Algorithm for dermocosmetic use in the management of cutaneous side-effects associated with targeted therapy in oncology.

Currently, numerous patients who receive targeted chemotherapy for cancer suffer from disabling skin reactions due to cutaneous toxicity, which is a significant problem for an increasing number of patients and their treating physicians. In addition, using inappropriate personal hygiene products often worsens these otherwise manageable side-effects. Cosmetic products for personal hygiene and lesion camouflage are part of a patients' well-being and an increasing number of physicians feel that they do not have adequate information to provide effective advice on concomitant cosmetic therapy. Although ample information is available in the literature on pharmaceutical treatment for cutaneous side-effects of chemotherapy, little is available for the concomitant use of dermatological skin-care products with medical treatments. The objective of this consensus study is to provide an algorithm for the appropriate use of dermatological cosmetics in the management of cutaneous toxicities associated with targeted chemotherapy such as epidermal growth factor receptor inhibitors and other monoclonal antibodies. These guidelines were developed by a French and German expert group of dermatologists and an oncologist for oncologists and primary care physicians who manage oncology patients. The information in this report is based on published data and the expert group's opinion. Due to the current lack of clinical evidence, only a review of published recommendations including suggestions for concomitant cosmetic use was conducted.

[An investigational study of acne treatment in France]. / Enquête sur la prise en charge des patients acnéiques en France.

BACKGROUND: Acne is one of the main reasons for dermatological consultation. Management may seem standardized, in particular for mild to moderate juvenile facial acne, where topical treatments are used for mild cases and topical treatments associated with systemic antibiotics are used for moderate cases. The aim of this investigational study was to evaluate current treatment approaches for mild to moderate acne patients by French dermatologists in private practice. METHODS: During this study, more than 252 dermatologists practising in over 144 French cities were asked about their preferred treatments (other than isotretinoin) for young acne patients. A questionnaire containing information about patient characteristics, disease severity and the prescribed therapy was completed by dermatologists at baseline and 2 months later. RESULTS: In total, 3145 acne patients were analyzed. This study showed that in 53% of cases, dermatologists prescribed several topical treatments (up to three) associated with one or several systemic therapies (up to three), in addition to a cosmetic product. In 51% of cases, dermatologists prescribed only application of a dermatological cosmetic product for patients with very mild acne; in 41% of cases, a single treatment, especially a topical treatment, was prescribed for patients with mild acne, and in 59 and 64% of cases, two treatments (a combination of local and systemic therapy) were prescribed respectively for patients with moderate and severe acne. CONCLUSION: This study demonstrated the complexity of management of acne patients by dermatologists, particularly in the case of mild to severe acne. Most notably, such therapeutic complexity raises the question of compliance, a key factor in successful treatment.

Interest of corrective makeup in the management of patients in dermatology.

BACKGROUND: Disfiguring dermatoses may have a significant impact on patients' quality of life, namely on their relationship with others, self image, and self esteem. Some previous studies have suggested that corrective foundation can improve the quality of life (QOL) of patients with facial dermatoses; in particular, in patients with acne vulgaris or pigmentary disorders. OBJECTIVE: The aim of this prospective study was to evaluate the impact of the skin conditions of patients with various skin diseases affecting their face (scars, acne, rosacea, melasma, vitiligo, hypo or hyperpigmentation, lentigines, etc) on their QOL and the improvement afforded by the use of corrective makeup for 1 month after being instructed on how to use it by a medical cosmetician during an initial medical consultation. METHODS: One hundred and twenty-nine patients with various skin diseases affecting the patients' face were investigated. The patients were instructed by a cosmetician on how to use corrective makeup (complexion, eyes, and lips) and applied it for 1 month. The safety of the makeup application was evaluated and the QOL was assessed via a questionnaire (DLQI) and using a 10-cm visual analog scale (VAS) completed before the first application and at the final visit. The amelioration of their appearance was documented by standardized photography. RESULTS: No side effects occurred during the course of the study. A comparison of the standardized photographs taken at each visit showed the patients' significant improvement in appearance due to the application of corrective makeup. The mean DLQI score dropped significantly from 9.90 ± 0.73 to 3.49 ± 0.40 (P < 0.0001). CONCLUSION: Our results suggest that dermatologists should encourage patients with disfiguring dermatoses to utilize appropriate and safe makeup to improve their appearance and their QOL. Corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient's adherence.

