We report on two female patientswho presentedwith painful recurrent palpable purpura,ulcers and necroses on the extremities. The results of all examinations and laboratory tests considered together suggested a diagnos...We report on two female patientswho presentedwith painful recurrent palpable purpura,ulcers and necroses on the extremities. The results of all examinations and laboratory tests considered together suggested a diagnosis of necrotizing leukocytoclastic vasculitis. Leukocytoclastic vasculitis is an inflammatory necrotizing condition of the superficial dermal vessels, presenting with variable clinical symptoms. In most cases it becomes manifest as palpable purpura,but hemorrhagic- necrotizing,bullous, nodular and urticarial presentations also occur. Common etiological factors include bacterial, viral or drug antigens, chronic infections (hepatitis B and C), non- Hodgkin lymphomas (monoclonal gammopathy, multiple myeloma), leukemia (hairy cell leukemia), and tumors (bronchial, breast, and gastric cancer) and also connective tissue disorders. In the course of the work- up, a plasmocytoma was discovered as the cause of the leukocytoclastic vasculitis, presenting in a similar way to livedo reticularis in one case and to pyoderma gangraenosum in the other.展开更多
Background. Loss of appetite and nausea can reduce the quality of life of patients with malignant melanoma and liver metastases. Often established antiemetic drugs fail to bring relief.Tetrahy drocannabinol (THC, Mari...Background. Loss of appetite and nausea can reduce the quality of life of patients with malignant melanoma and liver metastases. Often established antiemetic drugs fail to bring relief.Tetrahy drocannabinol (THC, Marinol TM), which is the active agent of Indian hemp, has been used successfully in this situation for other malignant tumors. Patients and methods. We treated 7 patients with hematogenous metastatic melanoma and liver metastases suffering from extensive loss of appetite and nausea supportively with dronabinol (Marinol ). All of these patients had previously received standard antiemetic therapy without adequate relief. Dronabinol is a synthetic △ - tetrahydrocannabinol. The drug was administered in capsule form. We evaluated the palliative effects of dronabinol with a special patient evaluation form, which was filled out at the beginning of the therapy and again after 4 weeks. Results. The majority of patients described a significant increase in appetite and decrease in nausea. These effects remained for some weeks, but then decreased as metastases progressed and the general condition worsened. All of the patients experienced slight to moderate dizziness, but it was not sufficiently troubling to cause interruption or termination of therapy. Conclusion. Loss of appetite and nausea due to liver metastases of malignant melanoma can be treated in individual cases supportively with Dronabinol.展开更多
We report on a patient with terbinafine-induced SCLE covering clinical, histopathological and serological findings.Positive serological results included ANA, SS-A (Ro)-antibodies and anti-histone-antibodies with speci...We report on a patient with terbinafine-induced SCLE covering clinical, histopathological and serological findings.Positive serological results included ANA, SS-A (Ro)-antibodies and anti-histone-antibodies with specificity for H1 and H3.The literature on terbinafine-induced SCLE is reviewed.We discuss H1-and H3-specific anti-histone antibodies as a possible diagnostic criterion of drug-induced SCLE.展开更多
The borderline syndrome is one of the most severe disturbances of psychosomatic dermatology.Patients with borderline syndrome are situatedon the borderof psychosis, neurosis and personality disorders.The skin as a...The borderline syndrome is one of the most severe disturbances of psychosomatic dermatology.Patients with borderline syndrome are situatedon the borderof psychosis, neurosis and personality disorders.The skin as a borderline organ carries a symbolic role.The clinical picture includes artefactual skin diseases due to self-mutilation by conscious or unconscious cutting, and rubbing, scratching or para-artefactual manipulations of pre-existing dermatoses.Leading symptoms of the borderline syndrome are poor impulse control, emotional instability and poor ego strength with low frustration tolerance and unstable personal relationships.We present the case of a 38-year-old female patient with borderline syndrome suffering from para-artefactual skin diseases of the face and a massive hyperhidrosis of the hands and feet.Within 9 months she was treated in four acute psychiatric hospitals and by 12 psychiatrists and psychotherapists.Early and accurate diagnosis and high-quality, sophisticated long-term therapy are necessary.展开更多
Efavirenz and nevirapine are frequently used drugs in antiretroviral therapy. Rashes are common side effects of these drugs. In this study, we examined the characteristics of efavirenz- and nevirapine- associated rash...Efavirenz and nevirapine are frequently used drugs in antiretroviral therapy. Rashes are common side effects of these drugs. In this study, we examined the characteristics of efavirenz- and nevirapine- associated rashes. This prospective nonrandomized multicenter study included 662 HIV- infected patients (efavirenz: 325, nevirapine: 337) to determine incidence, duration, cross- reactivity, and outcome upon reexposure. Of the treated patients, 4.5% (n=30) developed rashes (nevirapine: 2.4% and efavirenz: 6.4% ). In four patients treatment was not interrupted. Three patients were reexposed to the initial drug without any side effects. Therapy with nevirapine or efavirenz does not have to be interrupted if rashes exhibit no blistering, mucosal manifestations, or systemic signs.展开更多
