Prediction of benzoyl peroxide phototoxicity by photoepidermotests after repeated applications. Preventive value of a UVB filter.

The predictive phototoxicity test known as photoepidermotest consists of twice daily applications of the product tested for 16 days, followed by total spectrum irradiation with a 2,500-W Xenon lamp in infraerythema and supraerythema doses. Phototoxicity is revealed by an erythema with the infraerythema dose and/or by accentuation of the erythema provoked by the supraerythema dose when compared with the "irradiation only" (i.e., no product) control skin area. This technique, used in a controlled, double-blind trial, showed that a 10% benzoyl peroxide (BPO) gel was phototoxic in eight out of 18 subjects tested (44%). It also showed that adding a UVB filter (phenylbenzimidazole sulfonic acid 1%) to the BPO preparation was effective in preventing phototoxic reactions in seven of these eight subjects.

[Macrodystrophia lipomatosa. Angiographic aspects (author's transl)]. / Macrodystrophie lipomateuse. Aspect artériographique.

A new case of this unusual entity is reported. The patient, male aged 43 has an hypertrophy of the first and second left fingers. Radiographic examination shows bony overgrowth and marked soft tissue thickening. Arteriography did not show any evidence of angioma or arteriovenous fistula. Histologic examination shows deposits of fat in soft tissue thickening. Macrodystrophia lipomatosa is a rare disease, usually confined to one or two digits of the hand, and sometimes of the foot. A dysembryoplasic aetiology could be sustained, and this entity is very close from others bone or soft-tissue hamartomas.

[Dosimetry of solar ultraviolet radiation. Daily and monthly changes in Paris]. / Dosimétrie du rayonnement ultra-violet solaire. Variations journalières et mensuelles à Paris.

The intensity of ultraviolet A and B radiations was measured in Paris (48 degrees North) by means of silicon photoelectric cells (Osram Centra dosimeter) from December, 1984 till February, 1986. The results, which must be regarded as approximate, are expressed as physical units (mW/cm2) and biological units (minimal erythema dose/hour). For sunny days two curves are presented separately for UVB and UVA: daily variations in radiation (hourly measurements) and daily variations at 11 hours (solar time) during one year. Maximum irradiation was observed at noon in early July: UVB 0.15 mW/cm2, UVA 5.4 mW/cm2. Between December and July the amount of UVB radiation was multiplied by 14 and that of UVA radiation by 9. For subjects with clear photo-type and when the sun was at its zenith, an MED per hour was obtained from May 1 onwards. Within a day, 30 p. 100 (summer) and 50 p. 100 (winter) of erythema-producing UV intensity were delivered between 11 and 13 hours (solar time). This kind of study has numerous clinical applications: advice regarding exposure to sun rays, dosing of heliotherapy, epidemiological data concerning photodermatitis (circumstances of exposure, UV threshold dose) and photocarcinogenesis (determination of annual MED doses in relation to areas of uncovered skin and occupational exposure to sun rays). Other studies on the French territory will provide a map of UV irradiation.

[Atopy and associated diseases]. / Atopie et syndromes associés.

In this study of the literature, the authors review the possible association between atopy and other conditions. The mostly reported observations are related to atopic dermatitis, but there is also some real relationship with respiratory allergy: this is true for mucoviscidosis. Some association are significant and interesting from the pathogenetic point of view: they may be classified under three headings (digestive and renal diseases, immunologic disturbances). Therefore, this study refers to intestinal absorption disturbance, gluten sensitive enteropathy, dermatitis herpetiformis, colic diseases, and also to glomerulopathies, immediate and delayed hypersensitivity deficiency and polymorphonuclear functional deficiency. Other associations do exist, but the low number of cases and the absence of a common pathogenesis allow no conclusion to be drawn (ectodermal anidrotic ectodermal dysplasia, Dubowitz syndrome). Some of them are certainly only fortuitous: this should be more definitely established by later studies. Some diseases may be accompanied by an eczematiform dermatitis (phenylketonuria, anomalies of histidin metabolism). Frequency of associations with alopecia areata and dominant ichthyosis vulgaris is also discussed. This review gives the possibility of emphasizing the absence of statistically significant hematopathic evolution of atopic dermatitis and calls attention on the Wiskott-Aldrich-syndrome as a model for the studies on atopy.

