DOCSLIB.ORG

Skin Manifestations of Food Allergy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Skin Manifestations of Food Allergy Skin Manifestations of Food Allergy Wesley Burks, MD ABSTRACT. The pediatrician is faced with evaluating who had improvement in their atopic dermatitis a panoply of skin rashes, a subset of which may be (AD) after avoiding specific foods in their diet. Other induced by food allergy. Acute urticaria is a common reports that followed were in conflict, and this led to manifestation of an allergic skin response to food, but the controversy on the role of specific food allergens food is rarely a cause of chronic urticaria. Approximately in AD.4 This controversy has continued into the 21st one third of infants/children with moderate to severe century, although there now are numerous labora- atopic dermatitis have food allergy. Although diagnosis of acute urticaria provoked by a food may be evident tory and clinical studies that suggest that the debate from a straightforward history and confirmed by diag- no longer needs to continue. The most recent studies nostic tests to detect food-specific IgE antibody, determi- have shown that the immunoglobulin E (IgE) re- nation of the role of food allergy in patients with atopic sponse after allergen-induced mast cell activation dermatitis is more difficult and may require additional has as its end product hypersensitivity reactions that diagnostic maneuvers, including elimination diets and are characterized by infiltration of monocytes and oral food challenges. The immunopathologic basis of lymphocytes.5,6 The pattern of cytokine expression in food-allergic disorders that affect the skin and a rational lymphocytes infiltrating acute atopic dermatitis le- approach to diagnosis and treatment are discussed. Ad- sions is predominantly that of the Th2 type (interleu- ditional disorders that are caused by or mimic ones kin-4, -5, and -13).7,8 In addition, these cytokines caused by food allergy are reviewed. Pediatrics 2003;111: 1617–1624; atopic dermatitis, urticaria, angioedema, der- promote eosinophil influx and activated eosinophils 7–10 matitis herpetiformis, auriculotemporal syndrome (Frey and eosinophil products. IgE-bearing Langerhans syndrome). cells that are upregulated by these cytokines are highly efficient at presenting allergens to T cells, primarily activating a Th profile (Fig 1). Thus, it ABBREVIATIONS. AD, atopic dermatitis; IgE, immunoglobulin E; 2 SBHR, spontaneous basophil histamine release; DBPCFC, double- seems that IgE antibody and the Th2 cytokine milieu blind, placebo-controlled food challenge; RAST, radioallergosor- do play a major role in the pathogenesis of these bent test; PST, prick skin test. lesions. Certainly, AD is an inherited genetic disor- der with an allergic diathesis. he skin is one of the target organs that is most often involved in food hypersensitivity reac- Laboratory Investigation tions. Clinical manifestations of food hypersen- Several studies in the laboratory investigation sup- T port a role for food-specific IgE antibody in the sitivity in the skin range from symptoms of atopic dermatitis, to urticaria and angioedema, dermatitis pathogenesis of AD. Patients have been shown to herpetiformis, and a masquerader of food allergy, have elevated concentrations of total IgE and food- Frey’s syndrome. All present with typical skin man- specific IgE antibodies.11,12 More than 50 years ago, ifestations of their food-allergic reactions. For most Walzer13,14 demonstrated that the ingestion of foods skin manifestations provoked by food hypersensitivity, would allow food antigens to penetrate the gastroin- pruritus is a hallmark of the disease. With this review, testinal barrier, which are then transported in the the above diseases are discussed, as well as the labora- circulation to IgE-bearing mast cells in the skin. Ad- tory and clinical investigations that demonstrate how ditional studies have shown that in patients who had food hypersensitivity plays a pathogenic role in the food-specific IgE antibodies and underwent oral skin manifestations of allergic reactions. food challenges, positive challenges were accompa- nied by increases in plasma histamine concentra- ATOPIC DERMATITIS tion,15 elaboration of eosinophil products,16 and ac- 17 Pathophysiology tivation of plasma eosinophils. Children who had AD and were chronically in- In the early 20th century, studies by Schloss1 and gesting foods to which they were allergic were found Talbot and Blackfan2,3 reported on