Dermatology today and tomorrow: from symptom control to targeted therapy.

For many decades and until recently, medical approach to dermatologic diseases has been based on the physician's ability to recognize and treat symptoms. Nowadays, advances in the understanding of the biology of diseases and in technologies for intervening against them have allowed physicians to diagnose and treat underlying disease processes rather than simply addressing the symptoms. This means that rather than addressing 'the disease in humans', physicians can now address the particular pathologic (biologic, molecular) disturbance as it presents in the individual patient, i.e., physicians now can practice something much closer to 'personalized medicine', leading to greater benefits for the patients and the health of society in general. The deeper understanding of ultraviolet radiation, the importance of photoprotection and increased knowledge about signalling pathways of melanoma and carcinoma have led to more complete care for the dermatologic patient. The current popularity for excessive exposure to the sun, without adequate application of the appropriate photoprotection remedies, is the origin of melanoma, but also for the weakening of the structure and functions of the skin. Indeed, fragility of the skin can affect humans around the world. In the senior population, this skin fragility is accompanied by pruritus, whereas atopic dermatitis is an inflammatory disease with highest prevalence in children and adolescents. Acne, the number one reason for dermatologic consultations worldwide, increases its prevalence in adolescents and in females. Senescent alopecia affects humans after menopause and andropause. The articles in this publication present an overview of the current advanced understanding of the diagnosis and therapeutic approaches in 6 fields of dermatology - dermatopaediatry and gerontodermatology, oncodermatology, hair loss, atopic dermatitis, photoprotection and acne - and thereby serve as a useful compendium of updated information and references for all healthcare professionals who see patients with presentations of the symptoms of these diseases.

Acne prevalence and associations with lifestyle: a cross-sectional online survey of adolescents/young adults in 7 European countries.

BACKGROUND: Although acne vulgaris is a common skin disorder, limited epidemiological data exist specifically for European populations. OBJECTIVE: To determine the prevalence of self-reported acne among young people in Europe and evaluate the effect of lifestyle on acne. METHODS: We conducted a cross-sectional population-based online survey in representative samples of individuals aged 15-24 years in Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n = 10 521), identified by a quota sampling method based on age, geographic location and socio-professional category. RESULTS: The overall adjusted prevalence of self-reported acne was 57.8% (95% confidence interval 56.9% to 58.7%). The rates per country ranged from 42.2% in Poland to 73.5% in the Czech and Slovak Republics. The prevalence of acne was highest at age 15-17 years and decreased with age. On multivariate analysis, a history of maternal or paternal acne was associated with an increased probability of having acne (odds ratio 3.077, 95% CI 2.743 to 3.451, and 2.700, 95% CI 2.391 to 3.049, respectively; both P < 0.0001), as was the consumption of chocolate (OR 1.276, 95% CI 1.094 to 1.488, for quartile 4 vs. quartile 1). Increasing age (OR 0.728, 95% CI 0.639 to 0.830 for age 21-24 years vs. 15-17 years) and smoking tobacco (OR 0.705, 95% CI 0.616 to 0.807) were associated with a reduced probability of acne. CONCLUSION: The overall prevalence of self-reported acne was high in adolescents/young adults in the European countries investigated. Heredity was the main risk factor for developing acne.

Acne across Europe: an online survey on perceptions and management of acne.

BACKGROUND: Acne is common among young people. OBJECTIVE: To describe the burden, management and sources of advice of acne in a representative sample of young people in Europe. METHODS: This cross-sectional survey was conducted in a representative sample of individuals aged 15-24 years from Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n = 3099). RESULTS: Most individuals considered their acne (all severity stages) to be no/minor problem, although 29.7% considered it a major problem/burden. Over-the-counter (OTC) topical treatments were used more frequently than prescribed treatments. Acne was diagnosed by physicians in 47.6% of cases; other health professionals (nurses, pharmacists) or patients accounted for the remainder of diagnoses. Physicians were the source of acne information in just over one-quarter of cases (27.0%). The vast majority of advice was from friends/family and the Internet. CONCLUSION: Almost one-third of young people consider acne to be a major problem/burden. Fewer than half of acne diagnoses are made by a physician, and acne is often self-managed using OTC treatments.

Gerontodermatology: the fragility of the epidermis in older adults.