[Juvenile spring eruption (author's transl)]. / La photodermatose printanière juvénile.

Juvenile spring eruption is seen in early spring and needs a combination of different factors such as light exposure and chilling. It affects mainly boys aged 5-15 or young male adults. It involves the ears in most of the cases and may itch. The helix develops reddish papules, many of which becoming vesicular and later on crusty. Sometimes papular lesions appear on the back of the hands. The lesions heal within 2 weeks without scarring. Recurrences during following springs can be seen. Juvenile spring eruption cannot be reproduced. Histopathology study performed on 2 cases reveals a picture close to erythema mulutiforme and confirms Burckhardt's findings.

[Oral submucous fibrosis. Review of the literature apropos of a case]. / Fibrose orale sous-muqueuse. Revue de la littérature à propos d'un cas.

The authors report a case of oral submucous fibrosis and present a review of the literature available on this subject. Oral submucous fibrosis is rare outside South-East Asia where it affects from 0.2 to 1 p. 100 of the population. A few cases have been described among Europeans. The disease seems to be specific to the oral and upper respiratory mucosae. It is characterized by the progressive development of subepithelial fibrosis and the subsequent occurrence of leukoplakia which may undergo transformation into epidermoid carcinoma. It initially presents as a non-specific stomatitis, sometimes with vesicles and ulcerations. Very gradually thereafter the buccal mucosa becomes pale in parts, as well as thicker and fibrous, while leukoplakia develops. These lesions progress slowly and may eventually result in complete and irreducible trismus. Histologically, oral submucous fibrosis is characterized by chronic subepithelial inflammatory reaction followed by hyalinization. Subsequently, the fibrosis extends to the underlying muscles. The epithelium is diversely affected: atrophy is thought to be the first lesion to appear; secondarily, and under the influence of various irritant factors, epithelial hyperplasia, ortho- or parakeratosis of the stratum corneum, or even cellular abnormalities may develop.(ABSTRACT TRUNCATED AT 250 WORDS)

[Photoallergy to quinine]. / Photo-allergie à la quinine.

A case of occupational photodermatitis induced by quinin sulphate is reported. Photobiologic investigation disclosed the responsible photoallergin, demonstrated the mechanism to be of the photoallergic type, and proved the active rays to be mostly UVA. It seems that we do not deal with a contact photodermatitis, but with an internal photosensitization induced by absorption or inhalation of quinin powder and possibly excreting during sweating.

[Nucleolar, homogeneous and peripheral fluorescence of epidermal nuclei in direct immunofluorescence: 4 cases (author's transl)]. / Fluorescence nucléolaire, homogène et périphérique des noyaux épidermiques en immunofluorescence directe: 4 observations.

Epidermal nucleolar IgG deposition on direct immunofluorescence of covered normal skin was found in two patients with scleroderma and high serum concentrations of antibody to nucleolar antigen. Epidermal homogeneous and peripheral IgG deposition was also observed in two patients with systemic lupus erythematosus, antinuclear antibody of homogeneous staining pattern, but without antibody to extractable nuclear antigen. Epidermal nuclear IgG deposition in a speckled, nucleolar, homogeneous or peripheral pattern appears to correlate with high titer serum antinuclear antibody giving on immunofluorescence the same staining pattern. These immunopathologic findings cannot be considered as being specific of a subset of connective tissue disease.

