Dermatoscope for the diagnosis of erythema with purpura induced by lidocaine/prilocaine cream:A case report

BACKGROUND Lidocaine/prilocaine(EMLA)cream is a local anesthetic that is applied to the skin or mucosa during painful therapeutic procedures with few reported side effects.CASE SUMMARY Here,we report the use of dermatoscopy to identify a case of erythema with purpura,a rare side effect,after the application of 5%EMLA cream.CONCLUSION We conclude that erythema with purpura is caused by irritation and toxicity associated with EMLA,but the specific mechanism by which the toxic substance affects skin blood vessels is unclear.In response to this situation and for cosmetic needs,we recommend tranexamic acid,in addition to routine therapy,to prevent changes in pigmentation in patients with dermatitis.

Necrolytic migratory erythema caused by pancreatic hyperglycemia with emphasis on therapeutic and prognosis:A case report

BACKGROUNDWith the incidence of pancreatic diseases increasing year by year,pancreatichyperglycemia,as one of the common complications,is gradually gaining attentionfor its impact on the skin health of patients.CASE SUMMARYThis was the case of an elderly female with clinical manifestations of necrolyticmigratory erythema,“three more and one less,”diabetes mellitus,hypertension,anemia,hypoproteinemia,and other syndromes,which had been misdiagnosedas eczema.Abdominal computed tomography showed a pancreatic caudal spaceoccupyinglesion,and the magnetic resonance scanning of the epigastric regionwith dynamic enhancement and diffusion-weighted imaging suggested a tumorof the pancreatic tail,which was considered to be a neuroendocrine tumor orcystadenoma.The patient was referred to a more equipped hospital for laparoscopicpancreatic tail resection.Post-surgery diagnosis revealed a neuroendocrinetumor in the tail of the pancreas.To date,the patient’s general condition is good,and she is still under close follow-up.CONCLUSIONNecrolytic migratory erythema can be induced by endocrine system tumors orendocrine metabolic abnormalities,with complex clinical manifestations,difficultdiagnosis,and easy misdiagnosis by dermatologists.The initial treatment principlesin dermatology include symptomatic supportive therapy and effectivedrugs to relieve skin lesions.After clarifying the etiology of glucagonoma,comprehensive treatment in collaboration with endocrinologists,generalsurgeons,and oncologists can help provide individualized treatment for patientsand improve their prognosis.

Neonatal erythema multiforme associated with a rotavirus infection:A case report

BACKGROUND Erythema multiforme(EM)is an extremely rare condition in neonates,and studies suggest its association with certain infections and neonatal vaccinations;however,few specific etiological agents have been identified.Rotavirus,a common pathogenic gastrointestinal virus in the neonatal period that is preventable via vaccination,has not been identified as a possible etiology.We report the case of a neonate who was referred for skin lesions presenting as EM,where a meticulous workup identified rotavirus as the sole causative agent.CASE SUMMARY A 14-day-old male infant was admitted to our hospital with a 1-day history of skin lesions.No medical history or medication intake was recorded.Except for the complaint of skin lesions,the caregivers denied any abnormal symptoms.Multiple tests,including routine laboratory evaluations,were performed to identify the cause of skin lesions.Serological tests for Immunoglobulin M for Toxoplasma,Rubella,Cytomegalovirus,Herpes Simplex Virus,and Epstein-Barr virus viral-capsid antigen were all negative.Multiple polymerase chain reaction(PCR)tests for respiratory viruses and bacterial pathogens were negative(including the severe acute respiratory syndrome coronavirus 2).Multiple PCR tests for gastrointestinal viruses and bacterial pathogens demonstrated evidence of rotavirus infection.No growth was reported in the blood and urine cultures.The patient received intravenous fluids for hydration;meanwhile,no other medications were prescribed.The lesions improved rapidly without specific treatment,and full recovery was achieved within a week.CONCLUSION The possibility of rotavirus,a major cause of pediatric gastrointestinal infections,being a trigger for neonatal EM should be considered.