The proportion of adults over 60 years of age is rapidly increasing and is estimated to reach approximately one-sixth of the global population by 2030. An ageing population is a real challenge for healthcare resources, including dermatologists and geriatricians, as age-related changes in skin integrity and barrier function make older adults more susceptible to developing skin pathologies such as pruritus, dermatitis and infections. Fragile skin arises from several interlinked causes, including age-related changes in skin barrier integrity, previous and current lifestyle choices, skin pathologies and medical interventions. Dermo-cosmetics can play a key role in enhancing skin care regimens and preventing pathologies in this age group. In vitro studies, clinical, and in-daily clinical practice studies of dermo-cosmetics have shown them to be effective in many skin conditions in older adults, like xerosis and pruritus. Incontinence-associated dermatitis (IAD), a common condition arising from contact with irritants such as urine and faeces which can significantly impact the quality of life of sufferers, can also be improved with a barrier cream in incontinent patients aged 70 years and older. This supplement focuses on the increased fragility of older skin, the development of common skin pathologies and the efficacy and tolerance of dermo-cosmetic products in older adults.

[Adverse effects of hair care in users]. / Effets indésirables des soins capillaires chez les utilisateurs.

The panoply of products used by hair care professionals to wash, dye, shape and beautify hair is not entirely free from adverse events. Such effects consist mainly of irritation dermatitis and allergic contact eczema affecting the scalp, as well as the back and front of the neck, the forehead and periorbital areas, and the cheeks. The most frequently cited allergens include paraphenylenediamine (PPD) in hair dyes, glycerol monothioglycolate (GMTG) in acid perm lotions, and ammonium persulphate in hair lighteners (the latter substance being responsible primarily for contact urticaria). However, care should also be paid to other allergens such as cocamidopropyl betaine among surfactants, as well as certain components in hair formulations such as preservatives and fragrances (as well as minoxidil, frequently used by patients).

Fragility of epidermis in newborns, children and adolescents.

Within their first days of life, newborns' skin undergoes various adaptation processes needed to accommodate the transition from the wet uterine environment to the dry atmosphere. The skin of newborns and infants is considered as a physiological fragile skin, a skin with lower resistance to aggressions. Fragile skin is divided into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. Extensive research of the past 10 years have proven evidence that at birth albeit showing a nearly perfect appearance, newborn skin is structurally and functionally immature compared to adult skin undergoing a physiological maturation process after birth at least throughout the first year of life. This article is an overview of all known data about fragility of epidermis in 'fragile populations': newborns, children and adolescents. It includes the recent pathological, pathophysiological and clinical data about fragility of epidermis in various dermatological diseases, such as atopic dermatitis, acne, rosacea, contact dermatitis, irritative dermatitis and focus on UV protection.

Fragility of epidermis and its consequence in dermatology.

The skin is the largest organ of the body, providing a protective barrier against bacteria, chemicals and physical insults while maintaining homeostasis in the internal environment. Such a barrier function the skin ensures protection against excessive water loss. The skin's immune defence consists of several facets, including immediate, non-specific mechanisms (innate immunity) and delayed, stimulus-specific responses (adaptive immunity), which contribute to fending off a wide range of potentially invasive microorganisms. This article is an overview of all known data about 'fragile skin'. Fragile skin is defined as skin with lower resistance to aggressions. Fragile skin can be classified into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. This article includes the epidemiologic data, pathologic description of fragile skin with pathophysiological bases (mechanical and immunological role of skin barrier) and clinical description of fragile skin in atopic dermatitis, in acne, in rosacea, in psoriasis, in contact dermatitis and other dermatologic pathologies. This article includes also clinical cases and differential diagnosis of fragile skin (reactive skin) in face in adult population. In conclusion, fragile skin is very frequent worldwide and its prevalence varies between 25% and 52% in Caucasian, African and Asian population.

Allergic hypersensitivity to topical and systemic corticosteroids: a review.

Corticosteroids, which are potent anti-inflammatory and immunomodulator agents used in the treatment of various inflammatory diseases including allergic diseases, can in some cases produce immediate or delayed hypersensitivity reactions. This review summarizes the epidemiological and clinical characteristics of such reactions, including related diagnostic issues. It also presents a detailed analysis of the proposed immunological mechanisms including underlying cross-reactions.

[Patch tests: indications or when testing should be performed]. / Tests épicutanés : indications ou quand les réaliser ?

Patch testing may be desirable or even essential for cases of suspected allergic contact dermatitis. Such testing allows identification with absolute certainty of the causative agent in "supposed" allergic contact dermatitis.

Pancreas transplantation for treatment of generalized allergy to human insulin in type 1 diabetes.

We report the case of a 29-year-old man with a 14-year history of type 1 diabetes, normal renal function, and mild diabetic retinopathy. The patient progressively developed a generalized allergic reaction to two insulin excipients--protamine and metacresol--with systemic manifestations of tremor, tachycardia, vertigo, shortness of breath, and short episodes of unconsciousness causing him to be out of work. In June 2003, he received a vascularized cadaveric pancreas transplant using induction with polyclonal antibodies along with tacrolimus and sirolimus but without steroids. A hyperglycemic episode following corticosteroid therapy for rejection treatment required reintroduction of insulin therapy with prompt reappearance of allergic manifestations. Now, the patient is euglycemic without insulin or allergic manifestations and a glycated hemoglobin of 6.4%.