Importance of treatment of skin xerosis in diabetes.

BACKGROUND: Cutaneous complications are common in diabetes patients and previous studies have shown that diabetes can affect some biophysical skin characteristics. However, the interest of emollients in diabetes has never been clearly demonstrated; i.e. whether they are able to limit skin complications in diabetes patients. OBJECTIVE: The aim of this study was to evaluate the tolerance and the effect of an emollient on patient with diabetes. METHOD: Forty patients with diabetes applied the emollient twice daily for 1 month on one arm and one leg, in normal conditions. RESULTS: A 1-month treatment with an emollient allows a similar skin hydration rate in diabetics to that in healthy people. This dry skin improvement is accompanied by a significant reduction in pruritus and desquamation, and a significant improvement in the skin barrier function. CONCLUSION: Emollient treatment can be useful in the management of diabetes by limiting skin complications associated with elevated blood sugar.

Photoprotection in moisturizers and daily-care products.

During usual daily activities, an appropriate protection against solar UV exposure should prevent clinical, cellular and molecular changes potentially leading to photoaging. In skin areas regularly exposed to sun, UV-damage is superimposed to tissue degeneration resulting from chronological aging. It is, therefore, important to know if moisturizers and daily-care products containing UVA absorbers combined with UVB ones are able to prevent these skin damages. This review will summarize clinical studies evaluating this topic. These studies demonstrate that broad-spectrum protection in moisturizers or daily-care products can prevent the "silent" sub-erythemal cumulative effects of UVR from inadvertent sun exposure.

A lipohydroxyacid-containing shampoo improves scalp condition and quality of life in patients with seborrheic dermatitis and light-to-moderate scalp psoriasis.

BACKGROUND: Dandruff is a common scalp disorder affecting almost half of the post-pubertal population of any ethnicity and both genders. It is one of the major reasons for patients to consult a dermatologist and it is the cause of significant psychological and social distress. AIMS: The aim of this open study was to evaluate the benefit of a 4-week treatment with a shampoo containing 0.1% lipohydroxyacid (LHA) and 1.3% salicylic acid on the scalp condition and on the quality of life of 275 volunteers with seborrheic dermatitis (SD) (n = 226) or light-to-moderate scalp psoriasis (SP) (n = 49). METHODS: The clinical benefit of the treatment was assessed by scoring the following parameters, i.e., severity of the dermatosis, scaling, itching, excoriations, and superficial burning sensation. The impact on the quality of life was assessed using the Scalpdex, a questionnaire specially developed by Chen et al. for patients with scalp dermatitis, which includes 23 questions regarding the symptoms, functioning and emotions affected by scalp dermatosis. RESULTS: The shampoo used in this study was well tolerated. After a 4-week treatment, dermatologists noticed a significant clinical improvement of all the scalp parameters evaluated (i.e., the composite lesional score was improved in 91% and 77% of the patients with SD or SP respectively). The symptoms, functioning and emotions scores of quality of life were also significantly improved in relation to the improvement of scalp condition. CONCLUSION: This study not only allowed a better understanding of the SD and SP patient's profile but also demonstrated that the shampoo evaluated is a convenient, efficient, safe, and well-tolerated cosmetic treatment of SD and light-to-moderate SP improving greatly the quality of life of the treated patients.

Emollient for maintenance therapy after topical corticotherapy in mild psoriasis.

Emollients or moisturizers can act as an important adjunctive therapy of topical treatment in psoriatic patients. However, the interest of emollients has never been clearly demonstrated; i.e. are they able to improve topical treatment efficacy and/or maintain continuous remission of the disease? The aim of this study was to evaluate the effect of an emollient on patients with mild plaque psoriasis during and after standard local corticosteroid therapy. Results showed that the use of an emollient can limit relapses after the end of corticotherapy, and maintain the improvement obtained after 1 month corticotherapy at clinical level (physician global assessment) and skin dryness.

Randomized study comparing the efficacy and tolerance of a lipophillic hydroxy acid derivative of salicylic acid and 5% benzoyl peroxide in the treatment of facial acne vulgaris.

