Successful treatment of erosive lichen planus with topical tacrolimus.
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Age Factors↗
Biomedical subjects
R A el-Azhary
Publications and source records attributed to R A el-Azhary.
Relevant contact sensitivities in patients with the diagnosis of oral lichen planus.
BACKGROUND: The concept of contact allergy aggravating or inducing oral lichenoid mucositis diagnosed as oral lichen planus (OLP) is well recognized but somewhat controversial. OBJECTIVE: We sought to identify clinically relevant contact allergens that may be important in the management of patients with OLP. METHODS: We retrospectively reviewed patients with OLP who had patch tests performed at Mayo Clinic Rochester and Mayo Clinic Scottsdale from 1994 to 1997 and 1988 to 1997, respectively. RESULTS: Patch tests were performed on 46 patients with a clinical and histopathologic diagnosis of OLP. Of these, 25 (54%) had positive patch test results. Eighteen (72%) of the patients with positive results had clinically relevant reactions. Of the patients with positive metal reactions, 5 had improvement after removal of the metal prosthesis or restoration. Six others noted that their most troublesome areas were adjacent to metal dental restorations. Six patients with reactions to flavorings and one patient with an acrylate dental retainer sensitivity had improvement after avoiding these allergens. CONCLUSION: Our findings support the concept that contact allergy to metals, flavorings, and plastics can be important in the pathogenesis and management of patients with oral lichenoid mucositis diagnosed as OLP.
Adult↗
Contact Allergen Avoidance Program: a topical skin care product database.
Management of allergic contact dermatitis can be challenging for patients because of difficulties they encounter while attempting to avoid antigens identified by patch tests. The disorder is commonly caused by fragrances, preservatives, or other ingredients found in skin care products. After patch testing, the clinician routinely educates the patient on the sources of the antigens to which he or she is sensitive. Because typical allergen names are long, are difficult to spell, commonly have numerous complex synonyms, and are often frankly intimidating for patients, compliance with allergen avoidance is frequently problematic. We have developed a Contact Allergen Avoidance Program database tool that generates an extensive list of skin care products that are free of the given patient's allergens. It has been used clinically for 2 years to facilitate successful antigen avoidance and has been positively received by both patients and clinicians.
Allergens↗
Topical psoralen-ultraviolet A therapy for palmoplantar dermatoses: experience with 35 consecutive patients.
OBJECTIVE: To report the effectiveness of topical psoralen-ultraviolet A (PUVA) therapy for palmoplantar dermatoses and to describe our method of administration of this treatment modality. DESIGN: We conducted a retrospective study of 35 patients, 27 to 66 years of age, who received topical hand and foot PUVA therapy. MATERIAL AND METHODS: Ten patients had psoriasis vulgaris, 8 had pustular psoriasis, 5 had dyshidrotic eczema, and 12 had other types of dermatitis. The affected area was soaked in a psoralen solution, 0.0005% methoxsalen (10 mg of methoxsalen in 2 L of warm water), for 30 minutes and then exposed to incremental amounts of ultraviolet A light three times weekly until the dermatosis subsided or cleared. Treatment frequency was then reduced and ultimately discontinued. Time to maximal improvement of the hands and feet was defined as the period from the beginning of PUVA treatment to the point at which the frequency of treatment was reduced from three times weekly to twice weekly. RESULTS: Fourteen patients (40%) had clearing of their disease, and 14 others (40%) had improvement of their conditions. The mean time to clearing was 2.8 months (range, 2 weeks to 7 months), and the mean number of treatments was 27.3 (range, 10 to 55). The mean total dose of ultraviolet A received was 140 J/cm2 (range, 9 to 530). Two patients (6%) had no response to treatment. Mild localized ultraviolet-related erythema developed in 16 patients (46%). Five patients "dropped out" of treatment, and nine other patients discontinued treatment during maintenance therapy. The principal reason cited was inconvenience. CONCLUSION: Topical PUVA therapy is an effective and safe treatment option for recalcitrant dermatoses affecting the palms and soles.
Adult↗
Contact hypersensitivity to tixocortol pivalate.