Acute interstitial nephritis and fatal Stevens-Johnson syndrome after propylthiouracil therapy.

We report a case of acute interstitial nephritis and fatal Stevens-Johnson syndrome in a 90-year-old woman with amiodarone-induced hyperthyroidism, who had been treated for 5 weeks with propylthiouracil (PTU). On admission, the patient exhibited acute renal failure and generalized macular purpuric eruption. Acute interstitial nephritis and Stevens-Johnson syndrome were diagnosed and PTU withdrawn. Although renal function recovered after PTU withdrawal and corticosteroid therapy, the patient's condition worsened, and she died after developing multiple organ failure. Acute interstitial nephritis seems to be rarely associated with PTU therapy. Moreover, a literature review suggested that this could represent the first published report of a Stevens-Johnson syndrome developing during PTU therapy.

Halomethasone (C 48.401-Ba) for the topical treatment of common dermatoses.

C 48.401-Ba cream, containing 0.05% halomethasone was compared in a double-blind between-patients trial with a cream containing 0.1% betamethasone valerate in forty-eight patients suffering from atopic dermatitis and in thirty-nine patients suffering from seborrhoeic dermatitis. A similar comparison was made with ointments containing the same concentration of active ingredient in forty-six patients suffering from atopic dermatitis. Both ointments were also compared in a within-patient double-blind trial in thirty patients suffering from psoriasis. The analysis of the results showed that for the treatment of the above-mentioned dermatoses, both drugs, the cream as well as the ointment, are equally effective and well tolerated.

[Acquired ichthyosis disclosing Hodgkin's disease. Simultaneous recurrence]. / Ichtyose acquise révélant une maladie de Hodgkin. Récidive simultanée.

INTRODUCTION: Hodgkin's lymphoma is rarely evidenced by dermatological signs or symptoms. OBSERVATION: A 37 year-old man progressively developed widespread cutaneous roughness, with small parallel lines producing fish-like scales. A skin biopsy confirmed the diagnosis of acquired ichthyosis, as evidenced by the absence of the epidermal granular layer. The patient's condition was assessed to be satisfactory. However, two months later, his general condition had gradually deteriorated (night sweats, weight loss, axillary and scalp alopecia, and adenopathies). Hodgkin's lymphoma was diagnosed. After treatment with adriamycin, bleomycin, vincristine and dacarbazine, complete remission of the lymphoma was obtained, and concomitantly, the symptoms of acquired ichthyosis resolved; this was confirmed by serial skin biopsies that evidenced the progressive complete restoration of the granular layer. The level of plasmatic vitamin A and carotene, which had decreased before the treatment, returned to normal values. A subsequent relapse of Hodgkin's lymphoma was preceded by the recurrence of ichthyosis; this time vitamin A and carotene levels were not decreased. DISCUSSION: As a paraneoplastic syndrome, acquired ichthyosis as a first sign of Hodgkin's lymphoma is discussed. In the presence of acquired ichthyosis, repeated monitoring of the patient is required since clinical symptoms of Hodgkin lymphoma are often delayed. Acquired ichthyosis is also an early marker of lymphoma recurrence.

[Chronic contact urticarias]. / Les urticaires chroniques de contact.

In most cases, contact urticaria is acute and is diagnosed straightforward; indeed it appears immediately after the application of the urticariogen(s) and disappears promptly after removal of the contact. On some rare occasions, contact urticaria is chronic for two main reasons: sometimes, it is provoked by an unknown urticariogen; in other cases, it is one of the clinical signs of protein contact dermatitis. In both situations, diagnostic procedures to be applied are of prime importance; treatment is submitted to the elimination of the responsible urticariogen. Acute and chronic varieties of contact urticaria can be subdivided into two categories: immunological and non-immunological. Diagnostic procedures include prick testing and/or patch testing (with immediate reading).

[Spectacle-frame acanthoma. Review of the literature and histopathological diagnosis versus chondrodermatitis nodularis helicis (author's transl)]. / Acanthome fissuré. Revue de la littérature et diagnostic histopathologique différentiel avec le nodule douloureux de l'oreille.

