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We analysed clinical symptoms, gender, age and social relations among 57 patients for whom a final diagnosis of dermatitis artefacta was established. The study is retrospective and the patients were seen in our department from 1982 to 2002. We observed that the diagnosis was 2.8 times more common in females than males. Symptoms were most common in the age group 18-60 years, median age 39 years. The skin lesions were 'multiple' among 88% of the patients. When self-infliction was suggested as the cause, two-thirds of patients initially denied it and only one patient agreed to meet with a psychiatrist. Only one-quarter had a job, the rest were unemployed or on sick leave. Many patients (61%) received medical treatment with anxiolytica. Ten patients (18%) had a psychiatric diagnosis. Among our 57 patients, 11 were deceased at the time of our study, but none because of suicide. Four had died before the age of 70, of whom two suffered from alcoholism and two had diabetes mellitus. Therapy should include an optimal nursing relationship with the patient so that social problems can be discussed. Psychological or psychiatric intervention appeared unhelpful because of patient denial.
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PMID:Self-inflicted skin diseases. A retrospective analysis of 57 patients with dermatitis artefacta seen in a dermatology department. 1639 99

We present a 61-year-old man with a 2-year history of persistent disseminated, psoriasiform annular pruritic lesions, acrodermatitis, weight loss, anemia and diabetes. Histopathology of the affected skin showed nonspecific subacute psoriasiform dermatitis. The computed tomographic scan of the abdomen revealed multiple hepatic tumors. Histopathological examination of ultrasound-guided needle biopsy from a hepatic lesion demonstrated a neuroendocrine tumor. Somatostatin-receptor scintigraphy with radio-labelled octreotide confirmed the likelihood of the neuroendocrine nature of the hepatic tumors and excluded the presence of other such lesions throughout the rest of the body, including the pancreas. The serum glucagon level was markedly increased. The diagnosis of necrolytic migratory erythema associated with hyperglucagonemia and neuroendocrine hepatic tumors was made and therapy with the long-acting somatostatin analogue octreotide was started. The skin changes resolved after the initiation of therapy, but no improvement of other symptoms was observed. Having reached the final stage of the disease, which was further complicated by congestive heart failure, the patient died one year later. As no autopsy was performed, we were unable to establish whether the hepatic tumors represented a metastatic process of previously undetected pancreatic glucagonoma or if they were extra-pancreatic glucagon-secreting tumors. The correct diagnosis of necrolytic migratory erythema is important, since it might be the clue for early detection of glucagonoma or of extra-pancreatic glucagon-secreting tumors.
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PMID:Necrolytic migratory erythema associated with hyperglucagonemia and neuroendocrine hepatic tumors. 1643 46

Occupational health problems of 240 male workers of roadways workshop, carriage workshop and battery factory were investigated. Cadmium concentrations in the hair were determined using atomic absorption spectrophotometer. Health effects, such as acidity, hypotension, hypertension, dermatitis, ophthalmic problems, cardiac disease, indigestion, diabetes, tuberculosis, hepatitis B, respiratory troubles, psychological and liver problems were found in subjects. Significant levels between the unhealthy and normal subjects were determined by applying a parametric test, the student's t test at a significant level of p < 0.05. The results of our studies indicate that the significant difference in cadmium levels were observed in subjects suffering from acidity, ophthalmic problems, hypertension, psychological problems, tuberculosis and their respective controls. No correlation with cadmium was obtained with cardiac diseases, diabetes, hepatitis B, respiratory problems, dermatitis and hypotension.
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PMID:Hair as an indicator for assessing adverse effect of cadmium on human health. 1666 37