BACKGROUND: New topical treatments for acne vulgaris are needed for patients who have tolerance problems with current treatments. AIMS: To compare the efficacy and tolerance of a lipophillic derivative of salicylic acid (lipo hydroxy acid or LHA) containing formulation and 5% benzoyl peroxide in subjects with acne vulgaris. METHODS: Eighty subjects with mild to moderate facial acne were randomized to receive either the LHA formulation twice a day or benzoyl peroxide once a day for 12 weeks. Efficacy and tolerance were evaluated at days 0, 28, 56 and 87. Results LHA formulation and benzoyl peroxide decreased the number of inflammatory lesions from baseline to week 12 by 44% and 47% and noninflammatory lesions by 19% and 23%, respectively. There was no statistically significant difference between the two treatments (P = 0.748; P = 0.445). CONCLUSION: These results suggest that the LHA formulation could be a treatment option to consider in mild to moderate acne vulgaris patients that are intolerant to benzoyl peroxide.

Metal hydrides for lithium-ion batteries.

Classical electrodes for Li-ion technology operate via an insertion/de-insertion process. Recently, conversion electrodes have shown the capability of greater capacity, but have so far suffered from a marked hysteresis in voltage between charge and discharge, leading to poor energy efficiency and voltages. Here, we present the electrochemical reactivity of MgH(2) with Li that constitutes the first use of a metal-hydride electrode for Li-ion batteries. The MgH(2) electrode shows a large, reversible capacity of 1,480 mAh g(-1) at an average voltage of 0.5 V versus Li(+)/Li(o) which is suitable for the negative electrode. In addition, it shows the lowest polarization for conversion electrodes. The electrochemical reaction results in formation of a composite containing Mg embedded in a LiH matrix, which on charging converts back to MgH(2). Furthermore, the reaction is not specific to MgH(2), as other metal or intermetallic hydrides show similar reactivity towards Li. Equally promising, the reaction produces nanosized Mg and MgH(2), which show enhanced hydrogen sorption/desorption kinetics. We hope that such findings can pave the way for designing nanoscale active metal elements with applications in hydrogen storage and lithium-ion batteries.

[Epilepsy surgery in France]. / La chirurgie de l'épilepsie en France Evaluation de l'activité

We report here the results of the first survey on epilepsy surgery activity in France. Data from a questionnaire sent to 17 centers practicing epilepsy surgery were analyzed. All centers responded; however, all items were not completely documented. Over 50 years, more than 5000 patients have been operated on for drug-resistant epilepsy and more than 3000 patients underwent some invasive monitoring, most often SEEG. Currently, nearly 400 patients (including more than 100 children) are operated on yearly for epilepsy in France. Over a study period varying among centers (from two to 20 years; mean, 9.5 years), results from more than 2000 patients including one-third children were analyzed. Important differences between adults and children, respectively, were observed in terms of location (temporal: 72% versus 4.3%; frontal: 12% versus 28%; central: 2% versus 11%), etiology (hippocampal sclerosis: 41% versus 2%; tumors 20% versus 61%); and procedures (cortectomy: 50% versus 23%; lesionectomy: 8% versus 59%), although overall results were identical (seizure-free rates following temporal lobe surgery: 80.6% versus 79%; following extratemporal surgery: 65.9% versus 65%). In adults, the best results were observed following temporomesial (TM) resection associated with hippocampal sclerosis or other lesions (class I: 83% and 79%, respectively), temporal neocortical (TNC) lesional (82%), while resections for cryptogenic temporal resections were followed by 69% (TM) and 63% (TNC) class I outcome. Extratemporal lesional resections were associated with 71% class I outcome and cryptogenic 43%. In children, the best results were obtained in tumor-associated epilepsy regardless of location (class I: 80%). A surgical complication occurred in 8% after resective surgery - with only 2.5% permanent morbidity - and 4.3% after invasive monitoring (mostly hemorrhagic). Overall results obtained by epilepsy surgery centers were in the higher range of those reported in the literature, along with a low rate of major surgical complications. Growing interest for epilepsy surgery is clearly demonstrated in this survey and supports further development to better satisfy the population's needs, particularly children. Activity should be further evaluated, while existing epilepsy surgery centers as well as healthcare networks should be expanded.

[Dual pathology]. / Les doubles pathologies.

