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Rudnicka L, Arenbergerova M, Grimalt R, Ioannides D, Katoulis AC, Lazaridou E, Olszewska M, Ovcharenko YS, Piraccini BM, Prohic A, Rakowska A, Reygagne P, Richard MA, Soares RO, Starace M, Vañó-Galvan S, Waskiel-Burnat A. European expert consensus statement on the systemic treatment of alopecia areata. J Eur Acad Dermatol Venereol 2024; 38:687-694. [PMID: 38169088 DOI: 10.1111/jdv.19768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Alopecia areata is an autoimmune form of non-scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA-approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA-approved for patients with severe alopecia areata. Other systemic medications used off-label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.
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Affiliation(s)
- L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - D Ioannides
- 1st Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - A C Katoulis
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - E Lazaridou
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - M Olszewska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Y S Ovcharenko
- Department of Infectious Diseases and Clinical Immunology of the V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences University of Bologna, Italy School of Specialization Dermatology and Venereology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Prohic
- Department of Dermatovenerology, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - A Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - P Reygagne
- Centre de Santé Sabouraud, Hopital Saint Louis, Paris, France
| | - M A Richard
- CEReSS-EA 3279, Research Centrer in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitary Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, Marseille, France
| | - R O Soares
- CUF Descobertas Hospital, Lisbon, Portugal
| | - M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences University of Bologna, Italy School of Specialization Dermatology and Venereology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - S Vañó-Galvan
- Department Ramon y Cajal Hospital, IRYCIS, Grupo Pedro Jaén Clinic, TricoHRC Research Group, University of Alcala, Madrid, Spain
| | - A Waskiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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2
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Assan F, Husson B, Hegazy S, Seneschal J, Aubin F, Mahé E, Jullien D, Sbidian E, D'Incan M, Conrad C, Brenaut E, Girard C, Richard MA, Bachelez H, Viguier M. Palmoplantar pustulosis and acrodermatitis continua of Hallopeau: demographical and clinical comparative study in a large multicentre cohort. J Eur Acad Dermatol Venereol 2022; 36:1578-1583. [PMID: 35366356 PMCID: PMC9546063 DOI: 10.1111/jdv.18127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/23/2022] [Indexed: 12/04/2022]
Abstract
Background Acral pustular disease within the pustular psoriasis/psoriasis‐like spectrum mainly includes palmoplantar pustulosis (PPP) and acrodermatitis continua of Hallopeau (ACH). Scarce data argue for a distinction between these two entities, but no study has compared the clinical and epidemiologic characteristics of ACH and PPP. Objectives We aimed to perform a comparative description of the epidemiological and clinical characteristics of PPP and ACH in a multicentre retrospective cohort. Methods In this multicentre national retrospective cohort study, we compared the epidemiological characteristics, comorbidities and psoriasis characteristics of patients with PPP and ACH. Results A total of 234 patients were included: 203 (87%) with PPP, 18 (8%) with ACH and 13 (6%) with both, according to 2017 ERASPEN criteria. As compared with ACH, PPP was associated with female sex, smoking activity and higher median BMI (P = 0.01, P = 0.02 and P = 0.05 respectively). A family background of psoriasis was more frequent in PPP than ACH. Age of onset of palmoplantar disease was similar between PPP and ACH patients, median age 44 and 48 years respectively. Peripheral joint inflammatory involvement was the only rheumatic disease associated with ACH. The association with another psoriasis type was similar in PPP and ACH (57.6% and 61.1% respectively). Conclusion Our study confirms in a large PPP cohort the predominance of females and a high prevalence of smoking and elevated body mass index but also shows an association of these features in PPP as compared with ACH. In addition, it highlights peripheral arthritis as the only arthritis endotype associated with ACH. Increased knowledge of the immunogenetic backgrounds underlying these two entities is warranted to better stratify pustular psoriasis or psoriasis‐like entities for precision medicine.
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Affiliation(s)
- F Assan
- Dermatology Department, Hôpital Robert-Debré, Reims, France
| | - B Husson
- Dermatology Department, Hôpital Robert-Debré, Reims, France
| | - S Hegazy
- Dermatology Department, Hôpital Larrey, Toulouse, France
| | - J Seneschal
- Dermatology Department, National Reference Center for Rare Skin Diseases, Hôpital Saint-André, Bordeaux, France
| | - F Aubin
- Dermatology Department and Inserm 1098, Centre Hospitalo-Universitaire (CHU), Besançon, France
| | - E Mahé
- Dermatology Department, Centre Hospitalier (CH), Argenteuil, France
| | - D Jullien
- Clinical Immunology Department, CH Lyon-Sud, Lyon, France
| | - E Sbidian
- Dermatology Department, Hôpital Henri-Mondor, Créteil, France
| | - M D'Incan
- Dermatology Department, CHU Estaing, Clermont-Ferrand, France
| | - C Conrad
- Dermatology Department, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - E Brenaut
- Dermatology Department, CHU, Brest, France
| | - C Girard
- Dermatology Department, CHU Lapeyronie, Montpellier, France
| | - M A Richard
- Dermatology Department, CEReSS-EA 3279, Research Center in Health Services and Quality of Life Aix Marseille University, University Hospital Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - H Bachelez
- Université de Paris, Paris, France.,Dermatology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM UMR1163, Institut Imagine, Necker Hospital, Paris, France
| | - M Viguier
- Dermatology Department, Hôpital Robert-Debré, Reims, France
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Shourick J, Taieb C, Seneschal J, Merhand S, Ezzedine K, Halioua B, Richard MA, Mrowietz U. EczemaPartner - adapting a questionnaire to assess the impact of atopic dermatitis on partners of patients. J Eur Acad Dermatol Venereol 2021; 36:e192-e193. [PMID: 34626005 DOI: 10.1111/jdv.17726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - C Taieb
- EMMA, Fontenay sous Bois, France
| | | | - S Merhand
- Association Française de l'Eczema, Redon, France
| | | | | | | | - U Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Bichon A, Brue A, Godefroy R, Sallee M, Daniel L, Farnarier C, Gobin N, Abed S, Richard MA, Villani P, Malissen N, Daumas A. [Minimal change nephropathy and IgA deposits associated with a Sezary syndrome]. Rev Med Interne 2021; 43:48-53. [PMID: 34419323 DOI: 10.1016/j.revmed.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/19/2021] [Accepted: 08/01/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The Sézary syndrome (SS) is an aggressive form of cutaneous T-cell lymphoma (CTCL) requiring a rapid diagnosis due to its poor prognosis. CASE REPORT We report the first case of an eighty-nine-year-old woman who presented with concomitant Sezary syndrome and anasarca, revealing a nephrotic syndrome caused by a minimal change nephropathy associated with immunoglobulin A (IgA) deposits. Scarce literature described rare cases associating these two entities (nephrotic syndrome and nephropathy). However, the nephrotic syndrome was delayed from disease onset, secondary to immunosuppressive treatment of SS, or due to the weaning of SS therapy. Thus, the direct link between the glomerular lesion and the cutaneous lymphoma was difficult to establish. However, the synchronous occurrence of both SS and glomerulopathy in our patient, along with Sezary cells in both urines (urinary cytology) and biopsy, and resolution of nephropathy after treatment of SS, support the likely attributability of SS in glomerulopathy. CONCLUSION Practitioners must acknowledge the possible occurrence of glomerular involvement in SS.
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Affiliation(s)
- A Bichon
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - A Brue
- Service de dermatologie et cancérologie cutanée, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - R Godefroy
- Service de néphrologie et de transplantation rénale, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - M Sallee
- Service de néphrologie et de transplantation rénale, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - L Daniel
- Laboratoire d'anatomie pathologique, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - C Farnarier
- Laboratoire d'immunologie, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - N Gobin
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - S Abed
- Laboratoire d'immunologie, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - M A Richard
- Service de dermatologie et cancérologie cutanée, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - P Villani
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - N Malissen
- Service de dermatologie et cancérologie cutanée, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - A Daumas
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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5
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Hébert V, Bastos S, Drenovska K, Meijer J, Ingen-Housz-Oro S, Bedane C, Lunardon L, Debarbieux S, Jedlickova H, Caux F, Chaby G, D'Incan M, Feliciani C, Boulard C, Schumacher N, Schmidt E, Roussel A, Richard MA, Gottlieb J, Ferranti V, Guérin O, Bénichou J, Joly P. International multicentre observational study to assess the efficacy and safety of a 0·5 mg kg -1 per day starting dose of oral corticosteroids to treat bullous pemphigoid. Br J Dermatol 2021; 185:1232-1239. [PMID: 34173243 DOI: 10.1111/bjd.20593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND European guidelines propose a 0·5 mg kg-1 per day dose of oral prednisone as initial treatment for bullous pemphigoid (BP). We assessed the safety and efficacy of this regimen depending on BP extent and general condition of the patients. METHODS In a prospective international study, we consecutively included all patients diagnosed with BP. Patients received a 0·5 mg kg-1 per day dose of prednisone, which was then gradually tapered 15 days after disease control, with the aim of stopping prednisone or maintaining minimal treatment (0·1 mg kg-1 per day) within 6 months after the start of treatment. The two coprimary endpoints were control of disease activity at day 21 and 1-year overall survival. Disease severity was assessed according to the Bullous Pemphigoid Disease Area Index (BPDAI) score. RESULTS In total, 198 patients were included between 2015 and 2017. The final analysis comprised 190 patients with a mean age of 80·9 (SD 9·1) years. Control of disease activity was achieved at day 21 in 119 patients [62·6%, 95% confidence interval (CI) 55·3-69.5]; 18 of 24 patients (75%, 95% CI 53·3-90·2), 75 of 110 patients (68·8%, 95% CI 59·2-77·3) and 26 of 56 patients (46.4%, 95% CI 33·0-60·3) had mild, moderate and severe BP, respectively (P = 0·0218). A total of 30 patients died during the study. The overall Kaplan-Meier 1-year survival was 82·6% (95% CI 76·3-87·4) corresponding to 90·9%, 83·0% and 80·0% rates in patients with mild, moderate and severe BP, respectively (P = 0·5). Thresholds of 49 points for BPDAI score and 70 points for Karnofsky score yielded maximal Youden index values with respect to disease control at day 21 and 1-year survival, respectively. CONCLUSIONS A 0·5 mg kg-1 per day dose of prednisone is a valuable therapeutic option in patients with mild or moderate BP whose general condition allows them to be autonomous.
