Pseudo-angiomatose éruptive associée à une séroconversion pour les entérovirus

BACKGROUND

Eruptive pseudo-angiomatosis is a benign, acute dermatosis, mostly associated with a viral infection. Skin lesions consist of angioma-like papules, scattered over the skin. Involution is usually spontaneous and swift.

CASE-REPORT

We report a case of eruptive pseudo-angiomatosis, which occurred in an immunocompetent 18 year-old adult together with acute gastroenteritis and enterovirus seroconversion.

DISCUSSION

Eruptive pseudo-angiomatosis was described for the first time in 1969 in 4 children and then several pediatric cases were reported. Recently, 9 eruptive pseudo-angiomatosis in adults have been described. Our case had some particularities: it occurred in an immunocompetent adult and the skin lesions were angioma-like.

Analyse des signes cliniques des malades atteints de pemphigoïde en fonction des antigènes reconnus par leur sérum en immunotransfert

INTRODUCTION

Clinical features and extent of bullous pemphigoid lesions differed widely among patients. The pathogenic role of anti-BPAG2 antibodies has been recently demonstrated. The aim of this study was to analyze the relationship between clinical features of bullous pemphigoid patients and the antigens recognized by their serum.

PATIENTS AND METHODS

One hundred and twelve bullous pemphigoid patients were included in this prospective multicenter study. Inclusion criteria were the following: 1) diagnosis of bullous pemphigoid established on the presence of 3 of the 4 clinical features of bullous pemphigoid, histological picture of bullous pemphigoid and positive direct immunofluorescence; 2) serum available for immunoblotting studies. The clinical and biological findings were prospectively recorded on standard forms. Sera were collected and analyzed using indirect immunofluorescence and immunoblotting on human epidermal extracts.

RESULTS

Analysis of patient's clinical features depending on the antigens recognized by their serum showed that patients whose serum contained anti-BPAG1 antibodies had more frequently pruritus, blisters on the lower limbs and a positive indirect immunofluorescence. Patients whose serum contained anti-BPAG2 antibodies had blisters more frequently localized on the head, and a more frequently negative indirect immunofluorescence. Patients whose serum was negative by immunoblotting had less frequently urticarial and/or eczematous lesions, bullae less frequently localized on the lower part of the trunk, abdomen and lower limbs, lower eosinophilia and a more frequently negative indirect immunofluorescence.

CONCLUSION

Patients with circulating anti-BPAG1 antibodies exhibited the most typical, clinical and biological features of bullous pemphigoid.

Clinical criteria for the diagnosis of bullous pemphigoid: a reevaluation according to immunoblot analysis of patient sera

BACKGROUND

We previously proposed a set of 4 clinical criteria for the diagnosis of bullous pemphigoid (BP) that consisted of age greater than 70 years, absence of atrophic scars, absence of mucosal involvement and absence of predominant bullous lesions on the neck and head. These results have been challenged because direct immunoelectron microscopy (IEM), which was used as the standard diagnostic criterion in our initial study, does not identify the different antigens of the basement membrane zone.

OBJECTIVE

To reassess the validity of these clinical criteria for the diagnosis of BP using immunoblot analysis of patient sera as the main diagnostic criterion, in order to precisely identify the antigens recognized by patient sera.

METHODS

One hundred and eighty-nine sera from patients with various subepidermal autoimmune blistering diseases (AIBDs) were tested by immunoblotting using dermal and epidermal extracts. IEM was used as a complementary diagnostic procedure in a few patients whose serum recognized BPAG2 exclusively or was negative in immunoblotting.

RESULTS

142 patients (75%) had at least 3 of the 4 clinical diagnostic criteria. Sera from patients who lacked the set of BP clinical criteria were more frequently immunoblot negative (34%) than sera from patients who had the criteria (18%; p = 0.025). BPAG1 was more frequently recognized by sera from patients with the set of BP clinical criteria (78%) than by sera from patients without the criteria (45%; p = 5.10(-4)). In contrast, BPAG2 was recognized by a great number of sera from patients who lacked the criteria of BP (71%), which was in accordance with the presence of numerous patients with cicatricial pemphigoid in this group. Among patients with various subepidermal AIBDs, the diagnosis of BP could be made with a sensitivity of 86%, a specificity of 90% and an excellent prognostic positive value over 95%, if 3 of these clinical criteria were present.

CONCLUSION

These results confirm the interest of this set of clinical criteria for the rapid diagnosis of BP.

[Kikuchi's disease associated with cutaneous manifestations evoking Well's syndrome]

BACKGROUND

Wells' syndrome is a dermatological disease with polymorphous lesions characterized histologically by an eosinophilic infiltrate of the dermis with edema and flame figures. Kikuchi's disease is a benign cause of lymphadenitis corresponding histologically to a necrotizing histiocyting adenitis without neutrophils. We describe the association of a Kikuchi's disease and cutaneous lesions similar to Wells'syndrome.