[Follicular tumidus retro-auricular lichen planus (author's transl)]. / Lichen plan folliculaire tumidus rétro-auriculaire

Referring to three comparable cases, a new form of lichen planus is described. This form is characterized by a prominent lesion, violaceus in color or pigmented, with white yellowish specks mimicking milia. The histologic picture of lichen follicularis, the presence of typical papules of lichen distant from the retro-auricular lesion make it possible to consider this clinical aspect as a variety of lichen planus.

[Idiopathic eruptive macular pigmentation (author's transl)]. / La pigmentation maculeuse éruptive idiopathique.

The feeling of the authors is that their seven reported cases of a pigmented dermatosis are different from the ashy dermatosis and from the erythema dyschromicum perstans. This disease, which affects children and teenagers, males as well as females, is characterized by pigmented macules 5-25 mm in diameter, affecting the neck, the trunk and the limbs. The first symptom is whether a pigmented spot, or an erythematous, papular or achromic lesion; in the latter instance the pigmentation occurs only secundarily. In most of the cases this dermatose is slowly and spontaneously regressive. The histological picture is not really specific. In one case there was a marked intraepidermal dyskeratosis of the sweat duct openings. The etiology remains unknown.

[Multiple tumors of the follicular infundibulum with basocellular degeneration. Apropos of a case]. / Tumeurs multiples de l'infundibulum pilaire avec dégénérescence baso-cellulaire. A propos d'un cas.

A progressive papular eruption on the face, limbs and vulva had been present for seven years in a 38-year old female patient. Some papules were small and confluent while others were sparse, as in nodular prurigo. Histology showed massive proliferation of the follicular sheath epithelium, connected to the lower surface of the epidermis. The lesion formed a plate-like area very similar to that observed in superficial basal cell carcinoma and corresponding to a tumour of the follicular infundibulum. Remarkable features of this case were the large number of lesions, their photosensitivity (they became pruriginous and increased in size after exposure to the sun), the presence of eccrine sweat glands beneath a skin lesion of the thigh, the basal cell degeneration of two lesions and the slight improvement observed after etretinate therapy. To our knowledge, such findings have not yet been reported in tumours of the follicular infundibulum.

[Factitious crusting cheilitis]. / Chéilites squamo-crouteuses factices.

The authors report 4 cases of factitious crusting cheilitis seen in young women. The lesions are crusty, yellowish or even black, forming as a mould casting the lip. The crusts are sometimes very thick just as an oyster-shell. When removed the underlying mucosa appears either normal or erosive and the crusts reappear rapidly. Emotional factors and personality disturbances are often present. Most probably the crusts are the result of a traumatic mechanism induced by chewing or sucking the lip. In the 4 reported patients the clinical aspect and the psychological status of the patients are similar, the 4 of them being not at all bothered by their cheilitis. The factitious keratotic cheilitis has to be differentiated from other cheilitis induced by Candida albicans (although Candida albicans may superinfect any cheilitis) or by an actinic phenomenon, from glandular cheilitis (of the Puente-Acevedo or of the Volkmann type) and from dermatitis localized on the lips. In some instances an exfoliative cheilitis may also to be of factitious origin. The factitious origin of such a cheilitis is always difficult to demonstrate but its possibility should be kept in mind.

[Benign adnexal tumors of late occurrence in verrucoid-sebaceous nevus (Jadassohn). Apropos of 7 cases]. / Tumeurs annexielles bénignes de survenue tardive sur naevus verruco-sébacé (Jadassohn). A propos de 7 cas.

Occurrence of basal cell epithelioma and syringocystadenoma papilliferum on sebaceous nevi is well known. But many other adnexal tumors, such as pilar or sweat gland tumours may also be associated with this dysembryoplasia. Out of 99 cases of verruco-sebaceous nevi we find 12 associated basal cell epitheliomas, 7 syringocystadenomas papilliferum and 6 benign adnexal tumors. Our report is about these 7 cases. All of these tumors appeared in adult-hood and were clinically suggesting the diagnostic of basal cell epithelioma. But, after histopathological examination was performed, they revealed to be 2 nodular hidradenomas, 1 chondroid syringoma, 1 trichilemmoma, 1 apocrine cystadenoma, 1 follicular poroma. Similar data are given by Mehregan and Pinkus in 1965 and Wilson Jones and Heyl in 1970, respectively out of 150 and 140 cases of verruco-sebaceous nevi.

