Area Of Erythema Research Articles

Tender indurated patches and plaques on lower limbs.

A 65-year-old Caucasian man presented with worsening dyspnoea, dependant oedema and a bilateral lower limb rash. He described intermittent tender areas of erythema limited to both lower legs.

A diagnostic dilemma: cytomegalovirus colitis as an uncommon comorbidity in inflammatory bowel disease: a case report

BackgroundThe role of cytomegalovirus infection as an opportunistic pathogen in exacerbating ulcerative colitis and its response to treatment remain a topic of ongoing debate. Clinicians encounter numerous challenges, including the criteria for differentiating between an acute ulcerative colitis flare and true cytomegalovirus colitis, the diagnostic tests for identifying cytomegalovirus colitis, and determining the appropriate timing for initiating antiviral therapy.Case presentationA 28-year-old Syrian female with a seven-year history of pancolitis presented with worsening bloody diarrhea, abdominal pain, and tenesmus despite ongoing treatment with azathioprine, mesalazine, and prednisolone. She experienced a new flare of acute severe ulcerative colitis despite recently completing two induction doses of infliximab (5 mg/kg) initiated four weeks prior for moderate-to-severe ulcerative colitis. She had no prior surgical history. Her symptoms included watery, bloody diarrhea occurring nine to ten times per day, abdominal pain, and tenesmus. Initial laboratory tests indicated anemia, leukocytosis, elevated C-reactive protein (CRP) and fecal calprotectin levels, and positive CMV IgG. Stool cultures, Clostridium difficile toxin, testing for Escherichia coli and Cryptosporidium, and microscopy for ova and parasites were all negative. Sigmoidoscopy revealed numerous prominent erythematous area with spontaneous bleeding. Biopsies demonstrated CMV inclusions confirmed by immunohistochemistry, although prior biopsies were negative. We tapered prednisolone and azathioprine and initiated ganciclovir at 5 mg/kg for ten days, followed by valganciclovir at 450 mg twice daily for three weeks. After one month, she showed marked improvement, with CRP and fecal calprotectin levels returning to normal. She scored one point on the partial Mayo score. The third induction dose of infliximab was administered on schedule, and azathioprine was resumed.ConclusionConcurrent cytomegalovirus infection in patients with inflammatory bowel disease presents a significant clinical challenge due to its associated morbidity and mortality. Diagnosing and managing this condition is particularly difficult, especially regarding the initiation or continuation of immunosuppressive therapies.

Fermented tea leave extract against oxidative stress and ageing of skin invitro and invivo.

The objective is to develop a natural and stable anti-oxidative stress and anti-ageing ingredient. In this study, we evaluated the changes in white tea leaves fermented with Eurotium cristatum PLT-PE and Saccharomyces boulardii PLT-HZ and their efficacy against skin oxidative stress. We employed untargeted metabolomics technology to analyse the differential metabolites between tea extract (TE) and fermented tea extract (FTE). Invitro, using H2O2-induced HaCaT cells, we evaluated cell vitality, ROS, and inflammatory factors (TNF-α, IL-1β, and IL-6). Additionally, we verified the effects on the extracellular matrix and nuclear DNA using fibroblasts or reconstructed skin models. We measured skin hydration, elasticity, wrinkle area, wrinkle area ratio, erythema area, and erythema area ratio in volunteers after using an emulsion containing 3% FTE for 28 and 56 days. Targeted metabolomics analysis of white tea leaves yielded more than 20 differential metabolites with antioxidant and anti-inflammatory activities, including amino acids, polypeptides, quercetin, and liquiritin post-fermentation. FTE, compared to TE, can significantly reduce reactive oxygen species (ROS) and protect against oxidative stress-induced skin damage in H2O2-induced HaCaT cells. FTE can inhibit H2O2-induced collagen degradation by suppressing the MAPK/c-Jun signalling pathway and can also mitigate the reactive oxygen species damage to nuclear DNA. Clinical studies showed that the volunteers' stratum corneum water content, skin elasticity, wrinkle area, wrinkle area ratio, erythema area, and erythema area ratio significantly improved from the baseline after 28 and 56 days of FTE use. This study contributes to the growing body of literature supporting the protective effects against skin oxidative stress and ageing from fermented plant extracts. Moreover, our findings might inspire multidisciplinary efforts to investigate new fermentation techniques that could produce even more potent anti-ageing solutions.

