Fifty-five patients with fixed drug eruption were investigated to determine the drug(s) causing the reaction. History, classic clinical features of well circumscribed erythema, edema and violaceous pigmentation, and the recurrence of the eruptions on the same sites on readministering drug were used as diagnostic criteria. This was confirmed by a provocative test. Sulfonamides and analgesics either alone or in combination were the most common causes of reaction.
Of the 44 patients of urticaria in children in 52.3 percent, the etiologic agents were defined with food as the major cause. The clinical features were characterized by itching, erythema, wheals and oedema of different configuration. The urticaria lesions were commonly seen on the extremities and the trunk. Largely the patients applied for treatment in the course of a week. Majority of the patients were in the age group of 5–9 years. The acute urticaria was most frequent, while the other variants were rare. The laboratory investigations were largely equivocal. The parasitic infestations in particular as etiologic factors were inconclusive.
Vitiligo incidence in the series was 14 per thousand. The affliction of the younger subjects was frequent, the mean value of age at onset being 24.25 years. Both the sexes were affected and there was no significant difference between the two. The duration of the disease had wide variations, majority reporting in the course of one year. The emotional undertones and the ocurrence of the disease amongst family links were observed as provocating factors in some cases. Ivory white macules associated sometimes with erythematous tinge, leucotrichiae and islets of pigmentation were classic. The lower extremities were frequently involved, followed by face and other parts of the body. The disease was largely progressive, though in a few it was stationary. Vitiligo vulgaris was its commonest variant, followed by areata, zosteriformis, mucosae and acrofacialis. The associations namely diabetes mellitus, liver diseases and others were recorded. The occurrence of myasthenia gravis and trigeminal neuralgia in vitiligo was interesting. Its association on the basis of autoimmunity is brought out. The importance of the clinical parameters in anticipating the prognosis after psoralen therapy are discussed.
The Treponema pallidum is capable of involving almost all the structures of the body, some commonly and others rarely. The skin is often affected, but the thick crusted ulcerative lesions of malignant syphilis (syphilis maligna praecox) are rare (Lejman and Starzycki, 1972). Hepatitis due to early syphilis has seldom been reported in recent years (Baker, Kaplan, Wolfe, and McGowan, 1971;Lee, Thornton, and Conn, 1971;Parker, 1972). The subject has been reviewed in the past by Hahn (1943) and Rajam and Rangiah (1954). These observations of the rarity of the condition prompted us to report this case of malignant syphilis and hepatitis.Case report A 24-year-old unmarried male labourer was admitted to the dermatological ward on May 23, 1973, with a rash and jaundice of 4 weeks' duration. He had had frequent sexual exposures with different women. The most recent was 4 months ago, and 1 month later he had developed a genital sore which healed within a week after two injections of penicillin and some herbal medicines. Fresh genital lesions appeared after a fortnight followed by skin lesions, jaundice, intermittent fever, joint pains, anorexia, and nausea. The skin lesions had first appeared on the face and then spread to other parts of the body. They had enlarged slowly and formed ulcers in places. The patient was not an alcoholic. He had not taken any other drug in the recent past nor had he received any blood transfusion. ExaminationThe patient was of moderate build, intelligent, and cooperative. He had marked jaundice. The mucous membranes of the mouth were normal. The pulse rate was 100 per minute with a blood pressure of 120/80 mm. The axillary temperature was 100°F. There was generalized lymphadenopathy characterized by discrete, non-tender, firm, mobile glands.
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