Psoriasis-like skin reaction in a patient with rheumatoid arthritis after sulphasalazine therapy.

Presented is a case story of a woman with classical rheumatoid arthritis, who during introduction of sulphasalazine (SASP) therapy developed a severe and lasting psoriasis-like skin reaction.

Oral mucosal lesions related to silver amalgam restorations.

A total of 49 consecutive patients with lesions of the oral mucosa that were in contact with corroding dental amalgam restorations were subdivided into two groups. In group 1 the lesions were restricted to the contact area opposing the dental restoration, whereas the extent of the lesions in group 2 exceeded that of the contact area. Epicutaneous test for mercury allergy showed that a significantly greater proportion of the patients in group 1 had positive reactions to mercury than in group 2 (p = 0.019). The amalgam restorations were replaced by composite resin or porcelain fused to gold crowns, or contact between amalgam fillings and oral mucosa was prevented by an acrylic splint. After this treatment regression of lesions was far more pronounced in group 1 than in group 2 (p less than 0.001). On the basis of these findings, contact allergy to mercury is suggested as a possible etiologic factor of the mucosal changes in group 1, and the designation contact lesion is proposed for such lesions. The lesions of patients in group 2 seem unrelated to a contact allergy to mercury, and other causes such as lichen planus should be considered.

Itraconazole in onychomycosis. Open and double-blind studies.

Fifteen patients with onychomycosis caused by Trichophyton rubrum or T. mentagrophytes were treated with 50 mg itraconazole daily for 3 to 6 months. Fingernail infections were cured in two patients and two responded with marked improvement, e.g. small residual lesion remained and positive microscopy. The infected toenails were markedly improved in nine of 13 patients. Twenty-seven patients with T. rubrum infected nails were given 100 mg itraconazole daily for 6 to 8 months. Fingernails were cured in nine of eleven patients, while toenail infections were cured in one and markedly improved in 14 of 25 cases. Responses to 100 mg itraconazole versus 500 mg griseofulvin daily for 6 months were compared and evaluated in 20 patients with onychomycosis caused by T. rubrum or T. mentagrophytes. Fingernail infections responded equally well to both drugs with half of the cases cured or markedly improved, whereas toenails responded better to itraconazole, e.g. 4 of 9 were markedly improved versus one of 10 on griseofulvin. In patients given 50 mg itraconazole daily a significantly better response was observed in persons below 30 years of age compared to older individuals. Also, side-effects which were mainly mild and located to the gastro-intestinal tract or the central nervous system were seen less often in this group of patients on the low dose. Follow-up studies showed that cured nails remained cured, that markedly improved toenails continued to improve until cure in three of 21 patients but that aggravation took place through the one year of follow-up in more than half of the patients evaluated as markedly improved at the end of treatment.

Hepatosplenomegaly in infectious mononucleosis, assessed by ultrasonic scanning.

The present study aims at an assessment of hepato-splenomegaly in infectious mononucleosis (IM). In 29 patients admitted to the ENT department with IM, based on the typical clinical and laboratory findings, including a positive mononucleosis test in most cases, the size of the liver and spleen was estimated by ultrasonic scanning on days 1, 3, 5, 10, 20, 30, 90 and 120 after admission. A control group of eight patients with peritonsillar abscess was included for comparison. The results showed that all patients had an enlarged spleen (mean enlargement: 50-60 per cent) but only a few were palpable. Half of the patients had enlargement of the liver (5-20 per cent), which was palpable in only 8 per cent. There was no correlation between the size of the spleen and that of the liver, not between the changes in the size of these organs. There was no enlargement of the liver or spleen in the control group. No correlation was found between the size, or changes in the size, of the organs and blood values such as lactatdehydrogenase and aspartatamino-transferase. There is, however, a striking parallelism between the curves for these parameters, which might indicate that the organs as well as the blood tests return to normal within 28 days. If this holds true, our warning to abstain from physical exercise and alcoholic intake may be limited to a period of about 1 month.