cases of patients to have increased “spontaneous” basophil histamine release (SBHR) from peripheral blood basophils in From the University of Arkansas for Medical Sciences, Arkansas Children’s vitro compared with children without food allergy or 18 Hospital, Little Rock, Arkansas. normal subjects. After placement on the appropri- Received for publication Sep 11, 2002; accepted Oct 30, 2002. ate elimination diet, they had significant clearing of Address correspondence to Wesley Burks, MD, University of Arkansas for their skin and significant fall in their SBHR. Other Medical Sciences, Arkansas Children’s Hospital, 1120 Marshall St, Slot 512-13, Little Rock, AR 72202. E-mail: [email protected] studies have shown that peripheral blood mononu- PEDIATRICS (ISSN 0031 4005). Copyright © 2003 by the American Acad- clear cells from food-allergic patients with high emy of Pediatrics. SBHR elaborate specific cytokines termed histamine Downloaded from www.aappublications.org/news by guestPEDIATRICS on September 30, Vol. 2021 111 No. 6 June 2003 1617 Fig 1. Immunologic progression of AD. releasing factors that would activate basophils from some patients during the milk and egg exclusion food-sensitive but not food-insensitive patients. Fur- phase, but no significant difference was seen in 40 thermore, passive sensitization experiments in vitro patients who completed the crossover trial. A study with basophils from nonatopic donors and IgE from by Juto et al23 indicated that approximately one third patients allergic to certain foods showed that ba- of the patients with AD had resolution of their rash sophils could be rendered sensitive to histamine re- and one half improved on a highly restricted diet. leasing factors.18 The cumulative results of these studies supported Food allergen-specific T cells have been cloned the role for food allergy in the exacerbation of AD, from normal skin and active skin lesions in patients but most of them failed to control other trigger fac- with AD.19,20 Cutaneous lymphocyte-associated an- tors, as well as controlling for placebo effect or ob- tigen is a homing molecule that interacts with E- server bias. selectin and directs T cells to the skin. In 1 study, In 1 of the original prospective follow-up studies, patients with milk-induced AD were compared with Sampson et al24 studied 34 patients with AD, 17 of control subjects with milk-induced gastrointestinal whom had food allergy, who were appropriately reactions without AD and with nonatopic control diagnosed by double-blind, placebo-controlled oral subjects.19 Casein-reactive T cells from children with food challenges (DBPCFCs). These patients had been milk-induced AD had a significantly higher expres- placed on an appropriate allergen elimination and sion of cutaneous lymphocyte-associated antigen experienced significant improvement in their clinical than Candida albicans-reactive T cells from the same symptomatology. They were followed up at a 1- to 2- patients and either casein or C albicans-reactive T and a 3- to 4-year time frame. They were compared cells from the control groups. with control subjects who did not have food allergy and children with food allergy who did not adhere to Clinical Studies their diet. These patients in follow-up did have im- Multiple clinical studies have addressed the role of provement in their AD compared with the control food allergy in AD and have shown that elimination groups, and their time frame for outgrowing their of relevant food allergens can lead to improvement food sensitivity was lessened. Lever et al25 per- in skin symptoms, that repeat challenge can lead to formed a randomized, controlled trial of egg elimi- redevelopment of symptoms, and that the disease nation in young children who had AD and positive can be partially prevented by prophylactically elim- radioallergosorbent test (RAST) to egg and were ex- inating highly allergenic foods from the diets of in- amined at a dermatology clinic. At the end of this fants and possibly breastfeeding mothers. study, egg allergy was confirmed by oral challenge, A number of studies have addressed the therapeu- and 55 children who were allergic to egg were ulti- tic effect of dietary elimination in the treatment of mately identified. There was a significant decrease in AD. Atherton et al21 showed that two thirds of chil- the skin area affected, as well as symptom scores in dren with AD between the ages of 2 and 8 years the children who avoided eggs compared with the showed marked improvement during a double-blind control subjects. crossover trial of milk and egg exclusion. Another Oral food challenges have been used to demon- trial by Neild et al22 demonstrated improvement in strate that challenge with a food allergen can induce 1618 SUPPLEMENT Downloaded from www.aappublications.org/news by guest on September 30, 2021 symptoms of rash and pruritus in children with food analysis of controlled trials comparing breastfeeding allergy-related AD. Sampson et al24,26–28 have pub- with formula feeding demonstrated a significant re- lished a number of articles that have used DBPCFCs duction in AD in the infants who received breast
