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Subacute cutaneous lupus erythematosus induced or exacerbated by terbinafine: a report of 5 cases.

BACKGROUND: Subacute cutaneous lupus erythematosus is a nonscarring, non-atrophy-producing photosensitive cutaneous disorder. Half of the patients have 4 or more of the criteria for classification as systemic lupus erythematosus. In some patients, drugs induce or exacerbate the cutaneous disease. OBSERVATION: We describe 5 patients who had either an exacerbation or a new onset of subacute cutaneous lupus erythematosus while taking terbinafine for presumed onychomycosis. CONCLUSION: In general, terbinafine is a safe drug, but perhaps patients with known lupus erythematosus or photosensitivity are predisposed to drug-induced or drug-exacerbated disease.

Adult↗

Functional profile of expanded suppressor/cytotoxic lymphocyte population in a patient with actinic reticuloid.

This study was undertaken to gain insight into the functional properties of the expanded suppressor/cytotoxic lymphocytes characteristically found in actinic reticuloid. Peripheral blood cells, either whole mononuclear cell populations or selectively enriched populations, were obtained from a patient with well-established actinic reticuloid. The patient had an expansion of circulating T lymphocytes expressing the suppressor/cytotoxic phenotype, i.e., CD3+, CD4-, CD8+. A proportion of these cells also expressed the Fc receptor for IgG. Functional studies, including pokeweed mitogen-driven immunoglobulin synthesis, mitogen and alloantigen response, natural killer and antibody-dependent cellular cytotoxicity were within normal ranges and suggested a polyclonal rather than monoclonal expansion. The present functional data extend previous phenotypic studies and support the hypothesis that a chronic reactive immunoregulatory disorder is involved in actinic reticuloid, as has been hypothesized for other T cell chronic proliferations.

Antibody-Dependent Cell Cytotoxicity↗

[Therapy of vascular-dependent skin pathology].

The therapeutic results obtained with twice daily medication with 3% hydrocortisone bendazac ester cream are indicated. This therapy was found to be effective particularly in photodermatoses radiation dermatitis and superficial vascular skin disorders. Moreover, it is also very useful for varicose veins and phlebitis, photoactive eczema and burns, since it can limit the necrotic evolution, correct excessive granulation tissue formation and control the tendency towards the development of keloids.

Administration, Topical↗

Immunohistochemical analysis of dermal mononuclear cell infiltrates in cutaneous lupus erythematosus, polymorphous light eruption, lymphocytic infiltration of Jessner, and cutaneous lymphoid hyperplasia: a comparative differential study.

Cutaneous lupus erythematosus (LE), polymorphous light-eruption (PMLE), lymphocytic infiltration of Jessner (LIJ), and cutaneous lymphoid hyperplasia (CLH) are often difficult to differentiate from one another by light microscopic examination. We conducted an immunohistochemical analysis of the mononuclear cell infiltrates in 13 LE, 12 PMLE, 10 LIJ, and 13 CLH with various antibodies. Antibodies L26, UCHL1, and S100 achieved statistically significant differences among the four diseases, but because of the overlaps in the number of UCHL1(+) T cells and S100 protein (+) cells in individual cases, these two antibodies were not useful. Only CLH could be distinguished from LE, PMLE, and LIJ by a greater number of CD20(+) B cells. The latter three conditions could not be differentiated. Contrary to previous reports, plasmacytoid-monocytes were not found to be increased in LIJ for the differentiation of the latter from LE and PMLE. Our results support the conclusion that CLH is a reactive lymphoid hyperplastic process with proliferation of both B and T cells, whereas the T cell was the predominant cell type in the infiltrates of LE, PMLE, and LIJ, indicating that they were related to T cell disorders. The histiocyte was only a minor component cell. The plasmacytoid monocyte in general was not significantly present in all four conditions, but relatively more plasmacytoid monocytes were present in CLH.

Analysis of Variance↗

[Non-hereditary photodermatoses in childhood].

Non-hereditary photodermatoses with well-known trigger factors and idiopathic light eruptions occur quite frequently during childhood and are at least temporarily associated with a marked impairment of quality of life in affected patients and their parents. Thus, it is crucial that the involved specialties are familiar with acquired UV-associated disorders in order to guarantee a quick diagnosis and effective therapy. Additionally, the recurrence of photodermatoses associated with potentially severe long-term complications has to be prevented. This requires a stringent prophylaxis that can only succeed after age-adapted instruction of the patient and parents.

