[Cutaneous manifestations revealing cryofibrinogenaemia associated with monoclonal gammopathy]. / Manifestations cutanées révélant une cryofibrinogénémie associée à une gammapathie monoclonale.

BACKGROUND: Cryofibrinogenaemia is an under-recognized cutaneous thrombotic vasculopathy that may be revealed by purpura or chronic necrotic ulcerations. We report two original cases characterized by their severity, their association with a monoclonal gammopathy and their excellent response to treatment. PATIENTS: A 38-year-old woman was admitted for large necrotic leg ulcers appearing 1 year earlier and already investigated. Non-specific signs were seen on a previous skin biopsy and the diagnosis of a factitious disorder was considered at that time. Further investigations revealed circulating cryofibrinogen associated with IgG kappa monoclonal gammopathy without cryoglobulinaemia. Plasmapheresis followed by bortezomid-dexamethasone to treat the monoclonal gammopathy resulted in rapid and complete healing of the ulcers, militating in favour of its involvement in cryofibrinogen formation. The second patient, a 91-year-old woman, was referred to our department for acute necrotic purpura of the legs. Skin biopsy revealed leukocytoclastic vasculitis. Glomerular nephropathy with acute renal failure and multiple arterial thromboses were associated with the skin condition. The cryofibrinogen assay was positive without cryoglobulinaemia and other causes of vasculitis were ruled out. The main component was monoclonal IgG lambda. Prednisone-cyclophosphamide treatment led to complete healing of the skin lesions and to recovery from the systemic consequences of cryofibrinogen without sequelae. CONCLUSION: Routine screening for cryofibrinogen in plasma should be performed to explore cutaneous symptoms of unexplained thrombotic vasculopathy, even in the presence of a non-specific skin biopsy. Specific treatment of cryofibrinogenaemia associated monoclonal gammopathy appears to be highly effective against manifestations of cryofibrinogenaemia.

Management of cutaneous adverse events induced by anti-EGFR (epidermal growth factor receptor): a French interdisciplinary therapeutic algorithm.

PURPOSE: Cutaneous adverse events induced by epidermal growth factor receptor (EGFR) inhibitors can hamper the patients' quality of life. The aim of our work was to draft an algorithm for the optimised management of this skin toxicity. METHODS: This algorithm was built in three steps under the responsibility of a steering committee. Step I: a systematic literature analysis (SLA) has been performed. Step II: the collection of information about practices was performed through a questionnaire.These questions were asked during regional meetings to which oncologists, gastro-enterologists, radiotherapists, and dermatologists were invited. Step III: a final meeting was organised involving the bibliography group and the steering committee and regional scientific committees for proposing a final algorithm. RESULTS: Step I: 14 publications were selected to evaluate the use of cyclines as curative or prophylactic treatment of the folliculitis induced by EGFR inhibitors. Nineteen publications were retained for the topical treatment of the folliculitis. Forty-six articles were selected for the management of the cutaneous lesions in link with appendages and 12 for xerosis and pruritus. Step II: 96 delegates attended the seven regional meetings and 67 questionnaires were analysed. Step III: a final algorithm was proposed on the basis of the conclusions of the first two steps and expert opinions present at this final meeting. The different propositions were unanimously approved by the 14 experts who voted. CONCLUSIONS: This multidisciplinary study summarising published data and current practices produced a therapeutic algorithm, which should facilitate the standardised, optimised management of skin toxicity associated with EGFR inhibitors in France.

[Tobacco contact dermatitis caused by sensitivity to sorbic acid]. / Eczéma de contact au tabac par sensibilisation à l'acide sorbique.

BACKGROUND: Contact dermatitis caused by tobacco is rare and poorly understood. In this paper, we report what is to our knowledge, the first case of tobacco contact dermatitis with identification of the causative agent. PATIENTS AND METHODS: A 46-year-old man was hospitalised for diffuse dermatitis originating in the left leg. Subsequent epicutaneous tests indicated that this dermatitis was ascribable to sensitisation to the sorbic acid present in Fucidin cream applied around a chronic wound. A persistent plaque of eczema observed on the day of examination opposite the patient's right trouser pocket suggested the implication of tobacco powder with which the pocket was soiled. An epicutaneous test using tobacco (moistened in water) proved positive (++ at 48 and 72 h). This tobacco contained sorbic acid, used as a preservative. DISCUSSION: The positive test for sorbic acid was relevant not only regarding the lesions on the patient's legs (application of a topical cream containing sorbic acid) but also for the lesion on the patient's thigh and for palmar dyshidrosis (through contact with strands of loose rolling tobacco). To our knowledge, this is the first recorded case of contact dermatitis caused by sorbic acid in tobacco.