MyMedR

Erythema Nodosum Leprosum (ENL) or Type II reaction is an immune complex syndrome seen in multibacillary leprosy. 20 patients with histological confirmation of ENL in leprosy were studied from 1982 to 1986. These patients had a range of clinical signs, from fever, tender dusky nodules, bullae, ulcers to lymphadenopathy, arthralgia and neuritis. The four major histological patterns are: a) classical pattern showing heavy infiltrations of neutrophils in three cases, b) sub-epidermal bulla pattern with marked oedema of the upper dermis, and collections of neutrophils in five cases, c) vasculitis pattern, affecting superficial and mid-dermal vessels, leading to epidermal necrosis, bulla formation and ulceration. Dilated vessels, congestion, lumenal fibrin clots and fibrinoid necrosis of vessels were seen, d) non-specific picture in nine cases with mild oedema, infiltration with neutrophils, and two cases with minimal reaction had chronic ENL with clinical vasculitis. All the five cases with vasculitis showed C1q, C3 and fibrinogen in the vessels. Comparing ENL reactions reported in Asia, our pattern is similar to that of Malaysians with the majority showing sub-epidermal oedema. Vasculitis is more common in India. Oedema with collagen necrosis as seen in acute ENL with iritis in New Guinea. The Lucio's phenomenon was not seen in any of the countries in Asia.

Matched MeSH terms: Erythema Nodosum/pathology*

Fulltext Erythema nodosum leprosum in Malaysians

Jayalakshmi P, Ganesapillai T, Ganesan J

Int. J. Lepr. Other Mycobact. Dis., 1995 Mar;63(1):109-11.

PMID: 7730709

Matched MeSH terms: Erythema Nodosum/pathology*

Assessment of skin types, skin colours and cutaneous responses to ultraviolet radiation in an Asian population

Wee LK, Chong TK, Quee DK

Photodermatol Photoimmunol Photomed, 1997 Oct-Dec;13(5-6):169-72.

PMID: 9542751

Ninety normal individuals were included in this study on skin types, skin colours and cutaneous responses to ultraviolet radiation. Skin types were recorded using Fitzpatrick's classification, skin colours were measured using the Minolta Chromameter CR-300, and cutaneous responses to UV radiation were measured in terms of minimal erythema dose (MED) to UVA, UVB and the immediate pigment darkening dose to UVA (IPDDA). Skin colour measurements were taken from the right cheek to represent facultative skin colours, and from the buttock to represent constitutive skin colours. The colours measured were expressed by the L x a x b colour space. Skin types and some colour parameters (L and b from covered parts of body) correlated fairly well with the minimal erythema doses (MED) to UVA and UVB. Skin colour measurements are more objective than skin type assessment and could be better markers of photosensitivity. However, there is still considerable overlap in MEDs for persons with different skin colours, and further studies of these parameters are warranted. Our MEDs are higher than other reports on similar skin types and skin colours. This could be due to differences in methodology, genetic make-up or acclimatization from chronic sun exposure. This illustrates the importance of local controls for each institution dealing with photosensitive disorders.

Matched MeSH terms: Erythema/etiology; Erythema/pathology

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in northeastern Malaysia

Kamaliah MD, Zainal D, Mokhtar N, Nazmi N

Int J Dermatol, 1998 Jul;37(7):520-3.

PMID: 9679693

BACKGROUND: Previous studies have reported that drugs and infections are common causes of erythema multiforme (EM) and Stevens-Johnson syndrome (SJS). Toxic epidermal necrolysis (TEN) is mainly related to drugs. No study has been conducted in Kelantan, the northeastern state of Malaysia, to assess these cutaneous reactions.

METHODS: A retrospective study of all hospitalized cases of EM, SJS, and TEN was conducted covering an 8-year period from 1987 to 1994.