Child↗

Cutaneous immunopathology: recent observations.

Immunofluorescent studies are currently being done on patients with pemphigus, pemphigoid, dermatitis, lupus erythematosus and its variants, the cutaneous prophyrias, scarring alopecia, erosive mouth lesions, light-sensitive disorders, and cutaneous vasculitis. In this paper I shall review some of the recent advances in immunopathology and report the results that have been obtained in our laboratory.

Alopecia↗

Co-existing actinic granuloma and giant molluscum contagiosum.

Actinic granuloma of O'Brien and giant molluscum contagiosum in immunocompetent adults are rare skin disorders. There have been no previous reports of these two conditions occurring together. We report this occurrence in a 57-year-old Caucasian woman.

Administration, Topical↗

Llama dermatology.

The purpose of this article is to add information to the many dermatologic topics initially discussed in the 1989 issue on llama medicine (normal anatomy; bacterial, fungal, ectoparasitic, immune-mediated, and zinc-responsive disease) and make mention of newly recognized diseases. Since 1989, it appears that one of the most common and perplexing groups of dermatoses seen at Colorado State University are hyperkeratotic/inflammatory dermatoses. These remain poorly understood. Idiopathic hyperkeratosis (zinc-responsive dermatosis) may be a true zinc deficiency or a keratinizing disorder responsive to supraphysiologic dosages of zinc supplementation. Idiopathic nasal/perioral hyperkeratotic/ inflammatory dermatosis (munge) and idiopathic necrolytic/neutrophilic/hyperkeratotic dermatosis bear clinical, histologic, and therapeutic similarities, and may be subsets of the same disease. Further studies (e.g., looking for metabolic derangements) are necessary to better answer these questions.

Animals↗

Neurological disorders in sheep during signal grass (Brachiaria decumbens) toxicity.

Severe neurological dysfunction was observed in sheep 4 weeks after grazing on Signal grass (Brachiaria decumbens). These neurological disorders included the stamping of forelegs, star-gazing, incoordination, head-pressing against the fence and circling movements. Histologically, numerous vacuolations of various sizes were observed in the white matter of the brain giving rise to a spongy appearance.

Animals↗

Skin manifestations of mitochondrial DNA syndromes: case report and review.

Mitochondrial DNA syndromes are an emerging class of diseases that can present at any age. Clinical findings are legion and may include renal tubulopathy, growth retardation, myopathy, seizures, and ophthalmoplegia. Mitochondrial DNA syndromes have presented with symmetric cervical lipomas, poikiloderma, and anhidrosis. We describe a child with a novel mitochondrial DNA syndrome who had poikiloderma on sun-exposed areas. We also reviewed 274 patients with mitochondrial DNA disorders for skin findings. Symmetric cervical lipomas were consistently associated with myoclonic epilepsy as part of 1 syndrome. With the exception of lipomas, skin findings were reported in 16 patients.

Acidosis, Lactic↗

[The Elba triad: harara, light dermatoses, leishmaniasis. The ecological background].

A report is given on a travel to Elba, the largest island of the Tuscany archepelago (Italy) and a holiday place preferred by German speaking tourists. In the last years some cases of visceral leishmaniasis and oriental sores, respectively, were introduced to Germany from this island. The geoecological background of this development was investigated. Reproduction and spread of the most abundant sandfly species Phlebotomus (Laroussius) perniciosus favour ruinous buildings, actually used as animal shelters sometimes in the immediate vicinity of new tourist bungalows. A typical allergic response upon sandfly bites occurs in almost all of the newcomers. This skin irritation is wellknown as urticaria multiformis endemica of Harara. Local people and tourists connect this itching disorder with certain types of sun trauma and do not take notice of their real etiology. Cortisone treatment in severe cases may facilitate the start of simultaneously transmitted leishmaniasis. The possible epidemiological role, which the dog travelling to southern countries in connection with leishmaniasis plays, is considered.

Animals↗

Recurrent painful hand crisis in a four-year-old girl, revealing an erythropoietic protoporphyria.

We report the case of a 4-year-old girl, who had been suffering for 2 years from a recurrent, painful crisis affecting both hands, following sun exposure. There were no obvious cutaneous lesions, which initially caused us to consider a diagnosis of a psychiatric disorder. However, the diagnosis of erythropoietic protoporphyria was then established by the demonstration of elevated levels of free protoporphyrin in erythrocytes. The present case illustrates the effectiveness of beta-carotene associated with canthaxanthin in erythropoietic protoporphyria.

