Erythema clinic

Kang et al. [23] compared the clinical, histologic, and molecular responses of normal human skin to topical retinol with that of retinoic acid. Application of retinol and retinoic acid produced epidermal thickening. However, retinol produced less erythema compared with retinoic acid. The authors suggest that these data are compatible with the idea that retinol may he a pro-hormone of retinoic acid. 

Clinically, rosacea presents with different degrees of severity, ranging from facial erythema to evident inflammatory lesions. Symptoms of rosacea include skin dryness and sensitivity, stinging and burning [1]. 

Clinical improvement should be seen within 48 hours of initiating treatment for peritonitis or catheter-related infections. Perform daily inspections of peritoneal fluid or the exit site to determine clinical improvement. Peritoneal fluid should become clear with improvement of peritonitis and erythema and discharge should remit with improvement of catheter-related infections. If no improvement is seen within 48 hours, obtain additional cultures and cell counts to determine the appropriate alterations in therapy. 

FIGURE 62-4. Irritant contact dermatitis. Erythema and edema with spared areas on the back at sites in contact with an irritant in a 30-year-old male. (From Wolff K, Johnson RA. Eczema/ dermatitis. Fitzpatrick s Color Atlas Synopsis of Clinical Dermatology. 5th ed. New York McGraw-Hill, 2005 20.)... 

A 15-month-old girl presents to the pediatric clinic with 2 days of fever (38.9°C), runny nose, and fussiness. Her mother states that she is more irritable than usual and cries many times throughout the night. She is not as interested in eating today. She attends day care and has a 5-year-old brother who recently had a cold. Physical examination reveals erythema and bulging of the right tympanic membrane and the presence of middle ear fluid. The left tympanic membrane is obscured with cerumen. 

A 56-year-old man presents to the emergency room with complaints of right lower leg pain and redness. Examining his leg, you notice that he has erythema and edema extending from his ankle to proximal tibia. The area feels warm. On questioning, the patient states that the redness started approximately 2 days ago. He has felt feverish over the previous 48 hours but did not check his temperature. He has had no other symptoms. He states that he bumped his shin on the bed frame last week and sustained a bruise but no apparent breaks in the skin. His vital signs at the clinic reveal a temperature of 38.3°C, pulse 102 beats per minute, blood pressure 11 0/72 mm Hg, and respiratory rate 20 breaths per minute. The physician diagnoses this patient with cellulitis. 

Not all diabetic foot ulcers are infected. However, infection is often difficult to detect when perfusion and the inflammatory response are limited in the diabetic patient. The common signs and symptoms (i.e., pain, erythema, and edema) of infection may be absent.32 Still, the diagnosis of diabetic foot infection depends mostly on clinical evaluation. 

In most instances, external-beam radiation therapy used in conjunction with breast-conserving procedures involves 4 to 6 weeks of radiation therapy directed to the breast tissue to eradicate residual disease. Complications associated with radiation therapy to the breast are minor and include reddening and erythema of the breast tissue and subsequent shrinkage of total breast mass beyond that predicted on the basis of breast tissue removal. Some clinical situations also require postmastectomy radiation therapy as well (see section on locally advanced breast cancer). 

Patients with peripheral neuropathy often do not experience pain but seek medical attention for swelling or erythema. Lesions vary in size and clinical features. A foul-smelling odor suggests anaerobic organisms. Temperature may be mildly elevated or normal. 

Dermal Effects. Dermal effects have been observed in humans following exposure to -hexane. /7-Hcxanc was 1 of 11 solvents tested for dermal toxicity in a male volunteer (Wahlberg 1984). A slight transient erythema was observed after 10-20 minutes exposure to 1.5 mL -hexane and a stinging and/or burning sensation reported by the volunteer. Application of 0.1 mL neat -hexane did not cause clinical signs or affect blood flow. 

Clinical signs in humans and animals related to acute toxic exposure to 1,2-dibromoethane are depression and collapse, indicative of neurologic effects, and erythema and necrosis of tissue at the point of contact (oral and pharyngeal ulcers for ingestion, skin blisters and sloughing for dermal exposure). Neurologic signs are not seen in animals exposed to nonlethal doses. 

