Skin induration

Subcutaneous interferon alfa sometimes causes local erythema and skin induration, which can be prevented by regularly changing the site of injection. Isolated reports have described more severe local reactions, with inflammatory painful nodules, purpuric papules and vasculitis, local ulceration, and injection site necrosis (SED-13 1095) (SEDA-20, 330) (SEDA-21, 372) (SEDA-22, 402). Despite previous findings, even patients receiving low-dose interferon alfa can have severe injection site reactions. A localized intradermal bullous eruption, which recurred following each interferon alfa injection, was also reported (283). 

A population pharmacokinetic study of intramuscular quinine (loading dose 20 mg/kg salt diluted 1 1 in water) in 120 Ghanaian children with severe malaria showed predictable profiles, which were within the target range for quinine (15-20 pg/ml) and independent of clinical and laboratory variables (1). Adverse events included skin induration or abscesses at the injection site (12%), all of which resolved without surgical intervention, and hypoglycemia (10%), a special risk in children who were hypoglycemic at presentation. 

The authors discussed the absence of significant skin induration and contractures secondary to severe fibrosis and the development of elastocollagenous balls and osseous metaplasia in long-standing lesions of nephrogenic systemic fibrosis [31 ]. 

Mastocytomas and diffuse cutaneous mastocytosis are further manifestations of cutaneous mastocytosis (CM) [9]. Solitary mastocytomas are common in children. Most are present at birth or develop in infancy. These lesions are flat or mildly elevated, well demarcated, solitary yellowish red-brown plaques or nodules, typically 2-5 cm in diameter. Diffuse cutaneous mastocytosis is a rare disorder characterized by diffuse mast cell infiltration of large areas of the skin that presents in infants in the first year of life. Severe edema and leathery indurations of the skin leads to accentuation of skin folds (pseudo-lichenified skin) and a peau-dbrange-like appearance. Systemic complications include hypotension and gastrointestinal hemorrhage. Infants and young children with considerable mast cell infiltration of the skin sometimes exhibit blister formation in the first 3 years of life. MPCM and other forms of CM have been classified in a consensus nomenclature (table 1) [10]. 

After 2 to 3 days of acute hemorrhagic pancreatitis, there may be a positive Turner s sign [local areas of discoloration (bruising) and induration of the skin near the umbilicus due to extravasation of blood]. 

Mild 2 Presence of at least two manifestations of inflammation (purulence or erythema, pain, tenderness, warmth or induration), but any cellulitis/erythema extends no more than 2 cm around the ulcer, and infection is limited to the skin or superficial subcutaneous tissues no other local complications or systemic illness... 

The patient was admitted and placed on respiratory isolation. Three separate sputum Gram stain specimens were reported to contain 3+ AFB. A PPD tuberculin skin test was placed. Sputum samples were sent for AFB, fungi, and bacterial cultures and sensitivities. After 48 hours, the PPD skin test was read as a 12-mm area of induration. 

Prominent skin edema, redness, warmth, and induration of the underlying tissue (inflammatory carcinoma)... 

The initial sign in more than 90% of women with breast cancer is a painless lump that is typically solitary, unilateral, solid, hard, irregular, and non-mobile. Less common initial signs are pain and nipple changes. More advanced cases present with prominent skin edema, redness, warmth, and induration. 

Cresols are also strong skin irritants in animals. All three cresol isomers, either alone or in combination, are severely irritating to rabbit skin, producing visible and irreversible tissue destruction (Vernot et al. 1977). Some cresylic acids produced induration and discoloration of the skin in rats (Campbell 1941). All reliable LOAEL values for acute dermal effects in rabbits are recorded in Table... 

Tuberculin skin testing is an important part of the care of all HIV-1-infected patients or persons at risk for HIV-1 infection. Tuberculin skin testing should be done using the Mantoux method. A tuberculin reaction of >5 mm of induration is classified as positive in persons known to have or suspected of having HIV-1 infection. Unfortunately, as the CD4 lymphocyte count declines with progression of HIV-1 disease, many patients no longer react to delayed-type hypersensitivity testing. More than 60% of persons with CD4 lymphocyte counts of <200 cells/pl may have skin test reactions of <5 mm. Thus, it is impossible to detect the presence of tuberculous infection in many HIV-l-infected individuals. 

Clinical expressions of cutaneous allergic reactions include eczematous, indurate-inflammatory, and urticarial eruptions. Irritant responses causing direct damage to the skin may be confused with allergic responses involving immune mechanisms. An important difference is that allergic reactions require an initial exposure to sensitize the individual dermatitis is then elicited by minimal subsequent exposure to the agent. 

Adverse effects include tinnitus, vertigo, leucopenia, hypokalemia, skin rash, urticaria, fever, pain and induration at injection site, excessive bleeding at injection site and abnormalities in liver function. 

Type IV Cell-mediated allergy is the mechanism involved in allergic contact dermatitis from topically applied drugs or induration of the skin at the site of an antigen injected intradermally. 

When transdermal estrogens are used there can be problems with poor adhesion and skin irritation. The latter occurs more often in hot humid weather and can rarely proceed to edema, induration, a vesicular rash, residual pigmentation, itching, and erythema (59). 

Post-phlebrtic syndrome, a complication of acute DVT is estimated to occur in approximately 4% of the population (213). This syndrome is characterized by persistent pain, edema, hyperpigmentation, induration of the skin, and stasis ulceration (214). The post-phlebrtic syndrome may be due to venous hypertension as a result of outflow obstruction or damage to the valves and in the cutaneous microcirculation may manifest as tissue hypoxia and lymphatic obstruction. Chronic venous insufficiency may lead to post-phlebetic syndrome. The syndrome may be the result of abnormalities in the superficial, the perforator, or the deep venous system. The diagnosis is purely clinical. The pharmacologic treament of post-phlebetic syndrome is rather limited, with pentoxifylline reported to improve the healing rate of skin ulcers. 

Subcutaneous administration can cause skin erythema and induration at the injection site (SEDA-16, 81). 

Lid involvement in AKC includes dermatitis, found in 62.2% of cases, as well as blepharitis, meibomianitis, trichiasis, ectropion, entropion, and madarosis. The lids may be eczematous and may appear red, indurated, and crusted. Infraorbital lid edema may cause a skin crease known as Dennie-Morgan Une. 

One unusual variant involves appljfing a transdermal preparation to the scrotum (71), a technique that has been claimed to mimic more closely the natural pattern of release of endogenous testosterone. It is not clear that appljfing it at this site has any special merit, although some work suggests that the scrotal skin is less likely than other skin areas to exhibit local reactions. Certainly topical preparations of testosterone can elicit such reactions, with pruritus and bUster-ing being common, while induration, erythema, and allergic reactions can also occasionally occur. 

Skin-test reactivity, that is induration and tissue factor generation by monocjdes, is reduced by therapeutic doses of oral anticoagulants, but Ijmphocyte transformation activity is not. This constitutes the rationale for the use of oral anticoagulants in the treatment of immune diseases characterized by fibrin deposition, such as allograft rejection and lupus nephritis (70). 

Disseminated vesiculopustular lesions, generalized and indurated erythematous papules or plaques, severe exacerbation of acne, and lenograstim-induced erythema nodosum, with recurrence on filgrastim administration, were mentioned in isolated patients (SED-13, 1116) (SEDA-20, 337). Finally, several reports convincingly involved G-CSF in exacerbations of chronic psoriasis or psoriatic arthritis, suggesting that activated neutrophils play an important role in the occurrence and propagation of skin inflammation (SEDA-21, 378) (62). 

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