BACKGROUND: Tixocortol pivalate is an established marker to topical corticosteroid allergy. The prevalence of tixocortol pivalate hypersensitivity is well established in Europe, where exposure to this corticosteroid as a therapeutic agent varies. In the United States, tixocortol pivalate is not commercially available and the prevalence of hypersensitivity to it is unknown. OBJECTIVE: We investigated the prevalence of tixocortol pivalate hypersensitivity in our patch-tested population. We further characterized these patients by clinical background, other contact allergens, and the reactivity to other corticosteroids. METHODS: Tixocortol pivalate has been incorporated in our standard 1-52 patch test series since November 1992. We reviewed the histories and patch test results in all patients tested with the standard 1-52 series from November 1992 to December 1996. RESULTS: Of 1536 patch-tested patients, 45 had hypersensitivity to tixocortol pivalate. Dermatitis involving the face was the most common (14 patients). Of the 45 patients, 40 had another allergen identified on patch testing. Eighteen patients underwent further patch testing to an extended corticosteroid panel, and 14 had sensitivity to another steroid agent. CONCLUSION: The 2.9% prevalence of tixocortol pivalate hypersensitivity in our patch test population is within the range reported in Europe. Patients with tixocortol pivalate hypersensitivity tend to have other contact allergens on patch testing. Predisposing factors to tixocortol pivalate hypersensitivity include facial dermatitis and sensitivity to other contact allergens.
Administration, Topical↗
Follicular mucinosis presenting as an acneiform eruption: report of four cases.
Follicular mucinosis can be a primary idiopathic disease or a secondary disease associated with lymphoma. When it appears in childhood or adolescence, it is usually primary and self-limited. We describe four cases of follicular mucinosis occurring in early adulthood that have had protracted courses. Each presented as an unusual acneiform eruption. Two of the cases demonstrated a clonal genetic rearrangement of the T-cell receptor within the cutaneous lymphoid infiltrate, a finding not previously reported. Although its significance is not clear, the clonal lymphocytic expansion indicates a need for continued surveillance of these patients.
Acne Vulgaris↗
The Arab Muslim client: implications for anesthesia.
The Arab Muslim client has unique cultural characteristics that should be incorporated into anesthetic care. In obtaining a preoperative assessment and consent, issues such as privacy, family roles, body language, group decision making, communication distances, and use of translators should be addressed. Intraoperatively, the need for modesty and the client's possible adherence to folk beliefs should also be recognized. Postoperatively, pain and overall needs assessments are a continuing challenge. The anesthetist must also understand the underlying family roles, the high correlation between fear and pain, and the possible coexisting folk beliefs when working within the labor and delivery setting. By addressing these unique issues, the anesthetist can provide appropriate and safe anesthetic care.
Anesthesia↗
Allergic contact dermatitis due to topical application of corticosteroids: review and clinical implications.
Allergy due to topically applied corticosteroids is being recognized more frequently. Testing for hypersensitivity to these agents is performed with delayed hypersensitivity patch testing. Cross-reactivity among topically administered corticosteroids is frequent and often can be predicted on the basis of additional patch testing and an established classification scheme. Herein we review allergy due to topically applied corticosteroids with regard to its prevalence, means of testing, cross-reactivity among the subclasses, risk factors, and relationship to steroids.
Administration, Cutaneous↗
Granulomatous vasculitis associated with herpes virus: a persistent, painful, postherpetic papular eruption.
Cutaneous granulomatous vasculitis manifesting as a postherpetic reaction pattern is uncommon hand has previously been reported as a delayed complication of varicella-zoster virus infection. We describe three patients who had persistent, painful, postherpetic papules in a zosteriform distribution that histologically demonstrated a small vessel granulomatous vasculitis. Herpes simplex virus DNA detected by the polymerase chain reaction technique was demonstrated in two cases.
Aged↗
Plantar granulomatous cutaneous T-cell lymphoma.
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Biopsy↗
Chronic hepatitis C, cryoglobulinemia, and cutaneous necrotizing vasculitis. Clinical, pathologic, and immunopathologic study of twelve patients.
