Isotretinoin treatment of severe acne in posttransplant patients taking cyclosporine.
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Acne Vulgaris↗
Biomedical subjects
M H Rustin
Publications and source records attributed to M H Rustin.
Toxic pustuloderma: a self-limiting eruption.
Three patients are described who developed numerous pinhead sized pustules within areas of a widespread toxic erythema. The eruption was precipitated by food poisoning in one patient, a suspected, but blood-culture-negative septicaemia in another and in the third patient, by a cephalosporin. This self-limiting syndrome consists of fever, a pustular and erythematous eruption, a neutrophil leucocytosis, subcorneal and spongiform pustules but without a history of psoriasis. We believe that this entity of toxic pustuloderma represents a severe form of toxic erythema.
Adult↗
Silica-associated systemic sclerosis is clinically, serologically and immunologically indistinguishable from idiopathic systemic sclerosis.
To determine whether the clinical, immunological and serological features of patients with silica-associated systemic sclerosis are different from patients with the 'idiopathic' form of systemic sclerosis (SS) we studied 22 underground coal miners who were exposed to silica dust (SD), 30 mine workers who later developed silicosis (S) and 17 mine workers exposed to silica dust who subsequently developed a systemic sclerosis-like disease (SA-SS). The patients with SA-SS had features clinically indistinguishable from individual patients with SS. They all had Raynaud's phenomenon, 14 had cutaneous sclerosis identical to that seen in acrosclerosis and three had a generalized cutaneous sclerosis. Sixteen patients had bibasilar pulmonary fibrosis, 10 had necrosis of the fingertip pulps, nine had oesophageal involvement and only one patient had renal involvement. Antinuclear antibodies and circulating immune complexes were detected in three and eight patients with SD, 14 and five patients with S and in 16 and nine patients with SA-SS, respectively. Anti-Scl-70 antibody was detected in eight of the 17 patients with SA-SS. Evidence for in vivo endothelial cell damage, as determined by elevated levels of von Willebrand factor, was found in nine patients with SD, 14 patients with S and in 10 patients with SA-SS. Following incubation of the patient's serum with confluent cultures of human umbilical vein endothelial cells there was only a significant reduction in calcium ionophore-induced release of prostacyclin with the serum from SA-SS patients compared to that with control serum (NC). The mean +/- SEM release of 6-keto-PGF1 alpha (the stable metabolite of prostacyclin expressed as ng/10(4) cells) decreased from 2.90 +/- 0.27 to 2.01 +/- 0.33 (SD), 3.34 +/- 0.42 to 1.76 +/- 0.31 (S), 1.98 +/- 0.12 to 0.64 +/- 0.07 (SA-SS) and 2.28 +/- 0.33 to 1.36 +/- 0.21 (NC) with 1 and 20% serum, respectively. This study demonstrates that immune complex and antinuclear antibody formation and in vivo endothelial cell damage occurs following occupational exposure to silica. The patients who subsequently develop a systemic sclerosis-like disease have clinical, immunological and serological features which are indistinguishable from the idiopathic form of the disease although as a group the SA-SS patients have a higher prevalence of pulmonary involvement and the anti-Scl-70 antibody.
6-Ketoprostaglandin F1 alpha↗
Pro-inflammatory mediators induce sustained release of prostaglandin E2 from human dermal microvascular endothelial cells.
The vasodilator prostaglandin E2 has been proposed as a mediator of erythema in a variety of cutaneous inflammatory reactions and prostacyclin levels have been found to be elevated in ultraviolet induced erythema. Human recombinant interleukin 1 alpha and lipopolysaccharide induced a concentration- and time-dependent release of prostaglandin E2, but not prostacyclin, from cultured neonatal and adult human dermal microvascular endothelial cells. Prostaglandin E2 was measurable at 2 h after stimulation with 1 U/ml interleukin 1 alpha, levels increased rapidly up to 6 h and more slowly up to 24 h. Lipopolysaccharide (20 micrograms/ml) induced measurable release of prostaglandin E2 between 2 and 4 h after stimulation and release continued up to 24 h when incubation was terminated. With both agonists, release of prostaglandin E2 was inhibited by indomethacin and significantly reduced by cycloheximide. The sensitivity and magnitude of responses of the cutaneous endothelial cells to these pro-inflammatory stimuli appeared to be dependent on their derivation.
Adult↗
Severe polymorphic eruption of pregnancy occurring in twin pregnancies.
We describe three women pregnant with twins who developed severely symptomatic polymorphic eruption of pregnancy. In all of these women oral prednisolone treatment was indicated and administered to two of them with resulting remission. Both these women breast fed their twins and relapsed in the puerperium requiring further systemic steroid therapy. The third woman was cured by early elective delivery. It has not been previously suggested that the severity of polymorphic eruption is related to multiple pregnancy and this possibility is discussed. The safety of oral prednisolone in pregnancy and during lactation is also reviewed.
Adult↗
Anorexia nervosa associated with acromegaloid features, onset of acrocyanosis and Raynaud's phenomenon and worsening of chilblains.
