Papillomavirus genotyping on formaldehyde fixed paraffin-embedded tissues in vulvar intraepithelial neoplasia.

PURPOSE: Few studies have described the epidemiology of human papillomavirus (HPV) in vulvar intraepithelial neoplasia (VIN). The aim of this study was to genotype HPV on formalin fixed paraffin-embedded tissues in VIN lesions. METHODS: A 5-year retrospective study was conducted by including all patients attending the teaching hospital of Nice with a diagnosis of VIN between 1st January 2010 and 31st December 2014. For all patients, HPV genotyping was performed with the PapilloCheck® microarray kit, routinely used on cervical cytology samples, and optimized for formaldehyde fixed paraffin-embedded tissues in VIN. RESULTS: Forty patients were included in the study: 39 patients had usual VIN and one presented with differentiated VIN. Among the 39 patients with usual VIN, the prevalence of HPV was 90% (35/39). Thirty-two patients had high grade VIN (82%) and seven low grade VIN (18%). In high grade VIN, the most represented HPV types were: HPV 16 (21/32 66%), HPV 56 (3/32 9%) and HPV 33 (2/32 6%). In low grade VIN, the most represented HPV types were: HPV 16 (4/7 57%) and HPV 6 (3/7 43%). Interestingly, 5/39 (13%) of patients diagnosed with usual VIN also had co-existing lichen sclerosus. CONCLUSIONS: We have optimized a HPV genotyping technique, routinely used on cervical cytology samples, and on paraffin fixed embedded tissue showing VIN. Moreover, we have identified five patients with lichen sclerosus co-existing with usual VIN. This association has rarely been reported and proves that these two entities can coexist.

[Sneddon-Wilkinson disease: efficacy of intermittent adalimumab therapy after lost response to infliximab and etanercept]. / Maladie de Sneddon-Wilkinson échappant à l'infliximab et à l'étanercept: efficacité de l'adalimumab.

BACKGROUND: Sneddon-Wilkinson disease (SWD) is a rare chronic neutrophilic dermatosis. The first-line treatment is dapsone but resistance to treatment may sometimes pose a challenge. CASE REPORT: We report a multidrug-resistant patient who responded dramatically before gradually losing response to infliximab and then etanercept. Complete remission was again obtained with adalimumab. DISCUSSION: Our case confirms the previously reported dramatic efficacy of anti-TNF biological agents in recalcitrant SWD but highlights the possibility of subsequent loss of response. Furthermore, it illustrates the efficacy of adalimumab in this indication.

[Treatment of mycosis fungoides by 308 nm excimer laser: a clinical and histological study in 10 patients]. / Traitement du mycosis fongoïde par le laser excimer à 308 nm: étude anatomo-clinique chez dix malades.

BACKGROUND: Mycosis fungoides is a cutaneous T-cell lymphoma. The early stages have a good prognosis but pose therapeutic problems due to chronic disease status and the frequent recurrence of lesions. We performed a retrospective clinical and histological study in 10 patients presenting mycosis fungoides in order to evaluate the efficacy of 308 nm excimer laser in this indication. METHODS: Ten patients with mycosis fungoides confirmed by histological examination were included. Treatment by 308 nm excimer laser was performed on a total of 29 lesions (25 patch-stage, 3 plaques and 1 nodule). After determination of the minimal erythemal dose, sessions were started twice weekly gradually increasing in accordance with tolerability. Clinical follow-up was performed and histological and immunohistological analysis was done, if possible, before and after treatment and at the end of the follow-up. RESULTS: Eighty-six percent of patch-stage or plaque lesions had completely cleared up by the end of treatment and 14% had cleared up partially, with a global response rate of 100%. The mean number of sessions was 15 (6 to 46 sessions) corresponding to a mean treatment duration of 2 months. The mean cumulative dose was 5 J/cm2 (1.3 to 16.1 cm2). Follow-up was performed in 19 lesions for a median period of 15 months (8 to 26 months). Persistent complete clearance was observed in 13 of 19 (68%) lesions (12 patch-stage and 1 plaque). Continued partial clearance was noted in 3 lesions (1 patch-stage and 2 plaques) (16%). Two lesions (both patch-stage) (11%) showed relapse 7 months after the end of treatment. The sole nodule in the study showed no response to treatment. Histological and immunohistological were consistent with clinical results and showed histological healing where lesions had clinically disappeared, except for one case with persistence of a few mycosis cells in the epidermis despite a clinical appearance of healing. DISCUSSION: This study demonstrates the efficacy of 308 nm excimer laser in stage Ia of mycosis fungoides. Given its limited availability and high cost, 308 nm excimer laser may be used as second-line therapy after failure of treatment with topical steroids.

[Mycobacterium fortuitum skin infection occurring after a facelift]. / Infection cutanée à Mycobacterium fortuitum après lifting.

INTRODUCTION: Mycobacterium fortuitum skin infections are rare and usually iatrogenic. We report a case with cervical involvement following a facelift. OBSERVATION: A 65 year-old woman, without past history, underwent bilateral surgical facelift, complicated by cutaneous necrosis and treated with directed healing at home. Six weeks later, an abscessed nodule appeared under the left maxillary and was drained surgically. Then other pre-auricular and left cervical inflammatory nodules appeared without adenopathy or fever. M. fortuitum was isolated in bacteriological samples. The initially probabilistic antibiotherapy with carithromycin, subsequently adapted with amikacine and cirprofloxacine and then imipeneme for a total duration of 3 months, led to the clinical cure. DISCUSSION: Mycobacterium fortuitum is a rapidly growing, ubiquitous, mycobacteria responsible for nosocomial infections in immunocompetent patients, notably following plastic surgery. Contamination occurs where there has been a rupture in the skin barrier through contact with a vector (water, surgical material, antiseptic.). Treatment, which is not codified, consists in the association of surgery and antibiotics for several months.