Load more

Recommended publications
  • Autoimmune Associations of Alopecia Areata in Pediatric Population - a Study in Tertiary Care Centre
    IP Indian Journal of Clinical and Experimental Dermatology 2020;6(1):41–44 Content available at: iponlinejournal.com IP Indian Journal of Clinical and Experimental Dermatology Journal homepage: www.innovativepublication.com Original Research Article Autoimmune associations of alopecia areata in pediatric population - A study in tertiary care centre Sagar Nawani1, Teki Satyasri1,*, G. Narasimharao Netha1, G Rammohan1, Bhumesh Kumar1 1Dept. of Dermatology, Venereology & Leprosy, Gandhi Medical College, Secunderabad, Telangana, India ARTICLEINFO ABSTRACT Article history: Alopecia areata (AA) is second most common disease leading to non scarring alopecia . It occurs in Received 21-01-2020 many patterns and can occur on any hair bearing site of the body. Many factors like family history, Accepted 24-02-2020 autoimmune conditions and environment play a major role in its etio-pathogenesis. Histopathology shows Available online 29-04-2020 bulbar lymphocytes surrounding either terminal hair or vellus hair resembling ”swarm of bees” appearance depending on chronicity of alopecia areata. Alopecia areata in children is frequently seen. Pediatric AA has been associated with atopy, thyroid abnormalities and a positive family history. We have done a study to Keywords: find out if there is any association between alopecia areata and other auto immune diseases in children. This Alopecia areata study is an observational study conducted in 100 children with AA to determine any associated autoimmune Auto immunity conditions in them. SALT score helps to assess severity of alopecia areata. Severity of alopecia areata was Pediatric population assessed by SALT score-1. S1- less than 25% of hairloss, 2. S2- 25-49% of hairloss, 3. 3.S3- 50-74% of hairloss.
    [Show full text]
  • Aeroallergen-Induced Th2 Inflammation Endogenous And
    Endogenous and Exogenous IL-6 Inhibit Aeroallergen-Induced Th2 Inflammation Jingming Wang, Robert J. Homer, Qingsheng Chen and Jack A. Elias This information is current as of September 26, 2021. J Immunol 2000; 165:4051-4061; ; doi: 10.4049/jimmunol.165.7.4051 http://www.jimmunol.org/content/165/7/4051 Downloaded from References This article cites 61 articles, 22 of which you can access for free at: http://www.jimmunol.org/content/165/7/4051.full#ref-list-1 Why The JI? Submit online. http://www.jimmunol.org/ • Rapid Reviews! 30 days* from submission to initial decision • No Triage! Every submission reviewed by practicing scientists • Fast Publication! 4 weeks from acceptance to publication *average by guest on September 26, 2021 Subscription Information about subscribing to The Journal of Immunology is online at: http://jimmunol.org/subscription Permissions Submit copyright permission requests at: http://www.aai.org/About/Publications/JI/copyright.html Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://jimmunol.org/alerts The Journal of Immunology is published twice each month by The American Association of Immunologists, Inc., 1451 Rockville Pike, Suite 650, Rockville, MD 20852 Copyright © 2000 by The American Association of Immunologists All rights reserved. Print ISSN: 0022-1767 Online ISSN: 1550-6606. Endogenous and Exogenous IL-6 Inhibit Aeroallergen-Induced Th2 Inflammation1 Jingming Wang,* Robert J. Homer,† Qingsheng Chen,* and Jack A. Elias2* Chronic Th2-dominated inflammation and exaggerated IL-6 production are characteristic features of the asthmatic airway. To understand the processes that are responsible for the chronicity of this response and the role(s) of IL-6 in the regulation of airway Th2 inflammation, we compared the responses induced by OVA in sensitized wild-type mice, IL-6 deficient (؊/؊) mice, and transgenic mice in which IL-6 was overexpressed in the airway (CC10-IL-6 mice).
