Acute exanthemas: a prospective study of 98 adult patients with an emphasis on cytokinic and metagenomic investigation.

BACKGROUND: Acute exanthemas (AEs) are frequently seen; they can be caused by drugs or viruses but often the cause is unknown. OBJECTIVES: To describe the clinical, virological and histological aspects of AEs and explore their cytokinic and metagenomic profiles. METHODS: This prospective study examined 98 patients with AE, from February to July 2014. Clinical data were recorded in a standardized chart. Virological investigation and skin biopsies were performed. In addition, blood and skin samples were analysed for cytokines and then by a shotgun metagenomic approach. We identified five groups of patients: those with maculopapular exanthemas (MPEs) that were virally induced (group 1); those with drug-induced MPEs (group 2), those with MPEs that were both viral and drug induced (group 3), those with idiopathic MPEs (group 4) and those with pityriasis rosea (group 5). RESULTS: A virus was identified in 29 cases (human herpesvirus 6, 72%). Cytokinic analysis of the skin (n = 23 MPEs) showed higher levels of interferon-γ and interleukin-1 receptor-α in viral MPEs, higher interleukin-33 levels in idiopathic MPEs, and higher macrophage inflammatory protein 1α levels in drug-induced MPEs. By metagenomics analysis (n = 10 MPEs), viruses identified with routine practice methods were not found in group 1 (n = 4 MPEs). However, Enterovirus A was detected in two cases, especially in a group 1 patient for whom metagenomic analysis rectified the diagnosis of the culprit agent. CONCLUSIONS: Human herpesvirus 6 was the virus most frequently identified, and histology did not discriminate MPEs. In addition, the level of interleukin-33 seen in idiopathic MPEs suggests that an environmental factor may be the trigger for these. The results bring into question the utility of routine polymerase chain reaction analysis and viral serology for determining cause in AE. What's already known about this topic? Acute exanthemas, especially maculopapular exanthemas, are a frequent reason for patients consulting emergency and dermatology departments. It is difficult to evaluate the aetiology of acute exanthema based on the clinical aspects. Few data are available on the investigations needed in routine practice, and no prospective series have been published. What does this study add? Our study provides a global and prospective description of acute exanthemas. Cytokine analysis could help to investigate the pathophysiology of idiopathic eruptions. Metagenomic analysis provides new insights about the value of routine practice virological investigations. We show for the first time the feasibility of metagenomics analysis in the skin, which results question the interest of routine PCR and viral sérologies for the exploration of such acute exanthemas.

Defining and validating a Body Skin Discomfort Index (BSDI).

OBJECTIVE: To understand the drivers of body skin discomfort and to validate a new index to assess its severity. This index should be sensitive enough to capture changes in response to treatment. METHODS: Previous consumer studies suggested seven potential main dimensions behind skin discomfort. Four of them refer to self-declarations (stinging, itching, warming and tightening), whereas three can be assessed by a dermatologist (skin dryness, redness and desquamation). Intensity and frequency or extent of these items were measured using 0-9 ordinal scales. To generate the data for validation of a new index based on the 7 items, a group of 49 subjects complaining of skin discomfort was followed up for 5 weeks: 1-week without product application to check reproducibility, followed by 4 weeks of treatment to evaluate sensitivity to change. Items not significantly reported at baseline or with changes because of treatment not sufficiently correlated with the overall change measured by the index were discarded. A control group of 49 subjects presenting no discomfort at all was also included to check the capacity of our index to discriminate both groups. The final index (Body Skin Discomfort Index, BSDI) was normalized to facilitate the clinical interpretation of the results. RESULTS: After discarding warming and skin redness, the BSDI is finally a five-dimension score calculated as follows: (TI + TF + SI + SF + ItI + ItF + DI + DE + DqI + DqE) 9 9/90 where T, S, It, D and Dq refer to tightness, stinging, itching, dryness, desquamation respectively, and I, F or E refers to intensity, frequency or extent. The final BSDI score displayed a good capacity to discriminate people with skin discomfort from people with 'normal skin', a good reproducibility (intraclass coefficient correlation ICC = 0.85) and a good sensitivity to detect change because of treatment (Difference vs. Baseline of 2.63 on a 0-9 scale). CONCLUSION: The developed index, BSDI, is a reliable way to address the measurement issue of the multidimensional skin discomfort syndrome. It thus should simplify the evaluation of cosmetic products effect and helps to compare products dedicated to body cleansing.

Effects of cattle treatment with a fluazuron pour-on on survival and reproduction of the dung beetle species Onthophagus gazella (Fabricius).

While resistance against many other classes of acaricides has been described, products containing benzoylphenyl urea are currently still successfully used against the pesticide-resistant blue tick (Boophilus decoloratus) in South Africa. In order to assess any adverse impact of these tickicides on the important dung beetle (Coleoptera: Scarabaeidae) fauna, a bioassay was undertaken on the ecotoxicological effects of a fluazuron (benzoylphenyl urea) pour-on formulation (Acatak) on the survival and reproduction of the African dung beetles species Onthophagus gazella (Fabricius). The experiment yielded no significant differences in adult or larval survival, egg production, fecundity and fertility between the control and treatment group following three beetle generations over. These results suggested that treatment of cattle with the fluazuron pour-on formulation Acatak was not detrimental to the selected dung beetle species in any notable way.

Effects of cattle treatment with a cypermethrin/cymiazol spray on survival and reproduction of the dung beetle species Euoniticellus intermedius (Coleoptera: Scarabaeidae).

In a bioassay to determine non-target ecotoxicological effects of a pyrethroid spray (Ektoban) on dung beetles, dung from both cypermethrin/cymiazol-treated and control cattle was collected one, two, three, five, seven, 14, 21 and 28 days after treatment and fed to a treatment and control group (respectively) of beetles of the species Euoniticellus intermedius (Reiche). This was done to assess whether a spray formulation of cypermethrin may affect dung beetles differently than previously tested pour-on formulations. Following three beetle generations for two weeks each, the experiment retrieved no significant differences in adult or larval survival, egg production, fecundity and fertility between the control and treatment group. These results demonstrated that the used spray formulation of cypermethrin is likely to be far less detrimental to dung beetles than previously tested pour-ons.