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Affiliation(s)
- V Hébert
- Department of Dermatology, Rouen University Hospital, Center for Autoimmune Bullous Diseases, and INSERM U1234, Normandie University, Rouen, France
| | - S Bastos
- Department of Dermatology, Rouen University Hospital, Center for Autoimmune Bullous Diseases, and INSERM U1234, Normandie University, Rouen, France
| | - K Drenovska
- Department of Dermatology, Medical University of Sofia, Sofia, Bulgaria
| | - J Meijer
- Center for Blistering Diseases, Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - S Ingen-Housz-Oro
- Department of Dermatology, Henri Mondor University Hospital, (AP-HP), Creteil, France
| | - C Bedane
- Department of Dermatology, Limoges University Hospital, Limoges, France
| | - L Lunardon
- Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Debarbieux
- Department of Dermatology, Hospices Civils de Lyon, Lyon, France
| | - H Jedlickova
- Department of Dermatology, St. Anne's Faculty Hospital, Brno, Czech Republic
| | - F Caux
- Department of Dermatology, Avicenne Hospital, University Paris 13, Bobigny, France
| | - G Chaby
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | - M D'Incan
- Department of Dermatology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - C Feliciani
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - C Boulard
- Department of Dermatology, Monod General Hospital, le Havre, France
| | - N Schumacher
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - A Roussel
- Department of Dermatology, Orleans Hospital, Orléans, France
| | - M A Richard
- Department of Dermatology, Hôpital la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - J Gottlieb
- Department of Dermatology, Saint Louis Hospital, (AP-HP), Paris, France
| | - V Ferranti
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - O Guérin
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - J Bénichou
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - P Joly
- Department of Dermatology, Rouen University Hospital, Center for Autoimmune Bullous Diseases, and INSERM U1234, Normandie University, Rouen, France
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6
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Jin X, Melle JV, Voors AA, Sim DKL, Jaufeerally FR, Lee SSG, Soon D, Loh SY, Ding ZP, Richard MA, Lam CSP, Ling LH. Left atrial function in heart failure with preserved ejection fraction vs. aortic stenosis: evidence for atrial myopathy? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Aim
Left atrial (LA) enlargement and impaired LA function are frequently found in patients with heart failure with preserved ejection fraction (HFpEF). Whether these structural and functional LA abnormalities are a consequence of increased LA pressure or whether HFpEF patients have an intrinsic LA myopathy is unknown. We compared LA pressure, size and function between patients with HFpEF and aortic stenosis, as a comparator with LA pressure overload, as well as community-dwelling control subjects.
Methods
Extensive echocardiographic assessments were performed in 219 patients with HFpEF (age 68 ± 11, 48% female), 173 patients with moderate to severe AS (age 69 ± 11, 55% female, aortic valve area index 0.55 ± 0.15 cm2/m2), and 219 controls (age 65 ± 9, 48% female, 42.2% hypertensive)
Results
Compared to controls, both patients with HFpEF and AS had larger LV and LA size and worse LV systolic, diastolic and LA function. Compared with AS patients, HFpEF patients had smaller LA volume index (40.2 ± 19.4 vs. 44.5 ± 11.9 ml/m2 p = 0.01) but similar LV filling pressure estimated by E/e’ (13.4 ± 4.8 13.4 ± 4.8 , p = 0.12). Despite smaller LA volume index and similar LV filling pressure, HFpEF patients had remarkably poorer LA function compared to AS [reservoir GLS, 22.6 ± 10% vs 31.4 ± 10.1 (p < 0.001); contractile GLS, 15.8 ± 6.1% vs 17.5 ± 6.9 (p < 0.05); LASrs, 0.92 ± 0.35% vs 1.27 ± 0.41 (p < 0.001); LASre, -1.49 ± 0.65 vs -1.86 ± 0.67 (p < 0.001)]. The differences in LA reservoir GLS and LASrs remained significant after adjustment for atrial fibrillation, diabetes, coronary artery disease, LV ejection fraction and LV mass index.
Conclusion
Patients with HFpEF had significantly worse LA function than patients with AS, despite similar LA pressure overload. These findings support the concept of an intrinsic LA myopathy in patients with HFpEF, beyond LA pressure overload.
Abstract Figure.
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Affiliation(s)
- X Jin
- National Heart Centre Singapore, Singapore, Singapore
| | - JV Melle
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - AA Voors
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - DKL Sim
- National University Heart Centre, Singapore, Singapore
| | | | - SSG Lee
- Changi General Hospital, Singapore, Singapore
| | - D Soon
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - SY Loh
- Tan Tock Seng Hospital, Singapore, Singapore
| | - ZP Ding
- National Heart Centre Singapore, Singapore, Singapore
| | - MA Richard
- National University Heart Centre, Singapore, Singapore
| | - CSP Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - LH Ling
- National University Heart Centre, Singapore, Singapore
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7
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Misery L, Shourick J, Sénéschal J, Paul C, de Pouvourville G, Jullien D, Mahé E, Bachelez H, Aubert R, Joly P, Héas S, Reguiai Z, Ezzedine K, Taieb C, Richard MA. Use of mind-body practices by patients with psoriasis: results from a study on 2562 patients. J Eur Acad Dermatol Venereol 2020; 35:e305-e307. [PMID: 33277731 DOI: 10.1111/jdv.17061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - J Sénéschal
- Department of Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | - C Paul
- Department of Dermatology, University Hospital of Toulouse, Toulouse, France
| | | | - D Jullien
- Department of Dermatology, Edouard Herriot Hospital, University Hospital of Lyon, Lyon, France
| | - E Mahé
- Department of Dermatology, Hospital of Argenteuil, Argenteuil, France
| | - H Bachelez
- Department of Dermatology, Saint Louis Hospital, AP-HP, Paris, France
| | - R Aubert
- Association France Psoriasis, Paris, France
| | - P Joly
- Department of Dermatology, University Hospital of Rouen, Rouen, France
| | - S Héas
- University of Rennes 2, Rennes, France
| | - Z Reguiai
- Department of Dermatology, Courlancy Polyclinic, Reims, France
| | - K Ezzedine
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - C Taieb
- EMMA, Fontenay sous Bois, France
| | - M A Richard
- Department of Dermatology, Timone Hospital, University Hospital of Marseille, Marseille, France
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8
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Jullien D, Paul C, Shourick J, Sénéschal J, de Pouvourville G, Misery L, Mahé E, Bachelez H, Aubert R, Joly P, Héas S, Reguiai Z, Ezzedine K, Taieb C, Richard MA. Psoriasis: frequency and reasons for absenteeism results from a study on 1609 active patients. J Eur Acad Dermatol Venereol 2020; 35:e301-e303. [PMID: 33289175 DOI: 10.1111/jdv.17056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- D Jullien
- Department of Dermatology, Edouard Herriot Hospital, University Hospital of Lyon, Lyon, France
| | - C Paul
- Department of Dermatology, University Hospital of Toulouse, Toulouse, France
| | - J Shourick
- Department of Epidemiology, University of Toulouse, Toulouse, France
| | - J Sénéschal
- Department of Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | | | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Mahé
- Department of Dermatology, Hospital of Argenteuil, Argenteuil, France
| | - H Bachelez
- Department of Dermatology, Saint Louis Hospital, AP-HP, Paris, France
| | - R Aubert
- Association France Psoriasis, Paris, France
| | - P Joly
- Department of Dermatology, University Hospital of Rouen, Rouen, France
| | - S Héas
- University of Rennes 2, Rennes, France
| | - Z Reguiai
- Department of Dermatology, Courlancy Polyclinic, Reims, France
| | - K Ezzedine
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - C Taieb
- Departement of Patients Priority, EMMA, Fontenay sous Bois, France
| | - M A Richard
- Department of Dermatology, Timone Hospital, University Hospital of Marseille, Marseille, France
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9
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Amatore F, Macagno N, Mailhe M, Demarez B, Gaudy-Marqueste C, Grob JJ, Raoult D, Brouqui P, Richard MA. SARS-CoV-2 infection presenting as a febrile rash. J Eur Acad Dermatol Venereol 2020; 34:e304-e306. [PMID: 32330336 PMCID: PMC7267606 DOI: 10.1111/jdv.16528] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- F Amatore
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - N Macagno
- Department of Pathology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - M Mailhe
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - B Demarez
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - C Gaudy-Marqueste
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - J J Grob
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - D Raoult
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - P Brouqui
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - M A Richard
- CEReSS-EA 3279, Research Centrer in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitary Hospital Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
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10
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Richard MA, Aractingi S, Joly P, Mahé E, Auquier P, Le Guen S, Acquadro C, Boucher F, Chalmers RJG. [French adaptation of a new score for global assessment of psoriasis severity: The Simplified Psoriasis Index (SPI)]. Ann Dermatol Venereol 2019; 146:783-792. [PMID: 31623858 DOI: 10.1016/j.annder.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/18/2019] [Accepted: 08/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although several scores exist to assess psoriasis severity, most have marked limitations that rule out their use in routine clinical practice. A new score, the Simplified Psoriasis Index (SPI), has recently been developed and validated in adults in Britain for such use. It has separate components for current severity (SPI-s), psychosocial impact (SPI-p) and past history and interventions (SPI-p), and it is suitable for either professional assessment or patient self-assessment. The aim of this work was to produce a validated translation of SPI into French (as spoken in France). METHODS The index was translated and validated using a strict methodology comprising respectively five and eight phases for the professional (proSPI) and self-administered instruments (saSPI). Translation of the saSPI instrument also involved a cognitive debriefing with five psoriasis patients. RESULTS Linguistic discrepancies and subtle differences of meaning arising during the process were closely examined. The developer of the instrument ensured conceptual accuracy. A panel of health experts guaranteed that medical terms were correctly translated. Five patients with plaque psoriasis (two female and three male of median age 45 years [range: 31-78]) tested the SPI-p version during cognitive interviews and found the questionnaire clear and easy to understand. CONCLUSION Validated French translations of both SPI instruments are now available for use in routine clinical practice. Further investigations are currently underway to validate the psychometric properties of the instrument.