Patientswithsystemicsclerosis(SSc)developoftenacralulcers which are resistant to therapy and may result in gangrene and amputation. We investigated the effect s of iloprost infusion on the acral ulcers and necrosis in...Patientswithsystemicsclerosis(SSc)developoftenacralulcers which are resistant to therapy and may result in gangrene and amputation. We investigated the effect s of iloprost infusion on the acral ulcers and necrosis in patients with five pa tients with SSc and one with mixed connective tissue disease who had been previo usly treated with various modalities without improvement. All patients had Rayna ud phenomenon, acral ulcers and necrosis. Iloprost 25 μg per day was administer ed intravenously daily over six hours for ten consecutive days. Eight weeks late r all patients were treated with a second iloprost therapy cycle for five days. Two patients with severe ulceration received a third cycle until remission occur red. In all cases acral ulcers hea led com pletely and no patient relapsed durin g an observation period of 6 months.展开更多
Recurring scarlatiniform scaled erythema of Fé ré ol-Besnier is a rare disease characterized by recurrent episodes of a prodromal phase with general malaise, head and muscle aches, gastrointestinal complaint...Recurring scarlatiniform scaled erythema of Fé ré ol-Besnier is a rare disease characterized by recurrent episodes of a prodromal phase with general malaise, head and muscle aches, gastrointestinal complaints and fever followed by an erythematous rash leading to extensive desquamation of the involved skin. It exists in a generalized and localized variant, the latter mainly involving the hands and feet. Its cause is unknown, although it has been speculated that a hyperergic reaction to infectious agents or medications may be etiopathologically involved. A typical case of the localized variant of this obscure disease is described and the common literature is reviewed.展开更多
Cutaneous leiomyosarcomas (LMS) originating from smooth muscle of the skin are rare malignant neoplasms. Preferential sites are hair-bearing areas, especially the legs. We report two patients in their 5th and 7th deca...Cutaneous leiomyosarcomas (LMS) originating from smooth muscle of the skin are rare malignant neoplasms. Preferential sites are hair-bearing areas, especially the legs. We report two patients in their 5th and 7th decade, in whom leiomyosarcomas were encountered in the lower leg and the capillitium, respectively. Histologically, the former was found to be a dermal leiomyosarcoma with subcutaneous infiltration, the latter an exclusively dermal tumor. The LMS of the lower leg had been excised three years previously in a different institution and had been diagnosed as a leiomyoma. Both lesions were excised with adequate safety margins in our institution and within a two-year postoperative observation period no recurrences were encountered. Dermal leiomyosarcomas have a 33% recurrence rate while that of subcutaneous leiomyosarcomas show is 50% . In contrast to exclusively dermal tumors, subcutaneous LMS show a tendency for hematogenic and lymphogenic metastases. Therapy of choice is excision with wide safety margins.展开更多
文摘We report on two female patientswho presentedwith painful recurrent palpable purpura,ulcers and necroses on the extremities. The results of all examinations and laboratory tests considered together suggested a diagnosis of necrotizing leukocytoclastic vasculitis. Leukocytoclastic vasculitis is an inflammatory necrotizing condition of the superficial dermal vessels, presenting with variable clinical symptoms. In most cases it becomes manifest as palpable purpura,but hemorrhagic- necrotizing,bullous, nodular and urticarial presentations also occur. Common etiological factors include bacterial, viral or drug antigens, chronic infections (hepatitis B and C), non- Hodgkin lymphomas (monoclonal gammopathy, multiple myeloma), leukemia (hairy cell leukemia), and tumors (bronchial, breast, and gastric cancer) and also connective tissue disorders. In the course of the work- up, a plasmocytoma was discovered as the cause of the leukocytoclastic vasculitis, presenting in a similar way to livedo reticularis in one case and to pyoderma gangraenosum in the other.
文摘Background. Loss of appetite and nausea can reduce the quality of life of patients with malignant melanoma and liver metastases. Often established antiemetic drugs fail to bring relief.Tetrahy drocannabinol (THC, Marinol TM), which is the active agent of Indian hemp, has been used successfully in this situation for other malignant tumors. Patients and methods. We treated 7 patients with hematogenous metastatic melanoma and liver metastases suffering from extensive loss of appetite and nausea supportively with dronabinol (Marinol ). All of these patients had previously received standard antiemetic therapy without adequate relief. Dronabinol is a synthetic △ - tetrahydrocannabinol. The drug was administered in capsule form. We evaluated the palliative effects of dronabinol with a special patient evaluation form, which was filled out at the beginning of the therapy and again after 4 weeks. Results. The majority of patients described a significant increase in appetite and decrease in nausea. These effects remained for some weeks, but then decreased as metastases progressed and the general condition worsened. All of the patients experienced slight to moderate dizziness, but it was not sufficiently troubling to cause interruption or termination of therapy. Conclusion. Loss of appetite and nausea due to liver metastases of malignant melanoma can be treated in individual cases supportively with Dronabinol.
