Ichthyosis: multinational European study on patient characteristics, involved body sites and impact on quality of life

We present the first large multinational study of ichthyosis to better understand the disease characteristics, the body sites involved and the effect of the disease on the quality of life of patients.

Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses

Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis.

Severe Scabies: A French Multi-centre Study Involving 95 Patients with Crusted and Profuse Disease and Review of the Literature

The aim of this multi-centre French retrospective study was to identify severe, i.e. crusted and profuse, scabies patients. Records were retrieved from 22 Dermatology or Infectious Diseases departments in the Ile-de-France from January 2009 to January 2015 to characterize epidemiology, demography, diagnosis, contributing factors, treatment features, and outcomes in severe scabies. A total of 95 inpatients (57 crusted and 38 profuse) were included. A higher number of cases was observed among elderly patients (>75 years), mostly living in institutions. Thirteen patients (13.6%) reported a history of previously treated scabies. Sixty-three patients (66.3%) had been seen by a previous practitioner for the current episode (up to 8 previous visits). Initial misdiagnosis (e.g. eczema, prurigo, drug-related eruptions, psoriasis) was documented in 41 patients (43.1%). Fifty-eight patients (61%) had already received 1 or more previous treatments for their current episode. Forty percent received corticosteroids or acitretin for an initial diagnosis of eczema or psoriasis. Median time from the onset of symptoms to the diagnosis of severe scabies was 3 months (range 0.3-22). Itch was present in all patients at diagnosis. Most patients (n=84, 88.4%) had comorbidities. Diagnostic and therapeutic approaches varied. Complications occurred in 11.5% of cases. To date, there is no consensus for diagnosis and treatment, and future standardization of is required for optimal management.

Safety and efficacy of high-dose clobetasol propionate 0.05% in cutaneous lichen planus

Cutaneous lichen planus is a highly pruritic dermatosis with an unmet need in its management. The aim of this study was to evaluate the short-term effect and tolerance of high doses of clobetasol propionate 0.05% in cutaneous lichen planus. We conducted a single-center retrospective cohort study from 2017 to 2021. All adults treated with high-dose (>5 g/day) clobetasol propionate 0.05% for cutaneous lichen planus were included. Patients with less than 10% affected body surface area at initial presentation or who received concomitant systemic therapy were excluded. The primary endpoint was the rate of complete remission by week 16. Secondary endpoints included maximum daily and median cumulative doses, reduction in pruritus and occurrence of adverse events. Fifty-seven patients, 60% female, with a mean age of 48 years (min-max,18-83) were included. Cutaneous lichen planus had been present for a median duration of 2 months at initial presentation (min-max, 1-4) and involved a median body surface area of 27%. Pruritus was reported by 55/57 (96%) patients. At week 16, 41/57 (72%) patients had achieved complete remission without treatment modification, among whom 25/41 (61%) had achieved it at week 6. The median daily and cumulative doses were, respectively, 20 g/day (IQR, 10-20) and 560 g (IQR, 320-925). Three patients experienced mild adverse events. No statistical association was demonstrated between the duration of the disease before treatment initiation and clinical response. In conclusion, high-dose clobetasol propionate 0.05% seems to be an effective, well-tolerated, and easy-to-implement treatment for cutaneous lichen planus.

Male genital vitiligo

Vitiligo is a polygenetic multifactorial disease leading to melanocytic loss in skin and sometimes in hair. Genital areas may be involved and represent a specific therapeutic challenge. Surprisingly, data on male genital vitiligo remain scarce. This review aims to collate current knowledge on male genital vitiligo and to discuss the risks and benefits of the various therapeutic approaches. Male genital vitiligo is relatively frequent and often induces marked impairment of quality of life, with a specific impact on sex life. Prompt recognition of activity remains mandatory to halt disease progression, as repigmentation remains difficult to achieve in most cases. Thanks to progress in understanding of the pathophysiology of vitiligo, new therapeutic approaches are under development. Topical ruxolitinib, a JAK pathway inhibitor, is currently the product in the most advanced stage of development, with a very encouraging repigmentation rate on the face, although specific efficacy in genital area remains to be assessed. The next generation of treatments, such as topical WNT agonists, could be of great interest in genital vitiligo as they will not require combination with UV therapy and they may be able to enhance the differentiation and proliferation of melanocyte stem cells in this difficult-to-treat area.

