[Impact of COVID pandemic on the detection of skin cancer]. / Impact de la pandémie de Covid sur la détection des cancers de la peau.

In 2020, we have seen patients with neglected skin cancer in the context of the COVID pandemic. But what is the global health impact of the pandemic on skin cancer patients ? Is it as high as the delayed care of a heart infarct ? To answer this question, we have confronted a theoretic, a probabilistic and a scientific approach. These analyses allow us to conclude that the impact overall was moderate. It allows to draw general guidelines on the diagnosis and treatment of skin cancer for future pandemics.

En 2020, nous avons observé des cas de cancers de la peau négligés en raison de la pandémie de Covid-19. Mais quel est l'impact réel de la pandémie sur la détection des cancers de la peau en termes de santé publique ? Est-il aussi grand que celui d'une prise en charge retardée d'un infarctus du myocarde ? Pour répondre à cette question, nous avons confronté des approches théorique, probabilistique et scientifique. Ces analyses nous permettent de conclure que l'impact global a été heureusement faible. Elles permettent de tirer les grandes lignes directives qui sont à tenir dans le domaine de la prise en charge des cancers cutanés en temps de pandémie.

Localized interstitial granuloma annulare induced by subcutaneous injections for desensitization.

We describe a patient with interstitial granuloma annulare associated with subcutaneous injection therapy (SIT) for desensitization to a type I allergy. Asymptomatic, erythematous, violaceous annular patches were located at the injection sites on both her arms. Medical history revealed perennial rhinoconjonctivitis treated with SIT (Phostal Stallergen® cat 100% and D. pteronyssinus/D.farinae 50%:50%).

Efficacious treatment of non-dermatophyte mould onychomycosis with topical amphotericin B.

BACKGROUND: Dermatophytes are the main cause of onychomycosis, but various non-dermatophyte moulds (NDMs) are often the infectious agents in abnormal nails. In particular, Fusarium spp. and other NDMs are mostly insensitive to standard onychomycosis treatment with topical agents as well as with oral terbinafine and itraconazole. OBJECTIVE: The aim of this work is to report the efficacy of a topical amphotericin B solution on NDM onychomycosis in a series of 8 patients resistant to multiple conventional topical and systemic treatments. METHODS: Treatment consisted in the application of an optimized amphotericin B solution once daily to the affected nails and surrounding tissue. No mechanical debridement or medications were allowed except for trimming excessively long nails or in some cases occasionally applying urea-based cream to soften thickened nail plates. RESULTS: Onychomycosis was clinically cured in all patients after a 12-month treatment. Mycological cure was obtained in all but 1 patient. CONCLUSIONS: Topical amphotericin B is an efficacious, safe, cheap and easy-to-apply treatment which should be considered as first-line therapy for NDM onychomycosis.

TNF blockade induces a dysregulated type I interferon response without autoimmunity in paradoxical psoriasis.

Although anti-tumor necrosis factor (TNF) agents are highly effective in the treatment of psoriasis, 2-5% of treated patients develop psoriasis-like skin lesions called paradoxical psoriasis. The pathogenesis of this side effect and its distinction from classical psoriasis remain unknown. Here we show that skin lesions from patients with paradoxical psoriasis are characterized by a selective overexpression of type I interferons, dermal accumulation of plasmacytoid dendritic cells (pDC), and reduced T-cell numbers, when compared to classical psoriasis. Anti-TNF treatment prolongs type I interferon production by pDCs through inhibition of their maturation. The resulting type I interferon overexpression is responsible for the skin phenotype of paradoxical psoriasis, which, unlike classical psoriasis, is independent of T cells. These findings indicate that paradoxical psoriasis represents an ongoing overactive innate inflammatory process, driven by pDC-derived type I interferon that does not lead to T-cell autoimmunity.

[Progressive cutaneous and pulmonary lesions without infectious etiology: two cases reports of sweet syndrome with pulmonary involvement]. / Lésions cutanées et infiltrats pulmonaires d'évolution défavorable sans cause infectieuse.

Sweet syndrome is a non infectious febrile disease with a neutrophilic infiltrate of dermis. Extracutaneous involvement can occur. We report two cases of Sweet syndrome with cutaneous and pulmonary involvement and give a short review of the literature of pulmonary involvement in Sweet syndrome.

Le syndrome de Sweet est une maladie fébrile se manifestant par un infiltrat neutrophilique important du derme, sans cause infectieuse. Une atteinte extra-cutanée n'est pas rare. Nous rapportons ici deux cas de syndrome de Sweet d'atteinte cutanée et pulmonaire et présentons une revue de la littérature sur les atteintes pulmonaires lors de syndrome de Sweet.

Purpura of the face and neck: an atypical clinical presentation revealing a hepatosplenic T cell lymphoma.

BACKGROUND: Hepatosplenic T cell lymphoma (HSTL) is a rare but very aggressive peripheral T cell lymphoma whose initial silent clinical presentation unfortunately delays the diagnosis and worsens the prognosis of patient survival. Efforts should be aimed at early recognition and treatment. METHODS: We describe a case of a 62-year-old woman who presented at our clinic with a non-palpable purpuric eruption of the face. Investigations revealed thrombocytopenia with hepatosplenomegaly, which showed rapid progression together with accentuation of the purpura. Two months later, a bone marrow biopsy revealed the diagnosis of a HSTL. RESULTS: The patient received six cycles of CHOP chemotherapy (vincristine, cyclophosphamide, doxorubicin, methylprednisolone) followed by a well-tolerated autologous bone marrow graft. Normalization of the platelet count resulted in regression of the purpuric rash. CONCLUSION: To our knowledge, this is the first report of a facial thrombocytopenic purpura as the inaugural symptom of HSTL. It emphasizes the privileged position of the dermatologist for early recognition of potentially lethal HSTL.