Dual pathology is defined as the association of two potentially epileptogenic lesions, hippocampal (sclerosis, neuronal loss) and extrahippocampal (temporal or extratemporal). Epileptic activity may be generated by either lesion and the relative importance of every lesion's epileptogenicity conditions the surgical strategy adopted. Most frequently associated with hippocampal sclerosis are cortical dysplasias. The common physiopathology of the two lesions is not clearly established. Extrahippocampal lesions may be undetectable on MRI (microdysgenesis, for example) and ictal discharge patterns may vary among dual pathology patients. The surgical strategy depends on the location of the extrahippocampal lesion and its relative role in seizure generation; however, reported surgical results suggest that simultaneous resection of mesial temporal structures along with the extrahippocampal lesion should be performed.

[Medicoeconomic assessment of epilepsy surgery in adults with medically intractable partial epilepsy. Three-year outcomes from a multicenter French cohort]. / Evaluation médicoéconomique de la chirurgie des épilepsies partielles pharmacorésistantes de l'adulte. Résultats à trois ans d'une étude prospective multicentrique française.

PURPOSE: To compare resective surgery and medical therapy in a cost-effectiveness analysis in a multicenter cohort of adult patients with partial intractable epilepsy. POPULATION AND METHODS: Adult patients with partial, medically intractable, potentially operable epilepsy were eligible and followed every year over five years. Effectiveness was defined as one year without seizure. The long-term costs and effectiveness were extrapolated over the patients' lifetime with a Markov model. Productivity (indirect costs) and quality of life (QOLIE-31, SEALS) were also assessed. Changes before and after surgery were compared between the two groups. RESULTS: Two hundred and eighty-nine patients were included (119 with surgery, 161 medically treated, six not eligible, three lost to follow-up). One year after surgery, 81% of the patients were seizure-free; at two and three years, this rate was 78%. In the medical group, these rates were 10, 18, and 15%, respectively. The cost of the explorations was euro 8464; including surgery, it was euro 19,700. In the medical group, the average annual direct costs were between 3500 and euro 6000. At two years after surgery, the annual direct cost decreased to euro 2768, at three years, it was euro 1233, predominately antiepileptic drug costs. Surgery became cost-effective between seven and eight years. In the surgical group, all the quality-of-life scores improved at one year after surgery and were stable during the second and third years. CONCLUSION: Surgical therapy was cost-effective at the middle term even though indirect costs were not considered.

Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women.

BACKGROUND: Chloasma, or melasma, is a pigmentary disorder that can affect between 50% and 70% of pregnant women. During pregnancy, chloasma does not require any particular treatment beside the use of an effective sunscreen and avoiding the use of any photosensitizing products or inappropriate skin care routine. However, there exist very few studies related to the benefits of sunscreens to prevent this dermatosis. OBJECTIVE: The aim of this study was to assess the role of a broad-spectrum sunscreen in the prevention and treatment of chloasma in pregnant women. METHODS: We tested the effectiveness and tolerance of a sunscreen composition (SPF 50+, UVA-PF 28) during a 12-month clinical trial on 200 parturients. RESULTS: The 'excellent' tolerance of the sunscreen under evaluation was confirmed. Out of 185 patients who completed the study, only five new cases of chloasma were noted, an occurrence of 2.7%, which is much lower than the 53% previously observed in an usual condition study (same investigators, same geographical area and same time frame). In addition, the clinical effectiveness of the evaluated sunscreen was judged 'excellent' by the majority of parturients and by the research dermatologists during all the consultations. It is also worth noting that at 6 months, a clinical improvement was observed in 8 out of 12 volunteers who were affected by a pre-existing chloasma observed during their inclusion visit. Colorimetric measurements showed that, at the end of their pregnancy, the parturients' skin was, on average, significantly lightened (increase of parameter L* in 38% cases) and less pigmented (reduction of parameter b* in 50% cases); thus, resulting in a significantly lighter skin colour (increase of ITA degrees in 69% cases) compared to their inclusion visit. CONCLUSIONS: This study clearly demonstrates the effectiveness of the well-tolerated broad-spectrum sunscreen evaluated, in the prevention of the development of chloasma in pregnant women.

Polysialylation of NCAM is upregulated by hyperthermia and participates in heat shock preconditioning-induced neuroprotection.