[Wells' syndrome or eosinophilic cellulitis. Apropos of 2 cases. Review of the literature]. / Le syndrome de Wells ou cellulite à éosinophiles. A propos de 2 cas. Revue de la littérature.

In 1971, four cases of a new dermatosis were described by Wells, under the name of recurrent granulomatous dermatitis with eosinophilia. In 1978, eight additional cases were reported by Wells and Smith and three authors suggested a shorter title: eosinophilic cellulitis for this syndrome. Since then, four additional cases were published in the literature. We report here two additional cases. From these eighteen upto now published cases, there is no doubt that this dermatosis, as initially described by Wells, is a distinct entity. Clinical course is characterized by sudden eruption of large infiltrated, itchy and/or painful plaques. Blisters are often associated. During the two or three weeks following the initial rash, the inflammatory aspect disappears. Lesions become indurated, and may resemble morphea. Spontaneous resolution occurs after about six weeks. Recurrences are constantly observed. Histologic features are a striking eosinophilic infiltrate associated with eosinophilic deposits constituting flame figures. Blood eosinophilia is present in most cases. Etiology of this entity remains unknown.

[Non-drug toxicoderma by a respiratory or probable percutaneous route (fluorocarbons, butane, phenyl-azo-beta-naphthol)]. / Toxidermies non médicamenteuses par voie respiratoire ou percutanée probable (fluorocarbures, butane, phényl-azo-bêta-naphtol).

Four cases of cutaneous rash, clinically more or less similar to erythema multiforme have been observed in patient who either stayed in a room with an accidentally high content of fluorocarbons, or had a skin contact with butane or phenyl-azo-beta-naphthol. The cutaneous lesions appear to be secondary to absorption of the toxic product, and probably induced by inhalation rather than by percutaneous penetration. Arguments for the responsibility of the substances rely on anamnestic data.

[Cutaneous pigmentation induced by minocycline: 2 cases]. / Pigmentation cutanée induite par la minocycline: deux cas.

Two new cases of cutaneous pigmentation induced by minocycline are reported, in addition to the 38 cases collected in the literature. Our first case was a 50-year old man with a history of multiple orthopaedic operations for injuries sustained in road accidents. Arthritis of the elbow, probably of bacterial origin, was treated with cephalexin and gentamicin, followed by minocycline 300 mg/day. After a total dose of 60 g of minocycline had been reached, a bluish-grey pigmentation was observed on the internal aspect of the left tibia and on the scars left by the orthopaedic operations. Subsequently, lenticular lesions of the hands developed, together with a blue area on the palate. Our second case was an 18-year old girl who presented initially with nodulo-cystic acne. Minocycline 200 mg/day was prescribed, then withdrawn on account of dizziness; no pigmentation was observed. The acne was cured after 7 months of treatment with 13-cis-retinoic acid in doses of 30 mg/day (for a patient's weight of 50 kg). A second course of minocycline 100 mg/day was prescribed; after a total dose of 3 g all the acne scars had become pigmented. A pathological study performed in the first case confirmed the data found in the literature: light microscopy displayed hyperpigmentation of the basal layer of the epidermis with Masson's silver stain, and an intrahistiocytic pigment coloured by Turnbull's stain; electron microscopy showed an increase in melanosomes within the basal keratinocytes, and a pathological accumulation of pigment in the dermis in the form of electron-dense granules usually surrounded by a membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lupus erythematosus and hereditary lack of complement. Review of about one case of C2 deficit (author's transl)]. / Lupus érythémateux et déficit héréditaire en complément. Revue générale à propos d'un cas de déficit en C2.