Male genital lichen planus: A retrospective study of 89 cases

BACKGROUND

Unlike other types of lichen planus (LP), there are no series concerning male genital LP.

OBJECTIVE

To describe the clinical characteristics, diagnosis, and response to treatment of male genital LP.

PATIENTS AND METHODS

A retrospective study of male patients with genital LP consulting a dermatologist specialized in anogenital diseases between January 2010 and 2019. Demographic data, history, functional signs, clinical characteristics, pathology, complications, and treatment efficacy were collected.

RESULTS

Eighty-nine patients were included at four centers. The median age was 51 years. Most patients were uncircumcised and asymptomatic. In 88.8% of cases, only the genital mucosa was involved. Erythema (71%), papules (21.3%), lacy network (15.7%), atrophic lesions (15.7%), erosions (14.6%), and post-inflammatory hyperpigmentation (2.2%) were less frequently observed. Biopsy results confirmed LP in 61.3% of cases but could not rule out other inflammatory genital dermatoses in other cases. Anatomic complications were observed in 30.3% of patients. Topical corticosteroids (TCS) induced remission in most cases. Tacrolimus efficacy was comparable to that of TCS.

CONCLUSION

Male genital LP is a rare inflammatory disorder chiefly affecting uncircumcised men. It is found predominantly on the mucosal component of the penis and presents as non-erosive inflammatory balanitis in most cases, with frequent partial or complete remission on treatment with TCS.

Impact de la crise de la COVID-19 sur les internes de dermatologie français

Introduction

Lors de la crise de la COVID-19, les internes de dermatologie, comme les autres professionnels de santé, ont été en première ligne. Nous avons souhaité évaluer l’impact de cette pandémie sur leurs pratiques professionnelles, leurs conditions de travail, leur formation universitaire et leur santé mentale.

Matériel et méthodes

Un questionnaire en ligne disponible du 17 au 26 avril a été envoyé à tous les internes français en dermatologie par la mailing list de l’association Futurs dermato-venerologues de France. Le questionnaire comprenait 104 questions dont le questionnaire de burn-out de Maslach.

Des régressions logistiques multivariées ont été effectuées pour examiner les facteurs associés au maintien d’une activité de dermatologie, une moins bonne supervision, une dégradation de la formation et les causes rapportées, et l’impact psychologique via un score de burn-out.

Résultats

Les internes déclarant une moins bonne supervision étaient les internes les plus avancés dans le cursus (OR 3,24 IC [1,65 ; 6,65], p < 0,001) ou en stage en CH périphériques (OR 2,21 IC [1,14 ; 4,46], p = 0,022). Pour 181 (76 %) internes, la pandémie a eu un effet négatif sur leur formation. La cause principale rapportée par 175 (74 %) d’entre eux était l’annulation des cours et des congrès. Il n’y avait de différence significative, entre les internes des zones fortement touchées ou non concernant la dégradation de leur formation ou des causes possibles liées à cette dégradation. Aucun interne n’était exempt de symptômes de burn-out, cinq (2 %) présentaient des symptômes intermédiaires, 43 (18 %) étaient fortement touchés dans 1 dimension, 76 (32 %) dans 2 et 112 (47 %) dans 3, sans différence significative entre les zones fortement et moins touchées.

Discussion

La crise de la COVID-19 a mis en tension notre système de santé mais également notre capacité à maintenir des activités essentielles pour les internes comme l’enseignement. Ces difficultés n’ont pas été exclusivement du fait du changement d’activité ou de la submersion des services par des patients atteints de la COVID-19, puisque la dégradation de la formation n’était pas corrélée à la situation géographique. La mise en place d’outils dématérialisés pour maintenir un lien et une formation adéquate n’a pas pu être mis en œuvre rapidement et efficacement durant la crise. Des stratégies pour accroître l’utilisation des outils numériques de formation et la télé-dermatologie semblent être des armes essentielles pour lutter en temps de crise épidémique avec le moins de répercussions sur leur travail et leur formation. Ces outils sont également adaptés aux nouvelles générations et aux nouveaux modes d’organisation du travail dans la société, dépassant même le cadre de la médecine et de la dermatologie.