Antioxidants↗

[Persistent acantholytic dermatosis with increased light sensitivity].

We report on a 72-year-old man suffering from transient acantholytic dermatosis (TAD). The histologic pattern resembled that of Darier's disease. The disorder first set on after an episode of intensive exposure to sunlight and persisted for 6 years. The only drug the patient took during this period was the prophylactic antimaterial preparation, Fansidar. His sensitivity to UVB radiation was markedly increased. After Fansidar was replaced by Resochin, the skin cleared up. After one year the sensitivity to UVB had normalized.

Aged↗

What is actinic prurigo in Britain?

Actinic prurigo (AP) belongs to the group of idiopathic photodermatoses sharing a predilection for occurring more commonly in females, and there is much controversy as to whether it is only a more severe form of polymorphous light eruption (PMLE) or whether it is a distinct entity in its own right. The condition is characterised by intensely itchy papules, plaques and nodules, along with excoriations and scars usually starting before puberty, and predominantly involves the sun-exposed areas although it may also affect covered sites. Seasonal exacerbations at the beginning of spring with improvement in the fall are typical, although the lesions frequently do not clear completely in the winter. The disorder may run a chronic course and persist into adulthood, but often spontaneous resolution occurs in late adolescence. Diagnosis is predominantly based on the clinical features, cutaneous irradiation tests and histology often being normal or non-specific. HLA typing has also been performed in both PMLE and AP patients, showing a strong association between HLA-DR4, in particular with the DRB1*0407 subtype, and AP; no HLA association has been found in PMLE. This HLA association is likely to be of pathogenic significance and strongly suggests a critical role for MHC-restricted antigen presentation in the development of photosensitivity AP.

Adolescent↗

Two cases of essential myoclonus, epilepsy, mental retardation and anxiety disorders.

We examined an 18-year-old female and an 18-year-old male with mild mental retardation who suffered from the oscillatory form of sporadic essential myoclonus from an age of 3 years. Although the generalized oscillatory myoclonus resembled severe essential tremor, surface electromyography revealed small myoclonic jerks with frequencies of 6-8 Hz. As concomitant symptoms, the female case exhibited overanxious irritability from early childhood and generalized epileptic seizures occurred from the age of 4 years. In the male case, an obsessive-compulsive disorder and photosensitive convulsive seizures were persistently noted from early childhood. All their symptoms had been stable for at least the last 10 years. Thus, although non-progressive tremulous movements are rare in early childhood, sporadic essential myoclonus is causative. In contrast to hereditary essential myoclonus, sporadic essential myoclonus is considered to be more heterogeneous, especially in the various associated symptoms.

Adolescent↗

Expression of stratum corneum chymotryptic enzyme in ichthyoses and squamoproliferative processes.

OBJECTIVE: Stratum corneum chymotryptic enzyme (SCCE) is a serine protease, which is thought to play a role in the desquamation of skin via the proteolysis of desmosomes in the stratum corneum. The objective of this study was to investigate the expression of SCCE in ichthyoses and squamoproliferative processes, conditions in which the shedding and replacement of epidermal cells is disrupted. DESIGN: Tissue samples from cases of Netherton's syndrome, congenital ichthyosiform erythroderma, ichthyosis vulgaris, actinic keratosis, squamous cell carcinoma in situ, and invasive squamous cell carcinoma were examined for expression of SCCE using immunohistochemistry. MAIN OUTCOME MEASURES: The slides were qualitatively analyzed for the expression of SCCE by a certified dermatopathologist. RESULTS: In all disease states, we found that the expression of SCCE was absent in areas of parakeratotic stratum corneum of normal thickness. In areas of mixed orthokeratosis and parakeratosis where the stratum corneum was greatly thickened as might correspond clinically to a cutaneous horn, SCCE staining was either absent or focally aggregated without regard to orthokeratosis or parakeratosis. Of note, complete absence of SCCE expression was not observed in any of the cases of ichthyosis examined, nor was there increased expression of SCCE in the atypical cells of the squamoproliferative disorders. CONCLUSIONS: These results suggest that SCCE is abnormally expressed in skin where epidermal cell kinetics are disrupted due to inherited and acquired defects. Further investigation is needed to determine causality between the abnormal expression of SCCE and the altered cell kinetics in these diseases.

Carcinoma in Situ↗