Bullous erysipelas: A retrospective study of 26 patients.

BACKGROUND: Erysipelas is a superficial form of cellulitis caused by a variety of microbes, and it responds to antibiotic treatment. During the past few years we treated several patients with a bullous form of erysipelas involving the lower legs. We believe their disease had a more protracted course than patients with nonbullous erysipelas. OBJECTIVE: We studied bullous erysipelas by conducting a retrospective analysis of 26 patients with bullous erysipelas of the legs treated by the authors during a 5-year period. METHODS: We conducted a retrospective review of the records of all patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, Hadassah Medical Center, Jerusalem, between the years 1992 and 1996. Data regarding patients with nonbullous erysipelas were obtained from the medical center's computerized data pool. RESULTS: A total of 26 cases of bullous erysipelas were found, comprising 22 women and 4 men whose ages ranged from 28 to 87 (mean, 58.8) years. The average hospital stay was 20.57 days (range, 12 to 46 days). The average hospital stay for patients with nonbullous erysipelas and cellulitis treated in the same department by the authors during the study period was 10.6 days (range, 2 to 54 days). CONCLUSION: Bulla formation is a complication of erysipelas, seen in our series in 5.2% of the patients (26 of 498 admissions for erysipelas and cellulitis). The course of the disease is protracted, requiring longer medical attention.

Porokeratosis of Mibelli. Overview and review of the literature.

Porokeratosis of Mibelli is an uncommon dermatosis, which may be associated with immunosuppression and may undergo malignant transformation. Due to the wide range of clinical presentations, numerous classifications have evolved, resulting in some confusion. This article examines the classification and presentation of porokeratosis and, in particular, reviews the association with immunosuppression.

Acro-angiodermatitis: review of the literature and report of a case.

Acro-angiodermatitis is a very common disorder, with a close clinical, anatomical and morphological resemblance to Kaposi's sarcoma. Several types of this disorder can be found in different settings. However, these conditions are often misdiagnosed and therefore mistreated. A review of the literature and a classification of all types of acro-angiodermatitis are presented. We also describe a case of a patient with acro-angiodermatitis which completely regressed following a course of dapsone combined with leg elevation and elastic support stockings.

Disseminated sporotrichosis.

The clinical manifestations of sporotrichosis can be classified into three disease patterns: (1) localized lymphatic sporotrichosis, (2) fixed cutaneous (or endemic) sporotrichosis, and (3) disseminated sporotrichosis. This presentation reflects a rare disseminated form of the disease with extensive cutaneous and systemic lesions, and further illustrates the difficulty in diagnosing systemic sporotrichosis infection.

Multicentric pigmented Bowen's disease. A report of 2 cases.

Multicentric pigmented Bowen's disease is a rare form of intra-epidermal carcinoma characterised by its pigmented appearance as well as its confinement to the perineal region. Two examples of this disease are presented, illustrating the classic features of this disorder.

Verrucous Bowen's disease in a black patient. A case report.

A rare verrucous form of Bowen's disease in a black subject is presented. Bowen's disease is extremely rare in blacks, but when it does occur, it tends to present in an atypical fashion.

Atypical Kyrle's disease.

Atypical Kyrle's disease developed on the limbs and on the palmar and plantar surfaces of an African man. Unusual histopathologic features, such as degenerating cells under the parakeratotic plug and eccrine duct in the parakeratotic plug, are described and the diagnostic criteria for Kyrle's disease are reviewed.

Elastosis perforans serpiginosa in a patient with renal disease.

We encountered a case of elastosis perforans serpiginosa in a patient with coexisting renal disease, the first such reported association of which we are aware. The perforating disorders tend to have atypical clinical features when associated with renal disease. The exact pathogenic mechanism by which renal disease predisposes to a perforating disease remains to be elucidated but is likely to be related to minor trauma, which occurs in renal disease.

Beta adrenergic blocking agents to control hypertension in aviation personnel.

Beta adrenergic receptor blocking agents were used in the treatment of 15 hypertensive aircrew who had failed to respond to thiazide diuretics. Atenolol (Tenormin) resulted in adequate control of blood pressure in all subjects. Side effects were minimal and insignificant. It is recommended that a cardio-selective, water-soluble beta blocker, such as atenolol, be made available to selected hypertensive aircrew.

Reciprocating tachycardia with only odd-numbered beats in the Wolff-Parkinson-White syndrome.

A case of Wolff-Parkinson-White syndrome with reciprocating tachycardia from retrograde Kent's bundle conduction is described. The paroxysms of reciprocating tachycardia manifested with the unusual, and hitherto unreported, feature of only odd-numbered beats. The phenomenon is explained on the basis of alternate anterograde conduction through two A-V nodal pathways.

Lorcainide -- an anti-arrhythmic agent for ventricular arrhythmias.

The long-term anti-arrhythmic efficacy of lorcainide (R15 889) was studied in 20 ambulatory postmyocardial infarction patients. Lorcainide reduced the frequency of ventricular ectopic beats by more than 70% and 90% in 17 and 11 of the patients respectively. The anti-arrhythmic response improved with long-term administration of the drug. Fourteen patients complained of insomnia during the early stages of the study, but this side-effect waned later on. On electrocardiographic examination, the P-R interval, QTc interval and QRS duration were prolonged, and T-wave changes were noted while the patients were receiving lorcainide. Lorcainide seems to be a useful addition to the available anti-arrhythmic agents, and should form part of the armamentarium against ventricular ectopic activity.

The efficacy of sotalol in suppressing ventricular ectopic beats.

Sotalol (Sotacor) is a beta-adrenergic receptor blocking agent, which in addition possesses class III anti-arrhythmic properties. In this study we report on the clinical effectiveness of sotalol in the suppression of ventricular ectopic beats in 20 patients suffering from ischaemic heart disease. Sotalol was compared with placebo and efficacy was determined by Holter tape monitoring. Sotalol produced an 88,5% (P < 0,001) reduction in ectopic beat frequency at the optimal titrated dosage, with relatively few physical or biochemical side-effects. In situations where ventricular anti-arrhythmic therapy is deemed necessary, especially if long-term use is considered, sotalol seems to be the agent of choice.