Erythroderma in Thai patients.

Erythroderma is a clinical manifestation of dermatoses from different causes. Our objective was to determine its incidence, causes and clinicopathological features. Clinical, laboratory, and biopsy materials of 49 patients diagnosed as having erythroderma were reviewed. They were treated in our department over a 10-year period (1985 through 1994). The male-female ratio was 2:1. The mean age at diagnosis was 51.7 years. The most common causative factors were drugs (38.77%) and preexisting dermatoses (26.5%). Hepatomegaly, jaundice and abnormal liver function tests were found more commonly in the drug allergy group, while in cases with preexisting dermatoses nail involvement was a common finding. Clinicopathologic correlation in our study did not inform the etiology because it showed chronic nonspecific dermatitis or psoriasiform dermatitis, without any clue as to its origin. Drug-induced-erythroderma had an acute onset and a good prognosis with rapid resolution when the causative drug was withdrawn, while histopathology and laboratory findings were largely unrewarding.

Clinical and microbiologic findings in cellulitis in Thai patients.

BACKGROUND: Cellulitis is an inflammation of subcutaneous tissue in which infective, generally bacterial cause is proven or assumed. However, attempts to culture bacteria from lesions are often unsuccessful. METHOD: One hundred and fifty cases diagnosed as cutaneous cellulitis at Siriraj Hospital between 1992 and 1995 were retrospectively studied. RESULTS: Our study in 150 adult Thai patients with cellulitis showed that the most common site of infection was the lower extremity. Forty two per cent of the patients had history of preceding local trauma. Fever and regional lymphadenopathy were detected in 77.3 per cent and 22.6 per cent respectively. Sixty nine per cent of patients had leukocytosis with a mean neutrophil ratio of 79.7 per cent of patients with underlying diseases predisposed to the infection, 61.6 per cent had positive lesional culture results in contrast to 31.6 per cent in patients without. Needle aspiration and blood gave low positive culture yields. The common organisms detected were S.aureus and Streptococcus group A (83%) in immunocompetent patients. Of immunocompromised patients, in one half of the cases gram negative bacteria were found. CONCLUSIONS: This study showed that in immunocompetent patients, the major bacterial isolated in cellulitis were S.aureus and Streptococcus group A. In immunocompromised patients, gram negative bacteria were found in one half. These findings may help in the selection of antimicrobials before the results of bacterial cultures are available or in culture negative cases.

Jellyfish dermatitis treated by the extract of ipomea pes-caprae.

Irritant contact dermatitis caused by Jellyfish and related Coelenterates are severe reactions which usually last for a long period, even after dermatitis has subsided. There is no antidote for these toxic substance, which are toxic proteins. Ipomea pes-caprae, the creeper of the family Convolvulaceae, which is found in abundance along warm water seashores is used as a medicant for jellyfish dermatitis by Thai fisherman. The leaves are usually used as an antidote and an antipruritic agent. This study was intended to determine if this plant is an effective treatment for jellyfish dermatitis or not. An extraction from the leaves of Ipomea pes-caprae by ether was prepared in the form of 1% cream (IPA 1%), was applied topically on 12 patients with jellyfish dermatitis. Five of the subjects who had only mild, pruritic erythematous papules received IPA 1%. Within the first day of treatment, they were releaved from itching and the dermatitis disappeared within two days. Seven patients with severe erosion and ulceration of the skin because if jellyfish dermatitis received IPA 1% within 3-30 days after the initial symptoms. There was 50% improvement seen within 7 days and complete recovery within 30-45 days, leaving few hypertrophic scars. These results show that IPA 1% is a very useful and effective drug for jellyfish dermatitis, especially with early and mild coses. In severe cases, no recurrence of symptoms, something which is usually found with other forms of treatment, was observed. IPA 1% cream was found to be a mild antihistamine, anti-inflammatory and antidote for jellyfish toxin.