In Vivo Evaluation of Laser-Induced Optical Breakdown (LIOBS) by 1064-nm Nd:YAG Fractional Picosecond Laser With Reflectance Confocal Microscopy and Precise Histopathologic Correlation.

Picosecond lasers with a microlens array can cause laser-induced optical breakdown (LIOBS) and LIC (Intradermal laser-induced cavitation) within high-fluence areas. This study aimed to describe the clinical, reflectance confocal microscopy (RCM), histopathological findings, and the characteristics of vacuoles caused by LIOBS and LIC in individuals with skin types III and IV. This study was performed on six Chilean healthy volunteers, males and females, aged 35-65 years old with Fitzpatrick skin phototypes III-IV. The laser was applied in the inner proximal area of the nondominant arm. RCM evaluation was performed 24 h later; 48 h later, skin biopsies were performed on the laser-treated areas. Clinical, histological, and RCM findings were recorded. Every individual developed a 10 mm2 area of clinical erythema in the treated area. Under RCM, all six volunteers had hyporeflective spherical structures at the level of the epidermis, consistent with intraepidermal vacuoles. Histopathological evaluation revealed different sizes of vacuoles in both the epidermis and dermis. The LIOBS and LIC processes and the secondary production of vacuoles could be highly valuable for effective dermal remodeling treatment and aid in promoting the production of new collagen, elastic fibers, and growth factors that could improve skin texture. These structures were visible under RCM and histopathological evaluation.

Localisations digestives gastriques et coliques de myélomes ; étude de 3 cas et revue de la littérature

Multiple myeloma is a malignant plasma cell proliferation located in the bone marrow and bones. It can secondarily manifest with extraosseous involvement, but the gastro-intestinal tract locations are rare. We report 3 cases of gastric and colonic localizations of myeloma in two males and one female, aged 66, 71 and 77years. Multiple myeloma had been diagnosed 1 to 7years before. Digestive symptoms were epigastric pain, rectal bleeding or an obstructive syndrome. Endoscopy revealed ulcerated and budding tumors in the stomach, and nodular pseudo-polypoid tumor formations or an ulcerated erythematous area in the colon. Histopathological examination of the biopsies showed a diffuse tumor cell proliferation in the lamina propria composed of cells with a plasmacytoid or plasmablastic appearance, expressing plasma cell markers such as CD138 on immunohistochemistry. The 3 patients died in the weeks following the diagnosis. The prognosis of digestive localizations of multiple myeloma remains very poor despite new therapies. In the presence of any digestive symptoms in these patients with multiple myeloma, more systematic endoscopy may allow an earlier diagnosis and the implementation of more effective therapies.

A Multi-Faceted Digital Health Solution for Monitoring and Managing Diabetic Foot Ulcer Risk: A Case Series.

Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement-key tools for improving patient adherence to their diabetic foot care plan.

Treatment of erythematous acne scars using 595-nm pulsed dye laser combined with 1565-nm ResurFX nonablative fractional laser.

Acne vulgaris is a common inflammatory disease associated with various sequelae after skin lesion remission. Acne erythema has been considered simple erythema or a vascular lesion; however, because the understanding of this disease has improved, acne erythema is currently considered an early scar with erythematous components. This study evaluated the efficacy of using both a 595-nm pulsed dye laser (PDL) and 1565-nm nonablative fractional laser (NAFL) for the treatment of erythematous scars caused by acne. Ninety patients with acne scars were equally randomized to two groups. Group A (n = 45) received treatment with the NAFL. Group B (n = 45) received treatment with the PDL and NAFL. Each patient underwent one treatment session and 4 weeks of follow-up. Qualitative (χ2 = 12.415; p < 0.05) and quantitative (t = 2.675; p < 0.05) scores of Groups A and B were determined using a global scarring grading system and exhibited statistically significant differences. The quantitative score of Group A was higher than that of Group B (6.67 ± 3.46 vs. 4.98 ± 2.44). The erythema areas of the groups differed significantly after treatment, with Group B exhibiting more notable score improvements (5.00 [3.10, 7.10] vs. 2.80 [1.65, 4.60]; Z = 3.072; p < 0.05). The erythema regression rate of Group B (88.9%) was significantly higher than that of Group A (66.7%) (χ2 = 20.295; p < 0.001). Adverse events, including redness and swelling (86.6%), scabbing (78.8%), and purpura (36.6%), occurred within 7 days for 86.6% of patients. The combined use of the PDL and NAFL is safe and effective for erythematous acne scars.

