Erythromycin versus cefadroxil in the treatment of skin infections.

Erythromycin is often overlooked for the treatment of skin and skin structure infections. We evaluated the efficacy and safety of erythromycin particles in tablets and of cefadroxil in 164 patients with skin infections; both treatments were given as 500 mg twice daily. One hundred percent of erythromycin and 96% of cefadroxil patients were clinically cured or improved, and 98% of susceptible pathogens were eradicated in both groups. Only three erythromycin patients and one cefadroxil patient left the study early because of GI-related adverse events. Erythromycin, therefore, was as effective and safe as cefadroxil in the treatment of mild-to-moderate skin infections.

Allergic contact dermatitis from Stomadhesive paste.

A woman developed dermatitis from Stomadhesive paste used to secure her colostomy appliance. Patch testing revealed that she was allergic to Gantrez (N-butylmonoester of polymethyl vinyl ether maleic acid in an ethanol solution), a water soluble copolymer with stabilizing properties used in the production of Stomadhesive.

Cyclic AMP-phosphodiesterase activity and histamine release in cord blood leukocyte preparations.

Atopic dermatitis, allergic rhinitis and asthma are a common group of diseases with a familial predisposition. At present there is no suitable predictive or diagnostic marker. Adults with atopic dermatitis or allergic respiratory disease have elevated mononuclear leukocyte cAMP-phosphodiesterase activity. This activity correlates closely with histamine release from basophils. We investigated newborn leukocyte phosphodiesterase activity and histamine release in umbilical cord blood. Phosphodiesterase activity was significantly elevated in cord blood leukocytes of 81 children with a positive history of atopy in first degree relatives, compared to 33 children with a negative history (p less than 0.025). In contrast to adults there was no correlation between phosphodiesterase activity and histamine release. Our studies suggest that elevated phosphodiesterase activity is a primary, genetically linked defect. Fetal basophils would appear to possess cytophilic IgE since they are capable of immunologically stimulated histamine release even without passive, in vitro IgE sensitization. In addition, there are functional differences between adult and cord blood basophils. Longitudinal studies may determine if elevated phosphodiesterase is predictive of atopic states.

Elevated umbilical cord blood leukocyte cyclic adenosine monophosphate-phosphodiesterase activity in children with atopic parents.

We found cyclic adenosine monophosphate-phosphodiesterase (cAMP-PDE) activity to be significantly elevated in the umbilical cord blood mononuclear leukocytes of forty-two children with one atopic parent (3.2 +/- 0.3) and in eighteen children with two atopic parents (4.2 +/- 0.7) as compared to twenty-two children with two nonatopic parents (1.9 +/- 0.2) (p less than 0.005). Among those newborns with one atopic parent, mean PDE activities were significantly elevated in cord blood cells regardless of whether only the father was atopic, thus eliminating the possibility of transplacental enzyme passage. Follow-up evaluations of twenty-four children, age 6 months or older, suggest that infants with elevated PDE activity at birth have an increased likelihood of developing dermatitis and/or "atopic features." Further long-term studies will determine the predictive value of newborn mononuclear leukocyte PDE activity.

"Recurrent herpes zoster": an unproved entity?

Physicians sometimes misdiagnose recurrent zosteriform herpes simplex virus (HSV) skin infections as "zoster" or "recurrent zoster." Misdiagnosis can lead to inappropriate therapy with potentially harmful consequences, particularly in patients with ophthalmitis or immunosuppression, in which early institution of the correct antiviral therapy may be crucial. We report three patients who were originally misdiagnosed to have recurrent herpes zoster skin infections before we cultured HSV from their vesicles. We suggest: (1) that most recurrent zosteriform eruptions are caused by HSV; (2) that "recurrent zoster" has yet to be documented; and (3) that the diagnosis of "recurrent zoster" be reserved for those patients who have laboratory confirmation of recurrent varicella zoster (VZ). Viral culture or examination of vesicle contents by indirect immunofluorescent technic can provide definitive diagnosis of the etiology of a zosteriform eruption.

Aleukemic leukemia cutis: juvenile chronic granulocytic leukemia presenting with figurate cutaneous lesions.

We report a 3 1/2-year-old girl who developed a figurate cutaneous eruption. Distinctive findings in her skin biopsies, as well as unusual red cell characteristics, in the presence of a normal peripheral smear and bone marrow biopsy, led us to suspect the diagnosis of preleukemic juvenile type chronic granulocytic leukemia. This is the first case we know of in which this diagnosis was suspected prior to abnormal findings in the peripheral smear or bone marrow.

Phytophotodermatitis due to Ruta graveolens.

We report phytophotodermatitis in a 5-year-old boy, his 6-year-old sister and his mother, evoked by their handling common rue (Ruta graveolens), a plant which contains psoralens. Psoralens are photoactive chemicals which, when rubbed on the skin, react with sunlight to produce erythema, hyperpigmentation and blistering. Phytophotodermatitis is an uncommon cause of such ill-effects, in children.

Allergic contact dermatitis from dodecyl maleamic acid in Curad adhesive plastic bandages.

Two patients, who developed eczematous eruptions beneath Curad-brand medical adhesive plastic bandages, were found to have allergic contact dermatitis to N-dodecyl maleamic acid. N-dodecyl maleamic acid is a monomer used in the production of the adhesive in Curad bandages. Our patients were also sensitive to several closely related chemical compounds. We discuss the chemical requisite for allergenicity of these compounds. These are the first documented cases of allergic contact dermatitis from dodecyl maleamic acid.

Perforating folliculitis of hemodialysis.

Three patients developed perforating skin lesions on the legs shortly after beginning hemodialysis for chronic renal failure. All had long-standing insulin-dependent diabetes mellitus and all three were white. The skin disease was refractory to all attempts at management. In one patient, however, the eruption cleared completely when hemodialysis was stopped in favor of a renal allograft transplanted from a cadaver. Clinically and histologically, some of the lesions showed evidence of prurigo nodularis, a consequence of vigorous rubbing of a discrete focus.