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1.
Ann Dermatol Venereol ; 146(5): 354-362, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30954294

RESUMO

BACKGROUND: Psoriasis affects 0.2-0.7 % of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. PATIENTS AND METHODS: This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41 dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. RESULTS: In all, 207 children (girls: 60.4 %; mean age: 10.5±4.2 years) were included. Scalp psoriasis (40.6 %) was the most frequent clinical type, while plaque psoriasis represented 26 % of cases. Nail, tongue, and arthritic involvement were rare. Less than 1 % of children suffered from hypertension, diabetes or dyslipidemia, but 16.4 % were overweight and 7.0 % were obese. Severity (PG≥4 at peak) was associated with excess weight (P=0.01). CONCLUSION: Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.


Assuntos
Psoríase/epidemiologia , Dermatoses do Couro Cabeludo/epidemiologia , Adolescente , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , França/epidemiologia , Humanos , Hipertensão/epidemiologia , Lactente , Masculino , Doenças da Unha/epidemiologia , Sobrepeso , Obesidade Pediátrica/epidemiologia , Prática Privada/estatística & dados numéricos
9.
Ann Dermatol Venereol ; 143(11): 675-681, 2016 Nov.
Artigo em Francês | MEDLINE | ID: mdl-27659388

RESUMO

BACKGROUND: Since 2007 in France, human papilloma virus (HPV) vaccination has been licensed for use as a vaccine against HPV 6, 11, 16 and 18. The impact on the epidemiology of external genital warts (EGWs) in a large population remains unclear. OBJECTIVES: To determine epidemiologic and clinical features of patients presenting EGWs in France in the era of HPV vaccination. PATIENTS AND METHODS: In this prospective, observational study, we analyzed clinical features and treatments between January 1st, 2012 and March 31, 2012 for patients consulting for EGWs at 15 STI clinics throughout France. RESULTS: A total of 372 men and 111 women were included; mean age 31.2 years. The women were younger than the men (31.7 and 28.9 years respectively P<0.05). Among the patients, 416 (85.7%) were heterosexual, 13 bisexual and 54 (11.2%) homosexual, including one female. Males reported more sexual partners in the last 12 months (more than 3 partners in 32.6% versus 11.9%, P<0.01). Among the men, 230 had involvement of the penis alone and 46 had involvement of the anus alone. Seventy-six patients had EGWs of the anus, and of these 26 were MSM. In females, 76 had an infection of the vulva alone and 22 co-infection of the vulva and anus. MSM and females were at higher risk than heterosexual males for anal involvement (P<0.0001 and P=0.004, respectively). Three women had been vaccinated: two with Gardasil® and one with Cervarix®. Cryotherapy was the preferred treatment. CONCLUSION: With the advent of HPV vaccination, a global strategy for the prevention and treatment of EGW should be implemented.


Assuntos
Doenças do Ânus/epidemiologia , Condiloma Acuminado/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ânus/terapia , Condiloma Acuminado/terapia , Crioterapia , Feminino , França/epidemiologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/terapia , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18 , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Parceiros Sexuais , Sexualidade/estatística & dados numéricos , Adulto Jovem
10.
Colorectal Dis ; 18(10): 997-1004, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26896041

RESUMO

AIM: Anal screening is recommended in HIV-positive patients, especially men who have sex with men (MSM), due to an increased incidence of anal cancer. The optimal screening methods are not generally agreed. METHOD: Screening for anal lesions by anorectal examination, including anoscopy, was offered to HIV-positive outpatients in a tertiary care university hospital regardless of gender or sexual orientation. RESULTS: Among the 1206 screened patients (701 MSM, 247 heterosexual men, 258 women), 311 (26%) had histologically proven lesions related to human papilloma virus (HPV) (34% MSM, 14% heterosexual men, 14% women); 123 (10%) had low-grade dysplasia and 70 (6%) high-grade dysplasia. Seven anal cancers were also diagnosed. Determinants of any lesion were age < 45 years [OR = 1.56 (95% CI, 1.16-2.11)], a CD4 count of < 200/mm3 [OR = 2.54 (1.71-3.78)], receptive anal intercourse [OR =3.03 (2.06-4.47)], sub-Saharan African origin [OR = 0.53 (0.33-0.85)], and history of HPV-related lesion [OR = 1.84 (1.35-2.51)]. These determinants were similar for all different grades of dysplasia. In patient subgroup analysis, receptive anal intercourse, the CD4 cell count and a history of HPV lesions were determinants of HPV-positivity in all patients, whereas age was only a determinant in men. CONCLUSION: Anoscopy is an alternative method for anal screening in an HIV-positive population. This screening has to be compared with other tools in populations at high risk of anal cancer.