A Case of Systemic Lupus Erythematosus Associated with Drug-Induced Liver and Erythema Multiforme-Like Lesions Which Was Mostly Consistent with the Rowell Syndrome

Rowell syndrome is a disease diagnosed by three major and three minor criteria. The major criteria include the presence of lupus erythematosus (systemic, discoid, or subacute lupus), EM-like lesions (with or without involvement of mucous membranes), and a speckled pattern of antinuclear antibodies. The minor criteria include chilblains, anti-Ro and/or anti-La antibodies, and positive RF. In this article, we present a patient whose manifestation indicated RS, because his diagnosis of Systemic lupus erythematosus was definite, and also onset with EM-like lesions and positive antinuclear antibodies. All these above are consistent with the three major criteria. In addition, his RF was positive, which was the complement for the minor criteria.

Glucagonoma syndrome with necrolytic migratory erythema as initial manifestation

To the Editor:Necrolytic migratory erythema(NME)is a group of cutaneous lesions characterized by periodic episodes of annular or figurative dark red plaques,which are typically accompanied by blisters,erosions,and crusting.It is often associated with glucagonoma.Glucagonoma is an extremely rare neuroendocrine tumor that arises from pancreatic isletαcells and manifests as elevated glucagon,with an incidence of about 1 in 20 million per year[1,2].

Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient:A case report

BACKGROUND Necrolytic acral erythema(NAE) is a rare dermatological disorder,which is associated with hepatitis C virus(HCV) infection or zinc deficiency.It is characterized by erythematous or violaceous lesions occurring primarily in the lower extremities.The treatment includes systemic steroids and oral zinc supplementation.We report a case of NAE in a 66-year-old human immunodeficiency virus(HIV)/HCV co-infected woman with NAE.NAE is rarely reported in co-infected patients and the exact mechanisms of pathogenesis are still unclear.CASE SUMMARY A 66-year-old HIV/HCV co-infected female patient presented with painless,nonpruritic rash of extremities for one week and underwent extensive work-up for possible rheumatologic disorders including vasculitis and cryoglobulinemia.Punch skin biopsies of right and left thigh revealed thickened parakeratotic stratum corneum most consistent with NAE.Patient was started on prednisone and zinc supplementation with resolution of the lesions and improvement of rash.CONCLUSION Clinicians should maintain high clinical suspicion for early recognition of NAE in patients with rash and HCV.

Granulomatous Mastitis with Erythema Nodosum That Responded to Low-Dose Steroid: Case Report and Literature Review of Nine Patients

A 31-year-old woman was referred with a painful mass in the left breast that was initially treated with antibiotics. Three weeks later, the mass had increased and polyarthritis and erythema nodosum had developed in both legs. A core needle biopsy led to a diagnosis of granulomatous mastitis with arthritis and erythema nodosum. Low-dose prednisolone (10 mg) rapidly improved the arthritis and the erythema nodosum. Granulomatous mastitis is a very rare, chronic inflammatory disease and only nine patients with granulomatous mastitis with erythema nodosum have been described. We reviewed the literature to determine the clinicopathological features and treatment of granulomatous mastitis. Appropriate diagnosis and steroid therapy should result in excellent outcomes.

Effect of a Cosmetic Use with 2% Isostearyl-L-Ascorbic Acid Gel for Postinflammatory Hyperpigmentation and Postinflammatory Erythema in Acne Vulgaris

Postinflammatory hyperpigmentation (PIH) and postinflammatory erythema (PIE) in acne vulgaris are important and refractory complications for patients with acne vulgaris. To clarify the effects of 2% isostearyl-L-ascorbic acid (ISAA) against PIH and PIE in acne vulgaris, a clinical pilot study with topical 2% ISAA gel was performed in 25 acne patients with PIH and PIE. Topical ISAA gel was applied on the whole face with PIH and PIE in acne vulgaris twice a day for 3 months. Regarding PIH and PIE, investigator’s global improvement rating (IGIR) was evaluated in 7-point scales according to the reduced area of PIH and PIE before and after the study. Remarkable improvement in PIH was observed in 7 patients (28.0%) and in PIE in 12 (48%) of the 25 patients. No adverse reactions were observed during the treatment. Topical ISAA application can be an alternative, non-invasive available treatment for PIH and PIE in acne vulgaris.