    [Show full text]
  • ON the VIRUS ETIOLOGY of PEMIPHIGUS and DERMATITIS HERPETIFORMIS DUHRING*, Tt A.MARCHIONINI, M.D
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector ON THE VIRUS ETIOLOGY OF PEMIPHIGUS AND DERMATITIS HERPETIFORMIS DUHRING*, tt A.MARCHIONINI, M.D. AND TH. NASEMANN, M.D. The etiology of pemphigus and dermatitis herpetiformis (Duhring) is, as Lever (33) has pointed ont in his recently published monograph (1953), still unknown, despite many clinical investigations and despite much bacteriologic and virus research using older and newer methods. There can be no doubt that the number of virus diseases has increased since modern scientific, (ultrafiltra- tion, ultracentrifuge, electron-microscope, etc.) and newer biological methods (chorionallantois-vaccination, special serological methods, tissue cultures, etc.) have been used on a larger scale in clinical research. Evidence of virus etiology, however, is not always conclusive. What is generally the basis for the assumption of the virus nature of a disease? First of all, we assume on the basis of epidemiology and clinical observations that the disease is iufectious and that we are dealing with a disease of a special character (morbus sui qeneris). Furthermore, it must be ruled out that bacteria, protozoa and other non-virus agents are responsible for the disease. This can be done by transfer tests with bacteria-free ultrafiltrates. If these are successful, final prcof of the virus etiology has to be established by isolation of the causative agent and its cultivation in a favorable host-organism through numerous transfers. Let us look now from this point of view at pemphigus and dermatitis herpetiformis (Duhring). We are not dealing here with the old controversy, whether both diseases are caused by the same virus (unitarian theory) or by two different viruses (dualistic theory) or are due to two variants of different virulence of the same virus (Duhring-virus-attenu- ated form).
    [Show full text]
  • The Tumor Necrosis Factor Superfamily Molecule LIGHT Promotes Keratinocyte Activity and Skin Fibrosis Rana Herro1, Ricardo Da S
    ORIGINAL ARTICLE The Tumor Necrosis Factor Superfamily Molecule LIGHT Promotes Keratinocyte Activity and Skin Fibrosis Rana Herro1, Ricardo Da S. Antunes1, Amelia R. Aguilera1, Koji Tamada2 and Michael Croft1 Several inflammatory diseases including scleroderma and atopic dermatitis display dermal thickening, epidermal hypertrophy, or excessive accumulation of collagen. Factors that might promote these features are of interest for clinical therapy. We previously reported that LIGHT, a TNF superfamily molecule, mediated collagen deposition in the lungs in response to allergen. We therefore tested whether LIGHT might similarly promote collagen accumulation and features of skin fibrosis. Strikingly, injection of recombinant soluble LIGHT into naive mice, either subcutaneously or systemically, promoted collagen deposition in the skin and dermal and epidermal thickening. This replicated the activity of bleomycin, an antibiotic that has been previously used in models of scleroderma in mice. Moreover skin fibrosis induced by bleomycin was dependent on endogenous LIGHT activity. The action of LIGHT in vivo was mediated via both of its receptors, HVEM and LTβR, and was dependent on the innate cytokine TSLP and TGF-β. Furthermore, we found that HVEM and LTβR were expressed on human epidermal keratinocytes and that LIGHT could directly promote TSLP expression in these cells. We reveal an unappreciated activity of LIGHT on keratinocytes and suggest that LIGHT may be an important mediator of skin inflammation and fibrosis in diseases such as scleroderma
    [Show full text]
  • Approaches for Assessing Health Risks from Complex Mixtures in Indoor Air: a Panel Overview by Carol J
    Environmental Health Perspectives Vol. 95, pp. 135-143, 1991 Approaches for Assessing Health Risks from Complex Mixtures in Indoor Air: A Panel Overview by Carol J. Henry,* Lawrence Fishbein,* William J. Meggs,t Nicholas A. Ashford,' Paul A. Schulte,§ Henry Anderson,/' J. Scott Osborne,' and Daniel W. Sepkovictt Critical to a more definitive human health assessment ofthe potential health risks from exposure to complex mixtures in indoor air is the need for a more definitive clinical measure and etiology ofthe helath effects ofcomplex mixtures. This panel overview highlights six ofthe eight presentations ofthe conference panel discussion and features a number ofthe major topical areas of indoor air concern. W. G. Meggs assessed clinical research priorities with primary focus on the role ofvolatile organic chemicals in human health, recognizing the areas where definitive data are lacking. By recogniz- ing many types ofchemical sensitivity, it may be possible to design studies that can illuminate the mechanisms by which chemical exposure may cause disease. The critically important topic of multiple chemical sensitivity was discussed by N. A. Ashford, who identified four high risk groups and defined the demographics ofthese groups. P. A. Schulte address- ed the issue ofbiological markers ofsusceptibility with specific considerations ofboth methodologia and societal aspects that may be operative in the ability to detect innate or inborne differences between individuals and populations. Three case studies were reviewed. H. Anderson discussed the past and present priorities from a public health perspective, focusing on those issues dealing with exposures to environmental tobacco smoke and formaldehyde off-gassing from materials used in mobile homeconstruction.
