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 Drug-induced-erythroderma had an acute onset and a good prognosis with rapid resolution when the causative drug was withdrawn, while histopathology and laboratory findings were largely unrewarding.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.

Stevens-Johnson syndrome and toxic epidermal necrolysis in Thailand.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life-threatening illnesses that have often been linked to drug exposure. METHODS: We looked retrospectively for all cases of SJS and TEN that were admitted to Siriraj Hospital between 1981 and 1990 to determine the drug etiology. RESULTS: Fifty-eight cases of SJS and 20 cases of TEN were identified. Eight patients initially had an SJS-like aspect, which subsequently evolved into TEN. A culpable drug was determined in 60 patients (77%). The mean time from first drug administration to onset of SJS or TEN was 6.8 +/- 6.5 days (range, 1 to 28 days). A longer incubation period was observed with thiacetazone (10.5 +/- 5.6 days), phenytoin (12 +/- 8.5 days), and carbamazepine (11.3 +/- 3.4 days). CONCLUSIONS: The culprit drugs included the following: antibiotics, 32 cases (penicillin, sulfonamides, tetracycline, erythromycin); anticonvulsants, nine (phenytoin, carbamazepine, barbiturates); antitubercular drugs, eight (thiacetazone); analgesics, four (acetylsalicylic acid, fenbufen); sulfonylurea, two; allopurinol, one; and others, four. The most frequent underlying diseases justifying the ingestion of one or more drugs in our patients were infections (52.7%), followed by pulmonary tuberculosis (10.8%), and by seizures (8.1%). The total mortality rate was 14%; 5% for SJS, and 40% for TEN. Mortality was not affected by the type of drug responsible.