Assuntos
Doenças do Ânus/diagnóstico , Neoplasias do Ânus/diagnóstico , Infecções por HIV/complicações , Lesões Pré-Cancerosas/diagnóstico , Proctoscopia/métodos , Adulto , Canal Anal/diagnóstico por imagem , Doenças do Ânus/virologia , Neoplasias do Ânus/virologia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/virologia , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais
11.
Ann Dermatol Venereol ; 143(1): 39-50, 2016 Jan.
Artigo em Francês | MEDLINE | ID: mdl-26804434

RESUMO

Sarcoidosis is a systemic granulomatous disorder of unknown aetiology. Its dermatological manifestations are extremely polymorphous. They are normally classed as either specific lesions, comprising granulomas, which are generally chronic, or non-specific lesions, principally acute erythema nodosum. These signs are seen in around 25% of sarcoidosis patients. The disease may be heralded by a skin disorder. Diagnosis of cutaneous sarcoidosis provides the clinician with three problems: screening for a visceral site of the disease, determination of the prognosis, and long-term management with regular monitoring coupled with suitable therapy in the event of cosmetic or functional impairment.


Assuntos
Dermatologia/educação , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia , Corticosteroides/uso terapêutico , Antimaláricos , Diagnóstico Diferencial , Educação Médica Continuada , Humanos , Imunossupressores/uso terapêutico , Prognóstico , Sarcoidose/fisiopatologia , Dermatopatias/fisiopatologia
12.
Ann Dermatol Venereol ; 137(12): 769-74, 2010 Dec.
Artigo em Francês | MEDLINE | ID: mdl-21134578

RESUMO

BACKGROUND: a clinical study of 14 patients presenting both malignant melanoma and HIV infection, and analysis of the literature to determine the frequency and specific features of this association. PATIENTS AND METHODS: ten men and four women of median age 43 years were included. In 50% of cases, the primary melanoma consisted of spreading superficial melanoma with a mean Breslow thickness of 2.83 mm. In two cases, regional lymph node metastasis was discovered but with no primary melanoma being identified. HIV infection was already documented on diagnosis of melanoma in 11 cases, and it was discovered in three cases at the time of surgery for melanoma (treatment of the primary melanoma in two cases, and in one case, regional lymph node dissection two years after the initial diagnosis). Eight patients died within a mean period of 39 months, with melanoma being the cause of death in six cases. Following relapse of melanoma, the course of the disease was severe, with mean stage IV survival of 3.6 months. No response to chemotherapy was observed where such treatment was feasible. DISCUSSION: the presence of HIV appears to be an aggravating factor for the outcome of metastatic melanoma. CONCLUSION: our study suggests the importance of clinical examination of pigmented lesions in HIV patients in order to ensure early identification of melanoma.


Assuntos
Soropositividade para HIV/diagnóstico , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Causas de Morte , Diagnóstico Precoce , Feminino , Soropositividade para HIV/mortalidade , Soropositividade para HIV/patologia , Humanos , Metástase Linfática/patologia , Masculino , Melanoma/mortalidade , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Taxa de Sobrevida
13.
Br J Dermatol ; 161(4): 904-9, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19466962

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV)+ patients have an increased risk of anogenital warts. High-risk (HR) human papillomaviruses (HPVs), especially types 16 and 18, are major risk factors for precancerous and cancerous lesions of the anogenital tract, while low-risk (LR) HPVs are associated with benign lesions. Cure of genital warts with ablative techniques, surgical excision, podophyllotoxin or trichloroacetic acid is frequently difficult. Treatment with imiquimod cream showed a total clearance of external genital or perianal warts in about 50% of immunocompetent subjects. However, total clearance was reduced in HIV+ subjects not treated with highly active antiretroviral therapy (HAART). OBJECTIVES: To assess clinically and by monitoring HPV content the efficacy of 5% topical imiquimod to treat anogenital warts in HIV+ subjects with at least partially restored immune functions. METHODS: Fifty HIV+ patients successfully treated with HAART (total CD4+ cells > or = 200 cells mm(-3) and plasma HIV RNA load < 10(4) copies mL(-1)) with anogenital warts were included. Imiquimod 5% cream was applied on external genital or perianal warts three times weekly for up to 16 weeks. Warts were tested at entry and after treatment for human LR- and HR-HPV DNA. RESULTS: Total wart clearance was observed in 16 of 50 (32%) patients at week 16. At enrolment, HPV DNA was present in more than 90% of lesions with a majority of lesions co-infected by HR- and LR-HPV. At study end, the HPV load decreased or became undetectable in 40% of cases studied. CONCLUSIONS: Imiquimod 5% cream did not show safety concerns and is suitable for use in HIV+ subjects with anogenital warts and successful HAART treatment.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adjuvantes Imunológicos/administração & dosagem , Aminoquinolinas/administração & dosagem , Doenças do Ânus/tratamento farmacológico , Condiloma Acuminado/tratamento farmacológico , Infecções por Papillomavirus/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Administração Cutânea , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Doenças do Ânus/virologia , Condiloma Acuminado/virologia , Esquema de Medicação , Feminino , Humanos , Imiquimode , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Resultado do Tratamento , Adulto Jovem
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