A 22 year old woman having disseminated discoid L.E. with alopecia, photosensitivity and normal renal function is presented. Speckled FANA type R.N.P. was found; L.E. cells and anti-DNA were not present. Direct IF of involved skin revealed deposits of IgG and C3 forming a band at the dermo-epidermal junction. In normal skin there was speckled epidermal nuclear staining with IgG. The study of the patient's complement revealed a selective defect of the C2 component (0 p.100) with a drop in total complement (6 p. 100). The father probably has a heterozygote deficit of C2 (55 p. 100); the mother, however, is within the normal range (119 p. 100). The HLA investigation of the patient and her immediate family did not demonstrate haplotype A10, B18, DW2 as is frequently seen in cases of L.E. associated with a C2 deficiency. The patient is A1, B18, DW--/A10 (W26), BW15, DW--.

[The difference forms of "parapsoriasis en plaques". A report of 90 cases (author's transl)]. / Les différentes formes du parapsoriasis en plaques. A propos de 90 cas

The term parapsoriasis was used by Brocq (1902) to group a number of conditions previously described under different names. This group has since then been modified, the same conditions being described under separate names and these have led to a great confusion especially between countries. In this study of 90 cases, three types of parapsoriasis en plaques are distinguished. The "parapsoriasis digitiforme" (40 cases) or benign type, or xanthoerythrodermia perstans, or chronic superficial dermatitis is characterized by small, oval or finger-like, yellow or pink patches. The histology is frequently not characteristic, but in a few cases, there is an exocytosis localized "en flammèches" in the epidermis. The condition is usually permanent but none of these cases has progressed to mycosis fongoides. The parapsoriasis "en grandes plaques simples" (25 cases) is characterized by few pink patches (3 to 5), larger than in benign type. In our cases the transformation to poikiloderma atrophicans vasculare is not observed. One of these cases progressed to mycosis fongoides. The "parapsoriasis en grandes plaques poïkilodermiques" (25 cas), or poikiloderma atrophicans vasculare, prereticulotic poikiloderma, atrophic parapsoriasis, parapsoriasis lichenoides, is characterized by large patches, in limited number, showing a reticulated pigmentation and slight atrophy with telangiectasia. Five cases changed into mycosis fongoides and 4 cases showed some symptoms of malignancy; The histologic features are the same in the two last types: sometimes they are non-specific, in numerous cases the picture is characteristic with micro-abscesses or "flammèches"; in some cases there is a dense infiltrate with a clearly defined lower limit: this histologic appearance can be seen in cases without transformation into mycosis fongoides.

[Normal proximal nail fold structure (author's transl)]. / Le repli sus-unguéal normal.

Normal structure of nail fold capillaries as observed by capillaroscopy and fluoroscopy is recalled. A procedure of proximal nail fold biopsy is described. The technique is simple without disadvantage for patients. Tissue from the proximal nail fold is studied in three different ways: light microscopy with histochemistry, electron microscopy and direct immunofluorescence. In the two normal cases studied, usual epidermal and dermal components are found. Some particular point may be emphasized: sweat's droplets draining of distal part of proximal nail fold, numerous and large nervous structures, capillaries basal lamina multiplication.

[Grover's acantholytic dermatosis (transient acantholytic dermatosis) (author's transl)]. / Dermatose acantholytique de Grover. A propos de deux observations.

The authors report two cases of Grover's transient acantholytic dermatosis. These two cases exhibit some unusual features. Case no. 1 is that of a 39-year-old female with typical lesions on chest, neck, back and upper limbs. The course was cyclic with spontaneous regressions. This condition had been present for 4 years. Case no. 2 was that of a 46-year-old man with a large erythemato-squamous plaque of the left chest wall exhibiting a vesicular lining. In both instances the histologic findings revealed a picture similar to that of Hailey-Hailey's familial benign pemphigus. In spite of these unusual data, long duration and atypical clinical aspects, these two cases are consistant with the diagnosis of Grover's disease as evidenced by description found in the literature.