Skin Anti-Aging Efficacy of a Lactobacillus plantarum GT-17F Fermented Dendrobium officinale Ingredient: A Randomized, Double-Blind, Placebo-Controlled Clinical Study

We previously found that fermented extract of Dendrobium officinale using Lactobacillus plantarum GT-17F has a stronger antioxidant effect, especially in free radical scavenging. The result provided a basis for further studies to evaluate the effectiveness of fermented D. officinale in preventing UV-mediated damage and photoaging in humans. Therefore, in this study, we aimed to assess the anti-aging efficacy of D. officinale fermented with GT-17F strain in a clinical trial, which was conducted as a double-blind, placebo-controlled, randomized parallel-group comparative study with 99 volunteers with visible wrinkles. During the study, subjects were instructed to apply one pump of each essence, which contains fermented, unfermented, or no D. officinale extract, evenly to their face, both in the morning and evening, following their cleansing routine. At 28 days post-treatment, compared to baseline, subjects in the fermented extract group demonstrated significant improvements in stratum corneum water content, skin elasticity, skin glossiness, wrinkle area and ratio, erythema area, and erythema area ratio. In contrast, the unfermented extract group showed a significant difference only in improving erythema index levels in the skin. This comprehensive study has rigorously investigated the anti-aging effects of D. officinale and its fermented version on human skin, highlighting a notable contribution to dermatological research.

Hyperdiluted Botulinum Toxin and Intense Pulsed Light Treatment: A Case Series to Illustrate a Novel Protocol for Hypertrophic Scar Reduction.

Hypertrophic scars can have significant and far-reaching effects on patients that range from itching to creating difficulty with mobility, all of which can negatively impact the individual's quality of life. A recent study showed that many patients with recent scars report pain, burning, pruritus, erythema, in combination with psychological difficulties that impact bodily movement, choice of clothing, and participation in leisure activities. Botulinum toxin Type A (BoNTA) and intense pulsed light (IPL) have shown promise in treating such scars. We propose a novel treatment protocol involving a 4-week intervention with hyperdiluted BoNTA injections and supplemental treatment with IPL for erythema, and a 6-month scar scale assessment and photographic documentation that occurs before and 6 months after treatment. We report four cases where using hyperdiluted BoNTA, either alone or in conjunction with IPL, substantially reduced scar size, improved overall scar appearance, and diminished erythema in areas on the face and the breasts. Although this report suggests that a schedule of alternating treatments with BoNTA and IPL may be beneficial in reducing scar size and enhancing appearance, further research is necessary to better understand the most effective dosages, the relationship between BoNTA and IPL, and the optimal management of scarring.

Cutaneous tuberculosis, different clinical spectrum of the same disease: the importance of pre-test probability.

This report presents three cases of cutaneous tuberculosis that were identified at the Calderon Hospital in Quito, Ecuador. The first case involved a 44-year-old man who had tuberculosis verrucosa cutis, characterized by circinate erythematous areas, ulcerated nodules, and verruciform plaques extending from the right lower limb to the hip. In the second case a 50-year-old woman with a 1-year history of pruritic dermatosis in the left ciliary area was diagnosed with lupus vulgaris. In the third case, a 23-year-old man with erythematous nodules draining caseous material at the neck, thorax, and axillary region was diagnosed with scrofuloderma. It was discovered that nearly every laboratory test that was accessible had drawbacks as a diagnostic technique. Correlating clinical and epidemiological features with the pretest probability is crucial for optimizing indicators and confirming or ruling out the diagnosis in immunocompromised and high-risk individuals with atypical lesions.

