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Biomedical subjects

J P Callen

Publications and source records attributed to J P Callen.

At least 73 records · Page 4Linked to original sources
PubMed1996

Low-dose methotrexate as an adjunctive therapy with surgery for ectropion complicating dermatomyositis.

We describe the clinical and histopathologic features of a 44-year-old woman who developed bilateral lower eyelid ectropion and upper lid entropion presumably secondary to dermatomyositis. A variety of inflammatory, infiltrative and/or scarring dermatoses have been associated with ectropion. Chronic inflammation, poikilodermatous change and mucinous infiltration of the eyelids due to dermatomyositis are the postulated mechanisms leading to ectropion in our patient. This case is unique in that neither dermatomyositis nor papular mucinosis has previously been reported as a cause of ectropion. Also interesting was the adjunctive effect of methotrexate therapy.

Adult↗
PubMed1996

Cutaneous manifestations of selected rheumatologic diseases.

Systemic lupus erythematosus, chronic cutaneous lupus erythematosus and subacute and acute cutaneous lupus erythematosus are associated with distinct cutaneous manifestations, and each disease has a particular clinical course and prognosis. Dermatomyositis, an immune-mediated disorder of unknown etiology that is often associated with a malignancy, consists of an inflammatory myopathy combined with characteristic cutaneous findings. Some patients with dermatomyositis also have clinical features that overlap with those of systemic lupus erythematosus or scleroderma. Manifestations of scleroderma range from cutaneous involvement alone to multisystem internal disease. Morphea, progressive systemic sclerosis, eosinophilic fascitis, eosinophilia myalgia syndrome and mixed connective tissue disease are all within the spectrum of scleroderma.

Dermatomyositis↗
PubMed1995

Photoexacerbation of cutaneous lupus erythematosus due to ultraviolet A emissions from a photocopier.

This report describes a woman with systemic lupus erythematosus (LE) who worked as a photocopy technician and developed cutaneous LE of the hands, neck, face, and chest. Her skin lesions improved when she discontinued her employment. Testing of several photocopy devices showed emission of small quantities of ultraviolet A (UVA), but no UVB. Phototesting of the patient with UVA and UVB induced skin lesions that were clinically and histopathologically consistent with LE. Thus, the action spectrum of cutaneous LE may be within the UVB range, the UVA range, or both ranges of the solar spectrum, and repeated exposure to short bursts of light may induce clinical disease. This case suggests that occupational sources of UV light should be considered as possible exacerbating factors in LE.

Biopsy↗
PubMed1995

Disseminated Fusarium solani infection.

Disseminated fungal infections commonly occur in immunocompromised hosts; Candida spp. are the most common. Fusarium spp., soil saprophytes once considered pathogenic only in plants, have emerged as serious pathogens in neutropenic patients with malignancies. We describe two patients, one with acute myelogenous leukemia and the other with metastatic breast cancer, in whom disseminated Fusarium solani infection developed. Both patients had neutropenia and fever when generalized, tender, erythematous papules developed; most of the papules had black necrotic centers. Despite aggressive therapy with antifungal agents and granulocyte-macrophage colony-stimulating factor, both patients died within 1 month. Disseminated Fusarium infection can be a life-threatening condition in which skin lesions are frequently the initial sign. Early recognition and hematopoietic recovery offer the best chance for survival.

Adult↗
PubMed1995

Effective treatment with alpha 1-protease inhibitor of chronic cutaneous vasculitis associated with alpha 1-antitrypsin deficiency.

The primary serum proteinase inhibitor is alpha 1-antitrypsin, and deficiency of this enzyme has been associated with a variety of systemic and cutaneous disorders. We report cutaneous vasculitis in a 49-year-old man with alpha 1-antitrypsin deficiency. His condition persisted despite treatment with colchicine, prednisone, and antibiotics but has been controlled by the administration of alpha 1-protease inhibitor.

Chronic Disease↗
PubMed1995

Widespread cutaneous necrosis as the initial manifestation of the antiphospholipid antibody syndrome.

We describe a patient with the acute onset of widespread cutaneous necrosis as the initial manifestation of the antiphospholipid antibody syndrome (APS). The patient was effectively treated with corticosteroids and anticoagulants, however extensive skin grafting was eventually required. We review 6 other reported cases and discuss the various underlying etiologies of vascular thrombosis resulting in cutaneous necrosis. Early recognition and treatment of the APS may limit the extent of thrombotic complications that can result in tissue necrosis.

Acute Disease↗
PubMed1994

Scalp involvement in dermatomyositis. Often overlooked or misdiagnosed.

