[Androgenetic alopecia: where do we stand in 2024?] / Alopécie androgénétique : où en est-on en 2024 ?

Androgenetic alopecia, the most prevalent type of hair loss, is characterized by a receding hairline in men and diffuse thinning of hair in women. Despite being considered a benign condition, it can exert a considerable psychological toll, especially on women and young men. Despite its high prevalence, only a limited number of medications have received approval for its treatment. In this article, we review the available treatment options, assessing their efficacy and potential side effects. Additionally, we explore minimally-invasive strategies such as photobiomodulation, micro-needling and platelet-rich plasma therapy. Furthermore, we delve into discussions on hair transplantation and camouflage methods.

L'alopécie androgénétique (AAG) est la forme la plus fréquente de perte de cheveux, caractérisée par le recul de la ligne frontale des cheveux chez les hommes et l'élargissement des lignes de partage des cheveux chez les femmes avec épargne de la ligne frontale. L'AAG, considérée comme une pathologie bénigne, a toutefois un impact psychologique pouvant être très important, notamment chez les femmes et les jeunes hommes. Bien qu'il s'agisse d'une entité très répandue, peu de médicaments sont approuvés pour son traitement. Dans cet article, nous parcourons les différentes options thérapeutiques disponibles, leurs efficacités et effets secondaires ainsi que les traitements minimalement invasifs tels que la photobiomodulation, aiguilletage de la peau ou encore le plasma riche en plaquettes. Nous discutons également de la greffe capillaire et des méthodes de camouflages.

[Surgical treatment of hidradenitis suppurativa]. / Prise en charge chirurgicale de l'hidradénite suppurée.

Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease that primarily affects the apocrine skin glands. Management options include risk factor modification, pharmacologic agents, and surgery. Many surgical management techniques exist, including incision and drainage, laser hair removal, deroofing, limited or wide local excision. Deroofing is an interesting alternative for simple superficial fistulas and potentially even for more complex lesions. Surgical treatment can be combined with drug treatment. The indication depends on a comprehensive and multidisciplinary assessment considering the severity and number of target lesions.

L'hidradénite suppurée (HS) est une maladie inflammatoire chronique récurrente qui affecte principalement les glandes cutanées apocrines. Les options de prise en charge comprennent la modification des facteurs de risque, les agents pharmacologiques et la chirurgie. De nombreuses techniques de prise en charge chirurgicale existent, notamment l'incision et le drainage, la thérapie au laser épilatoire, le deroofing et l'excision limitée ou large. Le deroofing est une alternative intéressante pour les fistules simples superficielles et, potentiellement, pour les lésions plus complexes. Le traitement chirurgical peut être combiné au traitement médicamenteux. L'indication dépend d'une évaluation globale et pluridisciplinaire prenant en compte la sévérité et le nombre de lésions.

[Vitiligo, no longer a fatality in 2023].

Vitiligo is an acquired auto-inflammatory disorder characterized by a depigmentation. It is a polygenic disease developed in a context of allelic variations. Its pathophysiology is complex, associating intrinsic skin defects, exposome triggering factors and innate then adaptive auto-immune activation leading to the loss of melanocytes. The diagnosis is clinical. Nevertheless, Wood's lamp is mandatory to assess the lesions and their activity, especially in fair-skinned patients. The management of vitiligo is long and aims to halt the depigmentation process and to repigment the affected areas. This requires a combination of immunosuppressive topical or systemic treatment with ultraviolet rays from phototherapy or sun exposure.

Le vitiligo est une dépigmentation acquise bien limitée, d'origine auto-immune. Il s'agit d'une maladie polygénique survenant dans un contexte de variations alléliques prédisposant son apparition. Sa physiopathologie est complexe et associe des défauts intrinsèques de la peau, des facteurs déclenchants liés à l'exposome et une activation immunitaire innée, puis adaptative, conduisant à la perte des mélanocytes. Son diagnostic est clinique mais la lumière de Wood est indispensable pour apprécier les lésions et leur activité, notamment sur peau claire. La prise en charge du vitiligo est longue et a pour but d'interrompre la dépigmentation et de repigmenter les zones lésionnelles. Pour cela, il faut associer un traitement immunosuppresseur topique ou systémique à des rayons ultraviolets, soit naturels, soit de la photothérapie.