    [Show full text]
  • Skin Manifestation of SARS-Cov-2: the Italian Experience
    Journal of Clinical Medicine Article Skin Manifestation of SARS-CoV-2: The Italian Experience Gerardo Cazzato 1 , Caterina Foti 2, Anna Colagrande 1, Antonietta Cimmino 1, Sara Scarcella 1, Gerolamo Cicco 1, Sara Sablone 3, Francesca Arezzo 4, Paolo Romita 2, Teresa Lettini 1 , Leonardo Resta 1 and Giuseppe Ingravallo 1,* 1 Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] (G.C.); [email protected] (A.C.); [email protected] (A.C.); [email protected] (S.S.); [email protected] (G.C.); [email protected] (T.L.); [email protected] (L.R.) 2 Section of Dermatology and Venereology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] (C.F.); [email protected] (P.R.) 3 Section of Forensic Medicine, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] 4 Section of Gynecologic and Obstetrics Clinic, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] * Correspondence: [email protected] Abstract: At the end of December 2019, a new coronavirus denominated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified in Wuhan, Hubei province, China. Less than three months later, the World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) to be a global pandemic. Growing numbers of clinical, histopathological, and molecular findings were subsequently reported, among which a particular interest in skin manifestations during the course of the disease was evinced. Today, about one year after the development of the first major infectious foci in Italy, various large case series of patients with COVID-19-related skin Citation: Cazzato, G.; Foti, C.; manifestations have focused on skin specimens.
    [Show full text]
  • Aeroallergen Sensitization and Allergic Disease Phenotypes in Asia
    REVIEW ARTICLE Asian Pacific Journal of Allergy and Immunology Aeroallergen sensitization and allergic disease phenotypes in Asia Elizabeth Huiwen Tham,1,2 Alison Joanne Lee,1,2 Hugo Van Bever1,2 Abstract Allergic diseases are on the rise in Asia. Aeroallergen exposure is a strong risk factor for sensitization, development and severity of atopic diseases, especially in the Asian paediatric population. Geographical and seasonal variations in aeroallergen sensitization are seen even within Asian countries and changes in aeroallergen sensitization patterns have been observed over time. Some possible reasons include climate change as well as rapid urbanization and improved sanitation which follow socioeconomic development. House dust mite allergy is present in up to 90% of Asian atopic patients, far exceeding that which is seen in Western populations which report prevalences of only 50% to 70%. Pollen and animal dander affect less than 10% of Asian patients as compared to 40-70% of individuals with asthma and allergic rhinitis living in the West, a burden almost equivalent to the dust mite burden in those regions. There is thus a pressing need for preventive measures to reduce dust mite sensitization in Asian children today. Keywords: Aeroallergen, Asia, allergy, house dust mites, sensitization From: Corresponding author: 1 Department of Paediatrics, Yong Loo Lin School of Medicine, National Elizabeth Huiwen Tham University of Singapore Department of Paediatrics, Yong Loo Lin School of Medicine, National 2 Khoo Teck Puat-National University
    [Show full text]
  • Xolair® (Omalizumab)
    Xolair® (omalizumab) When requesting Xolair® (omalizumab), the individual requiring treatment must be diagnosed with one of the following FDA-approved indications and meet the specific coverage guidelines and applicable safety criteria for the covered indications. FDA-approved indications • Xolair® (omalizumab) is indicated for the treatment of moderate to severe persistent asthma in individuals with a positive skin test or in vitro reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with inhaled corticosteroids. • Xolair® (omalizumab) is indicated for the treatment of chronic idiopathic urticaria in individuals who remain symptomatic despite treatment with a histamine-1 (H1) antihistamine. Approved Off-label Compendial use • None Coverage Guidelines Moderate to Severe Persistent Asthma The individual must meet all of the following criteria for initial approval: • Diagnosis of moderate to severe persistent allergic asthma confirmed by appropriate diagnostic testing • Greater than or equal to 6 years of age • Has a positive skin test or in vitro reactivity to a perennial aeroallergen • Has inadequate control of symptoms after 3 months of consecutive treatment with the following o High-dose corticosteroid o Long-acting beta agonist or leukotriene inhibitors • Age 12 years and over: Has baseline serum total Immunoglobulin E (IgE) levels between 30 Units/mL and 700 Units/mL • Age 6 years to less than 12 years: Has baseline serum total Immunoglobulin E (IgE) levels between 30 Units/mL and up to 1300 Units/mL • Has a body weight that is 150 kg or less • Is not concurrently taking Cinqair, Nucala, or Fasenra V1.0.2019 - Effective 1/1/2019 © 2019 eviCore healthcare.
