[Skin tests in chronic hand dermatitis]. / Place des tests allergologiques dans l'eczéma chronique des mains.

Chronic hand dermatitis is often multifactorial but allergic causes are frequent and can complicate atopic dermatitis or irritant dermatitis. The management of patients affected by hand dermatitis includes detailed interrogation and a complete examination of the skin. Allergologic tests must be systematically realized if examination is suggestive of contact dermatitis or protein contact dermatitis, if an occupational origin is suspected but also in all patients in which treatment is ineffective. Skin tests include patch tests with the European standard series, specialized or additional series if necessary. Skin tests may also include personal items used by patients on a daily basis. If protein contact dermatitis is suspected skin tests include prick tests. Only complete and definitive eviction of allergens can allow a complete and definitive cure of chronic hand dermatitis.

[Therapeutic patient education in chronic hand dermatitis]. / Éducation thérapeutique du patient dans l'eczéma chronique des mains.

Hand dermatitis (HD) is usually due to a combination of various interacting factors. It involves significant impairment of the quality of life with psychological and socioeconomic impact. A therapeutic education program in HD.was elaborated by 19 health professionals (dermatologists, occupational clinical physicians, nurses, psychologists, environmental medical advisor) with experience in therapeutic education or skills in HD, according to the recommendations of Haute Autorité de Santé. The program includes an individual medical consultation to perform educational diagnostic, two collective workshops and a medical evaluation consult. Two group workshops "the disease, irritant factors and its treatments" and "the experiences and feelings" were elaborated with learning objectives and educative tools. Different scores were proposed to evaluate the program and acquired skills. Therapeutic education is an efficient way to help patients to adopt skin protection measures essential to healing. We propose a guideline of therapeutic education in HD including skills and educative tools and intended for health professionals to serve as working basis.

[An atypical skin rash in a setting of antiphospholipid syndrome]. / Éruption cutanée atypique au cours d'un syndrome des antiphospholipides.

BACKGROUND: Antiphospholipid syndrome (APS) is characterised by arterial or venous thrombosis combined with the presence of specific antibodies known as antiphospholipids. It is commonly associated with cutaneous signs. Herein we report a case of atypical cutaneous eruption occurring during the course of APS and we discuss the possible mechanism. PATIENTS AND METHODS: A 45-year-old woman consulted twice within six months for an erythematosus papular eruption around the neckline. She was being followed-up for antiphospholipid syndrome treated with fluindione (Préviscan®), and her International Normalized Ratio (INR) was consistent with the prescribed anticoagulation target. Blood tests confirmed the presence of anticardiolipin and antiphospholipid antibodies, but no laboratory evidence of lupus was seen. Histopathological examination of a skin biopsy demonstrated the presence within the vascular lumen of a weakly eosinophilic anhistic substance positive for PAS stain. The patient was given acetone salicylic acid (Kardégic®) combined with fluindione, and four years later, she had presented no relapses. DISCUSSION: Despite a clinically evocative appearance, the diagnosis of lupus tumidus was ruled out in our patient by histopathological features, and associated systemic lupus erythematosus was repeatedly refuted on the basis of clinical and laboratory data. We suggest that the specific histological images of intraluminal deposits within the dermal vessels seen in this patient, although not typical of thrombosis, are associated with APS. The clinical remission seen from the start of antiplatelet treatment could be due to the action of these drugs against the obstruction of small-calibre dermal vessels.

[Bullous drug eruption with Nigella sativa oil]. / Éruption bulleuse à l'huile de nigelle.

BACKGROUND: Nigella sativa is classically used for its various therapeutic properties, particularly in the field of allergic diseases. We report a case of bullous eruption following application of Nigella sativa oil to the skin, possibly involving an associated systemic mechanism linked to ingestion of the oil. PATIENTS AND METHODS: A 53-year-old woman was hospitalized for febrile rash consisting of erythematous plaques with vesicles and bullous lesions. She had Nigella sativa oil applied to her skin and ingested it for two weeks. Cutaneous histopathology revealed sub-epidermal detachment and necrosis of the epidermal surface consistent with toxic epidermal necrolysis. The lesions healed slowly, but depigmented macules persisted three months later. Patch tests for Nigella sativa oil were strongly positive. DISCUSSION: Erythema multiforme due to contact with Nigella sativa oil was initially diagnosed on the basis of lesions on skin where the oil was applied, as well as on cutaneous histopathology and positive patch tests. However, a systemic reaction such as toxic epidermal necrolysis could not be ruled out since the patient had also ingested the oil. The most likely diagnosis was thus systemic and contact bullous drug eruption. The discovery of new therapeutic properties of Nigella sativa in other clinical domains underscores the need for particular vigilance regarding future use of this substance on account of the risk of severe drug eruptions.