[Skin and pregnancy]. / Peau et grossesse.

Pregnancy has a substantial impact on the hormonal status of the organism, consequently influencing the physiology of the skin. This results in dermatoses that only occur during pregnancy, which can also improve or exacerbate pre-existing dermatoses. In this article, we explain the management of pregnancy-specific dermatoses : atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and intrahepatic cholestasis of pregnancy. It is essential to clearly distinguish these different dermatoses as some of them, such as pemphigoid gestationis, impetigo herpetiformis and intrahepatic cholestasis of pregnancy, can have fetal consequences and as result, need to be closely monitored by the obstetricians.

La grossesse a un impact considérable sur le statut hormonal de l'organisme, influençant ainsi la physiologie cutanée. Cela se traduit par des dermatoses qui ne se manifestent que pendant la grossesse. Cette dernière peut également améliorer ou exacerber des dermatoses préexistantes. Dans cet article, nous précisons la prise en charge des dermatoses spécifiques de la grossesse : l'eczéma atopique de la grossesse, l'éruption polymorphe gravidique, la pemphigoïde gestationnelle, l'impétigo herpétiforme et la cholestase intrahépatique gravidique. Il est important de distinguer ces dermatoses, puisque la pemphigoïde gestationnelle, l'impétigo herpétiforme et la cholestase intrahépatique gravidique présentent un risque fœtal et par conséquence nécessitent un suivi obstétrical rapproché.

[A non-infectious cellulitis to know: Wells' syndrome]. / Cellulite non infectieuse à connaître: le syndrome de Wells.

Wells' syndrome is a rare inflammatory eosinophilic dermatosis. It typically appears as a sudden-onset of one or multiple inflammatory plaques associated with a pruritus. General symptoms are rare. There is often blood eosinophilia and a marked dermal eosinophilic infiltrate with flame figures on skin biopsy. Numerous trigger factors and associated diseases are described. The etiology is unclear. Most experts believe it to be a type IV hypersensitivity reaction in predisposed individuals with an imbalance TH1/TH2 cells. Circulating TH2 cells may be implicated by producing IL- 5 which stimulates eosinophils' degranulation. The aim of this article is to review the diagnostic and therapeutic options of this pathology knowing that the main differential diagnosis is cellulitis of infectious origin.

Le syndrome de Wells est une dermatose éosinophilique rare qui se présente sous forme de plaques inflammatoires d'apparition brutale, souvent prurigineuses, généralement sans signes généraux. Une hyperéosinophilie sanguine est souvent présente et, en histopathologie, un infiltrat éosinophilique avec des images «â€…en flammèche ¼ est retrouvé. Il existe de nombreux facteurs déclenchants et maladies associées. La physiopathologie est inconnue, certains auteurs parlent d'une hypersensibilité retardée (réaction de type IV) sur un terrain prédisposé avec un déséquilibre TH1/TH2 et des cellules TH2 sécrétant de l'interleukine-5, qui stimulerait la dégranulation des éosinophiles. Le but de cet article est de faire le point sur cette pathologie rare, le principal diagnostic différentiel étant une cellulite d'origine infectieuse.

[Lipedema†: an unknown entity]. / Le lipœdème†: une entité méconnue.

Lipedema is an infrequently recognized disorder. It is characterized by bilateral painful enlargement of the legs due to abnormal depositions of subcutaneous fat, that can result in considerable disability. The diagnosis is established on the basis of medical history and clinical findings. Early diagnosis of this disorder is necessary to start adapted management and prevent progression and complications of the disease. Currently there is no curative treatment. The conservative treatment requires a multidimensional approach including manual lymph drainage, compression garments and management or prevention of obesity as well as other comorbidities. In some cases, surgery may be considered.

Le lipœdème est une pathologie méconnue et sous-diagnostiquée. Il se caractérise par une accumulation anormale et douloureuse de tissu adipeux sous-cutané aux membres inférieurs, pouvant induire une morbidité et un retentissement psychologique importants. Le diagnostic est clinique. Il doit être posé le plus tôt possible afin d'initier une prise en charge adaptée, et ainsi empêcher le développement de la maladie et de ses complications. Il n'existe pour l'heure pas de traitement curatif. La prise en charge doit être globale. Le traitement conservateur comprend des drainages lymphatiques manuels, une compression, une gestion ou une prévention de l'obésité ainsi que des éventuelles comorbidités. Dans certains cas, une chirurgie peut être envisagée en privilégiant une liposuccion par tumescence.