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Affiliation(s)
- M A Richard
- EA 3279, département de dermatologie, centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix-Marseille université, hôpital de La Timone, Assistance publique-hôpitaux de Marseille, 13385 Marseille, France.
| | - S Aractingi
- Dermatologie, hôpital Cochin-Tarnier, 89, rue d'Assas, 75006 Paris, France
| | - P Joly
- Service de dermatologie, CHU de Charles Nicolle, université de Normandie, 76000 Rouen, France
| | - E Mahé
- Dermatologie, hôpital Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - P Auquier
- EA 3279, centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix-Marseille université, 13385 Marseille, France
| | - S Le Guen
- R&D, Novartis pharma SAS, 92506 Rueil-Malmaison, France
| | - C Acquadro
- Languages services, Mapi, an ICON plc Company, 69000 Lyon, France
| | - F Boucher
- Languages services, Mapi, an ICON plc Company, 69000 Lyon, France
| | - R J G Chalmers
- Centre for Dermatology, University of Manchester, Manchester, Royaume-Uni
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11
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Polivka L, Oubaya N, Bachelez H, Paul C, Richard MA, Beylot-Barry M, Schmutz JL, Beneton N, Mahé E, Viguier M, Chosidow O, Canoui-Poitrine F, Sbidian E. Trends in hospitalization rates for psoriasis flares since the introduction of biologics: a time series in France between 2005 and 2015. J Eur Acad Dermatol Venereol 2018; 32:1920-1929. [PMID: 29729123 DOI: 10.1111/jdv.15044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the late 2000s, the introduction of biologics transformed the prognosis for patients with moderate-to-severe psoriasis. We hypothesized that treatment with biologics may associate with a reduction in the hospitalization rate for psoriasis flares. OBJECTIVE To analyse changes over time in the hospitalization rate for psoriasis flares. METHODS We included inpatient stays in any of nine French hospitals between 2005 and 2015 for a psoriasis flare, as documented in the national inpatient database. In two centres, we also analysed data from the individual patients' electronic medical records. RESULTS A total of 3572 stays were included. The introduction of biologics was not associated with a decrease in the number of hospitalizations for a psoriasis flare; on the contrary, we observed a non-significant increase in the number of hospitalizations (13 hospitalizations for psoriasis flares per quarter per 10 000 beds). In the two-centre study, the introduction of biologics was associated with a significant increase in the hospitalization of patients receiving topical treatments only (520 hospitalizations per year per 10 000 beds) and those with a first psoriasis flare. CONCLUSION The number of hospitalizations for a psoriasis flare tended to increase between 2005 and 2015. The availability of additional treatment options might have increased patient demand and/or broadened the indications in clinical practice.
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Affiliation(s)
- L Polivka
- Department of Dermatology, Necker-Enfants Malades Hospital (AP-HP), Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - N Oubaya
- Department of Clinical Research and Public Health, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), UPEC, DHU A-TVB, Paris-Est University, Créteil, France
| | - H Bachelez
- Department of Dermatology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France
| | - C Paul
- Department of Dermatology, Larrey Hospital, Toulouse University, Toulouse, France
| | - M A Richard
- Dermatology Department, Centre de recherche en oncologie biologique et oncophamacologie', UMR 911, INSERM CRO2, Timone Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - M Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - J L Schmutz
- Department of Dermato-Allergology, Brabois Hospital, Nancy University, Vandoeuvre-lès-Nancy, France
| | - N Beneton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - E Mahé
- Department of Dermatology, Victor Dupouy Hospital, Argenteuil, France
| | - M Viguier
- Department of Dermatology, Robert Debré Hospital, University of Reims-Champagne Ardennes, Reims, France
| | - O Chosidow
- Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,Centre d'Investigation Clinique 1430, INSERM, Créteil, France.,UPEC, DHU VIC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Paris-Est University, Créteil, France
| | - F Canoui-Poitrine
- Department of Clinical Research and Public Health, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), UPEC, DHU A-TVB, Paris-Est University, Créteil, France
| | - E Sbidian
- Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,Centre d'Investigation Clinique 1430, INSERM, Créteil, France.,UPEC, DHU VIC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Paris-Est University, Créteil, France
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12
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Audureau E, Roux F, Lons Danic D, Bagot M, Cantagrel A, Dernis E, Gouyette N, Hilliquin P, Jullien D, Lioté F, Passeron T, A Richard M, Claudepierre P. Psoriatic arthritis screening by the dermatologist: development and first validation of the 'PURE-4 scale'. J Eur Acad Dermatol Venereol 2018; 32:1950-1953. [PMID: 29430720 DOI: 10.1111/jdv.14861] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/29/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dermatologists are recommended to ask psoriasis patients about musculoskeletal complaints to allow early detection and treatment of psoriatic arthritis (PsA). Screening tools have been developed to help identify patients warranting further rheumatologic assessment, but evidence suggests room for improvement in their diagnostic value and ease of use for outpatient practice. OBJECTIVE To develop and internally validate a brief tool for dermatologists to screen patients to refer to a rheumatologist for PsA diagnosis. METHODS After the literature review, 23 items were selected, covering pain at various locations and inflammatory signs of PsA. The validation study was conducted in medically diagnosed psoriasis patients consecutively recruited between 2012 and 2014 (Saint Joseph Hospital, Paris, France). Patients were enrolled by a dermatologist who helped to complete the questionnaire. Diagnosis of PsA was established by a rheumatologist based on CASPAR criteria. Multivariate logistic regression models were performed to build the scale, assessing discrimination through sensitivity, specificity and area under the ROC curve (AUC). Final model was internally validated using bootstrapping techniques. RESULTS One hundred and sixty-eight patients were recruited, of whom nine were excluded for known PsA and 21 did not attend the rheumatologist consultation. Of 137 included patients (median age 43 years, 59.6% men), 21 (15.3%) had a PsA diagnosis. Final regression model retained four independent items, including evocative signs of dactylitis, inflammatory heel pain, bilateral buttock pain and peripheral joint pain with swelling in patients aged <50. A total score (the PURE-4) was computed (0-4 points) that demonstrated excellent discriminative power (AUC = 87.6%; Sensitivity = 85.7% and Specificity = 83.6% at the threshold of ≥1/4 points), with no evidence for over-optimism in bootstrapped internal validation. CONCLUSION These findings demonstrate the good diagnostic properties of a new screening scale using only four easy-to-collect items. If confirmed in other populations, it may prove useful in outpatient dermatology clinics for triage of psoriasis patients requiring further assessment by the rheumatologist.