文摘We report on a patient with terbinafine-induced SCLE covering clinical, histopathological and serological findings.Positive serological results included ANA, SS-A (Ro)-antibodies and anti-histone-antibodies with specificity for H1 and H3.The literature on terbinafine-induced SCLE is reviewed.We discuss H1-and H3-specific anti-histone antibodies as a possible diagnostic criterion of drug-induced SCLE.
文摘The borderline syndrome is one of the most severe disturbances of psychosomatic dermatology.Patients with borderline syndrome are situatedon the borderof psychosis, neurosis and personality disorders.The skin as a borderline organ carries a symbolic role.The clinical picture includes artefactual skin diseases due to self-mutilation by conscious or unconscious cutting, and rubbing, scratching or para-artefactual manipulations of pre-existing dermatoses.Leading symptoms of the borderline syndrome are poor impulse control, emotional instability and poor ego strength with low frustration tolerance and unstable personal relationships.We present the case of a 38-year-old female patient with borderline syndrome suffering from para-artefactual skin diseases of the face and a massive hyperhidrosis of the hands and feet.Within 9 months she was treated in four acute psychiatric hospitals and by 12 psychiatrists and psychotherapists.Early and accurate diagnosis and high-quality, sophisticated long-term therapy are necessary.
文摘Efavirenz and nevirapine are frequently used drugs in antiretroviral therapy. Rashes are common side effects of these drugs. In this study, we examined the characteristics of efavirenz- and nevirapine- associated rashes. This prospective nonrandomized multicenter study included 662 HIV- infected patients (efavirenz: 325, nevirapine: 337) to determine incidence, duration, cross- reactivity, and outcome upon reexposure. Of the treated patients, 4.5% (n=30) developed rashes (nevirapine: 2.4% and efavirenz: 6.4% ). In four patients treatment was not interrupted. Three patients were reexposed to the initial drug without any side effects. Therapy with nevirapine or efavirenz does not have to be interrupted if rashes exhibit no blistering, mucosal manifestations, or systemic signs.
文摘Patientswithsystemicsclerosis(SSc)developoftenacralulcers which are resistant to therapy and may result in gangrene and amputation. We investigated the effect s of iloprost infusion on the acral ulcers and necrosis in patients with five pa tients with SSc and one with mixed connective tissue disease who had been previo usly treated with various modalities without improvement. All patients had Rayna ud phenomenon, acral ulcers and necrosis. Iloprost 25 μg per day was administer ed intravenously daily over six hours for ten consecutive days. Eight weeks late r all patients were treated with a second iloprost therapy cycle for five days. Two patients with severe ulceration received a third cycle until remission occur red. In all cases acral ulcers hea led com pletely and no patient relapsed durin g an observation period of 6 months.
文摘Recurring scarlatiniform scaled erythema of Fé ré ol-Besnier is a rare disease characterized by recurrent episodes of a prodromal phase with general malaise, head and muscle aches, gastrointestinal complaints and fever followed by an erythematous rash leading to extensive desquamation of the involved skin. It exists in a generalized and localized variant, the latter mainly involving the hands and feet. Its cause is unknown, although it has been speculated that a hyperergic reaction to infectious agents or medications may be etiopathologically involved. A typical case of the localized variant of this obscure disease is described and the common literature is reviewed.
文摘Cutaneous leiomyosarcomas (LMS) originating from smooth muscle of the skin are rare malignant neoplasms. Preferential sites are hair-bearing areas, especially the legs. We report two patients in their 5th and 7th decade, in whom leiomyosarcomas were encountered in the lower leg and the capillitium, respectively. Histologically, the former was found to be a dermal leiomyosarcoma with subcutaneous infiltration, the latter an exclusively dermal tumor. The LMS of the lower leg had been excised three years previously in a different institution and had been diagnosed as a leiomyoma. Both lesions were excised with adequate safety margins in our institution and within a two-year postoperative observation period no recurrences were encountered. Dermal leiomyosarcomas have a 33% recurrence rate while that of subcutaneous leiomyosarcomas show is 50% . In contrast to exclusively dermal tumors, subcutaneous LMS show a tendency for hematogenic and lymphogenic metastases. Therapy of choice is excision with wide safety margins.