Five cases of spectacle-frame acanthoma are reported; four were retro-auricular (three unilateral; one bilateral) and one was present on the left side of the nose. Clinical aspects of the lesions are described by the light of all the other cases that have been previously reported in the literature. Histopathological features are compared to those encountered in chondrodermatitis nodularis helicis for which a frictional origin may also be suspected. In the vast majority of cases, spontaneous resolution is obtained when responsible spectacle frames are removed whereas a few lesions persist indefinitely despite of the fact that corrective measures are applied, on the contrary to what has been reported in previous papers. Apart from removing spectacles, these few cases needed surgical excision for a complete cure. Anatomo-clinical confrontations seem to indicate that those persistent lesions are completely fissured acanthomas.

[Keratoacanthomas and xeroderma pigmentosum (author's transl)]. / Kératoacanthomes et xeroderma pigmentosum

A girl with xeroderma pigmentosum has developed seven successive keratoacanthomas on the face, since the age of 5, during a period of two and a half years. The clinical diagnosis of keratoacanthoma was obvious for most lesions. Three keratoacanthomas have been removed and the diagnosis has been confirmed histologically. The four more recent lesions have regressed without any surgical treatment. No impairment of the cell-mediated immune function has been noticed (there is no failure in D.N.C.B. sensitization; the level of the blastogenic transformation after phytohaemagglutinin stimulation lies within limits of normal values obtained from control subjects). Keratoacanthoma is an uncommon complication of xeroderma pigmentosum, since only 15 other cases (2 of them are successive keratoacanthomas) have been reported in the literature. In a recent publication, it has been stressed that a deficit of cell mediated immunity can be associated with xeroderma pigmentosum. Such a deficit has also been observed in a patient with multiple keratoacanthomas. In contrast with those reports, no failure of cell mediated immunity has been observed in our patient, as far as provocative tests are concerned.

[Permanent tattoos following injections with Dermo-Jet: anatomoclinical study. Apropos of 5 cases]. / Tatouages permanents consécutifs à des injections par Dermo-Jet: étude anatomo-clinique. A propos de cinq observations.

Blue or black tattoos were observed in five patients who had received several intradermal injections (of a lidocaine solution or of a triamcinolone acetonide suspension) with the Dermo-Jet. A histological examination revealed the presence of black masses, rounded or elongated, different in size, distributed throughout dermal tissue. Additionally, conglomerates of black grains in the cytoplasm of histiocytes and of pericytes are precisely observed in semi-thin sections. It has been proved by several investigations that these foreign particles are not of metallic nature. It can be concluded from electron microscopic studies that the particles are fragments of black rubber, from the upper joint of the reservoir. Indeed, some rubber fragments are leached into the reservoir. Some of these are passing through the wire-mesh filter of the nozzle (with the solution or the suspension) when injections are made. Therefore, they are injected intradermally and are permanently tattooing the skin.

[Radiodermatitis after transjugular intrahepatic portosystemic shunt: 4 cases]. / Radiodermites après shunt intrahépatique portosystémique transjugulaire: 4 cas.

BACKGROUND: Radiodermatitis following invasive radiographic procedures has been reported recently in the literature, mainly after cardiac catheterization. Only two publications are related to transjugular intrahepatic portosystemic shunt (TIPS), a recently introduced angiographic technique for achieving portal decompression. CASE REPORTS: We report four cases of radiodermatitis following a transjugular intrahepatic portosystemic shunt. A 63-year-old woman developed in 1997 a chronic radiodermatitis under the right scapula; a shunt was placed in 1992; from 1992 to 1997, she had a second transjugular intrahepatic portosystemic shunt and thereafter four dilatations. A 50-year-old man developed in 1994 a radio-induced ulceration in the same area, one week after a transjugular intrahepatic portosystemic shunt; the same year the shunt was expanded. The patient had a second transjugular intrahepatic portosystemic shunt in 1995; at that time, the cutaneous lesions evolved into chronic radiodermatitis. In 1995 a 67-year-old man developed chronic radiodermatitis under the right scapula; a transjugular intrahepatic portosystemic shunt was placed in 1992; endoprosthesis was dilated four times from 1992 to 1995. A 82-year-old women developed in 1993 an ulcerated radiodermatitis, five days after a transjugular intrahepatic portosystemic shunt. DISCUSSION: The major advantage of the transjugular intrahepatic portosystemic shunt is the ability to provide portosystemic decompression without major surgery. However, radiation exposure during the procedure is sometimes very high. Otherwise the prosthesis is readily blocked up; this side-effect requires repeated angiographic dilatations. The procedures were very long by all our patients. This explains the high absorbed radiation doses. Transjugular intrahepatic portosystemic shunt and cardiac catheterization are not the only procedures at risk. A lot of invasive radiographic techniques can result in high radiation exposure and hence radiodermatitis.