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Affiliation(s)
- E Audureau
- Department of Public Health, Henri Mondor Hospital, Université Paris Est Créteil, EA 7376 - CEpiA, Créteil, France
| | - F Roux
- Department of Rheumatology, Saint Joseph Hospital, Paris, France
| | - D Lons Danic
- Department of Dermatology, Saint Joseph Hospital, Paris, France
| | - M Bagot
- Department of Dermatology, Hospital Saint-Louis, University Paris 7, Inserm U976, Paris, France
| | - A Cantagrel
- Department of Rheumatology, Purpan Hospital, Toulouse, France
| | - E Dernis
- Department of Rheumatology, Le Mans Hospital, Le Mans, France
| | | | - P Hilliquin
- Department of Rheumatology, Sud Francilien Hospital, Corbeil Essonnes, France
| | - D Jullien
- Department of Dermatology, Edouard Herriot Hospital, University Claude Bernard Lyon-1, University of Lyon, Lyon, France
| | - F Lioté
- Department of Rheumatology, Lariboisière Hospital, University Paris Diderot, Sorbonne Paris Cité, Inserm UMR 1132 Bioscar, Paris, France
| | - T Passeron
- Department of Dermatology, INSERM U1065 équipe 12, C3M, Nice, France
| | - M A Richard
- Department of Dermatology, Aix-Marseille University, UMR 911, INSERM CRO2, Timone Hospital, Marseille, France
| | - P Claudepierre
- Department of Rheumatology, Henri Mondor Hospital, APHP, Université Paris Est Créteil, EA 7379 - EpidermE, Créteil, France
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13
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Gaudy-Marqueste C, Samimi M, Soria A, Aractingi S, Bodemer C, Chosidow O, Cribier B, Lacour JP, Paul C, Richard MA, Beylot-Barry M, Dreno B. [Guide to university hospital careers in dermatology. The GRENT (Graines Engrais Tuteurs - Seed Fertilizer Plant stick) Program]. Ann Dermatol Venereol 2018; 145:200-209. [PMID: 29449018 DOI: 10.1016/j.annder.2017.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C Gaudy-Marqueste
- Service de dermatologie et oncologie, hôpital La Timone, Assistance publique-Hôpitaux de Marseille, Marseille, France; UMR 911, Inserm, « centre de recherche en oncologie biologique et onco pharmacologie » (CRO2), université Aix-Marseille, 13385 Marseille, France
| | - M Samimi
- Service de dermatologie, université François-Rabelais, CHU de Tours, 37000 Tours, France; Laboratoire « biologie des infections à polyomavirus », ISP 1282, INRA, université François-Rabelais, 37000 Tours, France
| | - A Soria
- Service de sermatologie et allergologie, hôpital Tenon, AP-HP, 13385 Marseille, France; Sorbonne université, UPMC université Paris 06, 13385 Marseille, France; Inserm U1135, centre d'immunologie et de maladies infectieuses (Cimi-Paris), 13385 Marseille, France
| | - S Aractingi
- Inserm UMRS 938, service de dermatologie, hôpital Cochin Paris, université Paris 5 Descartes, AP-HP, 75005 Paris, France
| | - C Bodemer
- Service de dermatologie, hôpital universitaire Necker-Enfant-Malades, AP-HP, 75015 Paris, France; Unité Inserm U1163, institut Imagine, université Paris-Descartes, Sorbonne Cité université, 75015 Paris, France
| | - O Chosidow
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Université Paris-Est Val-de-Marne (UPEC) Créteil, 94000 Créteil, France
| | - B Cribier
- Clinique dermatologique, université de Strasbourg, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - J P Lacour
- Service de dermatologie, hôpital universitaire de Nice, 06200 Nice, France
| | - C Paul
- Service de dermatologie, hôpital universitaire de Toulouse, 06200 Toulouse, France; Université Paul-Sabatier, 31400 Toulouse, France
| | - M A Richard
- Service de dermatologie, hôpital La Timone, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; UMR 911, Inserm, « centre de recherche en oncologie biologique et onco pharmacologie » (CRO2), université Aix-Marseille, 13385 Marseille, France
| | - M Beylot-Barry
- Service de dermatologie, CHU de Bordeaux, 33000 Bordeaux, France; Inserm U1053, université de Bordeaux, 33000 Bordeaux, France
| | - B Dreno
- Service de dermatologie, université de Nantes, CHU de Nantes, 44000 Nantes, France; Inserm U892, 44000 Nantes, France.
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14
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Richard MA, Amici JM, Basset-Seguin N, Claudel JP, Cribier B, Dreno B. Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians. J Eur Acad Dermatol Venereol 2018; 32:339-346. [PMID: 29235161 DOI: 10.1111/jdv.14753] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/20/2017] [Indexed: 12/15/2022]
Abstract
Actinic keratoses (AK) arise on sun-exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam™ expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents and patients with chronic lymphocytic leukaemia. The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC. A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high-risk patients are presented, taking into account the experts' own clinical experience and current guidelines. In most of these 'at-risk' situations, patients can be treated according to the AKTeam™ treatment algorithm. Difficult-to-treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun protection strategies are mandatory, and patients should undergo more regular follow-up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions. This expert consensus provides guidance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs.
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Affiliation(s)
- M A Richard
- Dermatology Department, UMR 911, INSERM CRO2, "Center for Research in Biological Oncology and Oncophamacology", Timone Hospital, Public Hospitals of Marseille, Aix-Marseille University, Marseille, France
| | - J M Amici
- Private Office of dermatology Rive Droite, Cenon, France.,Dermatology Department, Hôpital Saint-Andre, Bordeaux, France
| | - N Basset-Seguin
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France
| | - J P Claudel
- Private Office of Dermatology, Tours, France.,Dermatology Department, CHU Clocheville, Tours, France
| | - B Cribier
- Dermatology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - B Dreno
- Department of Dermato cancerology, University Hospital Hotel Dieu, Nantes, France
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15
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Gaudy-Marqueste C, Dussouil AS, Carron R, Troin L, Malissen N, Loundou A, Monestier S, Mallet S, Richard MA, Régis JM, Grob JJ. Survival of melanoma patients treated with targeted therapy and immunotherapy after systematic upfront control of brain metastases by radiosurgery. Eur J Cancer 2017; 84:44-54. [PMID: 28783540 DOI: 10.1016/j.ejca.2017.07.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/16/2017] [Accepted: 07/11/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Targeted therapy (TT) and immunotherapies (ITs) have dramatically improved survival in metastatic melanoma (MM). However, their efficacy on brain metastasis (BM) remains limited and poorly documented. PATIENTS AND METHODS Retrospective cohort of consecutive MM patients (pts) with BMs, all systematically upfront treated by Gamma-Knife (GK) at first BM and retreated in case of new BMs, from 2010 to 2015 at the time when ipilimumab BRAF ± MEK inhibitors and anti-PD1 were introduced in practice. Survival after 1st GK (OSGK1) according to prognostic factors and treatment. RESULTS Among 179 consecutive pts treated by GK, 109 received IT and/or TT after the 1st GK. Median OSGK1 was 10.95 months and 1- and 2-year survival rates were 49.5% and 27.4%, respectively, versus a median overall survival (OS) of 2.29 months (p < .001) in those who did not receive IT or TT. In pts who initially had a single BM, median OS and 1- and 2-year survival rates were 14.46 months, 66.7% and 43.4%, respectively; in pts with 2-3 BMs: 8.85 months, 46.4% and 31%, respectively; in pts with >3 BMs: 7.25 months, 37.2% and 11.9%, respectively. Multivariate analysis for OSGK1 confirmed that IT and TT were significantly and highly protective. Best OSGK1 was observed in BRAF-wild-type pts receiving anti-PD1 or in BRAF-mutated pts receiving BRAF-inhibitors and anti-PD1 (12.26 and 14.82 months, respectively). CONCLUSION In real-life MM pts with BMs, a strategy aiming at controlling BM with GK together with TT and/or TT seems to achieve unprecedented survival rates.
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Affiliation(s)
- C Gaudy-Marqueste
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - A S Dussouil
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - R Carron
- Department of Stereotaxic and Functional Neurosurgery, Gamma-knife Unit, Inserm U751, Aix-Marseille University, APHM, Marseille, France
| | - L Troin
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - N Malissen
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - A Loundou
- Public Health Department, Aix-Marseille University, APHM, Marseille, France
| | - S Monestier
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - S Mallet
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - M A Richard
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - J M Régis
- Department of Stereotaxic and Functional Neurosurgery, Gamma-knife Unit, Inserm U751, Aix-Marseille University, APHM, Marseille, France
| | - J J Grob
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France.
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16
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Richard MA, Williams CC, Orellana RM, Blair SJ, Dolejsiova AH. 0053 Validation of a commercially available β-hydroxybutyrate meter for assessing rumen development in dairy calves. J Anim Sci 2016. [DOI: 10.2527/jam2016-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Finet A, Viguier M, Chazouillères O, Amatore F, Paul C, Richard MA, Chosidow O, Bachelez H, Sbidian E. Liver test abnormalities in patients admitted for severe psoriasis: prevalence and associated risk factors. J Eur Acad Dermatol Venereol 2016; 30:1742-1748. [PMID: 27226222 DOI: 10.1111/jdv.13674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/22/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Few epidemiologic data are available regarding biologic liver abnormalities during psoriasis flares. OBJECTIVES The aim of this study was to assess the prevalence of biological liver test abnormalities (LTA) in a psoriasis population and the risk factors associated with LTA. METHODS A retrospective cross-sectional study in four hospital dermatology tertiary care centres included patients admitted for severe psoriasis flare between 1st January 2010 and 31st December 2011. During the same period, a control population was selected comprising patients admitted for contact and/or atopic eczema. Data were collected on hospital records and biology software. LTA was defined as serum AST and/or ALT and/or ALP concentration above the upper normal limit (UNL) and/or GGT concentration above 2 UNL. Prevalence of LTA with 95% confidence intervals (95% CI) was compared between the psoriatic and control populations. Factors associated with LTA at P < 0.05 were considered for the final multivariate logistic regression model. RESULTS Two hundred and forty psoriasis patients and 96 eczema control patients were included. One hundred and fifty-five(64.6%) of the psoriasis patients were male, aged 55 years on average (±17.6); 192 (80.0%) had plaque-type psoriasis (PV) and 52 (21.6%) had localized (n = 32) or generalized (n = 20) pustular psoriasis (PP). Prevalence of LTA was 36% (95% CI, 30-42) in the psoriatic population, significantly higher than in controls (17%, 95% CI 9.5-25). Risk factors independently associated with LTA comprised PV (OR 3.79; 95% CI 1.48-9.65), PP (OR 3.80; 95% CI 1.40-10.25) and previously diagnosed liver disease (underlying hepatic steatosis, viral hepatitis or excessive alcohol consumption) (OR 3.88; 95% CI 2.02-7.45). No association was found with systemic antipsoriatic drug therapies. CONCLUSION In severe psoriasis, liver impacting comorbidities and/or specific psoriatic inflammation, the latter mostly in PP cases, more than drug-related liver toxicity, appears to predominantly account for LTA. Clinicians should be aware of this, to avoid unjustified withdrawal of useful systemic drugs.