Clinical characteristics predicting erythema nodosum leprosum(ENL) among patients with multibacillary leprosy(MBL) in Sarawak

Objective:To determine the clinical features predicting erythema nodosum leprosum(ENL) in a non endemic leprosy area.Methods:Twenty newly diagnosed patients with MBL attending the skin clinic,Sarawak General Hospital from 1992 to 2007 were analyzed.They were divided into 2 groups,one with ENL and one without. Analysis of the presenting clinical features was done to determine the risk factors for ENL.Chi square and student t test was used for statistical analysis.Level of significance was set at 0.05.Results:ENL was present in 40%patients,all with lepromatous leprosy(LL).Clinical features that were seen more frequently in patients developing ENL include earlobe thickening(100%cf.25%,P =0.00),loss of the lateral third of the eyebrows(75%cf.16.7%,P=0.02) and mean bacteriology index(BI)(5.1 cf.2.9,P=0.03) and mean morphological index(MI)(17.8 cf.7.0,P =0.02).Number of thickened nerves(mean 2.5 cf. 1.4,P = 0.12),number of skin lesions(mean 19.4 cf.10.9,P = 0.15) and duration of illness(mean 15. 3 cf.12.8 months,P =0.68) did not predict ENL development.Conclusion:Finding LL patients with thickened earlobes,loss of lateral third of the eyebrow,high BI and MI should alert treating clinician to the possibility of ENL in a non endemic leprosy area.

Entropy and enthalpy for triggering cutaneous erythema

The molar entropy(OS)and molar enthalpy(△H)for the denaturation event that triggers cutaneous erythema was determined to be △S=190J/(mole K)and△H=146.9×10^(3) J/mole.The experiment involved placing heated water against the skin of the forearm,for a range of termperatures and exposure times.Exposing the skin to 45℃ for 22 s was at the threshold for producing erythema,which was similar to the threshold for a slight degree of pain.

Yan Xiaoning's experience in treating erythema nodule

Erythema tuberculum is a common disease in dermatology and difficult to treat.Chang an cheng's skin under the successive generations of the successor,unique,unique experience.Yan xiaoning summarized the etiology and pathogenesis of nodular erythema as heat and humidity toxicity,and divided the syndrome differentiation into two syndromes:wind and heat toxicity containing moisture and heat.The prescription drug emphasizes in the overall concept of the foundation,both inside and outside treatment,treatment of the need to reconcile,both the spleen and stomach for the specimens.In this paper,Professor Yan Xiaoning's experience in the treatment of erythema nodule is summarized,and case 1 is attached as evidence.

Erythema Nodosum Following EBV Infection in a Child

Epstein-Barr virus (EBV) is one of the eight known human herpesviruses, which is widespread in nature and infects most of the world population. In infants and young children, primary infection is usually asymptomatic or produces an acute illness that is often not recognized as being due to EBV. It has a well-established oncogenic potential, and has been implicated in the pathogenesis of various autoimmune diseases. Here is reported the case of a 32-months old boy, who presented with a history of two days of low-grade fever, pain in both legs, swollen ankles and inability to walk. On physical examination, the child appeared moderately ill, without fever. On both shins were observed nodules 2 - 3 cm in diameter, red to bluish in color, firm and poorly demarcated. Clinically, a diagnosis of Erythema nodosus was performed. Laboratory examinations revealed increased inflammatory parameters. After a full workup, EBV was established as the causative agent. Erythema nodosum is the most common form of panniculitis in children;however, it is relatively uncommon in the pediatric population. It is a self-limited disease, and most of infectious origin in children. Although uncommon, EBV infection is a potential cause of pediatric erythema nodosum.