This study was undertaken to document prevalence, motives and observed complications of steroid use as a depigmenting agent amongst African blacks in southeast Nigeria. This practice is very common in the African environment. Consecutive new patients attending the dermatology clinic of the University of Nigeria TeachingHospital, Enugu, from June to December 2004 were recruited. Active substances of products used were determined from packages, while unknown concoctions were analyzed. Chi-squared and Fischer tests were used for statistical analysis, with a significant threshold fixed at 5%. Females aged 18-69 years accounted for 75% (414) of patients. Main topical steroids used by both women and men were class-1 steroids, and these were often compounded with other bleaching products. Median duration of usage was 9 years +/- 1.3. Disorders observed included steroid-induced acne (45.3%), macular hyperpigmentation of face (37.2%), mycoses (40.4%), striae (28.3%), telangiectasis (21.3%), hypertrichosis (13.9%) and diabetes mellitus (2.1%). Duration of utilization of these topical steroids was significantly associated with severe local and systemic consequences, while withdrawal of the offending steroids usually resulted in severe withdrawal dermatitis that was unpleasant to patients. This may suggest that discontinuation is impossible.
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PMID:Topical steroid abuse: its use as a depigmenting agent. 1677 16

We describe a patient with Stevens-Johnson syndrome (erythema multiforme major) associated with an increase in glipizide dosage administration. Glipizide is a second-generation sulfonylurea commonly used to treat patients with noninsulin-dependent diabetes mellitus. Although several reports have documented Stevens-Johnson syndrome caused by first-generation sulfonylureas, our case appears to be the first report of a second-generation sulfonylurea associated with Stevens-Johnson syndrome.
Dermatitis 2006 Mar
PMID:Stevens-Johnson syndrome associated with glipizide therapy. 1680 Feb 77

The misery of living with atopic eczema (syn. dermatitis, AD) cannot be overstated for it may have a profoundly negative effect on the health-related quality of life (HRQoL) of children and their family unit in many cases. As it is one of the commonest chronic relapsing childhood dermatosis (UK lifetime prevalence 16-20% by 20 years), with increasing worldwide prevalence, this has major social and financial implications for individuals, healthcare providers and society as a whole. This review explores the impact of AD on the lives of children and their family units and the use of some of the recently developed HRQoL measures, which have enabled investigation and categorisation of the physical, psychological and psycho-social effects of childhood eczema across all aspects of life. These effects include symptoms of itching and soreness, which cause sleeplessness in over 60%. Sleep deprivation leads to tiredness, mood changes and impaired psychosocial functioning of the child and family, particularly at school and work. Embarrassment, comments, teasing and bullying frequently cause social isolation and may lead to depression or school avoidance. The child's lifestyle is often limited, particularly in respect to clothing, holidays, staying with friends, owning pets, swimming or the ability to play or do sports. Restriction of normal family life, difficulties with complicated treatment regimes and increased work in caring for a child with eczema lead to parental exhaustion and feelings of hopelessness, guilt, anger and depression. The hidden costs involved in eczema management can be significant and have particular impact on lower income families. The impairment of quality of life caused by childhood eczema has been shown to be greater than or equal to other common childhood diseases such as asthma and diabetes, emphasising the importance of eczema as a major chronic childhood disease. HRQoL measures are proving to be valuable tools for use in the clinical setting, as outcome measures for pharmaceutical studies, for health economics and audit purposes. It is therefore recommended that in future, they should be used in conjunction with objective measures of severity, as part of the assessment process of a child with atopic eczema. Lack of information on eczema and treatments heightens parental anxiety. Education of all individuals involved in the care of children with eczema is fundamental in the management of AD and it is essential to provide simple clear, unambiguous information on treatment and disease management in order to reduce the negative impact on HRQoL.
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PMID:Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. 1689 32