    [Show full text]
  • Shingles (Herpes Zoster) Hives (Urticaria) Psoriasis
    Shingles (Herpes Zoster) Shingles starts with burning, tingling, or very sensitive skin. A rash of raised dots develops into painful blisters that last about two weeks. Shingles often occurs on the trunk and buttocks, but can appear anywhere. Most people recover, but pain, numbness, and itching linger for many -- and may last for months, years, or the rest of their lives. Treatment with antiviral drugs, steroids, antidepressants, and topical agents can help. Hives (Urticaria) A common allergic reaction that looks like welts, hives are often itchy, and sometimes stinging or burning. Hives vary in size and may join together to form larger areas. They may appear anywhere and last minutes or days. Medications, foods, food additives, temperature extremes, and infections like strep throat are some causes of hives. Antihistamines can provide relief. Psoriasis A non-contagious rash of thick red plaques covered with white or silvery scales, psoriasis usually affects the scalp, elbows, knees, and lower back. The rash can heal and recur throughout life. The cause of psoriasis is unknown, but the immune system triggers new skin cells to develop too quickly. Treatments include medications applied to the skin, light therapy, and medications taken by mouth, injection or infusion. Eczema Eczema describes several non-contagious conditions where skin is inflamed, red, dry, and itchy. Stress, irritants (like soaps), allergens, and climate can trigger flare-ups though they're not eczema's exact cause, which is unknown. In adults, eczema often occurs on the elbows and hands, and in "bending" areas, such as inside the elbows. Treatments include topical or oral medications and shots.
    [Show full text]
  • BETA Betamethasone Valerate Cream 0.1% W/W Betamethasone Valerate Ointment 0.1% W/W
    NEW ZEALAND CONSUMER MEDICINE INFORMATION BETA Betamethasone valerate cream 0.1% w/w Betamethasone valerate ointment 0.1% w/w discoid lupus Some of the symptoms of an What is in this leaflet erythematosus (recurring allergic reaction may include: scaly rash) shortness of breath; wheezing or This leaflet answers some common prickly heat skin reaction difficulty breathing; swelling of the questions about BETA Cream and insect bite reactions face, lips, tongue or other parts of Ointment. prurigo nodularis (an itching the body; rash, itching or hives on and thickening of the skin the skin. It does not contain all the available with lumps or nodules) information. It does not take the contact sensitivity reactions Do not use BETA Cream or place of talking to your doctor or an additional treatment for Ointment to treat any of the pharmacist. an intense widespread following skin problems as it reddening and inflammation could make them worse: All medicines have risks and of the skin, infected skin (unless the benefits. Your doctor has weighed when milder topical corticosteroids infection is being treated the risks of you using BETA Cream cannot treat the skin condition with an anti-infective or Ointment against the benefits effectively. medicine at the same time) they expect it will have for you. acne BETA Cream is usually used to rosacea (a facial skin If you have any concerns about treat skin conditions on moist condition where the nose, taking this medicine, ask your surfaces; BETA Ointment is usually cheeks, chin, forehead or doctor or pharmacist. used to treat skin conditions on dry, entire face are unusually scaly skin.