Professor Liu Guobin used traditional Chinese medicine to cure a case of primary erythema limb pain

Primary erythema limb pain is a very rare disease,and its pathogenesis is not clear.Usually,the pain symptoms of patients exist for a long time,which seriously affect the daily life of patients and increase the economic burden of patients.Professor Liu Guobin,who has been engaged in the diagnosis and treatment of peripheral vascular diseases for nearly 30 years,believes that heat-toxin and blood stasis collaterals are closely related to the disease,and emphasizes the principle of heat-toxin and evil qi causing the disease.It is emphasized that clearing heat and detoxification,promoting blood circulation and dispersing blood stasis are the main treatment principles.This paper selects a typical case to describe Professor Liu's clinical experience in the treatment of primary erythema limb pain by oral and external use of traditional Chinese medicine,so as to provide an effective method of traditional Chinese medicine for the treatment of primary erythema limb pain.

Carnosine and N-Acetylcarnosine Induce Inhibition of UVB Erythema in Human Skin

Background: Carnosine is a low molecular weight water soluble biological dipeptide, composed of alanine and histidine, present in a levorotatory form in mammalian tissues. Interesting activities are related to the detoxification from free radical species and byproducts of membrane lipids peroxidation. Objectives: The aim of the present study was to evaluate the photoprotective properties of carnosine and acetylated carnosine when applied to human skin. Materials and methods: Carnosine and N-acetylcarnosine at 0.5% solution in water were applied before and after UVB irradiation in twenty healthy volunteers with phototype 2 or 3. 9 patients were males and 11 females, 25 to 46 years of age. None of the patients had a positive case history for photodermatoses or had received any sun exposure. The minimal erithemal dose (MED) for UVB was determined before the study with a UVB Philips TL12 lamp with a radiance of 4 mW/cm2 and a 290 - 320 nm emission spectrum. Results: Carnosine solution obtained 3.6% reduction of erythema (compared to MED) and N-acetylcarnosine 7.3% reduction. Conclusions: An antioxidant capacity of N-acetylcarnosine and carnosine was shown, probably more significant with vehicles improving skin penetration of the substances through skin barrier. N-acetylcarnosine represents an interesting hydrophilic antioxidant for dermatological preparations.

The Effect of Mesobotox Together with Intense Pulsed Light on Facial Wrinkles and Erythema

Facial ageing is a gradual process which could be due to intrinsic and extrinsic causes, it ultimately results in the appearance of gravity-induced tissue ptosis, wrinkles, epidermal and dermal atrophy, dryness, senile lentigo, flushing, telangiectasia, and enlarged pores. Mesobotox treatment is a technique of microinjections of diluted Botulinum toxin type A (BTX) to preserve the facial mobility in order to preserve the natural beauty. BTX treatment enhances the aesthetic improvements attained with IPL. Ten patients of age ranging between 40 - 60 years old ( mean 45±10.3 years) with skin type ranging between (III - V) were treated using BTX and Intense Pulsed Light (IPL) using cutoff filter 550 nm with a fluence of 25 J/cm2 together as a combination therapy. All patients received standard IPL treatment and were assigned to receive eight 0.1 mL intradermal injections of BTX in each cheek (8 U total dose). Vertical lines within the forehead also received five 0.1 mL intradermal injections of BTX. Small wrinkles and fine lines, erythema, apparent pore size, skin texture, and overall appearance were evaluated after one week. A significantly higher proportion of patients showed improvement in small wrinkles and erythema with IPL plus BTX compared with the baseline demonstrated by computerized image analysis. In conclusion, A combined therapy of mesobotx and IPL is an effective and safe treatment for fine wrinkles, telangiectasia, flushing.

A Case of Erythema Nodosum Associated with Subareolar Abscess

While erythema nodosum is a nodular, erythematous eruption predominantly affecting the extensor aspects of the legs, breast abscesses are the result of relatively common bacterial infections, and only 2 studies have reported an association between erythema nodosum and breast abscesses. Here, we report the case of a patient with repeated erythema nodosum associated with subareolar abscesses. The patient was a 34-year-old woman with painful erythematous nodules on her right shin, accompanied by an indurated lesion on her right breast 4 days before the onset of the nodules. Therefore, the patient underwent circumareolar incision, and consequently the painful erythematous nodules disappeared. However, after 39 days, the patient developed another tender, painful lesion in her right breast and painful erythematous nodules on her right shin. After another circumareolar incision, the painful erythematous nodules disappeared again. Therefore, we suggested a significant association between erythema nodosum and breast abscess in this patient. The most common underlying causative organism in breast abscess is Staphylococcus aureus;however, erythema nodosum has rarely been proven to be associated with staphylococcal infections. Therefore, the relationship between S. aureus and erythema nodosum is rather controversial. However, the resistance to the usual treatment methods and prolonged clinical course in our case suggest that the pathogenesis of erythema nodosum associated with breast abscesses might be different from that of the common form of erythema nodosum.

