Treatment of the Erythema and Flushing of Rosacea
As a form of defence, cells with DNA damage arrest at the G1-S cell cycle checkpoint when damage is sensed by the protein product of the ATM gene. Inherited mutations in this gene are responsible for the rare recessive disease ataxia telangiectasia, which is characterized by cerebellar ataxia, dilation of the blood vessels of the eye, immunodeficiency and growth retardation, and by a strong predisposition to cancer (Strachan and Read, 1999). By processes that are poorly understood, the ATM protein signals DNA damage to TP53, resulting in increased concentrations of the p53 tumour suppressor protein, which is often described as the 'guardian of the genome'. In its tetrameric form, p53 is a transcription factor normally present in low concentrations through interactions with the MDM-2 protein that signals its degradation (Evan and Littlewood, 1998). When p53 concentrations are raised, progression through the cell cycle is halted, providing time for DNA repair or for initiation of...
Differentiation between IgE-mediated and non-IgE-mediated reactions may therefore be difficult. The Melbourne Milk Allergy Study, conducted by Hill and colleagues,17 identified three types of reaction in sensitized children - immediate reactions (rapid skin reactions with perioral erythema, facial angioedema and urticaria, some developing anaphylaxis), intermediate reactions (gastrointestinal symptoms such as vomiting or diarrhea occurring 1-24 h after ingestion) and delayed reactions (eczema flares or respiratory symptoms such as cough and wheeze, occurring between 1 and 5 days after challenge). The volume of milk required
Endoscopy and biopsy are the main ways to establish the diagnosis. Endoscopic findings, when present, are non-specific and include erythema, antral nodular lesions, ulcers and, rarely, a narrowed lumen. In mucosal involvement, histology is diagnostic in more than 80 of patients,
Collagenous gastritis is an extremely rare disorder of unknown etiology, To date, fewer than ten cases have been reported in the literature. The condition is characterized by deposition of a subepithelial collagen band greater than 10 im in thickness. The disorder was originally described by Colletti and Trainer in a 15-year-old girl with refractory H. pylori-negative chronic gastritis.55 It has been reported either as an isolated entity or with synchronous collagenous colitis, collagenous duodenitis, lymphocytic colitis or celiac disease. Clinical features, such as epigastric pain, vomiting, anorexia, postprandial fullness and weight loss are reported. Endoscopic findings include diffuse nodularity, patchy or diffuse erythema, erosions and frank ulcers with hemorrhage. The diagnosis relies on mucosal histology, usually of the fundus and corpus, sharing discontinuous subepithelial collagen deposition with entrapped capillaries and fibroblasts, in association with mild glandular...
Despite radiographic and manometric evidence typical of achalasia, pseudoachalasia secondary to a tumor at the GE junction must be ruled out.67,73 Findings consistent with achalasia may include a dilated, atonic esophageal body mucosal thickening and or erythema and a puckered LES which fails to open with insufflation, but which is easily passed with the endoscope. If there is visual evidence of extrinsic compression or the endoscope fails to pass through the GE junction with gentle pressure, then a tumor must be excluded. Biopsies should be taken from suspicious areas seen above the GE junction or seen on retroflexion from within the stomach.
Involvement of the gastric mucosa is common in children with intrahepatic or extrahepatic causes of portal hypertension.33 Endoscopic findings vary from mild involvement, including a snake-skin mosaic pattern of the mucosa, a fine pink speckling and superficial erythema (scarlatina-type rash), to a severe gastropathy, defined by cherry red spots with a diffuse confluence of reddened areas and a hemorrhagic appearance. These patterns seem to be specific for portal hypertensive gastropathy and have not been found in any of 500 endoscopic examinations performed in children without hepatic disease. The fundus and corpus are usually involved, although antral involvement is occasionally observed. Histologically, portal hypertensive gastropathy is characterized by ectasia of mucosal capillaries and venules and by submucosal venous dilatation, with no acute or chronic inflammation.
The use of the skin patch (atopy patch) test, in which the relevant antigen is maintained against the skin under a sealed patch for 48 h, has been suggested to identify cases of non-IgE-mediated delayed allergy. A positive test is signaled by the finding of erythema and induration at 72 h. Combination of patch testing with either skin prick testing or specific IgE testing has identified significant numbers of food-sensitized children who may have been negative on classic testing.83,84 Of children with delayed reactions to antigen, 89 were identified by patch test in one study.83 This test has not become widely used and remains under evaluation. Recent reports do, however suggest that patch testing may be clinically useful, particularly in the presence of eczema.85,86 There are some logistic difficulties, in that the test should be read only after 3 days, requiring a second clinic visit, and some children will not tolerate an occlusive dressing for so long. It is also potentially open...
Typical endoscopic findings are 'beefy' redness or erythema and, occasionally, erosions, but the presence of bile in the stomach during endoscopy does not have clinical significance. The distinctive histological features, also defined as 'chemical gastropathy', include foveolar elongation, complexity and hypercellularity, together with edema, vasodilatation and a paucity of acute and chronic inflammatory cells in the lamina propria.31 These findings do not correlate with gastric bile concentration.
How To Deal With Rosacea and Eczema
Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.