[Psoriasis. Treatment]. / Psoriasis. Traitement.

FUNDAMENTALS: The aim of treatment in psoriasis is to reduce the degree of extension to a point compatible with the patients social, occupational and personal lifestyle. The patient should be informed that there is no curative treatment. A good patient-doctor relationship is required for the patient to understand that the proposed treatment can provide symptomatic relief but must take into account an optimal balance between treatment benefit and risk. Therapeutic abstention must be recognized as a possibility. In all cases, efforts must be made to recognize and eliminate if possible any favoring factors. A TWO-PHASE TREATMENT: Initially, the aim of the treatment is to induce an involution of the active lesions. A second phase is aimed at avoiding subsequent fiare-ups. Local treatments: Local care should always be preferred in patients with limited lesions. Keratolytic agents, dermocorticoids and vitamin D3 derivatives can be used. Topical retinoids, particularly tazarotene are in the development stage. SYSTEMIC TREATMENTS: Systemic treatments should be reserved for extensive psoriasis and for failure after well-conducted local care. Photoherapy, particularly PUVA-therapy and more recently narrow-spectrum UVB-therapy play an important role. Systemic retinoids can be used alone or in combination with PUVA-therapy. The risks of methrotrexate and cyclosporin impose their use exclusively in specialized centers. Several other treatments are still in the experimental stage, particularly promising highly selective immunotherapy.

[Recurrent infectious and metastatic cellulitis cause by Escherichia coli]. / Cellulite infectieuse récidivante et métastatique à Escherichia coli.

BACKGROUND: We report a case of recurrent and metastatic infectious cellulitis caused by Escherichi coli. CASE REPORT: A 79-year-old man with a history of alcoholic cirrhosis and a myelodyplasia syndrome was hospitalized for skin rash and inflammatory edema of the right leg associated with bullous and necrotic lesions. Culture of a bulla puncture fluid grew E. coli. A two-drug intravenous antibiotic regimen and surgical cleansing led to a favorable outcome in 3 weeks. One week after withdrawal of the antibiotics, the patient developed a recurrent erythematous and inflammatory lesion of the right flank. Blood culture grew E. coli. The intravenous antibiotics were reinitiated immediately and provided rapid regression of the skin signs. Search for a urinary or digestive tract neoplastic focus was negative. DISCUSSION: E. coli cellulitis is a very uncommon usually fatal condition. Clinicians should be aware of a possible association with alcoholic cirrhosis. In case of recurrence, it is important to search for a digestive, hepatobiliary or urinary tract focus. Broad spectrum empirical antibiotic therapy must be initiated rapidly. Surgery is required in case of necrotizing cellulitis whatever the infectious agent.

[Myiasis caused by Dermatoba hominis after an organized tours in Amazonia]. / Myiases à Dermatobia hominis après voyages organisés en Amazonie.

BACKGROUND: Human cutaneous myiasis is a common disease in endemic tropical zones. The incidence of imported cases follows the development of organized tours in the tropics. CASE REPORTS: We report 2 cases of Dermatobia hominis furonculoid myiasis in patients who took 2 different organized tours which both visited the same Amazonian site in Peru (Puerto Maldonado). DISCUSSION: In Latin American countries, D. hominis myiasis is transmitted by Diptera (generally mosquitos, rarely flies) who carry eggs laid by an adult fly to man. This phenomena is called "phoresia" and explains the preferential localization of lesions in exposed areas unlike African myiasis caused by Cordylobia anthropophaga which contaminates clothing soiled when drying.

[Mammary staphylococcal cellulitis of the newborn]. / Dermohypodermite mammaire staphylococcique néo-natale.

BACKGROUND: Neonatal cellulitis is usually caused by staphylococcal infection of the mammary gland which has generally reached the stage of abscess formation at the time of diagnosis. The circumstances of onset and possible complications remain poorly known. We report a recent case. CASE REPORT: A female neonate developed major bilateral mammary hypertrophy. Her mother had tried to express the breasts, fearing "congestion". Three days later, the right breast showed signs of inflammation with a fluctuant central zone suggestive of a cellulitic infectious abscess confirmed at ultrasound. Recovery was achieved with incision and antistaphylococci antibiotic therapy. DISCUSSION: Mammary cellulitis of the newborn appears to generally occur following an attempt to manipulate a pre-existing physiological hypertrophy of the breast. Staphylococcus aureus is the most commonly found agent. Early surgical care is generally required as there is a real risk of progression to necrotizing faciitis.

[Cutaneo-mucous manifestations of dengue]. / Manifestations cutanéo-muqueuses de la dengue.

OBJECTIVES: To describe muco-cutaneous manifestations of dengue fever, assessing their incidence and histopathological aspects. PATIENTS AND METHODS: During a dengue 2 epidemic, occurring in Guadeloupe in 1994, all patients admitted with a confirmed diagnostic of dengue fever were assessed for dermatological changes by 2 clinicians; 5 patients underwent skin biopsy with immuno-fluorescence staining. RESULTS: Among 39 adult inpatients (Sex ratio 1.1, medium age 41 years) none presented a severe form of the disease, whereas 18/39 (46 p. 100) had some muco-cutaneous changes, associating rash (13 cases (33 p. 100)), mucous membranes involvement (7 cases (18 p. 100)), or minor haemorrhages (6 cases (15 p. 100)). The rash appeared macular, discrete, itching, troncular with peripheral extension, rather than maculo-papular (morbiliform) as usually described. Apart from cases which minor haemorrhagic changes, significatively associated with marked thrombocytopenia (medium 37 x 10(9)/1), dengue cases either with or without muco-cutaneous changes had similar clinical (duration, severity) or biological (neutro-lympho-thrombocytopenia, transaminases) features, and evolution. Histological changes appeared non specific (minor lymphocytic dermal vasculitis, non contributive immuno-fluorescence). DISCUSSION: Clinical and histological features of the rash are unspecific and inconstant: they do not allow an easy and accurate diagnosis. Complete clinical, epidemiological (very recent travel in endemic areas) or biological data should be collected, and early virological or later serological confirmation is needed. As well as travel facilities are growing, the dengue area is extending: dengue fever should therefore be considered in every traveller with fever and rash.

[Endemic subcutaneous Dirofilaria repens filariasis in Southern France]. / Filariose sous-cutanée autochtone due à Dirofilaria repens dans le département du Var.

BACKGROUND: Human dirofilariosis is endemic in southern France. The causal agent is Dirofilaria repens transmitted to man by mosquitos. The human organism is an accidental host while the dog is the reservoir. Approximately 60 cases have been reported in France, mainly in southern continental areas and Corsica. Most cases involve subcutaneous and occular manifestations. CASE REPORT: A 47-year old woman living in the Var department in southern france consulted for a subcutaneous nodule with the aspect of an epidermoid cyst. At incision, the nodule was found to contain a helminth found at parasite examination to be Dirofilaria repens. DISCUSSION: The prevalence of endemic subcutaneous dirofilariosis is probably underestimated as the clinical expression is non-specific and spontaneous cure is common. The diagnosis of epidermoid cyst is frequently suggested. History taking does not reveal travel to intertropical areas. The helminth is discovered when the nodule is opened, also providing successful cure.