BACKGROUND: Several patients with chronic hepatitis C infection and cutaneous vasculitis have been described. OBJECTIVE: The objective of this study was to define better the features of necrotizing vasculitis and mixed cryoglobulinemia in patients with hepatitis C infection. METHODS: A retrospective review of 611 patients with hepatitis C antibodies was conducted. Patients with clinical and histopathologic findings of cutaneous necrotizing vasculitis were identified. Clinical, histologic, and laboratory data were recorded. RESULTS: Twelve patients with necrotizing vasculitis and chronic hepatitis C infection were identified. Palpable purpura was the most common clinical presentation. Onset of skin lesions was usually more than 10 years after infection. The lower extremities were affected in all patients. Cryoglobulinemia of the mixed type II was present in 10 of 11 patients. Liver function tests were evaluated at the time of vasculitis in most of the patients. Rheumatoid factor was elevated in all nine patients tested. Total complement was decreased in seven of nine patients, and C4 was decreased in six of seven patients. CONCLUSION: Cutaneous vasculitis associated with cryoglobulinemia and hypocomplementemia is not uncommon in the course of chronic active hepatitis C infection. The triad of necrotizing vasculitis, chronic hepatitis C infection, and cryoglobulinemia occurs late after initial infection with hepatitis C. Antibodies to hepatitis C virus should be determined in a patient with necrotizing vasculitis, especially if liver function tests are elevated.
Adult↗
Disseminated cutaneous Mycobacterium avium-intracellulare resembling sarcoidosis.
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Abdomen↗
Chronic hepatitis C and skin diseases: a review.
OBJECTIVE: To emphasize the ongoing role of chronic hepatitis C virus (HCV) infection in the cause or exacerbation of severe dermatologic disorders. DESIGN: We present two case reports to outline the pertinent findings in hepatitis C-related cryoglobulinemia, leukocytoclastic vasculitis, and lichen planus and discuss the main disorders associated with chronic HCV infection. RESULTS: Chronic HCV infection has recently been recognized in association with various skin disorders. The most commonly reported association is the triad of leukocytoclastic vasculitis, cryoglobulinemia, and chronic HCV infection. Other cutaneous disorders associated with HCV infection include porphyria cutanea tarda, lichen planus, erythema nodosum, urticaria, erythema multiforme, and polyarteritis nodosa. CONCLUSION: Patients with onset or exacerbation of these disorders should undergo assessment for HCV infection.
Adult↗
Lymphomatoid papulosis: a clinical and histopathologic review of 53 cases with leukocyte immunophenotyping, DNA flow cytometry, and T-cell receptor gene rearrangement studies.
BACKGROUND: Lymphomatoid papulosis (LyP) is a recurrent hemorrhagic papular skin eruption with a clinically benign course and histopathologic features of lymphoma. OBJECTIVE AND METHODS: To better characterize this disease, we studied 53 patients seen since 1965. RESULTS: A lymphoproliferative malignancy developed within 2 to 36 years after onset of LyP in eight patients. Histologically, the dermis in LyP showed an infiltrate of large (type A) or small (type B) atypical lymphocytes. The large atypical cells (type A) stained with CD30 (Ber-H2). Seven of the patients in whom lymphoma developed had type A histologic features. DNA flow cytometry showed mainly a diploid pattern, except for two cases that showed aneuploidy. Five of 11 patients showed T-cell receptor (TCR) clonal gene rearrangements; lymphoma has not developed in these patients. One patient had a TCR rearrangement in a plaque of mycosis fungoides but not in the LyP lesion. CONCLUSION: LyP is either a reactive skin condition or a localized lymphoid malignancy. Neither DNA flow cytometry nor TCR gene rearrangement can predict the 15% to 19% of patients in whom a lymphoma will develop. Continued observation of all patients is essential.
Adult↗
Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients.
BACKGROUND: Wegener's granulomatosis (WG) is a systemic disease characterized by necrotizing granulomatous inflammation and vasculitis. Its cutaneous manifestations vary. OBJECTIVE: We reviewed and characterized the clinical, pathologic, and immunopathologic features of the specific cutaneous manifestations of WG and investigated the sensitivity and the specificity of anti-neutrophilic cytoplasmic antibody (c-ANCA) in the cutaneous manifestations of this disease. METHODS: A retrospective analysis was conducted of 244 cases of WG observed between 1988 and 1992. RESULTS: Skin involvement occurred in 14% of the patients and was more frequent in generalized WG. Skin lesions may be an early premonitory sign of renal disease. Necrotizing ulcerations resembling pyoderma gangrenosum were not uncommon. Leukocytoclastic vasculitis was the most common cutaneous pathologic pattern. Findings of c-ANCA were positive in 81% of patients with cutaneous WG. CONCLUSION: Skin involvement usually occurred at presentation with generalized disease. c-ANCA is a valuable adjunct to diagnosis and follow-up of WG.