OBSERVATION

A 62-year-old man presented over 3 years several simultaneous episodes of left axillary lymphadenitis and of cutaneous lesions compatible with a diagnosis of Wells'syndrome. No precipitating event or disease described with the Wells'syndrome was established. Concerning the axillary nodes, a cancer, a lymphoproliferative syndrome, a systemic lupus and several infectious diseases were excluded. Standard histology and immunochemistry of a lymph node showed signs of Kikuchi's disease. Bilateral anterior uveitis was incidentally detected. The three conditions improved with oral corticosteroids (1 mg/kg/d).

DISCUSSION

The patient had Kikuchi's disease and a recurrent dermatosis for which the clinical and histological aspects, the evolution and the absence of arguments for another cause, suggest a Wells'syndrome. Cutaneous manifestations occur in 16 to 40 p. 100 of cases of Kikuchi's disease and often have characteristic histologic features not corresponding to Wells'syndrome. The association of the 2 diseases may be then incidental, despite 4 simultaneous episodes. Two viral agents, VIH and VZV have been associated with the two diseases but do not seem to be the cause in our patient. Concerning the anterior uveitis, a single case of uveitis has been described for each condition.

[Survey on the activity of hospital departments of dermatology in France]

INTRODUCTION

The Collège des Enseignants de Dermatologie de France initiated a study to assess the activity of the departments of dermatology in French hospitals. We report the results of this survey.

MATERIAL AND METHODS

The study was conducted during a randomly selected week in the year 2000. An anonymous questionnaire was sent to all the departments of dermatology in the hospitals in France and was completed for each patient leaving the hospital during that week. The data collected were: the type of establishment, admission method, hospitalization method, type of pathology, motive for hospitalization, length of hospitalization and type of treatment used.

RESULTS

The response rate was of 96 p. 100 for the University hospital centers and 80 p. 100 for the non-university hospitals. The number of patients treated per year was of 65 628 for the University hospitals and of 16,000 for the others. Ninety percent of the hospitalizations corresponded to direct admissions. The pathologies at the origin of the majority of yearly hospitalizations were, for the University hospitals: melanoma, leg ulcers, highly specialized dermatoses and systemic diseases and for the other hospitals: leg ulcers, HIV infection, highly specialized dermatoses and erysipela. The pathologies requiring the greatest number of hospitalization days were melanoma, leg ulcers, erysipela and highly specialized dermatoses.

DISCUSSION

This study shows that the activity in the departments of dermatology is centered on pathologies that are clearly severe in terms of Public Health (oncology, infectious diseases and angiology). It also shows the efforts made for the management of patients in out-patient settings.

[Trumpet nail deformity during the course of Dowling-Meara type epidermolysis bullosa simplex. A report of two cases]

INTRODUCTION

We report two patients with Dowling-Meara type epidermolysis bullosa simplex: who had trumpet nail deformity.

CASE REPORTS

Two 75 and 72 year-old sisters, had flare-ups of epidermolysis bullosa simplex since childhood. The aspect of the lesions and electron microscopy were in favour of the diagnosis of the Dowling-Meara variant of epidermolysis bullosa simplex. Both women had several fingernails with pincer and trumpet nail deformities. There were no such signs among the other siblings, who had never had epidermolysis.

DISCUSSION

Nail involvement is not rare during the course of superficial epidermolysis bullosa. The trumpet lesions appear to be relatively specific to the present two cases of epidermolysis bullosa simplex. The electron microscopic findings of these two cases were also noteworthy, with whisk-like but not round clumping of the perinuclear tonofilaments.

Hyperpigmentation of the distal phalanx in healthy Caucasian neonates

Transient alterations in pigmentation are frequently observed in black neonates, but to our knowledge, have not previously been reported in Caucasian infants. In 54 Caucasian newborns, we found at least mild periungual hyperpigmentation similar to the variation in coloration in the periungual region of many black newborns. This pigmentation should be added to the transient benign dermatoses of Caucasian infants.

Pyodermitis of genital areas: an atypical manifestation of eosinophilic pustulosis of childhood

Eosinophilic pustulosis of the scalp was first described in 1984. It has also been described in other sites than the scalp. We report a case in which the lesions exclusively involved the genitals. A 4-month-old boy presented with papulopustular lesions of the genitals in the form of pyodermitis with a favourable course over several days but which subsequently recurred. A smear of a pustule revealed no signs of scabies or viral, fungal or bacterial infection. Histology showed a non-follicular eosinophilic pustulosis. This case emphasizes the ubiquitous and sometimes misleading nature of eosinophilic pustulosis and the non-follicular nature of the lesions.

[Warts and molluscum contagiosum: practical point of view]

Warts and molluscums contagiosums are two benign viral skin diseases that commonly affect children. Contamination occurs by autoinoculation or during skin to skin contact. Molluscums contagiosums are more frequent in immunodeficient and atopic children. Swimming-pool practice and contact sports favour warts transmission. The choice of treatment depends upon the age of the child and the number and location of the lesions. Natural resolution can be awaited when lesions are limited. In first intent, curettage of the lesions under local anesthesia for molluscums contagiosums, salicylic acid preparation or cryotherapy according to location for warts, are the treatment of choice. In neither affection school ousting is necessary.