The interaction of a chemical (hapten) with epidermal proteins (carrier) can result in a hapten-carrier complex capable of activating skin-associated lymphoid tissue (sensitisation) and dissemination of antigen-specific T l)unphocytes (induction). Subsequent encoimter with the same or cross-reactive chemicals can result in the elicitation of a characteristic inflammatory skin reaction. The clinical condition is referred to as allergic contact dermatitis and is characterised by erythema, oedema, vesiculation and pruritus. Allergic contact sensitisation is, therefore, classed as a cell-mediated immunological response to chemicals that contact and penetrate the skin. 

Persistent photosensitivity developed in eight men after occupational exposure to hot epoxy resin fiimes. The condition was limited to sites contacted by the resin. Small doses of ultraviolet-A light evoked abnormal reactions consisting of erythema, edema, and papules in the clinically involved skin. Positive photopatch tests were observed to epoxy resin in four subjects and to bisphenol A in all subjects. Another study showed that bisphenol A can be released during the thermal decomposition of epoxy resin in the temperature range of 250-350°C. Photosensitizing activity was explained by the formation of ftee radicals during exposure to ultraviolet-B radiation of bisphenol A vapor, to form a semiquinone derivative of bisphenol A ... 

Rash In controlled clinical trials, rash occurred in 21% of patients treated with atazanavir. Discontinue atazanavir if severe rash develops. Cases of Stevens-Johnson syndrome and erythema multiforme have been reported in patients receiving atazanavir. 

Local injection site reactions The most common adverse events associated with enfuvirtide use are local injection site reactions. Manifestations may include pain and discomfort, induration, erythema, nodules and cysts, pruritus, and ecchymosis. Pneumonia An increased rate of bacterial pneumonia was observed in subjects treated with enfuvirtide in the phase 3 clinical trials compared with the control arm. Hypersensitivity reactions Hypersensitivity reactions have been associated with enfuvirtide therapy and may recur on rechallenge. Hypersensitivity reactions have included individually and in combination Rash, fever, nausea and vomiting, chills. 

When a normal diet is followed, biotin dehciency is rare. Clinical symptoms of dehciency are alopecia and cntaneons abnormalities snch as seborrhoeic dermatitis (especially in patients affected by phenylketonnria), periorihcial erythema, and fnngal infection. The main sonrces of biotin are liver, kidney, egg yolk, some vegetables snch as soybeans, nnts, spinach, mnshrooms, and lentils. In green plants and frnits, biotin occnrs in water-extractable forms, whereas in yeast and animal prodncts, it is a hrmly bonnd complex [417]. The variability on the amonnts of biotin in foods is due to both natural variation, bnt also to methodological problems. 

The most common adverse reaction to etanercept is mild to moderate erythema, pain, or pruritus at the injection site (37%). Headaches and abdominal pain can also occur. New positive autoantibodies, such as antinuclear antibodies (ANA), anti-dsDNA antibodies, and anticardiolipin antibodies, can develop in patients treated with etanercept. Although there is so far no association between this and the development of autoimmune diseases or malignancies, long-term studies have yet to be done. Rare cases of pancytopenia may be associated with this drug. Although clinical trials showed no increased risk of infection with etanercept treatment, postmarketing reports of serious infections, sepsis, and associated fatalities exist. 

Injection site reactions characterized by mUd to moderate erythema, itching, burning, and/or pain occur in approximately one-third of patients but rarely necessitate drug discontinuation. The impact of etanercept on the host s response to new or chronic infections is not fully understood. Serious infections and sepsis, including fatalities, have been reported in patients treated with etanercept. Increased levels of autoantibodies, including antinuclear antibodies and anti-double-stranded DNA antibodies, have also been reported, but the clinical significance of this observation is unknown. 

Mechanism of Action Topical corticosteroids exhibit anti-inflammatory, antipruritic, and vasoconstrictive properties. Clinically, these actions correspond to decreased edema, erythema, pruritus, plaque formation, and scaling of the affected skin. Pharmacokinetics Approximately 3% is absorbed during an 8-hr period. Metabolized in the liver. Excreted in the urine. 

The majority of clinically definite and immunologically confirmed reactions have erythema as a main feature. Erythema is, however, a common accompaniment to the administration of many drugs, often as a result of directly mediated histamine release, and it should not be regarded as part of a life-threatening reaction unless there are changes in other systems of the body. In addition, most reactors have oedema, particularly of the eyelids. 

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