Adolescent↗
The spectrum of cutaneous granulomatous vasculitis: histopathologic report of eight cases with clinical correlation.
Cutaneous granulomatous vasculitis is an uncommon histopathologic finding that has been associated with lymphoproliferative disorders, systemic vasculitis, autoimmune inflammatory diseases, and infection. To define further the concept of cutaneous granulomatous vasculitis and to emphasize its clinical importance, we reviewed biopsy material from 8 patients seen from 1985 through 1992. All biopsies showed evidence of blood vessel damage with fibrinoid change or hemorrhage (or both) and granulomatous inflammation in and around vessel walls. Special stains for microorganisms were negative in all cases. Associated medical disorders included neuropathy (2 patients), sarcoid-like disease (2), systemic vasculitis (1), lymphoma and suspected lymphoma (1 each), and associated herpes simplex virus (1). T-cell gene-rearrangement studies were negative in a patient with suspected lymphoma. Granulomatous cutaneous vasculitis is most commonly associated with lymphoma and systemic vasculitis. In selected cases, infection should be considered as an underlying cause.
Aged↗
Efficacy of vitamin D3 derivatives in the treatment of psoriasis vulgaris: a preliminary report.
The efficacy of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] and the new analogue calcipotriene (MC 903) in the treatment of psoriasis was investigated. Eight patients with psoriasis were enrolled in a pilot study with systemically administered vitamin D3 and were given 1,25(OH)2D3 (Rocaltrol; Hoffmann-La Roche) in dosages from 0.5 microgram to 2 micrograms/day for a 6-month trial. In one patient, the psoriatic plaques resolved within 2 months after treatment (0.5 microgram/day) was initiated. Moderate improvement was noted in one other patient (1 microgram/day). The serum level of 1,25(OH)2D before treatment was not less than the normal range of the adult population. Side effects of systemically administered 1,25(OH)2D3 included a dose-dependent increase in the 24-hour urinary calcium excretion and a decrease in the total number of platelets. Seven patients with symmetric plaque-type psoriasis were treated topically with 2 micrograms/g of 1,25(OH)2D3 in petrolatum. During 3 months of follow-up, mild improvement was noted in three patients. Five patients in the calcipotriene study were part of a nationwide double-blind placebo-controlled trial by Bristol-Myers Squibb. Moderate to marked improvement was noted in the two patients who received 50 micrograms/g of calcipotriene topically. The three patients who received placebo showed no response. We conclude that a subset of patients with psoriasis responds well to 1,25(OH)2D3. Calcipotriene is efficacious and an excellent alternative to topically applied corticosteroids.
Administration, Oral↗
Erythema elevatum diutinum: a clinical and histopathologic study of 13 patients.
BACKGROUND: Erythema elevatum diutinum is a rare condition representing a chronic leukocytoclastic vasculitis. OBJECTIVE: Clinical and laboratory features of the disease were reviewed to better understand the disease. METHODS: The medical records and histopathologic slides of 13 patients with erythema elevatum diutinum were studied. RESULTS: The lesions were violaceous, deep red, or brown and typically were papules or plaques. Lesions were most often located on the extensor surfaces of the extremities. Associated medical problems included hematologic abnormalities in six patients: IgA clonal gammopathies (four), multiple myeloma (one), and myelodysplasia (one). Erythema elevatum diutinum preceded the myeloproliferative disorders by an average of 7.8 years. All patients showed vasculitis. Leukocytoclasia was present in 27 of 35 specimens. The predominant cell type in the inflammatory infiltrate was polymorphonuclear leukocytes or a mixture of polymorphonuclear leukocytes and lymphocytes. CONCLUSION: The most significant finding of this study is the association of erythema elevatum diutinum with hematologic disease, most frequently an IgA monoclonal gammopathy.
Adult↗