Geographic Stomatitis with Multiple Areas Involvement of Oral Cavity: A Case Report and Review of Literatures

Background: Geographic stomatitis is an uncommon migratory benign lesion of oral mucosa with unknown etiology. It can affect all the areas of the oral mucosa, but the dorsum and lateral borders of the tongue are the most commonly involved areas called geographic tongue. The clinical appearance of this condition is the oval or circular erythematous areas with irregular elevated keratotic borders. These characteristic features of geographic stomatitis are diagnostic for all clinicians when appearing on the dorsum of the tongue, despite other affected areas of oral mucosa that can confuse clinicians. This condition may be associated with some diseases such as psoriasis, Reiter’s syndrome, and atopic conditions, so the clinicians should rule out these diseases and diagnose the geographic stomatitis. Case Report: A 17-year-old male attended to our department for a routine dentistry checkup. During the intraoral examination, we found multiple erythematous areas surrounded by a thin white border on different surfaces of his oral cavity. His extraoral examinations were completely normal. Conclusion: Due to the rarity of this lesion on the other sites of oral mucosa rather than dorsum and lateral borders of the tongue such as labial mucosa, buccal mucosa, the floor of the mouth, ventral surface of the tongue, and palate, it is necessary to report, study and evaluate each case of this condition that clinicopathologic findings have confirmed this diagnosis, to treat and advice these patients on the best approach. [GMJ.2021;10:e2071]

The combined treatment of gold nanoparticles associated with photobiomodulation accelerate the healing of dermonecrotic lesion

Introduction: The search for fast and efficient treatment for dermonecrotic lesions caused by the venom of the spider from the Loxosceles simillis, is a demand in health. Prednisolone is one of the most used drugs, however it has side effects. In this context, addictionally gold nanoparticles (GNPs) have anti-inflammatory, antioxidant, and antibacterial properties. The use of photobiomodulation has show to be efficient in the process of tissue repair. Therefore, the purpose of this study was to investigate the anti-inflammatory effect of photobiomodulation and GNPs associated or not with a low concentration of prednisolone in animal models of dermonecrotic lesion. Methodology: For this, rabbits with venon-induced dermonecrotic lesion were subjected to topical treatment with prednisolone + laser or GNPs + laser or Pred-GNPs + laser. The area of edema, necrosis and erythema were measured. On the last day of treatment, the animals were euthanized to remove the organs for histopathological and biochemical analysis. Results: All treatments combinations were effective in promoting the reduction of necrotic tissue and erythema. Conclusion: With this results, we suggest that the use of laser and nanoparticles, associated or not with prednisolone, should be considered for the treatment of dermonecrotic injury.

Effects of honey-lemon spray on recurrent aphthous stomatitis comparing to Triamcinolone ointment

Recurrent aphthous stomatitis (RAS) is recurrent and painful diseases of the oral mucosa that can be very painful and annoying despite their small size. There is no definitive cure for this disease and the usual treatments are mainly based on pain control. The aim of this study was to investigate the effect of honey-lemon spray (mucotin) in the treatment of recurrent aphthous stomatitis. Methods: This study is a randomized controlled clinical trial conducted in 2020 at Zahedan University of Medical Sciences on 46 RAS patients. The participants were randomly assigned to the intervention (mucotin) or control groups (Triamcinolone ointment) equally (23 patients in each group). Patients were evaluated for the severity of pain and ulcer size. Evaluations were performed on days 0, 2, 7 of the treatment using VAS. Data were analyzed using ANOVA statistical test. Results: The inner aspect of the lower lip was the most common site of RAS in the participants (48.8%) and the lowest site went for hard palate (2.4%). Four items including pain, burning sensation, necrosis area, and erythematous area were evaluated in both groups. There was no significant difference in all parameters before the treatment period (day 0). The mean pain score, burning sensation, necrosis, erythematous areas were not different in days 0, 2 and 7 between groups respectively (p=0.849, p=0.105, p=0.917, p=0.442). Conclusion: Honey-lemon spray (Mucotin) and topical corticosteroid have similar effects in RAS treating, So Mucotin can be used as the first line of treatment for RAS lesions. This herbal medicine has no side effects.