RESULTS: There were four cases (13.8%) of EM, 22 cases (75.9%) of SJS, and three cases (10.3%) of TEN. Drugs as a definitive cause was observed in one case (25%) of EM, 12 cases (54.5%) of SJS, and two cases (66.7%) of TEN. Drugs as a probable cause was observed in seven cases (31.8%) of SJS and one case (33.3%) of TEN. The male to female ratio was equal in EM and SJS. Antiepileptics were the commonest culprits, followed by antibiotics. One patient died of SJS and one patient died of TEN, giving mortality rates of 4.5% and 33.5% respectively. Fever was noted in 18 patients (62.1%). Leukocytosis was noted in 10 patients (34.5%), and nine patients (31.0%) had elevated liver transaminase enzymes. No significant correlation was noted between these biochemical changes and cutaneous eruption. Secondary infections were observed in 11 patients (37.9%): Staphylococcus aureus was the commonest isolated organism.

CONCLUSIONS: This study shows that drugs remain the commonest culprit in SJS and TEN. Despite adequate treatment, the mortality rate remains high, especially in TEN. These findings are similar to those of other reported studies.

Matched MeSH terms: Erythema Multiforme/chemically induced; Erythema Multiforme/drug therapy; Erythema Multiforme/epidemiology*

Influence of Inlet Air Temperature and Feed Flow Rate on the Physical Properties of Spray-dried Mengkudu (Morinda citrifolia) Extract

Mohamad Yusof Maskat, Lee LY

Sains Malaysiana, 2004;33.

Due to the increase in consumer interest, mengkudu (Morinda citrifolia) extract is being produced in several forms including dry powder. One of the methods that can be used to produce dry powder is spray drying. This study was done to determine the physical properties of powdered mengkudu extract produced by spray drying from different sections of the spray-dryer. Mengkudu extract at 50% (v/v) dilution was spray-dried using two levels of feed flow rate (350 mL/hr and 475 mL/hr) and inlet air temperature (170oC and 190oC). Spray dried mengkudu extract from the cyclone and colletion sections of the spray dryer was collected and analyzed for amount produced, moisture content and colour. No significant interaction between feed flow rate and inlet air temperature used was observed for all parameters measured. Inlet temperature used did not show any significant effect on amount of production. However, increasing the inlet air temperature from 170oC to 190oC did produce lower moisture content for samples from the cyclone but no significant difference for samples from the collection bottle, while lowering the degree of redness of samples from the collection bottle, while lowering the degree of brightness for samples from both cyclone and collection sections of the spray-dryer. Feed flow rate used did not produce any significant effect on all parameters measured.

Matched MeSH terms: Erythema

Fulltext Two years review of cutaneous adverse drug reaction from first line anti-tuberculous drugs

Tan WC, Ong CK, Kang SC, Razak MA

Med J Malaysia, 2007 Jun;62(2):143-6.

PMID: 18705448 MyJurnal

First line Anti-TB therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol/streptomycin is very effective. However, major adverse reactions to antituberculous drugs can cause significant morbidity and mortality. Cutaneous adverse drug reaction (CADR) is one of the commonly observed major adverse events. This retrospective study looked at the cases of TB treated in Respiratory Unit, Penang Hospital from January 2004 to December 2005. Of 820 patients treated for active TB, 47 patients (25 females; 22 males) developed CADR (5.7%). CADRs observed include morbiliform rash (72.3%), erythema multiforme syndrome (8.5%), urticaria (8.5%) and others (which include exfoliative dermatitis and lichenoid eruption). Ninety-seven percent of events occurred within two months after the initial dose. Incidence rate of CADR among the first line anti-TB drugs, pyrazinamide was the commonest offending drug (2.38%), followed by streptomycin (1.45%), ethambutol (1.44%), rifampicin (1.23%) and isoniazid (0.98%). Various clinical characteristics of patients with CADR identified include Human Immunodeficiency Virus (HIV) infection (27.7%), polypharmacy (21.3%), elderly (19.1%), autoimmune disorders (6.4%), pre-existing renal impairment (4.3%), pre-existing liver disorders (4.3%). In conclusion, CADR is common and majority of cases occurred within two months after initiation of anti-TB treatment, particularly in HIV infected patients. Pyrazinamide is the commonest offending drug.

