Inflammation of actinic keratoses from systemic chemotherapy

Seven patients receiving systemic chemotherapy for solid tumors developed an erythematous papulosquamous eruption resembling a drug eruption in sun-exposed areas. Careful examination revealed that the lesions were actually inflamed actinic keratoses. Biopsies of typical lesions in three of the patients confirmed this clinical impression. While one patient was receiving systemic 5-fluorouracil alone, and three were receiving 5-fluorouracil and cisplatin, three others developed inflammatory flares of actinic keratoses while receiving other chemotherapeutic drugs. One patient received doxorubicin and vincristine, one received doxorubicin alone, and one received the combination of dactinomycin, vincristine, and decarbazine. Since this phenomenon appears to be due to the effect of chemotherapy on the atypical keratinocytes present in actinic keratoses, discontinuation of the chemotherapy is not indicated in this situation.

Glucan-induced keratoderma in acquired immunodeficiency syndrome

Six of 20 patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex receiving intravenous infusions of soluble glucan (beta-1-3 polyglucose) developed a keratoderma of the palms and soles. The eruption began during the first two weeks of therapy and resolved two to four weeks after its discontinuation. The eruption was different in appearance from our previously reported keratoderma blennorrhagica in AIDS-associated psoriasis. None of the other 735 patients with AIDS or AIDS-related complex not treated with soluble glucan developed a similar keratoderma. The correlation between receiving glucan and the hyperkeratosis is highly significant. Since glucan is a naturally occurring component of the cell walls of yeast, fungus, and some bacterial organisms, recognition of its ability to induce such a striking reaction pattern may be of general significance and interest, although the reaction itself may be limited to patients with AIDS.

A frequent polymorphism of the complement component C4 gene

Images

Oral acyclovir for the prevention of herpes-associated erythema multiforme

Herpes simplex virus is the single most common precipitator of erythema multiforme. Typically, erythema multiforme lesions appear 10 to 14 days after a recurrent herpes simplex virus infection and attacks can be disabling when they occur at frequent intervals. Prior to the introduction of acyclovir (Zovirax), there was no effective therapy to prevent herpes-associated erythema multiforme. Four patients were treated with a maintenance dose of acyclovir for periods ranging from 10 to 26 months; there were no significant side effects from the drug and only one recurrence of erythema multiforme. Oral acyclovir may become the treatment of choice for herpes-associated erythema multiforme.

Reactive annular erythema after intramuscular vitamin K

We present a case of a 70-year-old woman who received multiple intramuscular vitamin K injections before undergoing an invasive diagnostic procedure. Four weeks later she noted enlarging annular erythematous plaques at the sites of each injection. Although this occurrence has been recognized in the European literature, it either occurs less frequently in the United States or is not commonly reported. This is the second case report in the English literature.

A double-blind study of prazosin in the treatment of Raynaud's phenomenon in scleroderma

Nineteen patients with Raynaud's phenomenon in conjunction with progressive systemic sclerosis were given either prazosin hydrochloride (1 mg orally three times a day) or a placebo for eight weeks, after which the treatment procedure was reversed for four weeks. Prazosin was shown to be effective in reducing both the frequency and the severity of vasospasm reported by the patients.

Intra-arterial reserpine for Raynaud's syndrome. Systemic reactions without therapeutic benefit

Twenty-four patients classified as having Raynaud's disease or Raynaud's phenomenon were given bilateral brachial artery injections of reserpine or saline in a double-blind fashion. In the six weeks following injection, there was no indication that reserpine produced clinical improvement or changed vasomotor reactivity in the treated patients. However, intra-arterial reserpine did produce systemic cardiovascular effects lasting up to six weeks. It is concluded that intra-arterial reserpine as used in this study is an ineffective treatment for Raynaud's disease or Raynaud's phenomenon and may have significant adverse effects.

HLA-B15 association with erythema multiforme

Erythema multiforme (EM) is a cutaneous reaction pattern which follows numerous infections, drugs, neoplastic and inflammatory disorders in some individuals. We undertook a prospective study of thirty-eight HLA specificities of the -A, -B, and -C series in 16 Caucasian patients with EM and in 140 local Caucasian controls. Seven of 16 patients (44%) with EM and 5 of 9 patients (55%) with EM following herpes simplex infections possessed the HLA-B15 antigen, compared to 7% of local controls and 11.6% of the 1980 WHO Workshop Caucasian controls. Both associations were highly significant (p = 0.0125 and p = 0.02) when corrected for 38 HLA antigens. This is the first reported HLA association for erythema multiforme, a disease which may be a host-specific immune response to various antigens, determined in part by genes linked to HLA-B15.

Neuroendocrine response to cold in Raynaud's syndrome

Eleven patients with Raynaud's syndrome accompanied by monospecific IgG ANA, nine patients with Raynaud's syndrome in the absence of ANA, and nine normal volunteers were exposed to an ambient cold challenge during which time venous blood was continuously sampled. ANA negative patients were shown to have significantly higher levels of cortisol during a cold challenge than either ANA positive patients or normal controls, and exhibited significantly lower levels of plasma norepinephrine compared with normal controls. ANA positive patients did not differ significantly from normals in their neuroendocrine response to cold. It is suggested that the high plasma cortisol found in Raynaud's syndrome in the absence of ANA may be responsible for the vasospasticity in this group of patients.

Approach to the study of the role of sex hormones in autoimmunity

Investigators from this laboratory have been studying sex hormones in normal and autoimmune mice for the past 10 years. We have found that immune responses to DNa are influenced by sex hormones. Androgens reduce and estrogens increase both spontaneous and immunization-induced antibodies to single-stranded DNA in NZB X NZW, NZB X C3H, NZB X CBA, NZB X DBA mice. Treatment of female NZB/W mice with testosterone or 5 alpha dihydrotestosterone retards the progress of autoimmunity. Castration is not necessary for this effect. In contrast, danazol has no favorable effect on the disease process. Estrogens cause a marked acceleration of autoimmunity and a reduction in thymus weight. During the course of these studies, we found that a number of problems or variables arise in studying sex hormone effects, including: 1) X-linked genes, 2) metabolism of testosterone to estrogens, 3) dose of hormone, 4) age at which administration is initiated, 5) differential effects of sex hormones on different autoantibodies and various immune responses.

Effect of the anti-estrogen, Nafoxidine, on NZB/W autoimmune disease

Treatment of female NZB/W F1 mice with Nafoxidine, an anti-estrogen, led to delayed manifestation of autoimmune features. Such treated mice had reduced anti-DNA antibodies, reduced proteinuria, and improved survival. These results support the hypothesis that sex hormones play an important role in the expression of autoimmunity and suggest that estrogens may accelerate autoimmunity in NZB/W F1 mice.