Toxic epidermal necrolysis associated with acute cholestatic viral hepatitis A.

A 35-year-old man with obvious hepatitis A (HA) developed toxic epidermal necrolysis, which, we suggest, may have been a direct result of the infection with HA virus.

An oral zinc loading test in psoriasis.

Changes of zinc in body fluids were evaluated in 12 patients with extensive psoriasis and compared with those of 11 healthy volunteers, using an oral zinc loading test. Plasma zinc levels and urinary zinc excretion were measured by atomic absorption spectrophotometry. No significant difference was found between plasma zinc levels and urinary zinc excretion following an overnight fast. Both groups showed extensive increases in urinary zinc excretion following the loading test. The peak levels of plasma zinc were significantly lower in the psoriatic patients two and four hours after zinc ingestion (P less than .01 and P less than .02, respectively).

Epidermolysis bullosa herpetiformis Dowling-Meara in a large family.

A large Arab family, originating from Jerusalem, including 38 affected members (19 male and 19 female) with epidermolysis bullosa herpetiformis Dowling-Meara over four consecutive generations is described. Fourteen of 38 affected members of the family were examined clinically; their ages ranged from 2 to 35. The main clinical features were bullae, generalized, solitary, and in groups, with predilection to the skin of the palms and soles. Mild to moderate patchy hyperkeratosis of the palms and soles was found in 5 affected members of the family; their ages ranged from 2 to 7; 9 other affected adults were free. Blisters in oral mucous membranes were noted and found in summer and in periods of fever; hair, teeth, and nails were normal. Age of onset of the disease was from birth to 2 weeks. Expressivity appeared equally variable within and between sibships. Improvement was noted by progression of age from 5 to 23 years, and by some in summer and by others in winter. In contrast to previous reports, aggravation of the disease was noted during fever periods. Ultrastructural studies from a fresh blister disclosed intraepidermal blister via cytolysis of basal cell cytoplasm. The pedigree shows the transmission of an autosomal dominant gene. Affection of both consanguineous parents and their six offspring with epidermolysis bullosa herpetiformis Dowling-Meara is the most striking feature of the family--probably 25% of their offspring were homozygote.

Esophageal involvement in pemphigus vulgaris.

Eight patients with pemphigus vulgaris were examined endoscopically for esophageal involvement. Most of them (seven of eight) had gastrointestinal symptoms of various types. Four of the patients had microscopical evidence of pemphigus vulgaris involving the esophagus. Three patients were found to have other diseases in their upper gastrointestinal tract accounting for their symptoms. There was no correlation between patients symptoms and macroscopic and microscopic findings. In patients with pemphigus vulgaris, endoscopy should be performed whenever gastrointestinal complaints appear, because the approaches to therapy could differ, according to the endoscopic findings.

Treatment of leishmaniasis nodosa (oriental sore) with intralesionally injected emetine hydrochloride.

Treatment of 31 patients with a total of 50 leishmaniasis nodosa (oriental sore) lesions with intralesional injections of emetine hydrochloride led to 100% cure. The injections were given once in 15 days except in the case of one patient, who was treated once a week. The total amounts injected were: 10 to 13 mg for lesions up to 0.5 cm in size in one injection and 160 mg for the largest lesion, which covered almost the entire surface of the patient's nose, in five weekly injections.

Efficacy of rifampicin and isoniazid in cutaneous leishmaniasis.

Thirty-nine patients with cutaneous leishmaniasis caused by Leishmania major were treated with rifampicin alone or in combination with isoniazid. No significant difference was found between these two therapeutic regimens, and about half of the patients were cured 2 months from the beginning of treatment. A review of rifampicin in cutaneous leishmaniasis is attached.

Topical treatment of cutaneous leishmaniasis.

Sixty-seven patients, 19 females and 48 males, 4-66 years old, suffering from lesions of cutaneous leishmaniasis were treated topically with an ointment comprising 15% paromomycin sulfate and 12% methylbenzethonium chloride in white soft paraffin (P-ointment, U.K. patent GB117237A). After 10 days of treatment, twice daily, the lesions in 72% of the treated patients were free of parasites, 15% became free within an additional 20 days, without further treatment, and 13% failed to respond. Pigmentation developed in 18% of the treated lesions and inflammation of varying degree was associated with the treatment. These developments did not affect the clinical healing process which was generally completed in a period of 10-30 days after termination of treatment. In addition, 94% of the treated lesions healed with little or no scarring. No adverse clinical or laboratory side effects were observed except for a burning sensation at the site of treatment. Parasites isolated from patients who failed to respond to topical treatment were found to be susceptible to PR-MBCl in both in vitro infected macrophages and in vivo in experimentally infected BALB/c mice.

Cutaneous leishmaniasis: treatment with ketoconazole.

A 17-year-old boy with an eight-month history of cutaneous leishmaniasis on the left earlobe was treated with ketoconazole for a period of four weeks. The patient showed excellent improvement both clinically and protozoologically. Ketoconazole, a new imidazole bound covalently to piperazine, has been developed as a broad spectrum antimycotic agent and appears to be a good antileishmanial drug.

Kyrle's disease. Response to high-dose vitamin A.

A 60-year-old man with a twelve-year history of Kyrle's disease is presented. Twice during this period, hospitalization and a variety of topical and systemic medications had resulted in little improvement. Recently, following the confirmation of the diagnosis, megadose vitamin A orally resulted in the resolution of most of the lesions. The amount of vitamin A was gradually reduced, and therapy was continued with a combination of vitamin A and vitamin E (dl-alpha-tocopheryl acetate).

Rifampicin treatment of cutaneous leishmaniasis.

In a small-scale preliminary trial of oral rifampicin treatment was considered successful in six out of eight cutaneous leishmaniasis patients and probably effective in a seventh. The in vitro effect of rifampicin on leishmania organisms concerns inhibition of mitochondrial function or replication. The need for protozoological control in the assessment of treatment is stressed.