Journal of the American Academy of Dermatology
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J. Am. Acad. Dermatol. · Feb 1992
Review Case ReportsDermatology and conditions related to obsessive-compulsive disorder.
Patients with cutaneous disorders may have obsessive-compulsive symptoms but treatment for these symptoms has been limited. Advances in our understanding of obsessive-compulsive disorders have led to the concept of a spectrum with similar phenomenology, underlying neurobiology, and psychopharmacotherapeutic response. Many of these disorders, which include trichotillomania, neurotic excoriation, onychophagia, body dysmorphic disorder, and dermatitis artefacta may respond to specific therapeutic interventions.
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Toxic epidermal necrolysis is perhaps the most formidable disease encountered by dermatologists. Uncommon but not rare, toxic epidermal necrolysis occurs in 60 to 70 persons per year in France. It remains as puzzling a disorder as it was 34 years ago, when described by Lyell. ⋯ Surviving patients completely heal in 3 to 4 weeks, but up to 50% will have residual, potentially disabling ocular lesions. The prognosis is improved by adequate therapy, as provided in burn units, that is, aggressive fluid replacement, nutritional support, and a coherent antibacterial policy. Corticosteroids, advocated by some in high doses to halt the "hypersensitivity" process, have been shown in several studies to be detrimental and should be avoided.
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J. Am. Acad. Dermatol. · May 1989
ReviewClinical correlations of linear IgA deposition at the cutaneous basement membrane zone.
To determine the specificity of linear IgA deposition at the cutaneous basement membrane zone for primary bullous disease, we reviewed the results of all direct immunofluorescence studies of skin biopsy specimens taken from patients seen at Mayo Clinic during the period 1982 through 1986. Of 4642 specimens submitted for direct immunofluorescence during this 5-year period, 44 from 42 patients showed linear IgA deposition at the basement membrane zone, with or without other immunoglobulins. Of these 42 patients, 36 (86%) had primary subepidermal bullous disease. ⋯ Sixteen had linear IgA and IgG at the basement membrane zone (10 with clinical cicatricial pemphigoid, 5 with bullous pemphigoid, and 1 with epidermolysis bullosa acquisita). There was a high frequency of mucosal involvement (67% of the 36 patients) and a somewhat higher frequency of ocular involvement in patients with cicatricial pemphigoid who had linear IgA without IgG at the basement membrane zone (6 of 8) than in those who had both immunoglobulins at the basement membrane zone (4 of 10). These results show that the direct immunofluorescence finding of linear IgA deposition at the basement membrane zone correlates with primary subepidermal bullous disease in a high percentage of patients but reflects a heterogeneous group of blistering disorders.
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J. Am. Acad. Dermatol. · Feb 1989
Review Case ReportsImpetigo herpetiformis: a variant of pustular psoriasis or a separate entity?
Impetigo herpetiformis is a rare pustular disorder that primarily affects pregnant women. Clinically and histologically it bears some resemblance to pustular psoriasis. This similarity has led authors to name the disease "the pustular psoriasis of pregnancy." A case is described that demonstrates the characteristic features of impetigo herpetiformis, as compared with pustular psoriasis, and emphasizes the need to preserve it as a separate entity.