Erythema multiforme and persistent erythema as early cutaneous manifestations of Lyme disease.

We report two cases of borreliosis (Lyme disease) with unusual cutaneous manifestations, erythema multiforme, and persistent erythema. The lesions in both of our patients had distinctive histopathologic features. To our knowledge, this is the first report of erythema multiforme and persistent erythema as early cutaneous manifestations of Lyme disease.

Growth dynamics of the cricoid cartilage and subglottic injury. An autoradiographic and histometric study in the rabbit.

Earlier studies in young growing rabbits have suggested that post-traumatic developmental deformities of the cricoid might play a role in failing treatment in children with similar injuries. Specific patterns of malformations in the animals occurred preferentially at the anterior side of the cricoid ring. In this study, the growth dynamics of the cricoid were studied by histometry and autoradiography. Results indicated that (1) the cell/matrix ratio remains unchanged from 4 to 24 weeks of age, with both tissue components thus contributing equally to growth of the cricoid; (2) mitoses occur in cartilage and perichondrium, indicating interstitial as well as appositional growth; (3) mitotic activity is mainly restricted to the first 4 weeks of life, while cell hypertrophy is thereafter the dominant feature; (4) the highest degree of mitotic activity and cell hypertrophy is found in the anterior half of the cricoid ring which therefore can be considered as a growth center. This center might play a role in the development of trauma-induced deformation in the anterior part of the cricoid ring.

Oral manifestations of gold allergy.

BACKGROUND: Sensitization to gold in a large group of patients suspected of clinical allergy to this metal has not been reported. OBJECTIVE: Two hundred patients with symptoms of persistent oral mucosal or cutaneous lesions that were possibly related to allergy to constituents of gold alloys or gold jewelry were patch tested to determine the frequency of sensitization. METHODS: Patch testing was performed with the European standard series and a series of dental materials including three different salts of gold. A persistent papular reaction to gold-(tri)chloride was considered a positive reaction. RESULTS: In 17 patients (8.5%, all women, mean age 50.2 years) persistent papular patch test reactions to both 0.5% and 1.0% gold(tri)chloride were observed. In five of seven patients with oral lichen planus (OLP) and in one of six patients with the burning mouth syndrome, gold in the dentures was replaced. Particularly in patients with OLP, a significant but variable improvement was observed. In all cases in which gold was replaced and improvement occurred, the patients were sensitized to 0.5% gold(tri)chloride. One patient with allergic contact stomatitis and one patient with allergic contact dermatitis healed completely after gold had been replaced. CONCLUSION: Sensitization to gold should be considered as a possible cause of allergic contact dermatitis and allergic contact stomatitis as well as a pathogenic or triggering factor in OLP.

[Amalgam. VI. Allergy to mercury in dental materials; oral and systemic reactions]. / Amalgaam. VI. Allergie voor kwik in tandheelkundig materiaal; orale en systemische reacties.

Allergy for mercury in dental alloys can be responsible for the induction of allergic contact stomatitis. Evidence is also available for a role of mercury sensitization in the pathogenicity of oral lichen planus in particular. Aspects related to the development of allergic processes in the oral cavity are summarized. Allergy for mercury as the cause of oral mucosal reactions is rather rare in spite of the frequent use in dental amalgam, but probably underestimation of the incidence should be considered. Recent views with respect to the role of mercury as allergen in allergic contact stomatitis, oral lichen planus, the so-called Burning mouth syndrome and in systemic allergic reactions are summarized. Immunologic aspects in the pathogenesis are briefly discussed. Especially in cases in which the site or oral lesions is opposite to the dental alloy it is important to establish sensitization for mercury by use of epicutaneous path testing. When a positive test to mercury is obtained replacement of mercury containing alloys should be considered.

[Parapemphigus and variants; clinical and immunological aspects]. / Parapemphigus en varianten; klinische en immunologische aspecten.

The clinical, histopathological and immunological findings and therapeutic data of 29 patients with different variants of pemphigoid seen by us in the period 1981-1988 are summarized. All 29 patients: disseminated or bullous pemphigoid (20 cases), localized pemphigoid (3 cases), cicatricial pemphigoid (2 cases), juvenile pemphigoid (2 cases), papular pemphigoid (1 case) and pemphigus vegetans (1 case) showed as common denominators subepidermal blister formation and linear deposition of Ig (IgG) and complement in the basement membrane zone. In nearly all the cases with disseminated pemphigoid treatment with immunosuppressive drugs orally was indicated. With particular reference to the age of patients in this subgroup (mean age greater than 70 years) aspects inherent to the treatment are briefly discussed. In contrast to the (relatively) benign course of the disease in localized pemphigoid and in juvenile pemphigoid, cicatricial pemphigoid with mucosal localization appears to be a variant within the spectrum of pemphigoid with severe complications due to tissue retraction and loss of local function.