"Brain tolerance"--a phenomenon in which a subtoxic challenge confers resistance to subsequent brain injuries--provides an ideal opportunity for investigating endogenous neuroprotective mechanisms. We investigated the potential role of the polysialylated (PSA) form of neural cell adhesion molecule (NCAM), which is thought to play a key role in plasticity. In a model where prior exposure to heat shock protects against kainate-induced cell damage in the hippocampus, we show that hyperthermia upregulates PSA-NCAM expression for at least 1 week, without affecting neurogenesis. Pharmacological manipulation of heat shock protein (HSP) expression demonstrates a tight positive link between HSP70 and PSA-NCAM. Finally, the presence of PSA was functionally linked to brain tolerance, as protection against kainate-induced cell death by heat shock pre-exposure was abolished in the absence of NCAM polysialylation. The upregulation of PSA-NCAM by hyperthermia may have a significant impact on hippocampal plasticity, permitting induction of the complex molecular cascade responsible for neuroprotection.

Apparent mismatch between extended x-ray absorption fine structure and diffraction structures of crystalline metastable WO3 phases.

The local structure of monoclinic, monohydrate, hexagonal, and pyrochlore WO3 phases was investigated by the extended x-ray absorption fine structure spectroscopy as preliminary studies of model compounds of amorphous and thin film WO3 based electrochromic species. In the four cases, we found a large W-O distribution of distances ranging from 1.70 to 2.35 A. The apparent discrepancy of these results and previously published crystal structures are discussed and interpreted as the detection of vacancies and local distortion disorder.

Side-effects of subthalamic stimulation in Parkinson's disease: clinical evolution and predictive factors.

Chronic bilateral high-frequency stimulation of the subthalamic nucleus (STN) is an alternative treatment for disabling forms of Parkinson's disease when on-off fluctuations and levodopa-induced dyskinesias compromise patients' quality of life. The aim of this study was to assess the evolution of side-effects during the first year of follow-up and search for clinical predictive factors accounting for their occurrence. We compared the frequency of side-effects at 3 and 12 months after surgery in a cohort of 44 patients. The off-medication scores of Unified Parkinson's Disease Rating Scale (UPDRS) II, III, axial symptoms, disease duration and age at surgery were retained for correlation analysis. Dysarthria/hypophonia, weight gain and postural instability were the most frequent chronic side-effects. Whereas dysarthria/hypophonia remained stable over time, weight gain and postural instability increased during the first year post-op. High axial and UPDRS II scores at surgery were predictive of dysarthria/hypophonia. Age and axial score at surgery were positively correlated with postural instability. Despite the occurrence of side-effects, the benefit/side-effects ratio of STN stimulation was largely positive during the first year of follow-up. Age, intensity of axial symptoms and UDPRS II off-medication score before surgery are predictive factors of dysarthria/hypophonia and postural instability after surgery.

Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson's disease.

BACKGROUND: High frequency stimulation of the subthalamic nucleus (STN) is an alternative but expensive neurosurgical treatment for parkinsonian patients with levodopa induced motor complications. OBJECTIVE: To assess the safety, clinical effects, quality of life, and economic cost of STN stimulation. METHODS: We conducted a prospective multicentre study in 95 consecutive Parkinson's disease (PD) patients receiving bilateral STN stimulation and assessed its effects over 12 months. A double blind randomised motor evaluation was carried out at 3 month follow up, and quality of life, self care ability, and predictive factors of outcome following surgery were assessed. The cost of PD was estimated over 6 months before and after surgery. RESULTS: The Unified Parkinson's Disease Rating Scale (UPDRS) motor score improved by 57% (p<0.0001) and activities of daily living improved by 48% (p<0.0001) at 12 month follow up. Double blind motor scoring improved by 51% at 3 month follow up (p<0.0001). The total PD Quality of Life Questionnaire (PDQL-37) score improved by 28% (p<0.001). The better the preoperative motor score after a levodopa challenge, the better the outcome after STN stimulation. Five patients developed an intracerebral haematoma during electrode implantation with permanent after effects in two. The 6 month costs of PD decreased from 10,087 euros before surgery to 1673 euros after surgery (p<0.0001) mainly because of the decrease in medication. These savings allowed a return on the procedure investment, estimated at 36,904 euros over 2.2 years. CONCLUSIONS: STN stimulation has good outcomes with relatively low risk and little cost burden in PD patients with levodopa induced motor complications.