Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
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A 35-year-old woman suffering from Crohn's disease for 3 years developed painful erythematous nodular lesions predominantly on the dorsa of her hands and feet, as well as on her elbows and wrists. The clinical features and histopathological picture of leukocytoclastic vasculitis were both highly suggestive of erythema elevatum diutinum. No improvement of the skin lesions was observed during treatment with high doses of oral steroids. ⋯ During a new attack of her Crohn's disease the erythema elevatum diutinum lesions flared again. The parallel clinical course of erythema elevatum diutinum and Crohn's disease, as well as the detection of immune complexes and neutrophilic granulocytes in lesions of both diseases, strongly suggest a common etiology. This hypothesis is discussed in context with this case and the recent literature.
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Case Reports
[Life threatening salicylate poisoning caused by percutaneous absorption in severe ichthyosis vulgaris].
In a 7-year-old boy, ichthyosis vulgaris was treated with a 10% ointment for application over a large area of the body surface. In this way, the child received 400 g salicylic acid (0.6 g/kg body weight per day) percutaneously over a period of 4 weeks. The patient was referred to hospital by the family doctor: he was in a deep somnolent state, apparently caused by hyperventilation following wheezing, vomiting, tinnitus and vertigo. ⋯ Fecal incontinence, bilateral ptosis and intermittent diverging strabismus on the right persisted for some weeks. It was 6 months before complete neurological resolution was achieved. The pathogenesis of salicylate toxicity and the need for safer therapies for ichthyosis vulgaris are discussed.
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Therapy of pyoderma gangrenosum can be complicated by side effects of the various systemic therapies, including corticosteroids, azathioprin and cyclosporin A. In this paper we report on a 49-year-old patient presenting with recalcitrant pyoderma gangrenosum who was treated successfully by topical application of cyclosporin A. Cyclosporin A serum levels were always in the subtherapeutic range, and no side effects were observed.
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A HIV-infected patient in stage CDC 3A with porphyria cutanea tarda (type I) was treated with chloroquin for some months and this led to full remission. The patient course is compared with earlier reports on HIV-infected patients with porphyria cutanea tarda. Possible provocation factors for porphyria cutanea tarda in HIV infection are considered. The increased prevalence of porphyria cutanea tarda in HIV infection, the interaction of HIV and UV irradiation as a prediposing factor for porphyria cutanea tarda and the photosensitivity present in HIV infection are discussed.
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Bullous pemphigoid (BP) is a bullous autoimmune disease of the elderly; it is characterized by tense bullae on both erythematous and otherwise apparently normal skin. Several clinical variants of BP have been described, and we now add our observations of two BP cases mimicking subacute prurigo. Both patients had suffered from intensely pruritic excoriated papules for several months before presentation. ⋯ Perilesional skin biopsies showed linear IgG or C3-deposits in the basement membrane zone. Immunoblotting of epidermal and dermal extracts demonstrated the binding of the antibodies to an epidermal 230-kD protein, which is the known major bullous pemphigoid antigen. These cases are described as a basis for discussion of the clinical spectrum of bullous pemphigoid.