Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial.

BACKGROUND: Hyperhidrosis is a disorder that can impair quality of life. Localized treatments may be cumbersome and ineffective, and no systemic treatments have proven to be significantly beneficial. OBJECTIVES: To evaluate the effectiveness and tolerance of low-dose oxybutynin for hyperhidrosis. METHODS: We conducted a prospective, randomized, placebo-controlled trial. From June 2013 to January 2014, 62 patients with localized or generalized hyperhidrosis were enrolled. Oxybutynin was started at a dose of 2·5 mg per day and increased gradually to 7·5 mg per day. The primary outcome was defined as improvement of at least one point on the Hyperhidrosis Disease Severity Scale (HDSS). Dermatology Life Quality Index (DLQI) and tolerance were also reported. RESULTS: Most patients (83%) in our study had generalized hyperhidrosis. Oxybutynin was superior to placebo in improving the HDSS: 60% of patients treated with oxybutynin, compared with 27% of patients treated with placebo, improved at least one point on the HDSS (P = 0·009). The mean improvement in quality of life measured by DLQI was significantly better in the oxybutynin arm (6·9) than in the placebo arm (2·3). The most frequent side-effect was dry mouth, which was observed in 43% of the patients in the oxybutynin arm, compared with 11% in the placebo arm. CONCLUSIONS: Treatment with low-dose oxybutynin is effective in reducing symptoms of hyperhidrosis in generalized or localized forms. Side-effects were frequent but minor and mainly involved dry mouth.

Efficacy of a silver lipidocolloid dressing on heavily colonised wounds: a republished RCT.

Nearly all open wounds are contaminated by microorganisms. This generally corresponds to simple bacterial growth, without leading to deleterious effects or compromising the progress of the healing process. In acute wounds, the probability of wound infection increases as the level of contamination does. However, it is more complex for chronic wounds, which are able to contain and tolerate large amounts of bacteria, many times higher than the usual threshold level (>105 bacteria/g of tissue) defining infection in acute wounds,1 without inducing local signs. Nevertheless, many clinical and experimental studies indicate that the probability for chronic wounds to heal properly is limited when the bacterial load exceeds this level of contamination; even when body defences are still able to prevent tissue invasion, bacteria can impair wound healing.

Cutaneous events during treatment of chronic inflammatory joint disorders with anti-tumour necrosis factor alpha: a cross-sectional study.

BACKGROUND: Anti-tumour necrosis factors (anti-TNF) are more and more used, but the rate of skin adverse events is not known. OBJECTIVE: The aim was to assess the number of skin infections and other dermatoses in patients treated with anti-TNFalpha. PATIENTS AND METHODS: One hundred eighty-seven patients suffering from rheumatoid arthritis or ankylosing spondylitis underwent a dermatological exam. Patients with anti-TNF were compared with those without this treatment in a prospective transversal study. RESULTS: Among them, 59 patients were treated with anti-TNFalpha and steroids were prescribed in 100 cases. There was no difference in the prevalence of skin infections or eczema or tumours. Skin drug reactions were observed in six patients. Infections by dermatophytes appear very frequent, approaching 70% in both groups. CONCLUSIONS: This study shows that skin infections (or other skin diseases) are not more frequent in these patients. No differences were observed in infections (bacterial fungal, parasital or viral), tumours, psoriasis or the manifestations of atopic dermatitis. Nonetheless, a long-term survey might be interesting, especially about skin tumours.

[Skin and mucosal manifestations of chikungunya virus infection in adults in Reunion Island]. / Manifestations cutanéo-muqueuses de l'infection par le virus chikungunya chez l'adulte à la Réunion.

Numerous skin and mucosal manifestations were observed during the 2005-2006 chikungunya epidemic in Reunion Island. A prospective study was carried out in a consecutive series of 212 patients treated for chikungunya at the emergency unit of the Saint-Pierre Hospital in Reunion Island from March 8 to April 27, 2006. Diagnosis of chikungunya was suspected in patients with fever and joint pain and confirmed by RT-PCR and/or serology (IgM). Skin involvement was observed in 50% of patients. It consisted of exanthema with patches of healthy skin mainly on the trunk and limbs that sometimes displayed diffuse, congestive and even edematous features. Itching was reported in some cases (19.3%) and was sometimes isolated. Peeling of the skin was observed in a few cases but remained uncommon in adults. Outcome was rapidly favorable in most cases sometimes with scaling or persistence of dyschromic patches. These findings suggest that chikungunya should be suspected in subjects presenting a febrile rash while in an endemic areas or after returning from a tropical zone.

Plasmid transfer and susceptibility to antibiotics in the halophilic phototrophs Rhodovibrio salinarum and Rhodothalassium salexigens.

The present study defines a series of genetic procedures to be used for molecular studies in photosynthetic halophilic species such as Rhodovibrio salinarum and Rhodothalassium salexigens. In both species, the minimal inhibitory concentrations for the antibiotics tetracycline, rifampicin, chloramphenicol, spectinomycin, streptomycin, and kanamycin were determined. In addition, conjugal transfer of IncP and IncQ plasmids from Escherichia coli was demonstrated and the resistance markers expressed in these halophiles were determined. Finally, Rth. salexigens growth dependence on variable salt concentrations was measured: maximal growth rates were seen at 6% and 4% NaCl under phototrophic and chemotrophic conditions, respectively. To the best of our knowledge, this is the first report analyzing the genetic properties of two representative species of halophilic purple non-sulfur phototrophs.

Lichen planus pigmentosus associated with acrokeratosis of Bazex.

A patient with an acquired pigmentation related to lichen planus pigmentosus is described. Features of acrokeratosis of Bazex were associated, related to a head and neck carcinoma. Both cutaneous conditions disappeared after treatment of the neoplasia. Diagnostic criteria of lichen planus pigmentosus are reviewed. The paraneoplastic nature of this original observation of lichen planus pigmentosus is discussed.

[Keratosis follicularis decalvans: nosological discussion of Siemens' disease. Apropos of 3 cases]. / Kératoses folliculaires décalvantes: discussion nosologique de la maladie de Siemens. A propos de trois cas.

We describe 3 cases of keratosis follicularis decalvans (Siemens' disease): a 15 year old boy and a 7 year old boy and his father. They represent 2 different patterns of the disease with different clinical courses and genetic background: an autosomal dominant type of good prognosis with elevated argininemia and absence of follicular atrophy in both father and son, a sporadic type, clinically severe, with follicular atrophy. This raises the question of the nosology of the so-called Siemens' disease, since it includes actually different diseases of variable prognosis.