Twinkle Artifact Observed During POCUS of a Human Myiasis Caused by the Dermatobia hominis Botfly

An 81-year-old man presented to urgent care for assessment of an area of erythema and tenderness on his right thigh after recent travel to Belize. Point of care ultrasound (POCUS) revealed a hyperechoic structure with acoustic shadowing in the subcutaneous tissue. Colour Doppler assessment of the structure produced a twinkle artifact. The structure was removed and pathology identified the object as a Dermatobia hominis larva (human botfly). The use of POCUS helped identify and localize the subcutaneous foreign body. The use of colour Doppler produced the twinkle artifact, which has not been previously reported as a finding produced during ultrasonographic assessment of botfly larvae.

Comparing Oral Versus Intravenous Antibiotics Administration for Cellulitis Infection: Protocol for a Systematic Review and Meta-Analysis

Background Cellulitis is defined as an infection of the skin that is usually characterized by localized but poorly demarcated areas of erythema, swelling, and pain. Erysipelas is a subtype of cellulitis that is characterized by a more superficial infection, often involving the face. Because gram-positive bacteria are the most common infective agent, beta-lactam antibiotics such as cephalosporins are commonly used. However, guidelines and physician preference vary widely as different antibiotic options and routes of administration exist, in addition to the fact that most cases are treated empirically without microbiological lab guidance. This lack of standardization in evidence, guidelines, and physician practice prompted this systematic review and meta-analysis of both randomized trial data and cohort studies to aggregate the currently available evidence for the optimal routes of antibiotic administration in cellulitis treatment. Objective The primary objective of our review is to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections, thereby providing clinicians with evidence-based guidelines for treatment. Methods We will search MEDLINE, Embase, and CENTRAL through Ovid as well as Web of Science and CINAHL for all available literature comparing different routes of antibiotic administration in the treatment of cellulitis and erysipelas. We will perform title and abstract as well as full-text screening in duplicate according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines and then extract the relevant data using a prepiloted data sheet. The primary outcome for our review is the duration of infection resolution, and secondary outcomes such as incidence of sepsis, mortality, hospital admission, and Clostridium difficile infection. We will assess the risk of bias in our included studies using the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and ROBINS-I (Risk of bias in non-randomized studies for interventions) tools, with a final quality assessment using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework and a sensitivity analysis to examine heterogeneity. Results We will publish the final results of our systematic review in a peer-reviewed academic journal. This project received no funding or financial assistance. Data analysis is currently underway, and the results are expected to be submitted for publication in late November 2023. Conclusions To our knowledge, this will be the most up-to-date review of the best available evidence comparing different routes of antibiotic administration for cellulitis. Because of the vast selection of antibiotic options available and the empirical nature of the treatment, we anticipate heterogeneity within our data but nonetheless hope to provide aggregated evidence on the efficacy of intravenous versus oral administration of antibiotics in cellulitis treatment. We hope the results from this study will better inform physician practices in the future for cellulitis infections. International Registered Report Identifier (IRRID) PRR1-10.2196/48342

Assessment of Vulvar Intraepithelial Neoplasia (VIN) Grades Based on Dermoscopic Features: A Diagnostic Study.

