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.

[Tolerance of the association sucralfate / Cu-Zn salts in radiation dermatitis]. / Tolérance de l'association de sucralfate / sels de Cu-Zn dans les radiodermites.

The aim of this study was to evaluate the tolerance of topical application of the combination sucralfate / copper zinc salts in radiation dermatitis in women suffering from breast cancer and treated by radiotherapy. 47 patients (average age : 57,5 years) that have to be treated by radiation therapy on non lesional areas, were included into this open multicentric study. They had to apply Cicalfate cream twice a day, from the fi rst radiation therapy session and during 10 weeks. Patients were treated by photon- or electrontherapy (72 % et 28 %, respectively; cumulated total dose : 58,6Gy). Tolerance was considered to be excellent. The radiation dermatitis (score NCIC > or = 2) was noted at the 3rd week of radiotherapy only in 5 % of the subjects and in 53 % of the subjects, the last week of treatment. Pruritus was significantly increased at D21. Pain and discomfort were increased at D28, but remained low intensity. The soothing effect of the combination of sucralfate/ copper zinc salts were considered satisfying or very satisfying by investigators and patients during the study, varying from 94 to 100 % of satisfaction. The impact of radiation therapy on the patients'quality of life, assessed by DLQI, evaluated at the end of the study was not statistically different from the score calculated at D7 (DLQI=0,8 et D7 versus DLQI=1 at D70). Thus, topical application of the combination sucralfate / copper zinc salts can be used in the indication radiation dermatitis.

[Medical corrective make-up in post- chemotherapy]. / Maquillage correcteur médical en post chimiothérapie.

INTRODUCTION: Medical corrective make up can be applied to hide the adverse effects of cancer treatments. The aim of this study was to evaluate the tolerance and the satisfaction of patients needing medical make up to hide the cutaneous side effects induced by chimiotherapy and to improve self-esteem. METHODS: 90 cancer patients were included in this multicentric study. They were being treated by chimiotherapy and had eyebrow alopecia, complexion changes, irregular lip contour or lip dryness. They were made up by socio-esthecians. Photos were taken before and after applications of make up. The patients had to fill in a self-questionnaire at home. The duration of the study varied from 1 to 4 weeks. RESULTS: Included patients were 52 years old. Tolerance was considered to be satisfactory or very satisfactory by 95,4% and 98,9% of the patients for eyebrow pencil corrector and the dual lip and contour corrector, respectively. Questions on quality of live and self-esteem revealed that the medical corrective make up improved the quality of life in general for 81,2% of the patients. This product range enhanced the self-esteem of 76,8% of the patients. Cosmetic agreement was highly satisfactory. CONCLUSION: In this study in which patients were suffering from cancer and treated by chimiotherapy, we showed that medical corrective make up can improve the quality of life with a very good tolerance.

Efficacy of sunscreens containing pre-tocopheryl in a surviving human skin model submitted to UVA and B radiation.

The aim of the present study was to evaluate by means of histological and biochemical tools the additive efficacy of pre-tocopheryl during photoprotection using a sunscreen containing mineral sunblock agents 50B-10A (TiO(2), ZnO) and pre-tocopheryl in comparison to a cream containing only mineral sunblock agents 50B-10A. For this purpose, an ex vivo technique and an acetone-impaired human skin model were used in order to approximate in vivo metabolic conditions. Creams were topically applied to the surface of the epidermis and submitted to UV radiations. Then, human skin explants were maintained alive in organ culture for 3 days. Free radical modulation was analysed by hydroperoxide assay. Epidermal (involucrin, cell proliferation, stratum corneum lipids) and dermal changes (elastic fibres and collagen) were studied. Analysis of ex vivo surviving skin samples impaired by UV irradiations and treated with the mineral sunscreen 50B-10A showed a significant decrease in hydroperoxide production and an improvement in the elastic fibre and collagen network in the dermis. Adding pre-tocopheryl to this formula induced an increase in involucrin and epidermal lipids such as squalenes and ceramides. Altogether, these results confirm the efficacy of the combination of a mineral sunscreen and pre-tocopheryl in photoprotection and free radical protection.