring further treatment, occurred at cartilage-excision margins in seven ears, and further cartilage excision alone was successful in four ears. This study demonstrates that only cartilage needs to be removed in the surgical treatment of chondrodermatitis nodularis.
Fifty-three adult patients (19 men, 34 women) with dermatomyositis were studied. Two had dermatomyositis associated with benign disorders. Twenty-three (43%) had a malignancy; the risk of malignancy increased with age, but there was no sex difference. Seven malignancies were recurrences and 9 were diagnosed during investigation of dermatomyositis; these 16 were suspected clinically or from abnormal results of simple investigations. Extensive screening tests did not increase the number of malignancies diagnosed. In 7 patients, a diagnosis of malignancy was made more than 9 months after onset of dermatomyositis, although a relationship between malignancy and dermatomyositis was uncertain in two cases; the diagnosis of gynecological malignancy was missed in 2 patients despite appropriate investigations, 1 patient had poorly controlled dermatomyositis, and in 2 patients late diagnosis of malignancy was due to failure to reinvestigate relapse of previously stable dermatomyositis.
Twenty-two primary, secondary, and tertiary amines were studied to determine whether they could reduce anthralin-induced inflammation. Amine solutions of 0.18 mol/L were applied after anthralin application to normal forearm skin. Inflammation was measured with the use of Harpenden calipers by the increase in skin thickness at 48 hours. Inflammation was reduced by 66% to 95% with the use of nine different amines. There was no overall correlation between the inhibiting effect and either amine basicity or octanol/water partition coefficient. However, within each of the series of primary, secondary, and tertiary alkylamines there appeared to be some correlation between inhibitory effect and alkyl chain size, which may reflect differences in transdermal flux. Some of these amines are used in cosmetics and skin cleansers and could help reduce the inflammation that accompanies anthralin therapy for psoriasis.
Twenty patients with chronic plaque psoriasis were treated with short-contact anthralin followed by 10% triethanolamine application to one side of the body and aqueous cream to the other. Anthralin-induced inflammation was inhibited on the triethanolamine-treated side whereas anthralin therapy had to be temporarily stopped in 18 patients on the aqueous cream side because of anthralin-induced inflammation. Therapeutic response was not different in the two sides. This study shows that anthralin-induced inflammation and its therapeutic effect can be dissociated.
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We report two breast-fed premature infants who developed transient symptomatic zinc deficiency with scaly erythema of cheeks and napkin area, 9-13 weeks after birth. Serum zinc concentrations were 3.6 and 4.8 mumols/l, and the lesions healed rapidly in response to oral zinc supplements. Both mothers had low breast-milk zinc levels (2.3 and 3.2 mumols/l at 21 and 15 weeks respectively). The infants were both initially misdiagnosed as having eczema and infection. Premature infants are in negative zinc balance and though the additional factor of a low maternal breast milk zinc concentration may be necessary to provoke symptoms, rashes developing in such infants in the months following premature birth should raise the suspicion of zinc deficiency.
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