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Affiliation(s)
- A Finet
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - M Viguier
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - O Chazouillères
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Sorbonne Université, UPMC Univ Paris 06, INSERM, UMR_S 938/CDR Saint-Antoine, Paris, France
| | - F Amatore
- Département de Dermatologie, AP-HM, Hôpital La Timone, Marseille, France
| | - C Paul
- Département de Dermatologie, Hôpital Larrey, Toulouse, France
| | - M A Richard
- Département de Dermatologie, AP-HM, Hôpital La Timone, Marseille, France
| | - O Chosidow
- Inserm, Centre d'Investigation Clinique 1430, Créteil, France
- EA EpidermE 7379, Université Paris-Est Créteil, Créteil, France
- Département de Dermatologie, AP-HP, Hôpital Universitaire Henri Mondor, Créteil, France
| | - H Bachelez
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
- INSERMU1163, Institut Imagine, Necker Hospital, Paris, France
| | - E Sbidian
- Inserm, Centre d'Investigation Clinique 1430, Créteil, France.
- EA EpidermE 7379, Université Paris-Est Créteil, Créteil, France.
- Département de Dermatologie, AP-HP, Hôpital Universitaire Henri Mondor, Créteil, France.
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Gaudy-Marqueste C, Carron R, Delsanti C, Loundou A, Monestier S, Archier E, Richard MA, Regis J, Grob JJ. On demand Gamma-Knife strategy can be safely combined with BRAF inhibitors for the treatment of melanoma brain metastases. Ann Oncol 2014; 25:2086-2091. [PMID: 25057167 DOI: 10.1093/annonc/mdu266] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Both Gamma-Knife radiosurgery (GKRS) and BRAF inhibitors (BRAF-I) have been shown to be useful in melanoma patients with brain metastases (BMs), thus suggesting that it could be interesting to combine their respective advantages. However, cases of radiosensitization following conventional radiation therapy in BRAF-I treated patients have raised serious concerns about the real feasibility and risk/benefit ratio of this combination. PATIENTS AND METHODS Review by two independent observers of brain magnetic resonance imaging (MRI) follow-up pictures, and volume and edema quantifications, and survival assessment in all patients who had been treated by GKRS and BRAF-I at a single institution. RESULTS Among 53 GKRS carried out in 30 patients who ever received BRAF-I and GKRS, 33 GKRS were carried out in 24 patients while under BRAF-I treatment, from which only 4 with an interruption of BRAF-I. The 20 other GKRS were carried out in 15 patients (including 9 of the 24) before initiation of BRAF-I treatment. No case of radiation-induced necrosis and no scalp radiation dermatitis occurred. A >20% increase in volume was observed in 35 of the 263 BM treated by GKRS (13.3%), but only 3 clear-cut edemas and 3 hemorrhages were detected within 2 months after GKRS, and 4 edemas and 7 hemorrhages later. Neither the MRI features nor the incidence of the volume changes, hemorrhage and edema were deemed unexpected for melanoma BM treated by GKRS. Median survival from first GKRS under BRAF-I and first dose of BRAF-I were 24.8 and 48.8 weeks, respectively. CONCLUSION This series does not show immediate radiotoxicity nor radiation recall, in melanoma patients with BRAF-I whose BMs are treated by GKRS. Interrupting BRAF-I for stereotactic radiosurgery (SRS) of BM seems useless, although it is still advised for other radiation therapies. The potential benefit of combining SRS and BRAF-I can be safely tested.
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Affiliation(s)
| | - R Carron
- Department of Stereotaxic and Functional Neurosurgery, Gammaknife Unit, Inserm U751
| | - C Delsanti
- Department of Stereotaxic and Functional Neurosurgery, Gammaknife Unit, Inserm U751
| | - A Loundou
- Department of Public Health, Aix-Marseille University, APHM, Marseille, France
| | - S Monestier
- Department of Dermatology and Skin Cancers, UMR911 CRO2
| | - E Archier
- Department of Dermatology and Skin Cancers, UMR911 CRO2
| | - M A Richard
- Department of Dermatology and Skin Cancers, UMR911 CRO2
| | - J Regis
- Department of Stereotaxic and Functional Neurosurgery, Gammaknife Unit, Inserm U751
| | - J J Grob
- Department of Dermatology and Skin Cancers, UMR911 CRO2
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Dréno B, Amici JM, Basset-Seguin N, Cribier B, Claudel JP, Richard MA. Management of actinic keratosis: a practical report and treatment algorithm from AKTeam™ expert clinicians. J Eur Acad Dermatol Venereol 2014; 28:1141-9. [PMID: 24612407 DOI: 10.1111/jdv.12434] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/31/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Actinic keratoses (AK) are common photo-induced cutaneous lesions that may progress to invasive squamous-cell carcinoma and serve as a risk marker for skin cancer. Although numerous studies present the various therapeutic options for AK, publications that can be used to pragmatically guide dermatologists in their daily practice are limited. National and international guidelines have been published, however, they are based on clinical trials with highly selected patient populations and do not always capture the range of patients seen in everyday practice. OBJECTIVE The objective of this expert panel of French dermatologists was to present an analysis of AK geared towards everyday practice, to express an informed opinion about most recent treatments, and to propose a treatment algorithm for AK for daily practice in France. METHODS Over a 12 month period, six expert dermatologists in the field of AK (AKTeam(TM) expert panel) met regularly to formulate an opinion about treatment in everyday practice compared with the analysis of the literature and guidelines published since 1990. RESULTS Definitions, terminology, diagnosis and risk factors were summarized. Data from the literature and current practices related to the initial evaluation, indications for biopsy, therapeutic indications, therapeutic options and effectiveness, monitoring and prevention were discussed. A pragmatic treatment algorithm was formalized according to current data available. This practical algorithm distinguishes between different clinical situations depending on the number of AK, their hyperkeratotic or suspicious nature, and includes cryotherapy, curettage-electrocoagulation, 5% 5-fluorouracil, 3% diclofenac sodium, 5% imiquimod, 150 and 500 μg/g ingenol mebutate, lasers, photodynamic therapy and surgery. CONCLUSION This up-to-date expert opinions about AK and its treatment provide a management strategy and practical treatment algorithm for AK for French dermatologists to use.
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Affiliation(s)
- B Dréno
- Department of Dermato cancerology, University Hospital Hotel Dieu, Nantes, France
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Abstract
Domestic animals are highly capable of detecting human cues, while wild relatives tend to perform less well (e.g., responding to pointing gestures). It is suggested that domestication may have led to the development of such cognitive skills. Here, we hypothesized that because domestic animals are so attentive and dependant to humans' actions for resources, the counter effect may be a decline of self sufficiency, such as individual task solving. Here we show a negative correlation between the performance in a learning task (opening a chest) and the interest shown by horses toward humans, despite high motivation expressed by investigative behaviors directed at the chest. If human-directed attention reflects the development of particular skills in domestic animals, this is to our knowledge the first study highlighting a link between human-directed behaviors and impaired individual solving task skills (ability to solve a task by themselves) in horses.
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Affiliation(s)
- C Lesimple
- Laboratoire d'Éthologie Animale et Humaine EthoS - UMR CNRS 6552, Station Biologique, Université de Rennes 1 Paimpont, France
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Reguiai Z, Bachet JB, Bachmeyer C, Peuvrel L, Beylot-Barry M, Bezier M, Boucher E, Chevelle C, Colin P, Guimbaud R, Mineur L, Richard MA, Artru P, Dufour P, Gornet JM, Samalin E, Bensadoun RJ, Ychou M, André T, Dreno B, Bouché O. Management of cutaneous adverse events induced by anti-EGFR (epidermal growth factor receptor): a French interdisciplinary therapeutic algorithm. Support Care Cancer 2012; 20:1395-404. [PMID: 22539049 DOI: 10.1007/s00520-012-1451-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 03/26/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE Cutaneous adverse events induced by epidermal growth factor receptor (EGFR) inhibitors can hamper the patients' quality of life. The aim of our work was to draft an algorithm for the optimised management of this skin toxicity. METHODS This algorithm was built in three steps under the responsibility of a steering committee. Step I: a systematic literature analysis (SLA) has been performed. Step II: the collection of information about practices was performed through a questionnaire.These questions were asked during regional meetings to which oncologists, gastro-enterologists, radiotherapists, and dermatologists were invited. Step III: a final meeting was organised involving the bibliography group and the steering committee and regional scientific committees for proposing a final algorithm. RESULTS Step I: 14 publications were selected to evaluate the use of cyclines as curative or prophylactic treatment of the folliculitis induced by EGFR inhibitors. Nineteen publications were retained for the topical treatment of the folliculitis. Forty-six articles were selected for the management of the cutaneous lesions in link with appendages and 12 for xerosis and pruritus. Step II: 96 delegates attended the seven regional meetings and 67 questionnaires were analysed. Step III: a final algorithm was proposed on the basis of the conclusions of the first two steps and expert opinions present at this final meeting. The different propositions were unanimously approved by the 14 experts who voted. CONCLUSIONS This multidisciplinary study summarising published data and current practices produced a therapeutic algorithm, which should facilitate the standardised, optimised management of skin toxicity associated with EGFR inhibitors in France.
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Affiliation(s)
- Z Reguiai
- Department of Dermatology, CHU Reims, Hôpital Robert Debré, avenue du Général Koenig, 51092 Reims, France.