Vulvar intraepithelial neoplasia (VIN) is a vulvar skin lesion considered a precursor of vulvar squamous cell carcinoma. No characteristics have been discovered to date that allows us to differentiate between grades of VIN, such as correlating the thickness of involvement of the epithelium (VIN1, VIN2, and VIN3) to the dermoscopic pattern. The aim of this study was to correlate the clinical and dermoscopic features of VIN cases with histopathological findings, with the purpose of identifying dermoscopic characteristics that allow us to differentiate between different grades of VIN. A retrospective study of the clinical and dermoscopic characteristics of VINs was recruited. Clinical and dermoscopic characteristics, as well as histopathology data, were gathered from patients at two Dermatology Units in Italy during the period spanning from January 2020 to December 2021. The study population consisted of 20 patients with a histologically confirmed diagnosis of VIN. The mean age of patients at the time of diagnosis was 55 years. At the dermoscopic level, VIN1 was characterized by a homogeneous erythematous area that completely involved the entire lesion, with a vascular pattern consisting of regular glomerular vessels. VIN3, was characterized by the presence of compact milky white areas that involved almost the entire lesion. VIN2 was characterized by the presence of non-compact white areas that allowed homogeneous erythematous areas to be seen transparently, without other distinguishing aspects. Although a definitive diagnosis and grading of VIN remains confirmed only histopathologically, our study shows how dermoscopy may aid the differential diagnosis between the different grades of VIN; the presence of a compact milky white area that involves nearly the entire lesion should be interpreted as an alarming feature, while homogeneous erythematous areas or a glomerular vascular pattern are more typical of the first stage of this neoplasia.

FRI696 Endocrine Shades Of Silicone Fillers: A Case Of Calcitriol-mediated Hypercalcemia

Abstract Disclosure: M.S. Martinez Cruz: None. T.G. Lozovoy Madsen-Barbosa: None. C.J. Haas: None. Introduction: In rare cases, foreign body granuloma (FBG) reaction is so vast that it leads to severe systemic disease, including increased granuloma-mediated production of calcitriol. Case Description: A 42-year-old woman was referred to the ED due to elevated serum calcium and worsening GFR on routine blood work. She endorsed a two-week of generalized weakness, myalgias, polyuria, polydipsia, and intermittent constipation with prior episodes of such symptomatology. On her first presentation, severe hypercalcemia (13.8 mg/dL), acute-on-chronic renal disease, a normal TSH, an appropriately low PTH, elevated PTHrP, a low 25-hydroxy vitamin D, and a normal 1,25 dihydroxy-vitamin D were noted. She was treated with IV fluids and zoledronic acid 4mg IV one time with subsequent normalization of calcium levels. Six months later, she was re-admitted with similar complaints. Additional blood workup was unremarkable, including urine and serum protein electrophoresis and kappa/lambda ratio. She once again presented with similar complaints; additional workup revealed a normal 25-hydroxy vitamin D, mildly elevated serum angiotensin-converting enzyme, and a negative QuantiFERON-TB gold, but a marked elevation of 1,25 dihydroxy-vitamin D (138 pg/mL). She admitted to subcutaneous silicone filler injections in the lips, cheeks, and hips applied by a non-healthcare provider six years ago. She described that one year after the injections, she had noted intermittently indurated erythematous areas in the skin of the hips and upper lateral thighs that were notably tender to palpation. Diagnostic imaging included a whole-body PET-CT that demonstrated moderate FDG uptake within the subcutaneous adipose tissue of the lateral aspect of bilateral gluteal regions extending from the iliac crests to the upper thighs. She was diagnosed with silicone filler injection-induced hypercalcemia secondary to granulomatous inflammation and initiated on prednisone 20 mg PO daily with progressive normalization in her hypercalcemia (9.7 mg/dl) a month after initiation of treatment. Unique features/Teaching points: FBG reactions occur more commonly against permanent fillers like silicone, especially if injected in larger volumes and highly vasculature areas like hips or buttocks. These reactions may occur years after the initial injection. In rare cases, significant granulomatous immune response leads to the overactivity of 1-alpha-hydroxylase in activated macrophages, resulting in uncontrolled overproduction of calcitriol and, subsequently, hypercalcemia. FBG reactions may also cause increased levels of PTHrP, further contributing to hypercalcemia. Treatment focuses on general hypercalcemia management and FBG remission, most effectively achieved with anti-inflammatory corticosteroid doses. Further studies are needed to evaluate long-term treatment efficacy. Presentation: Friday, June 16, 2023

A Case of Early Barrett's Adenocarcinoma With Eosinophilic Esophagitis

ABSTRACT A 61-year-old man presented with epigastric pain and underwent upper gastrointestinal endoscopy. A strongly erythematous area was found in the short segment of the Barrett's esophagus, and a biopsy revealed well-differentiated adenocarcinoma. Linear furrows were observed in the lower esophagus, and a biopsy of the lesion revealed eosinophil infiltration of 30 eosinophils per high-power field. Therefore, a diagnosis of Barrett's adenocarcinoma with eosinophilic esophagitis was made. Although rare, the incidence of Barrett's adenocarcinoma and eosinophilic esophagitis has been increasing in Japan in recent years, and the number of cases may increase in the future.