OBJECTIVE: To characterize scalp involvement in patients with dermatomyositis. DESIGN: Case series. PATIENTS: All patients with dermatomyositis seen in our office between 1988 and mid 1993. Patient inclusion in this study required fulfillment of three or more of Bohan and Peter's criteria for dermatomyositis. RESULTS: Of 17 patients with the diagnosis of dermatomyositis, scalp involvement was present in 14. Five of the 14 patients with scalp involvement were diagnosed as having scalp psoriasis or seborrheic dermatitis before progression of their disease or tissue examination revealed the diagnosis of dermatomyositis. In all patients, the scalp involvement was manifested as atrophic, erythematous, scaly plaques. In addition, alopecia was noted in six of the 14 patients. Treatment of cutaneous involvement included sun avoidance, topical corticosteroids and/or antimalarials, and/or methotrexate. CONCLUSIONS: Recognition of this process is important because scalp involvement is often overlooked, may be misdiagnosed initially, and can be the presenting complaint in some patients with dermatomyositis.

Adolescent↗
PubMed1994

Successful treatment of lentigo maligna and lentigo maligna melanoma with Mohs' micrographic surgery aided by rush permanent sections.

BACKGROUND: Lentigo maligna (LM) is a pigmented neoplasm on sun-exposed skin of elderly patients. LM slowly increases in size and may become lentigo maligna melanoma (LMM), a potentially fatal malignancy. Complete excision is the treatment of choice. Mohs' micrographic surgery (MMS) with frozen and permanent sections may be used for complete eradication of the lesion, while sparing as much normal tissue as possible. The authors studied the efficacy of MMS for the treatment of LM and LMM. METHODS: Between 1985 and 1992, 45 patients with LM (26) and LMM (19) were treated with MMS. The authors' technique was to use examination of frozen sections and rush permanent sections (prepared and read within 24 hours). Positive frozen sections warranted further excision. For negative or equivocal frozen sections, surgery was interrupted until the examination of permanent sections was performed. RESULTS: All 45 patients were free of local disease and evidence of metastases at an average of 29.2 months (range, 4-81 months) after therapy. CONCLUSIONS: MMS aided by rush permanent sections yielded a prolonged disease free survival for all 45 patients with LM or LMM. Because the MMS technique minimizes the removal of normal tissue, and the local cure rate in this study was superior to that reported for conventional surgery, the authors recommend this technique for the treatment of LM and LMM.

Adult↗
PubMed1994

Leukocytoclastic vasculitis caused by drug additives.

Chronic cutaneous small vessel (leukocytoclastic) vasculitis (LCV) is a process believed to be related to the presence of circulating immune complexes. The most frequent causes and associated disorders are medications, infections, collagen vascular disorders, paraproteinemias, and, rarely, neoplasia. Reports of food or food additives as a causative factor for LCV have appeared but are rare. We report a patient with chronic cutaneous LCV in whom the presumed cause was an excipient (a dye) used in the capsule form of lithium carbonate. Furthermore, ingestion of foods containing dyes results in a disease flare in our patient.

Azo Compounds↗
PubMed1994

Myositis and malignancy.

Dermatomyositis appears to be associated with a greater frequency of malignancy than expected in the general population. For polymyositis, there does not appear to be a greatly increased risk of malignancy. Ovarian cancer may be overrepresented in women with dermatomyositis and difficult to detect. A paraneoplastic course, in which the activity of the myositis parallels that of the malignancy, occurs in some patients but is unusual. Although the frequency of malignancy rises with increasing age, young patients may harbor malignancy. The search for malignancy should be directed by symptoms, findings on physical examination, or laboratory testing, and it should be age appropriate.

Age Factors↗
PubMed1994

Oral metronidazole, an effective treatment for Sweet's syndrome in a patient with associated inflammatory bowel disease.

A 39-year-old woman with chronic, recurrent Sweet's syndrome (acute febrile neutrophilic dermatosis) and possible Crohn's disease was successfully treated with oral metronidazole. After 4 years of recurrent skin lesions which involved the hands and face, our patient developed genital and perianal ulcerations which were also histopathologically characterized by a neutrophilic infiltrate. In addition, she had a nondeforming polyarthritis that accompanied recurrences of her skin lesions. The patient was given oral metronidazole, an agent frequently used for perianal Crohn's disease, and achieved complete resolution of the perianal and perineal ulcers, the cutaneous lesions of Sweet's syndrome and the associated polyarthritis.

Administration, Oral↗
PubMed1994

Relationship of cancer to inflammatory muscle diseases. Dermatomyositis, polymyositis, and inclusion body myositis.

Dermatomyositis (DM) is probably associated with a greater frequency of malignancy than expected in the general population. For polymyositis (PM), there does not appear to be greatly increased risks. Ovarian cancer may be over-represented in women with DM. A paraneoplastic course occurs in some patients with DM, but is unusual. Even young patients with DM should be evaluated. The malignancy evaluation should be directed by symptoms, findings on physical examination or laboratory testing, or be age-appropriate.

Adult↗