Plant materials derived from the Aloe plant are used as cosmetic ingredients, including Aloe Andongensis Extract, Aloe Andongensis Leaf Juice, Aloe Arborescens Leaf Extract, Aloe Arborescens Leaf Juice, Aloe Arborescens Leaf Protoplasts, Aloe Barbadensis Flower Extract, Aloe Barbadensis Leaf, Aloe Barbadensis Leaf Extract, Aloe Barbadensis Leaf Juice, Aloe Barbadensis Leaf Polysaccharides, Aloe Barbadensis Leaf Water, Aloe Ferox Leaf Extract, Aloe Ferox Leaf Juice, and Aloe Ferox Leaf Juice Extract. These ingredients function primarily as skin-conditioning agents and are included in cosmetics only at low concentrations. The Aloe leaf consists of the pericyclic cells, found just below the plant's skin, and the inner central area of the leaf, i.e., the gel, which is used for cosmetic products. The pericyclic cells produce a bitter, yellow latex containing a number of anthraquinones, phototoxic compounds that are also gastrointestinal irritants responsible for cathartic effects. The gel contains polysaccharides, which can be acetylated, partially acetylated, or not acetylated. An industry established limit for anthraquinones in aloe-derived material for nonmedicinal use is 50 ppm or lower. Aloe-derived ingredients are used in a wide variety of cosmetic product types at concentrations of raw material that are 0.1% or less, although can be as high as 20%. The concentration of Aloe in the raw material also may vary from 100% to a low of 0.0005%. Oral administration of various anthraquinone components results in a rise in their blood concentrations, wide systemic distribution, accumulation in the liver and kidneys, and excretion in urine and feces; polysaccharide components are distributed systemically and metabolized into smaller molecules. aloe-derived material has fungicidal, antimicrobial, and antiviral activities, and has been effective in wound healing and infection treatment in animals. Aloe barbadensis (also known as Aloe vera)-derived ingredients were not toxic in acute oral studies using mice and rats. In parenteral studies, the LD(50) using mice was > 200 mg/kg, rats was > 50 mg/kg, and using dogs was > 50 mg/kg. In intravenous studies the LD(50) using mice was > 80 mg/kg, rats was > 15 mg/kg, and dogs was > 10 mg/kg. The 14-day no observed effect level (NOEL) for the Aloe polysaccharide, acemannan, in the diet of Sprague-Dawley rats, was 50,000 ppm or 4.1 to 4.6 g/kg day(-1). In a 3-month study using mice, Aloe vera (extracted in ethanol) given orally in drinking water at 100 mg/kg produced reproductive toxicity, inflammation, and mortality above that seen in control animals. Aloe vera extracted in methanol and given to mice at 100 mg/kg in drinking water for 3 months caused significant sperm damage compared to controls. Aloe barbadensis extracted with water and given to pregnant Charles Foster albino rats on gestational days (GDs) 0 through 9 was an abortifacient and produced skeletal abnormalities. Both negative and positive results were found in bacterial and mammalian cell genotoxicity assays using Aloe barbadensis-derived material, Aloe Ferox-derived material, and various anthraquinones derived from Aloe. Aloin (an anthraquinone) did not produce tumors when included in the feed of mice for 20 weeks, nor did aloin increase the incidence of colorectal tumors induced with 1,2-dimethylhydrazine. Aloe-emodin (an anthraquinone) given to mice in which tumor cells had been injected inhibited growth of malignant tumors. Other animal data also suggest that components of Aloe inhibit tumor growth and improve survival. Various in vitro assays also demonstrated anticarcinogenic activity of aloe-emodin. Diarrhea was the only adverse effect of note with the use of Aloe-derived ingredients to treat asthma, ischemic heart disease, diabetes, ulcers, skin disease, and cancer. Case reports include acute eczema, contact urticaria, and dermatitis in individuals who applied Aloe-derived ingredients topically. The Cosmetic Ingredient Review Expert Panel concluded that anthraquinone levels in the several Aloe Barbadensis extracts are well understood and can conform to the industry-established level of 50 ppm. Although the phototoxicity anthraquinone components of Aloe plants have been demonstrated, several clinical studies of preparations derived from Aloe barbadensis plants demonstrated no phototoxicity, confirming that the concentrations of anthraquinones in such preparations are too low to induce phototoxicity. The characterization of aloe-derived ingredients from other species is not clear. In the absence of well-characterized derivatives, biological studies of these materials are considered necessary. The studies needed are 28-day dermal toxicity studies on Aloe Andongensis Extract, Aloe Andongensis Leaf Juice, Aloe Arborescens Leaf Extract, Aloe Arborescens Leaf Juice, Aloe Ferox Leaf Extract, Aloe Ferox Leaf Juice, and Aloe Ferox Leaf Juice (ingredients should be tested at current use concentrations). In Aloe-derived ingredients used in cosmetics, regardless of species, anthraquinone levels should not exceed 50 ppm. The Cosmetic Ingredient Review Expert Panel advised the industry that the total polychlorobiphenyl (PCB)/pesticide contamination of any plant-derived cosmetic ingredient should be limited to not more than 40 ppm, with not more than 10 ppm for any specific residue and that limits were appropriate for the following impurities: arsenic (3 mg/kg maximum), heavy metals (20 mg/kg maximum), and lead (5 mg/kg maximum).
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PMID:Final report on the safety assessment of AloeAndongensis Extract, Aloe Andongensis Leaf Juice,aloe Arborescens Leaf Extract, Aloe Arborescens Leaf Juice, Aloe Arborescens Leaf Protoplasts, Aloe Barbadensis Flower Extract, Aloe Barbadensis Leaf, Aloe Barbadensis Leaf Extract, Aloe Barbadensis Leaf Juice,aloe Barbadensis Leaf Polysaccharides, Aloe Barbadensis Leaf Water, Aloe Ferox Leaf Extract, Aloe Ferox Leaf Juice, and Aloe Ferox Leaf Juice Extract. 1761 30