Patients with anorexia nervosa may develop many physical and endocrinological complications. We wish to report two patients who developed soft tissue swelling of their hands and worsening of their peripheral vascular disease, evidenced by the appearance of acrocyanosis and Raynaud's phenomenon and more severe perniosis, following the onset of their anorexia nervosa.
Acromegaly↗
Management of irritable skin disorders in the elderly.
Irritable skin conditions are a source of considerable morbidity in the elderly. In order to deal effectively with the problem it is essential to have a working knowledge of the diagnostic features and treatment of the common skin disorders in this age group.
Adrenal Cortex Hormones↗
Elastic fibres in patients with systemic sclerosis. A morphological study.
Dermal elastic fibres in biopsies taken from sun-exposed involved digital skin and sun-protected uninvolved skin on the medial aspect of the upper arms from 13 patients with systemic sclerosis were examined by light and transmission electron microscopy. For controls, biopsies were taken from similar sites from 4 age- and sex-matched healthy volunteers and 4 patients with primary Raynaud's phenomenon. On light microscopy only the control digital biopsies showed mild actinic changes of the elastic fibres whereas in all the biopsies from patients with systemic sclerosis identical changes of thickening, clumping and fragmentation of the elastic fibres were observed. Quantitative assessment of the dermal elastic fibres using microdensitometry and video image analysis showed no significant difference between the patients and controls. On electron microscopy more advanced abnormalities similar to those seen in actinic damage and chronological aging were found in the biopsies from all the patients with systemic sclerosis compared to the controls.
Adult↗
Release of prostacyclin from cultured human endothelial cells following prolonged exposure to histamine.
Histamine is an important pro-inflammatory molecule mediating leukocyte margination, plasma extravasation and vasodilation, but its precise mode of action on vascular endothelium is unclear. We report that histamine is able to induce prolonged release of prostacyclin (PGI2) from human endothelial cells via occupancy of the H1 receptor, without an absolute requirement for the presence of histamine or synthesis of new enzyme protein to facilitate continued release of PGI2.
1-Methyl-3-isobutylxanthine↗
Epidermal MHC class II antigen expression in systemic sclerosis.
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Adult↗
Erythema multiforme due to griseofulvin.
Three patients are reported who developed erythema multiforme during treatment with griseofulvin. To our knowledge there have been no previously documented reports of this drug causing erythema multiforme in either the English or American literature.
Adult↗
Chronic leg ulceration with livedoid vasculitis, and response to oral ketanserin.
We report a patient with a 6-year history of recalcitrant painful ulceration of both lower legs, diagnosed as being due to livedoid vasculitis. The lesions healed rapidly and remained healed on treatment with oral ketanserin.
Administration, Oral↗
Effect of human recombinant interleukin-I alpha on release of prostacyclin from human endothelial cells.
Incubation of human recombinant IL-1 alpha (hrIL-1 alpha) with cultured human endothelial cells induced a dose- and time-dependent increase in the release of prostacyclin (PGI2). Above a dose of hrIL-1 alpha 0.05 units/ml and following a variable lag phase of between 2 and 4 h, PGI2 release (measured as the stable hydrolysis product 6-keto-prostaglandin F1 alpha) was detected in the culture supernatant and levels continued to rise throughout a 48-h incubation. The release of PGI2 required the continued presence of hrIL-1 alpha, did not demonstrate tachyphylaxis and was not reduced by pre-incubation with the protein synthesis inhibitors cycloheximide, tunicamycin and actinomycin or by the calmodulin antagonist trifluoroperazine. The relationship of these results to ultraviolet radiation induced erythema is discussed.
Cells, Cultured↗
The treatment of chilblains with nifedipine: the results of a pilot study, a double-blind placebo-controlled randomized study and a long-term open trial.
A pilot study, a double-blind placebo-controlled randomised study and a long term open trial have indicated that nifedipine is effective in the treatment of perniosis. At a dose of 20 mg to 60 mg daily, nifedipine significantly reduced the time to clearance of existing lesions and prevented the development of new chilblains. Nifedipine also reduced the pain, soreness and irritation of the lesions. A comparison of the pre- and post-treatment skin biopsies showed resolution of the dermal oedema and diminution of the perivascular infiltrate. An increase in cutaneous blood flow following administration of nifedipine suggests that the vasodilator action of this drug may be important in its action.
Adolescent↗
Polyostotic fibrous dysplasia associated with extensive linear epidermal naevi.
Albright's syndrome is characterized by the combination of polyostotic fibrous dysplasia, precocious puberty and café-au-lait spots. We describe a patient with polyostotic fibrous dysplasia who also had extensive linear epidermal naevi, an association that has not been previously described in the English literature.
Adult↗
Follicular mucinosis presenting as acute dermatitis and response to dapsone.
Follicular mucinosis is usually regarded as an eruption consisting of follicular papules or infiltrated plaques with prominent follicular openings associated with loss of hair. We describe a patient who presented with an acute extensive dermatitis confined to the face which was later diagnosed as follicular mucinosis. We believe that such a florid presentation has not previously been reported in the literature and serves to illustrate the difficulty in distinguishing acute follicular mucinosis from acute eczematous dermatitis, pyogenic infections and inflammatory fungal infections.
Acute Disease↗