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Biomedical subjects

J P Callen

Publications and source records attributed to J P Callen.

At least 19 recordsLinked to original sources
PubMed1992

Cutaneous leukocytoclastic vasculitis associated with active Wegener's granulomatosis.

BACKGROUND: Cutaneous manifestations are common in Wegener's granulomatosis and may occur at any time during the illness. OBJECTIVE: Our purpose was to describe the relation of the appearance of cutaneous leukocytoclastic vasculitis to activity and other manifestations of Wegener's granulomatosis. METHODS: Three patients with Wegener's granulomatosis who had recent onset of skin lesions are reported. Data regarding the relation of their cutaneous disease to their systemic disease was collected. RESULTS AND CONCLUSION: In each case, onset of the skin lesions of biopsy-proven cutaneous leukocytoclastic vasculitis was associated with activation of the systemic features of Wegener's granulomatosis.

Adult↗
PubMed1992

Human papillomavirus type 11 in multiple squamous cell carcinomas in a patient with subacute cutaneous lupus erythematosus.

Squamous cell carcinoma (SCC) is a rare complication of cutaneous lupus erythematosus (LE). Aside from the documented role of ultraviolet light, SCC may arise in areas of chronic scarring, such as in lesions of discoid LE. Iatrogenic immunosuppression associated with organ transplantation also results in a predisposition to SCC, often with multiple tumors. A role for certain human papillomaviruses (HPV) in the development of squamous cell carcinoma has been documented; specifically, HPV types 5 and 8 are detected in SCCs in patients with epidermodysplasia verruciformis and in recipients of organ transplants. HPV-11 is generally found in benign genital condylomata or laryngeal papillomas, but has not yet been associated with malignancy. We describe a patient with non-scarring cutaneous LE who was treated with azathioprine and prednisone and developed multiple SCCs. HPV-11 DNA and the target oncogenes neu and Ki-ras were detected in tumor tissue with the polymerase chain reaction. The HPV may have been involved in tumor induction and the azathioprine may have been involved in tumor promotion.

Acute Disease↗
PubMed1992

Oral lesions in systemic lupus erythematosus. Do ulcerative lesions represent a necrotizing vasculitis?

BACKGROUND: It has been suggested that oral lesions in patients with systemic lupus erythematosus (SLE) may be grouped clinically as erythema, discoid lesions, or oral ulcerations. Oral ulcerations have been said to foretell a severe systemic disease flare and the proposal that oral ulcers represent a mucosal vasculitis has been suggested to explain this hypothesis. OBJECTIVE: Our objective was to test the hypothesis that oral ulcers in patients with SLE result from vasculitis. METHODS: We studied 10 patients with American College of Rheumatology (ACR) criteria for a diagnosis of SLE who had oral lesions of lupus (six prospectively and four retrospectively) clinically and by routine and immunofluorescence microscopy. Biopsy specimens were reviewed in a single-blinded fashion. RESULTS: In our patients, no oral lesion, regardless of morphology, demonstrated vasculitis histologically. All lesions demonstrated an interface mucositis. CONCLUSION: Our data strongly contradict the hypothesis that leukocytoclastic vasculitis explains a possible unproven correlation between oral ulceration and disease flares in patients with SLE.

Adult↗
PubMed1992

Oculocutaneous manifestations observed in multisystem disorders.

Patients with multisystem disorders frequently present with or eventually manifest cutaneous disease. Many of these patients will also manifest ocular changes. In these disorders, the dermatologist or ophthalmologist may act as primary provider or consultant. Thus, familiarity with these conditions will enable the specialist to provide better care for these patients. This article reviews the oculocutaneous manifestations of sarcoidosis, Behçet's disease, Reiter's syndrome, and Sjögren's syndrome.

Arthritis, Reactive↗
PubMed1992

Atypical melanocytic nevi. Clinical and histopathologic predictors of residual tumor at reexcision.

BACKGROUND: The appropriate method for surgical management of melanocytic lesions with disordered architecture and melanocytic atypia (formerly dysplastic nevi) has been controversial. Physicians often reexcise these lesions after primary removal because of their potential relation to malignant melanoma. The outcomes of these reexcisions and the original biopsy specimens have not been previously examined. OBJECTIVE: The purpose of this study was to examine reexcision specimens and their respective original specimens to determine whether there were any characteristics predictive of the presence of residual nevus cells (RNCs) on reexcision. METHODS: One hundred eighty-nine reexcision specimens of atypical melanocytic lesions were evaluated for this study. The original specimens were examined for specific histopathologic features without knowledge of the findings on reexcision. Clinical characteristics were also examined. RESULTS: Of the 189 reexcision specimens, 47 (24.9%) contained RNCs. The proportion of specimens with RNC on reexcision was significantly greater if the original lesion was removed by punch biopsy rather than by shave or elliptical excision (38.3% vs 22.0% vs 10.5%, respectively; p < 0.03). Lesions located on the chest had a higher likelihood of RNCs than those on the back or leg (52.2% vs 21.7%; p = 0.009; 52.2% vs 9.7%, p < 0.002, respectively). Mean age was greater in those with RNCs at reexcision than those without (43.6 vs 37.9 years, respectively; p < 0.0001). The proportion of specimens with RNCs at reexcision was greater in those that had both lateral margins involved than in those that had nevus cells in either one or neither of the lateral margins in the original biopsy specimens (39.7% vs 24.0% vs 7.8%, respectively; p = 0.0005). One of the 189 reexcision specimens (0.5%) contained melanoma, although the original histopathologic diagnosis was an atypical melanocytic nevus. CONCLUSION: We identified several clinical and histopathologic factors that are strongly associated with the presence of RNCs on reexcision.