NECROTIZING ULCERATIVE GINGIVITIS AS A COMPLICATION OF FEBRILE NEUTROPENIA IN ACUTE MYELOID LEUKEMIA PATIENT

Background: Necrotizing ulcerative gingivitis (NUG) is a periodontal disease characterized by gingival pain, interdental gingival necrosis, and bleeding. NUG is closely related to immunosuppression, smoking, poor oral hygiene, malnutrition, and stress. Acute myeloid leukemia (AML) is a bone marrow malignant neoplasm. Chemotherapy as the treatment for AML often causes febrile neutropenia which results in immunosuppression conditions and is a risk factor for NUG. This case report aimed to discuss NUG as a complication of febrile neutropenia. Case: A 22-year-old woman was referred from hemato-oncology with acute myelomonocytic leukemia (AML-M4) and febrile neutropenia due to her oral complaints. She had undergone one cycle of chemotherapy and developed febrile neutropenia. Intra-oral showed ulcers covered with white-grayish plaques on the gingival region 35 to 45 and 15 to 25. There were white plaques that could be removed leaving an erythematous area on the dorsal tongue. Blood laboratory tests showed pancytopenia and severe neutropenia. The diagnoses were necrotizing ulcerative gingivitis and pseudomembranous candidiasis. Case management: Debridement using 1.5% hydrogen peroxide solution, rinsing with 0.2% chlorhexidine gluconate, as well as cleaning teeth and tongue 2 times daily. The internal medicine department gave meropenem. The lesions and gingiva were healed after three weeks of therapy. Conclusion: Febrile neutropenia due to chemotherapy reduces the body's ability to fight infection, oral homeostasis is disturbed therefore bacterial growth increases, neutrophils carry out phagocytosis forming reactive oxygen species which causing necrotic cells and then NUG occurred. Appropriate, adequate, and immediate therapy is needed to avoid further complications. Keywords: Acute myeloid leukemia, Febrile neutropenia, Necrotizing ulcerative gingivitis

The dose response of erythemal area and intensity on the unprotected skin fits well to a logistic 3P model in SPF tests of a Chinese population, which has the potential to improve the precision and consistency of minimal erythema dose determination.

The current ISO guidelines for minimal erythema dose (MED) determination require assessment of erythema area of UV-irradiated skin sites. However, this parameter has not been adequately quantified in daily practice. The aims of this study were to investigate the dose response on the unprotected skin sites by quantifying the erythema area and intensity and to show the potential for improving the precision and consistency of MEDu determination by developing predictive models. Standard radiation tests were conducted on the back of 31 healthy Chinese volunteers and the MEDu site of each subject was clinically determined by dermatologists. Images of test sites were captured 24 h after radiation, and the erythema area (%EA) and intensity (∆a*) were measured by image analysis. The data were fitted to a logistic 3P function to obtain dose-response curves, and a set of logit (inverse-logistic) models were then derived. An erythema area threshold of %EA = 52% was established to predict MEDu based on the clinical endpoints defined by ISO 24444:2019. Analysis of the clinically determined MEDu sites revealed wide ranges of %EA (62.3 ± 15% SD) and ∆a* (2.96 ± 0.92 SD). The dose response fitted well to a logistic 3P model (mean R2 = 0.965 and 0.975 for %EA and ∆a*, respectively). Applying the area threshold, values of MEDu were determined by the logit model for the test population, which significantly improved the consistency of MEDu determination (52 ± 0% SD and 2.73 ± 0.61 SD for %EA and ∆a*, respectively). This study demonstrated that the dose response of UV-induced erythema can be quantified and modeled once the erythema area and intensity are measured. The results of this study show the potential to improve the precision and consistency of MEDu determination in an SPF test. The similar potential in photodermatological, therapeutic, and diagnostic applications was also implied.