Matched MeSH terms: Erythema/chemically induced

Fulltext A 'target' skin lesion

Loh KY

Aust Fam Physician, 2008 Nov;37(11):946.

PMID: 19037470

A boy, 12 years of age, was being treated for pneumonia. The cold haemagglutination test was positive for Mycoplasma pneumoniae. He developed an isolated asymptomatic skin lesion on his lower limb which disappeared completely after 1 week.

Matched MeSH terms: Erythema Multiforme/diagnosis*; Erythema Multiforme/etiology; Erythema Multiforme/physiopathology

Method optimization on the use of postocclusive hyperemia model to assess microvascular function

Yvonne-Tee GB, Rasool AH, Halim AS, Wong AR, Rahman AR

Clin. Hemorheol. Microcirc., 2008;38(2):119-33.

PMID: 18198413

Recent development had allowed non-invasive assessment of microvascular function in vivo; however, the method has not been fully optimized and standardized. In this study, we aimed to characterize the "effective" occlusion duration needed to elicit sufficient postocclusive hyperemia (PORH) responses in forearm skin using laser Doppler fluximetry (LDF), in subjects with differing age, gender and menstrual phases.

Matched MeSH terms: Erythema/etiology

Lucio's phenomenon: a report of three cases seen in Johor, Malaysia

Choon SE, Tey KE

Int J Dermatol, 2009 Sep;48(9):984-8.

PMID: 19702985 DOI: 10.1111/j.1365-4632.2009.04078.x

Lucio's phenomenon is a rare and aggressive necrotising variant of erythema nodosum leprosum that classically occur in patients with undiagnosed, diffuse non-nodular lepromatous leprosy. It is a potentially fatal leprosy reaction characterised by extensive, bizarrely-shaped, painful purpuric skin lesions and ulcerations. Lucio's phenomenon is very rarely reported outside of Mexico and Costa Rica.

Matched MeSH terms: Erythema Nodosum/pathology*

Objective assessment of psoriasis erythema for PASI scoring

Ahmad Fadzil MH, Ihtatho D, Mohd Affandi A, Hussein SH

J Med Eng Technol, 2009;33(7):516-24.

PMID: 19639508 DOI: 10.1080/07434610902744074

Skin colour is vital information in dermatological diagnosis as it reflects the pathological condition beneath the skin. It is commonly used to indicate the extent of diseases such as psoriasis, which is indicated by the appearance of red plaques. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, the current gold standard method, PASI (Psoriasis Area and Severity Index), is used to determine severity of psoriasis lesion. Erythema (redness) is one parameter in PASI and this condition is assessed visually, thus leading to subjective and inconsistent results. Current methods or instruments that assess erythema have limitations, such as being able to measure erythema well for low pigmented skin (fair skin) but not for highly pigmented skin (dark skin) or vice versa. In this work, we proposed an objective assessment of psoriasis erythema for PASI scoring for different (low to highly pigmented) skin types. The colour of psoriasis lesions are initially obtained by using a chromameter giving the values L*, a*, and b* of CIELAB colour space. The L* value is used to classify skin into three categories: low, medium and highly pigmented skin. The lightness difference (DeltaL*), hue difference (Deltah(ab)), chroma (DeltaC*(ab)) between lesions and the surrounding normal skin are calculated and analysed. It is found that the erythema score of a lesion can be distinguished by their Deltah(ab) value within a particular skin type group. References of lesion with different scores are obtained from the selected lesions by two dermatologists. Results based on 38 lesions from 22 patients with various level of skin pigmentation show that PASI erythema score for different skin types i.e. low (fair skin) to highly pigmented (dark skin) skin types can be determined objectively and consistent with dermatology scoring.

Matched MeSH terms: Erythema/pathology*

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