Donald C. Abele

Ocular rosacea : Signs, symptoms, and tear studies before and after treatment with doxycycline

OBJECTIVE To examine ocular signs, symptoms, and results of tear analysis in patients with cutaneous rosacea before, during, and after doxycycline therapy. DESIGN Before-after trial. SETTING General community. PATIENTS OR OTHER PARTICIPANTS Thirty-nine patients with cutaneous rosacea underwent dermatologic and ocular examinations, testing of tear break-up time, and Schirmer testing at baseline and 4, 8, and 12 weeks. Six patients did not complete the study. Baseline tear break-up time and results of Schirmer test were compared with those of 13 patients without rosacea who were matched for age and sex. INTERVENTION Patients with rosacea were given doxycycline, 100 mg daily for 12 weeks. MAIN OUTCOME MEASURE Statistically significant (P, .05) improvement in tear break-up time. RESULT The most frequent ocular symptoms were dryness, itching, blurred vision, and photosensitivity, all of which improved significantly with treatment. All patients had signs of ocular disease, most commonly erythema and telangiectasia, meibomian gland dysfunction, and ciliary base injection. Significant improvement (P,.05) for scales, erythema and telangiectasia, ciliary base injection, bulbar injection, papillary hypertrophy, and punctate epithelial erosions was seen. Average tear break-up time for the patients with rosacea was 5.7 seconds, which improved to 10.8 seconds after 12 weeks of treatment (P = .007). Baseline tear break-up time was significantly lower than for the comparison group of normal subjects (P = .001). There was no correlation between severity of cutaneous disease and ocular disease. CONCLUSIONS All patients with cutaneous rosacea had some degree of ocular involvement. Tear break-up time is abnormal in patients with rosacea. Ocular erythema and telangiectasia, meibomian gland dysfunction, and short tear break-up time in patients with cutaneous rosacea are indicators of ocular rosacea. Doxycycline, 100 mg daily, will improve ocular disease and increase the tear break-up time.

The many faces and phases of borreliosis II

Borrelia burgdorferi, the etiologic agent of Lyme disease, has also been associated with other cutaneous conditions. Acrodermatitis chronica atrophicans and lymphadenosis benigna cutis are also caused by B. burgdorferi. Recent evidence links some cases of progressive facial hemiatrophy of Parry-Romberg, benign lymphocytic infiltrate of the skin (Jessner-Kanof), lichen sclerosus et atrophicus, morphea, and Shulman syndrome with borreliae. This article reviews the manifestations of the diseases definitely linked to borreliosis and the evidence linking borreliae to progressive facial hemiatrophy, benign lymphocytic infiltrate, lichen sclerosus et atrophicus, morphea, and Shulman syndrome.

Localized exogenous ochronosis: Report of a case and review of the literature

A 58-year-old black woman with localized exogenous ochronosis due to the use of a proprietary hydroquinone bleaching cream is described. Histologic studies, including electron microscopy, are presented. The differential diagnosis of blue-black hyperpigmentation is discussed. The literature on ochronosis, both endogenous (alkaptonuria) and exogenous, is reviewed, and a unifying theory for the formation (from hydroquinones) of hydroxylated indoles similar to melanin precursors is outlined.

Progressive facial hemiatrophy (Parry-Romberg syndrome) and borreliosis

We report a 5 year-old girl with progressive facial hemiatrophy and with borreliosis as suggested cause .

The many faces and phases of borreliosis I. Lyme disease.

Lyme disease is increasingly being reported throughout the United States and many parts of the world. Borrelia burgdorferi, the etiologic agent of Lyme disease, is a spirochete that, not unlike the treponema of syphilis, can cause a spectrum of disease from the initial skin lesion, through widely varied symptoms and signs, to chronic neurologic and arthritic disability. The borrelial spirochete and Lyme disease are the subject of this review. A subsequent article will review other definite and possible cutaneous manifestations of borreliosis.

Case reportsLocalized exogenous ochronosis: Report of a case and review of the literature

A 58-year-old black woman with localized exogenous ochronosis due to the use of a proprietary hydroquinone bleaching cream is described. Histologic studies, including electron microscopy, are presented. The differential diagnosis of blue-black hyperpigmentation is discussed. The literature on ochronosis, both endogenous (alkaptonuria) and exogenous, is reviewed, and a unifying theory for the formation (from hydroquinones) of hydroxylated indoles similar to melanin precursors is outlined.