Diffuse skin disease

Diagnostic criteria for SSc were developed by the American College of Rheumatology (38). Limited and diffuse skin disease differs in clinical presentation, autoimmune signature, and evolution. Limited disease (about 60% of all patients with SSc) is defined by distal cutaneous sclerosis that can involve the face but not the tmnk or limbs proximal to the elbows and knees. Diffuse disease (about 40% of all patients with SSc) is defined by proximal cutaneous sclerosis, extending to the trunk. In SSc sine scleroderma most features of SSc are present, except for skin thickening (37). ANA is positive in 90% to 100% of all patients. Anti-centromere antibodies, present in up to 60% of patients with limited SSc, and anti-topoisomerase 1 antibodies (anti-SCl-70 antibodies), found in 20% to 40% of patients with diffuse SSc (37) are mutually exclusive. 

Silicone implants sometimes provoke systemic adverse effects. More than 20 women developed muscle pain, joint pain and swelling, pulmonary disease including pleural effusions, pulmonary infiltrates, and reduced pulmonary diffusing capacity, dry eyes, dysphagia, bladder dysfunction, neurological abnormalities, and skin disease (including localized and diffuse scleroderma-hke changes) (9). 

Many steroid-drugs are used for the treatment of skin diseases. Superoxide produced from steroids should also produce chemiluminescence by the same mechanism. Therefore, the above approaches were applied to study the efficacy, i.e., toxicity, of steroid drugs. The properties are summarized in Table 2. These properties were not related to log P values, indicating that efficacy does not depend on molecular mass or solubility due to diffusion. The analysis of chemical reactivity was the important factor, and the atomic partial charge contributes to the activity. 

Scanning electron microscopy (SEM) in concert with x-ray energy spectrometry (XES) has been used to detect silver in pulmonary, lacrimal sac, and skin tissues of individuals with diffuse interstitial lung disease, chronic dacryocystitis, and skin disorders, respectively (Brody et al. 1978 Loeffler and Lee 1987 Tanita et al. 1985). Brody et al. (1978) observed particles of preselected lesions of human pulmonary tissue magnified to 300x by SEM, and the silver content was analyzed by XES. The authors noted that SEM and XES techniques permit a rapid and conclusive determination of silver, silver compounds, and complexes in tissue lesions. 

A 44-year-old woman received interferon alfa 6 MU/ day for relapse of chronic myeloid leukemia 7 years after successful bone marrow transplantation. About 2 years later, interferon alfa was withdrawn because of diffuse erythematous skin lesions with discoid lupus erythematosus on skin biopsy and severe dysphagia with esophagitis and pseudomembranes at endoscopy. Fever, bilateral pulmonary infiltrates, and respiratory distress syndrome subsequently developed, and she required mechanical ventilation. An open lung biopsy showed features of chronic pulmonary graft-versus-host disease. All her symptoms completely resolved with ciclosporin and corticosteroids. An infectious cause was ruled out. 

Systemic sclerosis is characterized by alteration of the microvasculature and by massive deposition of collagen. This disease can present as a spectrum of differing manifestations depending on affected areas and the extent of disease. Sclerosis of the skin is a hallmark for this disease. There can be a proximal diffuse (truncal) sclerosis. 

The other extreme is the widely disseminated lepromatous form, characterized by markedly impaired cell-mediated immunity and diffuse infiltration of the skin. M. leprae is demonstrable in smears, and granulomas containing bacteria-laden histiocytes are present. As the disease progresses, large nerve trunks are involved and anesthesia, atrophy of skin and muscle, absorption of small bones, ulceration, and spontaneous amputations may occur. 

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