    [Show full text]
  • Erythema Annulare Centrifugum ▪ Erythema Gyratum Repens ▪ Exfoliative Erythroderma Urticaria ▪ COMMON: 15% All Americans
    Cutaneous Signs of Internal Malignancy Ted Rosen, MD Professor of Dermatology Baylor College of Medicine Disclosure/Conflict of Interest ▪ No relevant disclosures ▪ No conflicts of interest Objectives ▪ Recognize common disorders associated with internal malignancy ▪ Manage cutaneous disorders in the context of associated internal malignancy ▪ Differentiate cutaneous signs of leukemia and lymphoma ▪ Understand spidemiology of cutaneous metastases Cutaneous Signs of Internal Malignancy ▪ General physical examination ▪ Pallor (anemia) ▪ Jaundice (hepatic or cholestatic disease) ▪ Fixed erythema or flushing (carcinoid) ▪ Alopecia (diffuse metastatic disease) ▪ Itching (excoriations) Anemia: Conjunctival pallor and Pale skin Jaundice 1-12% of hepatocellular, biliary tree or pancreatic cancer PRESENT with jaundice, but up to 40-60% eventually develop it World J Gastroenterol 2003;9:385-91 For comparison CAN YOU TELL JAUNDICE FROM NORMAL SKIN? JAUNDICE Alopecia Neoplastica Most common report w/ breast CA Lung, cervix, desmoplastic mm Hair loss w/ underlying induration Biopsy = dermis effaced by tumor Ann Dermatol 26:624, 2014 South Med J 102:385, 2009 Int J Dermatol 46:188, 2007 Acta Derm Venereol 87:93, 2007 J Eur Acad Derm Venereol 18:708, 2004 Gastric Adenocarcinoma: Alopecia Ann Dermatol 2014; 26: 624–627 Pruritus: Excoriation ▪ Overall risk internal malignancy presenting as itch LOW. OR =1.14 ▪ CTCL, Hodgkin’s & NHL, Polycythemia vera ▪ Biliary tree carcinoma Eur J Pain 20:19-23, 2016 Br J Dermatol 171:839-46, 2014 J Am Acad Dermatol 70:651-8, 2014 Non-specific (Paraneoplastic) Specific (Metastatic Disease) Paraneoplastic Signs “Curth’s Postulates” ▪ Concurrent onset (temporal proximity) ▪ Parallel course ▪ Uniform site or type of neoplasm ▪ Statistical association ▪ Genetic linkage (syndromal) Curth HO.
    [Show full text]
  • Effectiveness of Medium-Dose Ultraviolet A1 Phototherapy in Localized Scleroderma
    Pharmacology and therapeutics Effectiveness of medium-dose ultraviolet A1 phototherapy in localized scleroderma Ozlem Su1, MD, Nahide Onsun1, MD, Hulya Kapran Onay2, MD, Yeliz Erdemoglu1, MD, Dilek Biyik Ozkaya1, MD, Filiz Cebeci1, MD, and Adnan Somay3, MD 1Department of Dermatology, Abstract Bezmialem Vakif University, Faculty of Background Recently, ultraviolet (UV) A1 phototherapy has been suggested as an effec- 2 Medicine, Neoson Imaging Center, tive treatment for localized scleroderma (LS); however, the optimal dose of UVA1 still has Radiology, and 3Department of not been determined. Pathology, Vakif Gureba Teaching and 2 Research Hospital, Istanbul, Turkey Objective We aimed to evaluate the therapeutic effectiveness of medium-dose (30 J/cm ) UVA1 phototherapy and to show that 13 MHz ultrasound is a valuable tool for assessing Correspondence the results of UVA1 phototherapy in LS. Ozlem Su, MD Methods Thirty-five patients with LS were treated with medium-dose (30 J/cm2) UVA1. Sıgırtmac Sok. No. 21 B blok d. 7 In total, 30–45 treatments and 900–1350 J/cm2 cumulative UVA1 doses were evaluated by Osmaniye Bakirkoy clinical scoring in all patients. In 14 patients, skin thickness was also determined by Istanbul 13 MHz ultrasound examination. Turkey Results In all patients, medium-dose UVA1 therapy softened sclerotic plaques, and E-mail: [email protected] marked clinical improvement was observed in 29 of 35 (82. 85%) patients. Ultrasound mea- surements showed that skin thickness was significantly reduced. No side effects were Conflicts of interest: None. observed during or after treatment. Conclusion Medium-dose UVA1 phototherapy is a highly effective, safe, and well-tolerated therapeutic modality for treatment of all types of LS.
    [Show full text]