Biomedical subjects

J S Kasteler

Publications and source records attributed to J S Kasteler.

5 recordsLinked to original sources

PubMed1997

Low-dose methotrexate administered weekly is an effective corticosteroid-sparing agent for the treatment of the cutaneous manifestations of dermatomyositis.

BACKGROUND: The cutaneous manifestations of dermatomyositis can be the most prominent finding and are often difficult to treat. OBJECTIVE: Our purpose was to determine whether low-dose methotrexate administered weekly in combination with other systemic therapies or as a sole systemic agent is effective in the treatment of the cutaneous disease in patients with dermatomyositis. METHODS: We reviewed the records of 13 patients who received oral methotrexate in doses ranging from 2.5 to 30 mg weekly. Their skin lesions had not been completely responsive to sunscreens, topical corticosteroids, oral prednisone, oral antimalarial therapy, and, in one patient each, chlorambucil and azathioprine. RESULTS: At the end of the study period, 4 of these 13 patients were free of all cutaneous manifestations of dermatomyositis, and another four had almost complete clearing. In the remaining five patients, methotrexate induced moderate clearing of their cutaneous lesions. In all patients, the addition of methotrexate allowed reduction or discontinuation of other therapies such as prednisone. All patients tolerated the methotrexate with minimal toxicity. CONCLUSIONS: Low-dose oral methotrexate administered weekly is effective in treatment of the cutaneous manifestations of dermatomyositis and frequently enables a reduction or discontinuation of corticosteroid therapy.

Administration, Cutaneous↗

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↗

PubMed1992

Circulating activated T lymphocytes in autoeczematization.

BACKGROUND AND DESIGN: Autoeczematization, the symmetric diffuse spread of a previously localized dermatitis, has an unclear etiology although some investigators have postulated that activated T lymphocytes play a role. Two estimates of activation of peripheral T lymphocytes are the cell surface expression of the HLA-DR antigen and the interleukin 2 receptor (IL-2R). We measured the percentage of circulating activated T lymphocytes in nine patients with autoeczematization compared with normal controls (n = 10), patients with stasis dermatitis (n = 6), and patients with severe (n = 10) or mild (n = 8) psoriasis. The percentage of activated T lymphocytes was determined by fluorescent, activated cell sorter analysis of peripheral leukocytes doubly stained with antibodies to T lymphocytes and HLA-DR antigen or IL-2R. RESULTS: Statistically significant elevations of HLA-DR- and IL-2R--positive T lymphocytes were seen in autoeczematization patients (P less than .004 and P less than .04, respectively) and those with severe psoriasis (P less than .004 for HLA-DR antigen and IL-2R). Percentages of HLA-DR- and IL-2R--positive T lymphocytes in patients with mild psoriasis were not significantly elevated. Two patients with autoeczematization had a reduction of their previously elevated levels of HLA-DR- and IL-2R--positive T lymphocytes after treatment. CONCLUSIONS: These data suggest a possible role for circulating activated T lymphocytes in the pathogenesis of autoeczematization and possibly in severe psoriasis.

Antigens, Surface↗

PubMedDate not supplied

Hypersensitivity reaction in a child due to lamotrigine.

Lamotrigine is an anticonvulsant with a broad spectrum of activity that has been approved in the United States for use in adults with either partial or generalized seizures. This drug is being widely prescribed by pediatricians and neurologists because it is effective in children with idiopathic, resistant, generalized seizures and does not impair cognition. As with other anticonvulsants, a hypersensitivity syndrome has been described. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, and lymphadenopathy. We report the first case of hypersensitivity syndrome in a child due to lamotrigine in which we believe the coadministration of valproic acid increased the duration of the reaction. Our patient had a high spiking fever, generalized morbilliform eruption, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and an elevation in his liver function tests. The syndrome resolved with the discontinuation of the medication. Anticonvulsant hypersensitivity syndrome may occur with the administration of lamotrigine. Variable presentations may be seen, as hypersensitivity syndromes may be multisystem in nature. The prompt recognition of the signs and symptoms of this condition allows an accurate diagnosis so that the drug may be discontinued and other anticonvulsant treatment options instituted.

Anticonvulsants↗

PubMedDate not supplied

Prevalence of cutaneous findings in hospitalized pediatric patients.

Cutaneous findings can be useful in establishing the diagnosis and treatment of hospitalized patients. Observation and identification of cutaneous abnormalities can improve the accuracy of diagnosis and result in improved patient care. We set out to determine the prevalence of cutaneous abnormalities in hospitalized pediatric patients in a hospital and how often these findings were noted and properly diagnosed by the admitting team of physicians. Children with medical problems admitted to Kosair Children's Hospital during the month of January 1995 were randomly selected for a skin examination, which was performed within 24 to 28 hours of admission. Parental consent was required prior to admission into the study. Of 117 patients offered participation, 110 accepted. Physical findings were noted and in addition the completeness of charting by the admitting physician and the relationship of any cutaneous findings to admitting diagnosis were noted. One hundred five of the 110 patients (95%) had cutaneous findings consisting of either a "rash" or a "congenital lesion." Fifty-one had more than one cutaneous finding noted on examination. Dermatitis was the most common diagnosis made, followed by pigmented lesions and congenital vascular malformations of all types. In 35 of the 105 patients with a dermatologic diagnosis, the dermatologic diagnosis related directly to the admitting diagnosis. In only 22 of these 35 (63%) was the cutaneous involvement noted by the admitting physician. In 9 of the 110 cases (8%), the findings on dermatologic examination altered the primary diagnosis and/or treatment. Cutaneous findings are very common in the hospitalized pediatric patient. The diagnosis, charting, and treatment of dermatologic conditions by the primary pediatric team were often incomplete, although an expert cutaneous examination can be critical to patient care.

Adolescent↗