Short-term cyclosporin monotherapy for chronic severe plaque-type psoriasis.

Cyclosporin is an effective treatment for psoriasis but its efficacy is only palliative. The aim of this study was to evaluate the percentage of patients in whom a short term therapy may be used without relapse after discontinuation of cyclosporin. In this multicenter, open, non-controlled study fifty-eight patients were included who had severe and extensive chronic plaque-type psoriasis. Treatment duration was 28 weeks. The absence of relapse was defined as the requirement to resume systemic treatment at 16 weeks after discontinuation of Sandimmun . The overall efficacy of Sandimmun at W20 was 72%. No relapse or premature withdrawal occurred in 18 cases out of 39 (47%). In these cases local treatment was sufficient following discontinuation. Thus we show the potential value of a single 5 month course of cyclosporin treatment. In this study tapering of cyclosporin was not useful. In 50% of cases short-term cyclosporin treatment was not followed by resumption of systemic treatment and constitutes an improvement in qualify of life.

[The Leser-Trélat symptom: report of two cases (author's transl)]. / Le signe de Leser-Trélat. A propos de 2 observations.

The sudden occurrence and rapid increase in size and number of seborrheic keratoses is considered to be a symptom of internal malignancy. But many authors did not fully agree with this finding. We report two cases respectively associated, the first with a mycosis fongoides, the second with a bronchial squamous cell carcinoma. These observations are compared with thin cases previously published in the dermatological literature (13 patients). According to Dantzig the commonest associated malignancy is an adenocarcinoma, and the most frequent site the stomach. But there are also report of acute leukemia, mycosis fongoides, Sézary and lymphocytic lymphoma. The mechanism of the simultaneous growth of the lesions remains unknown and may be purely coincidental. Other case reports and several criteria still to be defined are needed before we accept this symptom as a malignancy marker.

[Paresthetic notalgia and multiple endocrine neoplasia type 2a (Sipple's syndrome): 3 cases]. / Notalgie paresthésique et néoplasie endocrinienne multiple de type IIA (syndrome de Sipple): 3 cas.

INTRODUCTION: Notalgia paresthetica is an isolated sensory mononeuropathy. Patients have a pruritus in the mid-upper back. Its association with multiple endocrine neoplasia type IIA has been reported in a few cases. We report three cases of this association. CASE REPORTS: Case n(o) 1: A 45 year-old woman had multiple endocrine neoplasia type IIA with a medullary thyroid carcinoma and a primary hyperparathyroidism; she had a mid-upper back pigmented lesion. Histological examination showed dermal melanosis and deposits of amyloid in the dermis. Case n(o) 2: A woman had a multiple endocrine neoplasia type IIA which was diagnosed at the age of 60; she had a surgical treatment for a pheochromocytoma, a medullary thyroid carcinoma, and a primary hyperparathyroidism; she had dermatological examination for a pruriginous lesion of the mid-upper back. Case n(o) 3: The daughter of the patient n(o) 2 had had a surgical cure for a medullary thyroid carcinoma and a pheochromocytoma at the age of 31; she had a papulous and pruriginous lesion in the left scapular area. Her daughter and her sister had a multiple endocrine neoplasia type IIA without notalgia paresthetica. DISCUSSION: Notalgia paresthetica is a benign cutaneous disorder which can be associated with multiple endocrine neoplasia type IIA. It can be considered that notalgia paresthetica is an early clinical marker of multiple endocrine neoplasia type IIA. Patients with a familial history of notalgia paresthetica or with an onset of notalgia paresthetica in childhood should be screened for multiple endocrine neoplasia type IIA. Patients with multiple endocrine neoplasia must also been screened for notalgia paresthetica because its finding is an argument for a familial form of multiple endocrine neoplasia type IIA. Dermatologists should be aware of this association.

[Extra-hepatic manifestations of viral hepatitis]. / Manifestations extra-hépatiques des hépatites virales.

A variety of prodromal symptoms of viral hepatitis (urticaria, fever, arthralgias, headache, polyradiculonevritis) are attributed to A, B, C, D or E hepatitis only when jaundice appears, and because they disappear with it. Spectacular extrahepatic symptoms (polyarteritis nodosa, cryoglobulinemia, glomerulonephritis, marrow aplasia...) may be associated with B or C hepatitis without any liver symptom. Some of the extrahepatic symptoms observed during chronic hepatitis C therapy with interferon (thyroid dysfunctions, cutaneo-mucous lichen) may be related to the immunomodulatory effects of interferon rather than to virus C itself.

[Herpes gestationis: immunologic findings]. / Herpes gestationis: apports de l'immunologie.

The treatment of herpes gestationis has been considerably changed in recent years by progress in electron microscopy and immunology. Herpes gestationis, a rare polymorphic vesiculo-bullous pruriginous dermatosis, occurs during pregnancy or the post-partum period. It evolves by acute periods of several weeks, and relapses during later pregnancies or on taking oestro-progestagens. Histologically, the bulla is situated at the dermo-epidermic junction. The epidermal oedema is both intra and extra-cellular. The ultrastructural studies show the importance of the oedema and the changes in the plasma membrane of the basal cells in the onset of the vesicles and the bullae. The immunological inquiry gives diagnostic certainly when one discovers under indirect immuno-fluorescence, a specific serum factor, the herpes gestationis factor. These ultrastructural and immunological data suggest a relationship between herpes gestationis and bullous pemphigus (Lever's disease). In treatment, the possible pathogenic role of prolactin suggests the use of bromocriptin during the postpartum period. The efficacy and innocuity of vitamin B6 make corticosteroids rarely necessary.