Patients with the rare X-linked syndrome, immune dysregulation, polyendocrinopathy, enteropathy (IPEX) may present early in life with type I diabetes, hyperthyroidism, chronic enteropathy, villous atrophy, dermatitis, autoimmune hemolytic anemia, and antibody- induced neutropenia and thrombocytopenia. Of the reported families with IPEX, most affected boys died before the age of 3 years of malabsorbtion, failure to thrive, infections, or other complications. Characteristic findings at autopsy include lymphocytic infiltrates affecting the lungs, endocrine organs, such as pancreas and thyroid and skin, and increased lymphoid elements in lymph nodes and spleen. Although symptomatic therapy with immunosuppressive drugs provides some beneficial effects, the only curative treatment is hematopoietic stem cell transplantation.
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PMID:Immune dysregulation, polyendocrinopathy, enteropathy, X-linked inheritance: model for autoaggression. 1771 89

Neuroendocrine tumor consisting of pancreatic alpha-cells -- glucagonoma -- is a very rare finding (one case per two million people a year). This functionally active, usually malignant tumor has typical clinical manifestations. Glucagonoma syndrome is a disease that has an original clinical picture that includes necrolytic migrating erythema with secondary bullous dermatitis, glucose tolerance disorder or diabetes mellitus, weight loss, anemia, hypoaminoacidemia, venous thrombosis, and alimentary and mental disturbances. By the time diagnosis is made, 60 to 70% of glucagonomas already give metastases, and even small glucagonomas should be considered tumors with unknown malignant potential or malignant tumors. Glucagonomas grow slowly, and patients live long (the survival median is approximately 15 years). The authors describe their own observation.
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PMID:[A case of pancreatic glucagonoma]. 1792 96

Konjac is a traditional Japanese food with a peculiar texture, and it has been suggested that its main ingredient, konjac glucomannan (KGM), ameliorates metabolic disorders such as diabetes and hypercholesteremia. We have found that feeding with pulverized KGM (PKGM) prevents skin inflammation in a murine model of atopic dermatitis. Here, we show that dietary PKGM suppresses allergic rhinitis-like symptoms in mice upon immunization and nasal sensitization with ovalbumin (OVA). The PKGM-fed mice showed a much lower frequency of sneezing than in control animals. We also found that PKGM supplementation exclusively suppressed OVA-specific IgE response without affecting IgG1/IgG2a responses as well as systemic Th1/Th2 cytokine production. These results suggest that PKGM can be a beneficial foodstuff in preventing nasal allergy such as seasonal pollinosis.
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PMID:Dietary pulverized konjac glucomannan prevents the development of allergic rhinitis-like symptoms and IgE response in mice. 1792 9


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