[Lyme Borreliosis in 2020 practice, from a dermatological point of view]. / Borréliose de Lyme vue par le dermatologue, en pratique en 2020.

Lyme borreliosis is a frequent disease in Switzerland. Due to the increasing number of symptoms attributed to this infection, the diagnostic is often controversy between different specialists and is often a subject of discussion. The diagnostic of Lyme disease lays particularly on the knowledge of cutaneous signs which are the only specific. Despite recent scientific progress, microbiological diagnostic is still delicate and serological tests currently used do not differentiate between an active infection versus a serological marker. Here we describe the different clinical presentations of Lyme disease diagnosis and management procedures according to stages of evolution.

La borréliose de Lyme est une maladie fréquente en Suisse. Elle a beaucoup fait parler d'elle ces dernières années en raison d'un nombre croissant de symptômes qui lui ont été attribués, faisant polémique auprès des spécialistes. Le diagnostic de la maladie de Lyme repose en grande partie sur la reconnaissance des signes cutanés qui seuls sont spécifiques. Malgré les progrès scientifiques, le diagnostic microbiologique reste toujours délicat, et les tests sérologiques utilisés actuellement ne permettent pas de faire la distinction entre une infection active et une cicatrice sérologique. Dans cet article, nous décrivons les différentes manifestations cliniques et la prise en charge diagnostique et thérapeutique selon les stades d'évolution de la maladie.

6D-ViCuT: Six degree-of-freedom visual cuboid tracking dataset for manual packing of cargo in warehouses.

Visual tracking of objects is a fundamental technology for industry 4.0, allowing the integration of digital content and real-world objects. The industrial operation known as manual cargo packing can benefit from the visual tracking of objects. No dataset exists to evaluate the visual tracking algorithms on manual packing scenarios. To close this gap, this article presents 6D-ViCuT, a dataset of images, and 6D pose ground truth of cuboids in a manual packing operation in intralogistics. The initial release of the dataset comprehends 28 sessions acquired in a space that rebuilds a manual packing zone: indoors, area of (6 × 4 × 2) m3, and warehouse illumination. The data acquisition experiment involves capturing images from fixed and mobile RGBD devices and a motion capture system while an operator performs a manual packing operation. Each session contains between 6 and 18 boxes from an available set of 10 types, with each type varying in height, width, depth, and texture. Each session had a duration in the range of 1 to 5 minutes. Each session exhibits operator speed and box type differences (box texture, size heterogeneity, occlusion).

Surgical treatment for colorectal cancer: analysis of the influence of an enhanced recovery programme on long-term oncological outcomes-a study protocol for a prospective, multicentre, observational cohort study.

INTRODUCTION: The evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life. METHODS AND ANALYSIS: A multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (BMJ Open, JAMA Surgery, Annals of Surgery, British Journal of Surgery). Abstracts will be submitted to relevant national and international meetings. TRIAL REGISTRATION NUMBER: NCT04305314.

A daily multidisciplinary assessment of older adults undergoing elective colorectal cancer surgery is associated with reduced delirium and geriatric syndromes.