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Berezne A, Seror R, Bussone G, Nguyen C, Morell-Dubois S, Fois E, Guillevin L, Mouthon L, Mouthon L, Carpentier P, Khau Van Kien A, Clerson P, Maillard H, Hachulla E, Frances C, Diot E, Lok C, Puzenat E, Sparsa A, Berezne A, Gressin V, Richard MA, Saketkoo LA, Escorpizo R, Keen K, Fligelstone K, Distler O, Assassi S, Leyva A, Mayes M, Sharif R, Nair D, Fischbach M, Nguyen N, Reveille J, Gonzalez E, McNearney T, Riccieri V, Sciarra I, Maset L, Passi L, Stefanantoni K, Vasile M, Scarno A, Spadaro A. S.11.1 Influence of digital ulcer healing on disability and daily activity limitations in SSc. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Claeys A, Gaudy-Marqueste C, Pauly V, Pelletier F, Truchetet F, Boye T, Aubin F, Schmutz JL, Grob JJ, Richard MA. Management of pain associated with debridement of leg ulcers: a randomized, multicentre, pilot study comparing nitrous oxide-oxygen mixture inhalation and lidocaïne-prilocaïne cream. J Eur Acad Dermatol Venereol 2010; 25:138-44. [DOI: 10.1111/j.1468-3083.2010.03720.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meziane M, Hesse S, Chetaille B, Bien-Aimée A, Grob JJ, Richard MA. [Cutaneous large B-cell leg-type lymphoma occurring on a leg burn]. Ann Dermatol Venereol 2009; 136:791-4. [PMID: 19917431 DOI: 10.1016/j.annder.2009.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 02/20/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas form a heterogeneous group of lymphoid proliferations found on the skin. We report a case of primary leg-type cutaneous large B-cell lymphoma occurring on the site a previous leg burn. A few rare cases of cutaneous lymphoma forming on burn scars have been described, but these concern primary cutaneous lymphomas of the T-cell phenotype. CASE REPORT An 85-year-old man with a history of a burn to the left leg 17 years ago, previously treated with several skin grafts, presented numerous ulcerative budding lesions on the scar area. Histological examination of the skin biopsy revealed the existence in the skin ulcers of atypical large lymphoid cells having an immunoblastic or centroblastic morphology and shown by immunohistochemistry to be of the B-cell phenotype, thereby evoking a diagnosis of large B-cell lymphoma. The lymphoma cells were positive for MUM1/IRF4 and BCL2, and more weakly for BCL6, but negative for CD10. The staging examination revealed only cortical lysis of the left tibia. Temporary initial regression was achieved by polychemotherapy comprising cyclophosphamide, vincristine and prednisone in combination with rituximab. DISCUSSION This case is novel in that it involves primary large B-cell lymphoma, leg type, occurring on burn scar tissue. Venous insufficiency and lymphatic stasis have already been incriminated in the genesis of this type of lymphoma; the prior injury and resulting immune dysregulation at the burn site may have also contributed to the development of this neoplasia.
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Affiliation(s)
- M Meziane
- Service de dermatologie, CHU de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Thuny C, Gaudy-Marqueste C, Nicol I, Gabert J, Costello R, Grob JJ, Richard MA. Chronic eosinophilic leukaemia revealed by lymphomatoid papulosis: the role of the FIP1-like 1-platelet-derived growth factor receptor alpha fusion gene. J Eur Acad Dermatol Venereol 2009; 24:234-5. [PMID: 19686260 DOI: 10.1111/j.1468-3083.2009.03382.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gaudy-Marqueste C, Jouhet C, Castelain M, Brunet P, Berland Y, Grob JJ, Richard MA. Contact allergies in haemodialysis patients: a prospective study of 75 patients. Allergy 2009; 64:222-8. [PMID: 19178401 DOI: 10.1111/j.1398-9995.2008.01833.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Haemodialysis exposes patients to many potentially sensitizing allergens. OBJECTIVES The primary objective of this study was to evaluate the prevalence of delayed hypersensitivity in a population of haemodialysis patients. Secondary objectives were to identify the possible risk factors for contact sensitization and to propose a series of skin tests adapted to haemodialysis patients. METHODS A prospective monocentric study was carried out in a nonselected population of haemodialysis patients. For each patient, medical history of atopy and allergic contact dermatitis, ongoing treatments (including topical ones), presence of eczema at the site of vascular access for haemodialysis were recorded. Allergological investigation included delayed hypersensitivity tests (European Environmental and Contact Dermatitis Research Group battery, tests GERDA, additional list and a battery of antiseptics and other dialysis-specific allergens) and latex skin prick test. RESULTS Seventy-five patients (41 men, 34 women, mean age of 65 years old), with a mean 3.8 years under dialysis, were included. Nineteen patients (25%) had at least one positive skin test and 13 (17%) a positive patch test to at least one allergen relative to dialysis process including eight tests to lidocaine-prilocaine cream and three to povidone-iodine. Tests results seemed clinically relevant since nine patients had localized pruritus at the fistula site and six patients active eczema around it. CONCLUSION Contact sensitizations are frequent in haemodialysis patients and are linked to vascular access conditioning especially the use of lidocaine-prilocaine cream. Designing a specific test battery could help to diagnose the potential allergens and subsequently to give advice to avoid contact with sensitizing agents.
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Affiliation(s)
- C Gaudy-Marqueste
- Department of Dermatology, Hôpital Sainte Marguerite, Marseille, France
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Richard MA. [Is it always necessary to treat skin cancer in the elderly?]. Ann Dermatol Venereol 2008; 135:641-3. [PMID: 18929911 DOI: 10.1016/j.annder.2008.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maza A, Renard L, Monestier S, Grob JJ, Richard MA. [Fever with skin rash and polyarthralgia in a genetically black-skinned woman]. Med Trop (Mars) 2008; 68:297-299. [PMID: 18689326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Adult onset Still's disease (AOSD) is a systemic disorder characterized by intermittent fever, evanescent rash, polyarthralgia or arthritis, and neutrophilic leucocytoclasis. Appearance of skin rash during fever episodes is the characteristic feature. An atypical form of AOSD with a fixed pigmented skin rash was described in 1994. Prognosis of the atypical form is thought to be more severe than that of the classic form. The purpose of this report is to describe the first case of atypical AOSD in a genetically black-skinned woman. Treatment required administration of high-dose systemic corticosteroids.
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Affiliation(s)
- A Maza
- Service de dermatologie, CHU Sainte Marguerite, Marseille.
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Tummino C, Barlesi F, Tchouhadjian C, Tasei AM, Gaudy-Marqueste C, Richard MA, Astoul P. [Severe cutaneous toxicity after Pemetrexed as second line treatment for a refractory non small cell lung cancer]. Rev Mal Respir 2007; 24:635-8. [PMID: 17519817 DOI: 10.1016/s0761-8425(07)91133-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Pemetrexed is a chemotherapeutic drug with good tolerance, used as first line treatment for malignant pleural mesothelioma in association with cisplatin, and alone as second line treatment in resistant or relapsing non-small cell lung cancer (NSCLC). However, cutaneous toxicity has been described, principally as a rash. Cutaneous toxicity of all grades has been observed in up to 14%, and grade 3 or 4 toxicity in 0.8-1.3% of cases. CASE REPORT We report the case of an 85 year old man treated for NSCLC presenting 15 days after administration of the second cycle of pemetrexed with cutaneous lesions including erythema, bullae, and desquamation, associated with deterioration in his general condition; a skin reaction corresponding to Lyell's syndrome. Treatment with steroids and gammaglobulins led to local resolution and improvement in his general condition. CONCLUSION Cutaneous toxicity from pemetrexed should be recognised on account of its potential severity. The appearance of skin lesions is an indication for careful follow-up for evidence of Lyell's syndrome for which intensive management is needed.
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Affiliation(s)
- C Tummino
- Faculté de Médecine, Université de la Méditerranée-Assistance Publique Hôpitaux de Marseille, Service d'Oncologie Thoracique, Hôpital Sainte-Marguerite, Marseille, France
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Abstract
A study carried out on 49 horses showed that it is possible to measure the attention time by operant conditioning. After teaching horses an instrumental task using a signal, we were then able to test their attention time by asking them to prolong it increasingly while setting success and failure criteria. Two tests were performed 3 weeks apart. The 2nd test was feasible without relearning, a proof of memory, and was repeatable, a proof of consistency in the attention time. A significant difference was observed between the 3 age groups. Young horses often performed very well during the 1st test but their attention dropped in the 2nd test while older horses were more stable with respect to attention and even increased it slightly. The study shows that there are individual differences but it was not possible to prove a significant influence of breed, gender and paternal influence. Consequently, learning appears to be one of the most interesting approaches for evaluating the attention of horses and for observing their behaviour.
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Affiliation(s)
- V Rapin
- Laboratoire d'Ecoéthologie, Université de Neuchâtel, Suisse.
