SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Exfoliative dermatitis associated with hepatitis has been reported in leprosy patients taking dapsone in daily dosage of 200 mg daily or more previously. This report concerns a 40 year-old-female who developed exfoliative dermatitis and hepatitis six weeks after starting dapsone in daily dosage of 100 mg for treatment of leprosy. She responded dramatically to administration of corticosteroids.
Exfoliative dermatitis is most commonly associated with antecedent cutaneous disorders, medications, and lymphoreticular malignancies. Three patients with exfoliative dermatitis associated with internal carcinoma are described. The importance of thorough evaluation of all patients who present with exfoliative dermatitis is stressed.
Among 30 patients who received a clinical diagnosis of exfoliative dermatitis and were biopsied between 1982 and 1990, nine showed microscopic features of lichenoid dermatitis. Clinical information was available in eight of these cases. Possible etiologic factors included lymphoma, herpes simplex infection, connective tissue disease, and (in five cases) reactions to drugs. In each instance, microscopic features included a superficial perivascular lymphocytic infiltrate involving the dermal-epidermal interface, vacuolar alteration of the basilar layer, and individually necrotic keratinocytes at all levels of the epidermis. Such microscopic changes are not usually described in connection with exfoliative dermatitis, with the possible exception of those cases related to lichen planus or lupus erythematosus. Disseminated lichenoid drug eruption is one possible interpretation of the drug-induced cases. Erythema multiforme is another condition that has similar microscopic features and has been associated with drugs (many of which also cause exfoliative dermatitis), infectious agents, neoplasms, and connective tissue diseases. Lichenoid dermatitis can become generalized and clinically mimic and exfoliative dermatitis. Many, but not all, of these eruptions may be triggered by drugs.
A 68-year-old woman developed exfoliative dermatitis while taking cimetidine for gastritis. She had no history of previous drug reactions, allergies, or skin disorders and had taken no other medications for three months. Although cimetidine is a relatively safe drug, severe reactions such as exfoliative dermatitis can occur.
Acute interstitial nephritis associated with hepatitis, exfoliative dermatitis, fever and eosinophilia is uncommon. The syndrome has been described previously in association with phenindione administration, leptospirosis and heavy metal poisoning. Four cases are described, two of which were due to phenindione sensitivity. The other two patients had been exposed to a number of toxins including allopurinol, frusemide, chlorothiazide and methyldopa so that the exact aetiological agent is unclear. Interstitial nephritis should be considered as a cause of acute renal failure in patients with other features of drug hypersensitivity.
Severe exfoliative dermatitis and liver dysfunction developed in a 5-year-old girl 3 weeks after initiation of phenobarbital therapy. Liver function improved gradually after discontinuation of phenobarbital. During the convalescent stage an initially mild renal dysfunction was exacerbated by episodes of post-transfusion haemolysis. Liver biopsy revealed moderate parenchymal damage with subacute cellular infiltration. Renal biopsy demonstrated the cardinal findings of interstitial nephritis, excluding the possibility of acute tubular necrosis caused by haemolysis. Serial lymphocyte transformation studies and skin patch tests gave positive results for phenobarbital, supporting the view that these were unusual complications of phenobarbital hypersensitivity.
A prospective study in 80 exfoliative dermatitis patients over a period of 5 years establishes 41.9 years as its mean age at onset. The disease affected both males and females, with a preponderance of the former. The clinical features were identical, irrespective of the etiology. The onset of the disease was usually insidious except in staphylococcal scalled skin syndrome and drug-induced erythroderma, where it was abrupt and florid. Microcytic hypochromic anemia, elevated erythrocyte sedimentation rate, eosinophilia, low serum proteins and electrolytes were salient laboratory features. Histopathology was largely unrewarding; only in 12 patients, a good clinicohistologic correlation was present. Preexisting dermatoses, namely psoriasis, air-borne contact dermatitis, phytophotodermatitis, photosensitive and seborrheic dermatitis, and other dermatoses constituted the major etiology. Antituberculous drugs were responsible for a substantial proportion of drug-induced erythroderma. No lymphomas were found. This study outlines that some salient features of exfoliative dermatitis may show geographic variations.