OBJECTIVES: Comprehensive geriatric assessment (CGA) has shown to benefit older patients undergoing urological and orthopedic surgery. However, this approach has been scarcely assessed in patients elected for colorectal surgery. MATERIALS AND METHODS: Retrospective cohort of patients aged ≥70 years admitted for elective colorectal cancer surgery to a single hospital between 2008 and 2012. Upon admission, patients were assigned to a usual care (UC) plan or a CGA-based care (GS) plan conducted by a multidisciplinary team, according to standard clinical criteria.Analyzed outcomes included the incidence of delirium and other geriatric syndromes during hospital stay, mortality, readmissions, andnumber of perioperative complications. RESULTS: The cohort included 310 patients, 203 assigned to the GS group and 107 to the UC group. Patients in the GS group had significantly lower Barthel and Lawton scores, higher prevalence of dementia and heart failure, and higher comorbidity burden. Fifty-four (17.5%) patientsexperienced delirium (23 [11.3%] and 31 [29.2%] in the GS and UC groups, respectively; p < .001), and 49 (15.8%) patient experienced other geriatric syndromes (21 [10.3%] and 28 [26.2%] in the GS and UC groups, respectively; p < .001). Serious complications were more frequent in the GS group: 154 (75.9%) vs 60 (56.1%) in the UC group; p < .001. No significant differences were observed between groups regarding readmissions, and in-hospital and post-discharge (1 year follow-up) mortality. CONCLUSIONS: Despite the poorer clinical condition of patients in the GS group, the CGA-based intervention resulted in a lower incidence of delirium and other geriatric syndromes compared with the UC group.

Recognition of early melanoma: a monocentric dermoscopy follow-up study comparing de novo melanoma with nevus-associated melanoma.

BACKGROUND: The earlier detection of melanomas occurring within preexisting nevi is theoretically possible using sequential dermoscopy. Characterizing the early follow-up changes of nevus-associated melanomas (NAMs) and differentiating them from those observed in de novo melanomas (DNMs) may help the earlier recognition of NAMs. METHODS: Using descriptive dermoscopic features to detect focal changes, we blindly evaluated retrospectively the baseline and follow-up images of 32 melanomas that were subsequently classified as histopathologically defined NAMs or DNMs. RESULTS: Correlates of growth, as structureless brown­black areas or clods, complemented each other for the identification of DNMs at baseline (structureless brown­black areas: 66.7% DNMs, 15% NAMs, P < 0.01; combined with clods, one or the other being present: 100% DNMs, 30% NAMs, P < 0.01) and when considering their baseline presence or their appearance at follow­up (100% DNMs, 35% NAMs, P < 0.01). Correlates of fibrosis, as white lines, when considering their baseline presence or their appearance at follow-up, were associated with NAMs (60%, 16.7% DNMs, P = 0.027). CONCLUSION: Significant differences, distinguishing NAMs from DNMs, were detected particularly when considering both baseline signs and follow-up changes. Earlier identification of NAMs and their subsequent improved histological characterization will help define the subgroup of high-risk patients, for whom comprehensive image monitoring may be beneficial.

Keratinocyte-Derived IL-17E Contributes to Inflammation in Psoriasis.

Psoriasis is a chronic inflammatory skin disorder effectively treated by blocking IL-17RA, a receptor chain used by several IL-17 family members, including IL-17E. Although IL-17A is critically involved in the pathogenesis of psoriasis, the contribution of IL-17E remains unknown. Here we show that IL-17E(+) cells are more abundant than IL-17A(+) cells in lesional psoriatic skin. IL-17E synthesis is increased in keratinocytes within psoriatic plaques, and macrophages having a mixed M1/M2 phenotype represent an important proportion of the IL-17E(+) cells infiltrating the dermis. Mechanistically, macrophages do not synthetize but rather take up IL-17E via receptor-mediated clathrin-dependent endocytosis. Furthermore, monocyte-derived macrophages in vitro polarized in M2, but not M1, express the IL-17E receptor and respond to IL-17E by preferentially producing inflammatory cytokines and chemokines involved in neutrophil recruitment. Remarkably, IL-17E expression in lesional psoriatic skin correlates with the number of neutrophils while being inversely proportional to the number of infiltrating T cells. These data provide strong evidence for a proinflammatory role of keratinocyte-derived IL-17E in psoriasis, possibly via macrophage activation.

Safety and efficacy of therapies for skin symptoms of psoriasis in patients with psoriatic arthritis: a systematic review.

Numerous guidelines and recommendations exist for the treatment of psoriasis in various populations. One important population is patients with psoriatic arthritis (PsA) who have symptoms of both joint and skin disease. In patients with both facets of psoriatic disease, skin and joints must be treated separately, but also simultaneously. As several systemic therapies are approved for either one or both, the concept of treating both facets with the same drug is feasible. This review summarizes evidence from studies in patients with PsA on the efficacy of these drugs on psoriatic skin disease in these patients.