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Monestier S, Gaudy C, Gouvernet J, Richard MA, Grob JJ. Multiple senile lentigos of the face, a skin ageing pattern resulting from a life excess of intermittent sun exposure in dark-skinned caucasians: a case-control study. Br J Dermatol 2005; 154:438-44. [PMID: 16445772 DOI: 10.1111/j.1365-2133.2005.06996.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Different patterns of skin ageing can be described depending on the predominant lesions, i.e. wrinkles, laxity, atrophy, senile lentigos (SLs), etc. They may correspond to different epidemiological contexts. OBJECTIVES To identify and assess the epidemiological factors for a skin ageing pattern characterized by a high density of SLs on the face, or 'lentigo ageing pattern' (LAP). METHODS An age- and sex-matched case-control study was conducted in individuals aged between 60 and 80 years, comparing cases (n = 118) with a very high number of SLs on the face for their age, and controls (n = 118) with no or very few SLs for their age. The cases and controls were recruited in two hospitals. RESULTS In univariate and multivariate analysis, LAP was associated with skin types III and IV, with frequent sunburns, and with the part of the lifetime cumulative sun exposure which was received during vacations. Conversely, there was no link with the occupational and everyday exposures and the total cumulative exposure. LAP was associated with multiple solar lentigos of the upper back. No relationship was found with postmenopausal hormonal therapy, number of naevi, or freckles. CONCLUSIONS Different epidemiological factors may account for the different skin ageing patterns. LAP seems to develop preferentially in dark-skinned caucasians who have repeatedly received intermittent and intense sun irradiations throughout their life, and have often developed solar lentigos on the upper back earlier in life, whereas the 'prominent wrinkling' pattern is known to affect light-skinned people and smokers with a life excess of continuous exposure.
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Affiliation(s)
- S Monestier
- Department of Dermatology, Hôpital Ste Marguerite, Assistance Publique des Hôpitaux de Marseille and Research Unit LIMP EA 3291, Université de la Méditerranée, France
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Richard MA. Pourquoi un numéro spécial sur le pied ? Ann Dermatol Venereol 2005; 132:739. [PMID: 16419502 DOI: 10.1016/s0151-9638(05)79438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nicol I, Boye T, Carsuzaa F, Feier L, Collet Villette AM, Xerri L, Grob JJ, Richard MA. Post-transplant plasmablastic lymphoma of the skin. Br J Dermatol 2003; 149:889-91. [PMID: 14616390 DOI: 10.1046/j.1365-2133.2003.05544.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rebecca WO, Richard MA. Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus. Cochrane Database Syst Rev 2003:CD002092. [PMID: 12535428 DOI: 10.1002/14651858.cd002092] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Esophageal carcinoma can be managed primarily with either a surgical or radiotherapeutic (non surgical) approach. Strategies to improve the outcome of either modality alone include the use of combined modalities. Combination chemotherapy radiotherapy is one approach that has been explored over the years with increasing application in clinical practice especially in North America. OBJECTIVES To evaluate the effectiveness of combined chemotherapy and radiotherapy versus radiotherapy alone in the outcome of patients with localized esophageal carcinoma. Outcomes of interest include overall survival, cause specific survival, local recurrence, dysphagia relief, quality of life, acute and chronic toxicities. SEARCH STRATEGY The Cochrane strategy for identifying randomized trials was combined with MeSH headings including esophageal neoplasms, radiotherapy, chemotherapy combined modality, drug therapy combination. MEDLINE, CancerLIT and EMBASE were searched using this strategy. In addition, the Cochrane library was also searched. References from relevant articles and personal files were included. SELECTION CRITERIA Randomized controlled trials in patients with localized esophageal cancer, with one arm employing radiotherapy alone, and one arm employing combination radiotherapy chemotherapy were included. Studies comparing non chemotherapy agents such as pure radiotherapy sensitisers, immunostimulants, planned esophagectomy, were excluded. DATA COLLECTION AND ANALYSIS Data were extracted by two independent reviewers, and the trial quality was assessed using both the Jadad scoring and Detsky checklist. Sensitivity analysis was planned to explore sources of heterogeneity where heterogeneity existed. The factors hypothesized a priori included combination versus sequential treatment, quality of study, biological effective radiotherapy dose (i.e. Radiotherapy dose) cisplatin versus non cisplatin containing trials, and 5FU versus non 5FU containing trials. Odds Ratio (OR) and 95% confidence limits were used to assess the significance of the difference between the treatment arms. Absolute risk difference and number needed to treat (NNT) were used to express the magnitude of difference where appropriate. MAIN RESULTS Thirteen randomized trials were included in the analysis. There were eight concomitant and five sequential radiotherapy and chemotherapy (RTCT) studies. The studies were analyzed separately due to observed heterogeneity across all the studies and biological considerations. Concomitant RTCT provided significant overall reduction in mortality at 1 and 2 years. The mortality in the control arms was 62% and 83% respectively. Combined RTCT provided an absolute reduction of mortality by 7% (95% CI 1-15%) and 7% (95% CI 0-15%) respectively. Expressed as NNT, this is 12 and 12 respectively. At longer follow up, the results were heterogeneous, cautioning against pooling of the data. There was a reduction in the overall local recurrence rate. The local recurrence rate for the control arms was in the order of 68%. Combined RTCT provided an absolute reduction of local recurrence rate of 12% (95% CI 3-22%) with a NNT of 9. There was significant increase of severe and life threatening toxicities with a NNH of 6, with this approach. The sensitivity analysis did not identify any factor that interacted with the results, or subgroup in which the benefit appear to be limited to. The results from the sequential RTCT studies were heterogeneous and could not be pooled. Factors hypothesized a priori did not identify any single source that could account for a significant component of the heterogeneity. Examining the results individually, there was no data to support clinical benefit. This approach was also accompanied by significant toxicities. REVIEWER'S CONCLUSIONS When a non-operative approach is selected, then concomitant RTCT is superior to the RT alone. This approach is accompanied by significant toxicities. In patients who are in good general condition, and the risk benefit has been thoroughly discussed with the patient, co thoroughly discussed with the patient, concomitant RTCT should be considered for the management of esophageal cancer compared with radiotherapy alone.
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Affiliation(s)
- W O Rebecca
- Radiation Oncology, Princess Margaret Hospital, 5th Floor, 610 University Avenue, Toronto, Ontario, Canada, M5G 2M9.
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Monestier S, Richard MA, Rey AC, Djemli A, Choux R, Grob JJ. [Multiple papules of the trunk]. Ann Dermatol Venereol 2002; 129:1315-6. [PMID: 12514525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- S Monestier
- Service de Dermatologie, CHU Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille
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Andreani V, Richard MA, Blaise D, Gouvernet J, Grob JJ. Naevi in allogeneic bone marrow transplantation recipients: the effect of graft-versus-host disease on naevi. Br J Dermatol 2002; 147:433-41. [PMID: 12207581 DOI: 10.1046/j.1365-2133.2002.04748.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Non-melanoma skin carcinoma is more common in transplant recipients, probably because of immunosuppression. An increased risk of developing melanoma could be a late effect of transplantation. The number of naevi, which is a risk marker for melanoma, is increased in renal transplant recipients of all ages and may be related to immunosuppression. The risk of melanoma has been suspected to be particularly high after bone marrow transplantation. Cutaneous graft-versus-host disease (GVHD) might be an interesting model for the study of interactions between naevi and the immune system. OBJECTIVE To assess whether aBMT exposes an individual to a particularly high risk of melanoma, using naevi as a surrogate measure of the risk. To improve our knowledge of the effect of the immune system on naevi, using GVHD as a model. METHODS We carried out an epidemiological case-control study with two age-, sex- and hair colour-matched controls for each case. The results were analysed with analysis of variance, a general linear model analysis and multivariate analysis. RESULTS The number of naevi was not significantly increased in aBMT patients, as compared with controls, although there was a significant excess on the palms and legs. In exploratory subgroup case-control comparisons and with the general linear model, patients who were conditioned with a combination of two alkylating drugs at high doses, and patients who had an aBMT before the age of 20 years tended to have a higher count of naevi (P = 0.002 and P = 0.06, respectively). Conversely, there was a trend in favour of a lower count of naevi in patients with diffuse skin lesions of chronic GVHD (P = 0.01). These data were corroborated by multivariate analysis, which showed that conditioning with high-dose chemotherapy, the absence of severe chronic cutaneous GVHD and a young age at transplantation were the main variables that independently predicted an excess of naevi. CONCLUSIONS This study of aBMT patients confirms that chemotherapy stimulates naevus growth. It also suggests for the first time that diffuse lesions of chronic cutaneous GVHD are associated with a decreased number of naevi. Whether allo-immunity, chronic skin inflammation or the masking of naevi by pigmentation and fibrosis is responsible for the decreased number of naevi requires further investigation. With respect to the long-term risk of melanoma in aBMT recipients, our results support an increased risk particularly when aBMT is performed at a young age, and when conditioning is with high doses of alkylating drugs.
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Affiliation(s)
- V Andreani
- Service de Dermatologie et LIMP (Laboratoire d'Investigation des Maladies de la Peau), Hôpital Sainte Marguerite, 270 Bd de Sainte Marguerite, Université de la Mediterranée, 13009 Marseille, France
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Abstract
INTRODUCTION First used as a sedative, thalidomide was taken out the market because of its teratogenicity. Despite other side effects, especially neuropathies, this drug is now again prescribed in various autoimmune and neoplasic diseases. Recently, venous or arterial thrombotic events have been described after the introduction of thalidomide. EXEGESIS In this report, we describe two new venous thrombosis cases occurring during a treatment with thalidomide. The first case is a 37-year-old man treated for a discoid lupus, who developed three deep-vein thrombosis and a massive pulmonary embolism, with recurrent thrombosis even with an efficient anticoagulation therapy until the final stop of thalidomide. The second one is a 66-year-old woman treated with thalidomide for a multiple myeloma and a melanoma in therapeutic escape, who developed a deep-vein thrombosis two months after the beginning of her treatment. Published reports suggest that most thrombotic events appeared under three months after the introduction of the treatment and that thalidomide could have acted as a precipitating or as a starting factor in a patient population already at risk of thrombosis. Those complications should be particularly severe, but the mechanism underlying thrombosis with thalidomide is unknown. CONCLUSION A complete coagulation check-up is advised before beginning a treatment with thalidomide.
