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Erythema Nodosum (EN)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Erythema nodosum is a skin condition that causes painful swollen red or purple bumps most commonly on the shins. Young women ages 15–30 are five times more likely than men to develop erythema nodosum. Inflammation of the subcutaneous fat causes tender red lumps or nodules of erythema nodosum that range in size from a dime to a quarter. They may be inflamed off and on for a period of weeks, then shrink and become flat, leaving a bruised appearance. This condition is the most common form of panniculitis, or inflammation of the fat layer underneath the skin. EN can develop on its own or in association with certain medical conditions (e.g., sarcoidosis, TB, IBD, etc.) and medications (e.g., penicillin, oral contraceptives with estrogen, salicylates, etc.). Erythema nodosum can go away on its own in three to six weeks. Chronic erythema nodosum is a condition in which additional lesions pop up in different locations for a period of weeks to months or may last for years.1
Cutaneous Lymphomas
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Emily Correia, Shalini Krishnasamy, Neda Nikbakht
Laboratory studies: Histopathologic examination may indicate panniculitis. Pleomorphic T cells of different sizes with hyperchromatic nuclei and many macrophages are seen. Commonly, necrosis, karyorrhexis, and cytophagocytosis in so-called beanbag cells is seen. In the early stages of disease, inflammatory cells may predominate, while neoplastic cells may lack significant atypia. Immunophenotypically, cells demonstrate α/β+ (Beta F1+), CD3+, CD4−, CD56−, and CD8+ markers with expression of cytotoxic proteins (TIA-1+, granzyme B+, and perforin+). The clonality test for TCR gene rearrangement is generally positive.
Lower legs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Panniculitis can be caused by: Cold, especially in the newborn.Trauma to heavy breasts and buttocks.Release of enzymes by pancreatic disease (e.g. pancreatitis or carcinoma of the pancreas).Discoid lupus erythematosus (lupus profundus).Artefact from self-injection of oily liquids (look for the needle mark in the centre).
Alpha-1 antitrypsin deficiency: current therapy and emerging targets
Published in Expert Review of Respiratory Medicine, 2023
Oisín F. McElvaney, Daniel D. Fraughen, Oliver J. McElvaney, Tomás P. Carroll, Noel G. McElvaney
It is also well established that levels of AAT increase significantly during infection which is the body’s natural acute phase anti-inflammatory response [125,126]. Recent data from this group shows that during COVID-19 infection, the levels of AAT in MM individuals rise very significantly. Nevertheless, this AAT elevation may be insufficient in the setting of significant systemic and local infection [53]. This would suggest that a single dose per week strategy does not replicate what happens in ‘real life’ and may need boosting particularly during times of infection and inflammation. This is clearly shown by the inflammatory processes surrounding panniculitis. In this relatively rare complication of AATD, which can occur in most AATD mutations, albeit more commonly in ZZs, the response to intravenous AAT is striking but complete resolution often requires quite high levels of intravenous AAT (often in excess of 120 mg/kg) which may need replenishing [13]. In these circumstances, aiming for a level of 11 µM would be insufficient.
Safety considerations when using non-ergot dopamine agonists to treat Parkinson’s disease
Published in Expert Opinion on Drug Safety, 2020
Fabrizio Stocchi, Barbara Fossati, Margherita Torti
Skin nodules are common side effects of long-term treatment with apomorphine involving the totality of patients in chronic subcutaneous infusion and half of those in intermittent therapy [86]. They are caused by a process of panniculitis that involves the subcutaneous tissue and that can be rarely complicated by infections and peri/subcutaneous abscesses. Local and systemic antibiotic therapy is usually sufficient to control these complications [154]. Skin nodules may represent one of the reasons of apomorphine withdrawal [135 + 155] due to the spread of nodules over large areas which cause impaired drug absorption and reduced efficacy [155]. An accurate hygiene and rotation of the injection sites, the use of Teflon needles, NeriaTM infusion system, emollients, massages, and a low concentration of apomorphine have been successfully used to manage this complication. Frequent use of ultrasounds can ameliorate the outcome of skin nodules [156].
The use of immunotherapy for the treatment of tuberculosis
Published in Expert Review of Respiratory Medicine, 2018
Octavio Ramos-Espinosa, León Islas-Weinstein, Marco Polo Peralta-Álvarez, Manuel Othoniel López-Torres, Rogelio Hernández-Pando
Another efficient immunotherapeutic agent derived from mycobacterial compounds is RUTI, which is a mixture of detoxified cell fragments from Mtb delivered in liposomes. It is an adjunct agent that is administered with conventional chemotherapy against latent TB infection with the aim to improve the efficacy and reduce the duration of the treatment [13]. RUTI is efficient to control latent TB in experimental models in mouse and guinea pigs, by an induction of a mixed Th1/Th2/Th3, polyantigenic response with no toxicity. When RUTI was administrated before infection with Mtb in animal models, it induced a strong Th1 response [107]. RUTI has begun its CTs; it is well tolerated, occasionally produced local sterile granulomatous panniculitis that can be prevented by an adequate dosification [108]. Therefore, the protective properties of RUTI may be explained by the accumulation of specific CD8 T cells and a strong humoral response [109]. Nowadays, RUTI has a couple of CTs running for latent TB infection, where it has proven safe and with a good tolerability. Although occasionally produced, local sterile granulomatous panniculitis, erythema, and induration can be prevented by an adequate dosification [108,110]. Furthermore, its possible use for the treatment of MDR-TB patients is now been evaluated (NCT02711735).