We describe a 51-year-old patient with endstage renal disease who developed vancomycin-associated exfoliative dermatitis. After four weeks of vancomycin hydrochloride treatment for staphylococcal pericarditis this patient developed a hypersensitivity reaction characterized by intermittent fevers, lymphadenopathy, peripheral eosinophilia, and exfoliative dermatitis. The reaction persisted for five weeks, probably because of inability to rapidly eliminate vancomycin secondary to underlying renal failure. Maculopapular rashes have been reported in two to six percent of patients who receive this drug, with severe skin reactions rarely reported. In addition to this case report, a review of the literature including 11 Eli Lilly/Food and Drug Administration case reports is presented. Although severe skin reactions to vancomycin rarely occur, they prolong morbidity, particularly in patients with renal failure.
This study was to investigate the epidermiological, etiological, clinical and prognostic aspects of patients with Generalised Exfoliative Dermatitis in Singapore. From 1981 to 1985, all patients with exfoliative dermatitis or erythroderma admitted to our dermatology wards were included into this study. A standard protocol was filled in for each patient, and they were subsequently followed up at our out-patient clinics. There were 79 male and 29 female patients (sex ratio 2.7:1). The average age was 61.5 years. Most of the patients were from low social income groups. Apart from scaling and erythema, peripherial oedema was the most common finding (44%), followed by hair loss (25%) and lymphadenopathy (22%), 15% of patients had haemoglobin level 10G/dl. The main etiological groups were eczema/dermatitis, psoriasis, drug reactions and those with unknown causes. Two patients were suffering from congenital dermatoses. None of our patients was casually related to malignancy. This study suggested that GED was not a fatal disease among our patients, and they often had a good prognosis.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Lymphocytes (T cells and B cells) of a patient with chronic lymphatic leukemia (CLL) were studied immunologically and scanning electron microscopically. The subpopulation percentage of rosette forming cells (T cell) and surface immunoglobulin bearing cells (B cell) were decreased in the peripheral blood. Moreover, tritiated thymidine uptake by lymphocytes in the cell culture stimulated by phytohaemagglutinin (PHA), porkweed mitogen (PWM) and purified protein derivatives (PPDs) was decreased. Scanning electron microscopy (SEM) showed many long villi on the surface of the lymphocytes in the peripheral blood, which implies B cell origin, Observation by electron microscopic immunohistochemistry using the ferritin antibody technique revealed that beta1C/beta1A receptors normally seen on the B cells were also seen on the leukemic lymphocytes. Thus it appears that the leukemic cells in the peripheral blood of this patient are functionally and morphologically abnormal B cells.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Thirty-eight patients with erythroderma of unknown etiology were diagnosed over a 15-year period, and represented 19% of all patients admitted to our department for erythroderma. The male:female ratio was 6.6:1, and the median disease duration was 2 years (range 1 to 23 years). Keratoderma of palms and/or soles was seen in 79%. Laboratory findings were normal, except for an increased IgE level in 69% of the patients studied. Lymph node histology showed dermatopathic lymphadenopathy. Bone marrow investigation results were normal in 48%, or showed eosinophilia (32%) or hyperplasia (20%). Initial skin biopsies showed nonspecific histology in most patients, but later biopsies revealed pleomorphic infiltration. During the observation period four patients progressed to mycosis fungoides and another nine patients were suspected of having mycosis. None developed Sézary's syndrome. Only one third of the patients went into complete remission; half of them died during the observation period. Patients with erythroderma of unknown etiology are predominantly men and seem to belong to a certain subgroup--herein called the red man syndrome.
Explore the source record for details and available documents.
Explore the source record for details and available documents.