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Affiliation(s)
- J Gachon
- Service de dermatologie, hôpital Sainte-Marguerite, CHU, 270, boulevard de Sainte-Marguerite, 13274 Marseille, France
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Richard MA, Saadallah S, Lefevre P, Poullin P, Buscaylet S, Grob JJ. [Extracorporeal photochemotherapy in therapy-refractory subacute lupus]. Ann Dermatol Venereol 2002; 129:1023-6. [PMID: 12442100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Extracorporeal photopheresis is a leukapheresis therapy that uses psoralen and ultraviolet A irradiation. We report the case of a woman with a refractory sub acute lupus which dramatically but transitionally responded to extracorporeal photopheresis. CASE REPORT This women, born in 1960, developed erythematous and squamous patches located on face and neckline, associated with hyperpigmented and atrophic lesions on the arms and shoulders. Investigations confirmed the diagnosis of subacute lupus without systemic disease. All lesions progressed, despite all conventional therapies leading to major aesthetic prejudice. Extracorporeal photopheresis was initiated, and after two months, all lesions, including atrophic and healing lesions had regressed, but laboratory abnormalities did not change. Extracorporeal photopheresis was well tolerated. However, treatment was discontinued nine months later, since the cutaneous lesions relapsed. COMMENTS Extracorporeal photopheresis could be efficient in the treatment of cutaneous autoimmune diseases through several immunomodulatory mechanisms. Extracorporeal photopheresis is a potent alternative agent in the therapy of refractory dermatological diseases
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Affiliation(s)
- M A Richard
- Service de Dermatologie, Hôpital Sainte Marguerite, Marseille, France.
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Richard MA. [Prickling or pain of the skin related to PUVA therapy]. Ann Dermatol Venereol 2002; 129:260-3. [PMID: 11973804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Richard MA, Grob JJ. [Urticaria in the child]. Arch Pediatr 2001; 8:1383-91. [PMID: 11811038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Most cases of urticaria in children are short-lived and related to viral infections and/or medicine. By comparison, allergic etiologies, particularly food allergy, are relatively rare, and are mainly observed in infancy and early childhood. Chronic urticaria is even rarer and has many similarities with adulthood chronic urticaria, including unclear physiopathology. Treatment has been much improved in recent years due to the availability of new antihistaminic drugs with better efficiency and tolerance. The management of urticaria in children requires above all a methodical approach, giving the priority to the history in order to orientate the etiological diagnosis.
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Affiliation(s)
- M A Richard
- Service de dermatologie, hôpital Sainte-Marguerite, 274, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
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42
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Abstract
Silicone-induced connective tissue disease raises a controversial issue. We report a case of Still's disease associated with silicone and collagen implants that showed improvement on steroids, but remained steroid-dependent despite removal of the silicone implants. This observation complements four previous cases in the literature and questions the role of breast implants in the pathogenesis of Still's disease. The number of cases studied is insufficient for conclusions, but silicone-implant-associated syndrome may be confused with Still's disease. We consequently propose the use of ferritinemia and its serum glycosylated fraction level as discriminating factors. Collagen has been associated with some inflammatory diseases, but never previously with Still's disease. However, considering this observation and previous data in the literature, its role may be postulated as an exacerbating factor or a pathogenic agent.
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Affiliation(s)
- E Crétel
- Service de Médecine Interne, H pital Sainte-Marguerite, France
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Abstract
PURPOSE Our purpose was to describe cutaneous manifestations associated with myelodysplastic syndromes. METHODS Data from seven patients with cutaneous vasculitis (four cases), neutrophilic dermatosis (one case), relapsing polychondritis (one case), and possible erythema elevatum diutinum (one case) in association with myelodysplastic syndrome (refractory anaemia RA, RA with excess of blasts--RAEB-, RAEB in transformation RAEBt, chronic myelomonocytic leukaemia--CMML-), and analysis of the literature were reviewed. RESULTS The cutaneous manifestations of myelodysplastic syndrome may or may not be specific, and may reveal hemopathy transformation. The cutaneous vasculitis are the most frequent and polymorphic. The relation with neutrophilic dermatosis is more specific; they are a spectrum of diseases including pyoderma gangrenosum, Sweet's syndrome, erythema elevatum diutinum (nuclear segmentation anomalies of neutrophils both in the skin and in the blood are a biological marker of the association). Relapsing polychondritis is significantly associated with myelodysplastic syndromes. Their pathogenesis are controversial. CONCLUSION Early biopsy of cutaneous lesions in myelodysplastic syndromes is indicated. Analysis of blood cell count (and more bone marrow biopsy in relapsing polychondritis) is indispensable in these neutrophilic cutaneous or vasculitis diseases.
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Affiliation(s)
- J J Morand
- Service de dermatologie, hôpital d'instruction des armées Laveran, BP 50, 13998 Marseille Armées, France
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Retornaz F, Monestier S, Richard MA, Seux V, Grob JJ, Soubeyrand J. [Ulceronecrotic purpura revealing Waldenström's macroglobulinemia]. Presse Med 2001; 30:1007. [PMID: 11433686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
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Richard MA, Fiszenson F, Jreissati M, Jean Pastor MJ, Grob JJ. [Cutaneous adverse effects during selective serotonin reuptake inhibitors therapy: 2 cases]. Ann Dermatol Venereol 2001; 128:759-61. [PMID: 11460042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors are widely used in the treatment of depressive and obsessive-compulsive disorders because of their low-frequency adverse effects. We report two cases of cutaneous adverse effects during selective serotonin reuptake inhibitors therapy. CASE REPORTS A man who complained of chronic anal idiopathic pruritus was treated with citalopram (Seropram(R)) 10 mg b.i.d. Six days after the beginning of the antidepressive treatment, he developed an extensive papular and purpuric erythema with keratinocytes necrosis and dermal leucocytoclastic vasculitis. Cutaneous lesions remained for several weeks, as the half-life of citalopram is very long (33 to 36 hours) but did not relapse. A women developed painful papular and purpuric erythema mainly located in sun-exposed sites, during therapy with paroxetine (Deroxat(R)) 20 mg b.i.d., which had been introduced one month before to treat depression. Cutaneous lesions healed spontaneously in 2 weeks after the discontinuation of paroxetine and with sun avoidance and didn't relapse. DISCUSSION Adverse cutaneous effects of selective serotonin reuptake inhibitors are rare but the knowledge of these reactions is important because toxic epidermal necrolysis and Stevens-Johnson syndrome had been reported during fluoxetine (Prozac(R)) and fluvoxamine (Floxyfral(R)) treatment. Different serotonin uptake blockers could be involved in the same allergic reaction, suggesting cross reactivity, although these drugs have different chemistry structures. It is advisable to substitute after an adverse effect a medication from one of the other classes of antidepressants.
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Affiliation(s)
- M A Richard
- Service de Dermatologie, Hôpital Sainte-Marguerite, Marseille.
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Richard MA. [Copahic erythema]. Ann Dermatol Venereol 2001; 128:580. [PMID: 11395666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- M A Richard
- Service de Dermatologie, Hôpital Sainte-Marguerite, 13009 Marseille
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Richard MA, Gachon J, Choux R, Laurans R, Folchetti G, Grob JJ. [Treatment of keratoacanthoma with intralesional methotrexate injections]. Ann Dermatol Venereol 2000; 127:1097. [PMID: 11173689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Grob JJ, Richard MA. [General and specific tools to measure quality of life in dermatology]. Ann Dermatol Venereol 2000; 127 Suppl 2:2S9-12. [PMID: 10962374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- J J Grob
- Service de Dermatologie, Hôpital Sainte-Marguerite, 13009 Marseille
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Abstract
BACKGROUND Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff. OBJECTIVES We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions. METHODS Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss. RESULTS Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group. CONCLUSIONS In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.
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Affiliation(s)
- M Winnefeld
- Service de Médecine du Travail et des Risques Professionnels, Hôpital de la Timone, 7 Bd Jean Moulin, 13385 Marseille Cedex 5, France
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Richard MA, Grob JJ, Philip N, Rey J, Chamson A, Mege JL, Andrac L, Faure F, Basseres N, Bonerandi JJ. Physiopathogenic investigations in a case of familial stiff-skin syndrome. Dermatology 2000; 197:127-31. [PMID: 9732160 DOI: 10.1159/000017983] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stiff-skin syndrome (SSS) is a rare cutaneous syndrome characterized by stony-hard skin and limitation of joint mobility. Its cause is still unknown. OBJECTIVE Biological investigations were performed in a new case of SSS. METHODS Collagen production and DNA biosynthesis were studied from fibroblast culture. Proinflammatory cytokines (TNF-alpha, IL-6 and TGF-beta2) were measured in the patient's serum. Results were compared with pathological findings. RESULTS Collagen production and DNA biosynthesis were normal whereas the level of circulating cytokines was high. Histological examination of the skin showed mild fibrosis in the dermis whereas the fascia was not thickened. CONCLUSION Our clinical and biological findings suggest that in this case, cutaneous changes may be related to an inflammatory process rather than to a primary fibroblast defect or a fascial abnormality as previously hypothesized.
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Affiliation(s)
- M A Richard
- Service de Dermatologie, Hôpital Sainte-Marguerite, Marseille, France
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