Erythema Nodosum Manifestation Post COVID-19 Vaccine: A Case Report

Erythema nodosum (EN) is a delayed hypersensitivity response that may be triggered by a range of conditions, including infections and vaccines. Rare cases of EN caused by COVID-19 were recently reported but none due to COVID-19 vaccines were documented. We report here a case of EN occurring after COVID-19 vaccination. Patient presented with painful nodular lesions of all 4 limbs, evolving for one month. These lesions appeared 48 h after the second dose of COVID-19 vaccination. The patient reported no recent infectious episodes. The physical examination found numerous, erythematous dermohypodermatitis knots with no palpable adenopathy. Some were regressive according to biligenesis shades. Biology and radiology findings eliminated other common causes of this dermatosis. The skin biopsy was done and suggested EN. The final diagnosis was post COVID-19 vaccine EN. Patient received a symptomatic treatment and had a slight improvement of the lesions 10 days after diagnosis. Physicians should be aware of the side effects of the vaccine including skin manifestations, especially since more people are bound to be vaccinated.

Quantitative Assessment of Chronic Skin Reactions Including Erythema and Pigmentation after Breast Conserving Therapy

Purpose: To evaluate long-term skin reactions following breast-conserving therapy by using the melanin-erythema index meter. Patients and Methods: 164 patients were followed for at least three years after breast-conserving therapy. For both the erythema and the melanin indices, the ratio of the irradiated-side index to the non-irradiated-side index was calculated. The time course of index ratios alternation was examined. Influences from additional therapies and patients’ age were also evaluated. Result: Both erythema and melanin index ratios of the breast skin were recovered to pre-radiation level three years after radiotherapy. However, both index ratios of the area administrated with 10-Gy boost irradiation were still high even after five years after radiotherapy. Endocrine therapy, chemotherapy and age had no significant influence on skin color reactions three years after radiotherapy. Conclusion: Quantitative assessment using the melanin-erythema index meter demonstrated that chronic skin reactions following breast conserving therapy had recovered to pre-radiation level for three years after irradiation except for the 10-Gy boost irradiated area.

A Study on The Effect of A Fresh-Milk Cream on Reducing Skin Erythema Response

This study evaluated the effect of a fresh-milk cream on reducing skin erythema response in 30 subjects(23.87±0.34 years)by objective instrumental method.The model of skin erythema was established by tape stripping and histamine stimulation.Herein the skin erythema index(EI),skin sensitivity value and skin images of subjects were measured.The data was statistically analyzed by SPSS software.The results showed that the fresh-milk cream could continuously decrease the value of the histamine-stimulated area’s erythema index and skin sensitivity,and relieve the skin redness.It indicated that the fresh-milk cream had the functions of reducing skin erythema response and soothing the skin sensitivity.

Flagellate erythema in transcription intermediary factor 1 gamma dermatomyositis

A 52-year-old Chinese woman was diagnosed with transcription intermediary factor 1(TIF1)gamma dermatomyositis in November 2022,with manifestations of myositis,polyarthralgia,and low-grade fever.She had cutaneous manifestations of Gottron's sign,V-neck sign,shawl sign,and flagellate erythema(Figure 1A).No interstitial lung disease was detected by high-resolution computed tomography.Comprehensive malignancy screenings,encompassing pap smear and mammogram,endoscopic examination,and computed tomography scans of the thorax,abdomen,and pelvis,were performed.They returned negative,apart from a lobulated nodule with biopsy confirmed as sclerosing pneumocytoma at the left lower lobe(Figure 1C).The therapeutic regimen,consisting of high-dose steroids and mycophenolate mofetil,effectively ameliorated the patient's myositis and rash(Figure 1B).