A case of chromomycosis treated by a combination of cryotherapy, shaving, oral 5-fluorocytosine, and oral amphotericin B.

A case of chromomycosis from Comoro Islands was first treated without success with high doses of oral amphotericin B (3 g per day). Treatment with itraconazole (400 mg per day) was also unsuccessful. Then, in vitro tests were done to study the susceptibility of this Fonsecaea pedrosoi strain to antifungal drugs. It was resistant to itraconazole, sensitive to 5-fluorocytosine, and the combination of 5-fluorocytosine with amphotericin B was synergistic. The patient was then treated with this last combination of drugs, which seemed to be effective. The patient stopped this treatment after six months, and relapse occurred two years later. The best therapeutic strategy in cases of chromomycosis seems to be a combination of two drugs chosen according to the results of prior antifungal susceptibility testing.

[Treatment of discoid lupus erythematosus with sulfasalazine: 11 cases]. / Traitement du lupus érythémateux chronique par la sulfasalazine: 11 observations.

INTRODUCTION: Antimalaria agents and thalidomide are two reference drugs for discoid lupus erythematosus. In non-responders or after secondary resistance or contraindications, there are a number of alternative therapeutics which are less effective and more toxic. We therefore conducted an open study in patients with discoid lupus erythematosus treated with sulfasalazine. PATIENTS AND METHODS: Seven men and four women (mean age 40 years) with severe discoid lupus erythematosus (mean duration of disease 14 years) were treated with sulfasalazine (2 g/d). This treatment was initiated after a previous failure or contraindication of antimalarial drugs or thalidomide. The acetylation phenotype was predicted in all patients with N-acetyltransferase 2 genotyping. Genome DNA was tested for mutations causing an N-acetyltransferase deficiency. Homozygous individuals or those with heterozygous composites for the tested mutations were predicted slow acetylators and those with a homozygous or heterozygous genotype for an allele carrying a normal sequence at the mutation sites were predicted rapid acetylators. RESULTS: We had 7 complete responses, 1 partial response and 3 failures. Mean delay to efficacy was 7 weeks, longer for lesions involving the scalp (4 to 5 months). Six of the 8 responders were given sulfasalazine exclusively. The effect was suspensive and dose-dependent; the minimal effective dose was 1.5 g/d. Excepting light sensitization requiring discontinuation, there were no clinically significant side effects. Neutropenia occurred in one patient and moderate and transient live enzyme movements did not require treatment withdrawal. The only immunoallergic side effect (light sensitization) observed occurred in a slow acetylator. All responders except one were rapid acetylators. DISCUSSION: Salazosulfapyridine, or sulfasalazine, is composed of a derivative of 5-aminosalicylic acid and a sulfamide fraction, sulfapyridine. It is only marginally used in dermatology except for psoriasis. Its efficacy in chronic lupus erythematosus has been reported in one case. We confirmed the role of this compound in the treatment of chronic lupus erythematosus. The rare observations of induced lupus and development of antinuclear antibodies are not a contraindication, but require close regular clinical and biological surveillance. The potential risk is that possible hypersensitivity could lead to reserving sulfasalazine for severe resistant chronic lupus erythematosus after failure with antimalarials and thalidomide. Nevertheless, our study demonstrates that the slow acetylator phenotype predicts immunoallergic events, as observed by other authors, and would be a factor predicting nonresponse. If these results are confirmed by other studies, it would be possible to propose sulfasalazine as a treatment for discoid lupus erythematosus in rapid acetylators.

[Achromic ungual melanoma. Apropos of a case]. / Mélanome unguéal achromique. A propos d'une observation.

A 55-year-old woman presented with suppurative paronychia that became chronic. In fact, this was an exceptional case of amelanotic subungual melanoma. This case is compared with a general review of subungual melanomas. Diagnosis is often delayed, due to the difficulty caused by the misleading clinical symptoms.

[Congenital diffuse melanosis]. / Mélanose diffuse congénitale.

Two cases of diffuse congenital melanosis are presented. The hyperpigmentation appeared shortly after birth and invades progressively the trunk and the limbs. It is diffuse and most intensive on the abdomen and the back, and reticulated on the neck, the genitals and in the groins. The nails are thin and their surface is slightly irregular. Histologic examination reveals the presence of melanin in the deep and superficial layers of the epidermis. On electron microscopy the melanosomes are not grouped within the keratinocytes, but are dispersed throughout the cytoplasm of the epidermal cells. The disease can be considered as an autonomous entity. The mechanism of the hyperpigmentation is not known.

Multiple clear-cell acanthoma (Degos): histochemical and ultrastructural study of two cases.

Two patients with clear-cell acanthoma with multiple lesions are reported; histologic and histochemical findings are similar to previous descriptions. The ultrastructural study confirms the overload of glycogen in keratinocytes, associated with an increase of mitochondria and nuclear deformations. The abundance of Langerhans' cells is emphasized. Extrusion of glycogen by keratinocytes and its phagocytosis by Langerhans' cells is suggested.

[Cardio-cutaneous syndromes (apropos of 2 observations)]. / Síndromes cardio-cutáneos (a propósito de dos observaciones)

Two cases of lentiginosis with associated heart anomalies are described. A review of the different syndromes in which pigmentary disturbances (cafe au lait spots, lentiginosis) are associated with cardiopathy is made by the authors. They emphasize the importance of investigation on members of the patient's family.