Adolescent↗
PubMed1991

Azathioprine. An effective, corticosteroid-sparing therapy for patients with recalcitrant cutaneous lupus erythematosus or with recalcitrant cutaneous leukocytoclastic vasculitis.

Azathioprine sodium has been reported to be effective therapy for chronic cutaneous lupus erythematosus (LE) but rarely for chronic cutaneous leukocytoclastic vasculitis (LV). We used azathioprine in the treatment of six patients with cutaneous LE, four of whom had subacute cutaneous (nonscarring) LE and two of whom had chronic cutaneous (scarring, discoid) LE, and six patients with chronic cutaneous LV. The conditions of all patients had been resistant to conventional therapy, and they required long-term oral corticosteroid therapy for control of their disease. Two of the patients with LE had prominent palmar and/or plantar involvement. Three patients with LE had an excellent response to azathioprine, with near complete clearing of the skin lesions, allowing a decrease in prednisone dosage. One patient with LE initially demonstrated significant improvement, but azathioprine therapy had to be discontinued because of pancreatitis. The treatment failed in two patients with LE; one had nausea and the other repeatedly developed a drug-induced fever. Five of the six patients with LV had improved conditions, with complete control of the disease occurring in two patients and partial control in three patients. Azathioprine is effective for some patients with cutaneous LE and chronic cutaneous LV, but it should be reserved for patients with severe disease in whom more conventional treatment fails.

Adult↗
PubMed1991

A double-blind, vehicle-controlled study evaluating masoprocol cream in the treatment of actinic keratoses on the head and neck.

This double-blind, vehicle-controlled, multicenter study evaluated the efficacy and safety of a new topical antineoplastic agent, masoprocol, in the treatment of actinic keratoses of the head and neck. Of the 113 patients who applied topical masoprocol twice a day for 14 to 28 days, there was a mean decrease in actinic keratoses from 15.0 to 5.4 and a median percent reduction from baseline actinic keratosis count of 71.4% at the 1-month follow-up visit. Comparable numbers for the vehicle-treated group were 13.4 to 11.1 actinic keratoses and 4.3% median percent reduction. Irritation, as manifested by erythema or flaking, occurred in 61.5% of topical masoprocol-treated patients versus 26.7% of those treated with vehicle and did not correlate with clinical response. Topical masoprocol appears to be useful in the treatment of actinic keratoses.

Administration, Cutaneous↗
PubMed1991

Collagen vascular diseases of childhood.

This article is devoted to collagen vascular diseases of childhood. The connective tissue diseases that are discussed are lupus erythematosus, scleroderma, and dermatomyositis. Of the vasculitic syndromes, Henoch-Schönlein purpura, acute hemorrhagic edema of infancy, and polyarteritis nodosa are discussed. Although the collagen vascular diseases are rare in the pediatric age group, when they occur they can be very serious.

Adolescent↗
PubMed1991

Clinical, serologic, and immunogenetic studies in patients with dermatomyositis.

Dermatomyositis is a disease of unknown etiology characterized by progressive, symmetrical, proximal muscle weakness with accompanying compatible cutaneous findings. Thirty-nine patients with dermatomyositis from the Louisville, Kentucky area were enrolled in this study. Patients were grouped into those with or without a malignancy. Ten patients (26%) either had or have had a malignancy. Twenty-five Caucasian patients were HLA typed for the A, B, DR and DQ locus antigens, of whom 5 had an associated malignancy and 20 did not have a malignancy. We found that no single antigen had a significantly increased or decreased frequency as compared with our control population for the entire group, or for any clinical subset we examined. Serologic testing revealed 4 patients with anti-Mi-2 antibodies and 1 patient with anti-PM-SCL antibodies. No patient had a positive anti-Jo-1 antibody in this group. The results of serologic tests in this group did not correlate with any clinical subset or HLA antigen. Our findings were in agreement with the previous reports in which approximately 25% of patients with DM have an associated malignancy. Our findings also support the notion that untargeted malignancy searches are not warranted. Contrary to previous reports we did not observe an inverse relationship between cancer and pulmonary disease in the dermatomyositis patient. This study does not indicate that there are any HLA associations or clinical associations, other than age, that distinguish patients with dermatomyositis as running a greater risk of developing malignancy.

Dermatomyositis↗
PubMed1991

Safety and efficacy of a broad-spectrum sunscreen in patients with discoid or subacute cutaneous lupus erythematosus.

An eight-week, open-label study was conducted to test the efficacy, safety, and cosmetic acceptability of a broad-spectrum sunscreen in patients with discoid lupus erythematosus or subacute cutaneous lupus erythematosus. The sunscreen combined the ultraviolet A absorber avobenzone (Parsol 1789, Givaudan Corp) and the ultraviolet B absorber padimate O and had a sun protection factor greater than fifteen. The overall clinical disease severity decreased from 2.7 (four point scale) at baseline to 1.7 after eight weeks (p = 0.005). Cutaneous signs and symptoms, including hyperpigmentation, papules, scaling, and erythema, were significantly less severe at the end of the study. The level of protection provided by the sunscreen was good to excellent in 54 percent of patients, and was judged to be superior or far superior to previously used sun protection factor-fifteen sunscreens in 77 percent of patients. Most patients found the sunscreen highly acceptable with respect to its cosmetic properties.

4-Aminobenzoic Acid↗
PubMed1979

Dermatitis herpetiformis and thyrotoxicosis.

Dermatitis herpetiformis has been associated with a variety of thyroid abnormalties. A case of thyrotoxicosis in a patient with pre-existing dermatitis herpetiformis is reported. Thyroid antibodies were present in the serum. This may suggest an immunologic relationship between dermatitis herpetiformis and thyroid disorders, that may be more than fortuitous.

Adolescent↗