[French guidelines on the use of systemic treatments for moderate-to-severe psoriasis in adults]. / Recommandations françaises sur l'utilisation des traitements systémiques chez les patients adultes atteints de psoriasis modéré à sévère.

AIM: These guidelines for the treatment of psoriasis have been developed by the Psoriasis Research Group of the French Society of Dermatology with the aim of providing updated decision-making algorithms for the systemic treatment of adult patients with moderate-to-severe psoriasis. METHODS: Our algorithms were generated after rigorous evaluation of existing guidelines on the treatment of psoriasis and of publications concerning new systemic treatments, not yet incorporated into existing guidelines. A total of nine existing guidelines and 53 publications related to new systemic treatments were found to meet our criteria for use in generating the algorithms. RESULTS: We propose two new algorithms to assess therapeutic response, both of which incorporate emerging criteria for evaluating treatment goals. Updated therapeutic strategy algorithms, incorporating both established and new systemic therapies, were also generated for the treatment of plaque psoriasis and psoriatic arthritis, together with recommendations for the treatment of particular forms of psoriasis and treatment of patients with comorbidities.

French guidelines on the use of systemic treatments for moderate-to-severe psoriasis in adults.

These guidelines were developed by the psoriasis research group of the French Society of Dermatology with the aim of providing updated decision-making algorithms for the systemic treatment of adult patients with moderate-to-severe psoriasis. Our algorithms were generated after rigorous evaluation of existing guidelines on the treatment of psoriasis and of publications concerning new systemic treatments, not yet incorporated into existing guidelines. A total of nine existing guidelines and 53 publications related to new systemic treatments were found to meet our criteria for use in the generation of the algorithms. We have proposed two new algorithms to assess therapeutic responses, both of which incorporate emerging criteria for evaluating treatment goals. Updated therapeutic strategy algorithms, incorporating both established and new systemic therapies, were also generated for the treatment of plaque psoriasis and psoriatic arthritis, together with recommendations for the treatment of particular forms of psoriasis and treatment of patients with comorbidities.

[What's news in dermatological therapy?]. / Quoi de neuf en thérapeutique dermatologique?

Innovations in dermatological therapy remain rare. In 2013, increase in the knowledge of mechanism of action and place in the therapeutic strategies concern some recent drugs. For psoriasis treatment, efficacy and safety of anti IL-17 and anti JAK pathway has been demonstrated in randomized studies versus placebo. In other inflammatory diseases, the role of rituximab in auto immune bullous diseases and of omalizumab in chronic urticaria is better known. This year was published the first randomized trial using anti TNF in hidradenitis suppurativa with positive but limited effects. For infectious diseases, the role of prolonged antibiotherapy in the management of recurrent cellulitis is well documented and new antibiotics appears for the treatment of multi resistant bacteria in infection of skin and soft tissues. Finaly, analysis of quality criteria in dermatological trial showed great capability for increase in quality, a strong prerequiste for treating our patient with safety and efficacy.

Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: a prospective study of 20 patients.

BACKGROUND: To analyze the clinical and histological features of permanent alopecia following a sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel regimen for adjuvant breast cancer treatment. PATIENTS AND METHODS: Women treated for breast cancer by a sequential adjuvant FEC and docetaxel regimen who developed permanent alopecia diagnosed between 2007 and 2011 were identified from the Department of Dermatology (Saint-Eloi Hospital, Montpellier, France) and the Department of Medical Oncology (CRLC Val d'Aurelle, Montpellier, France). Data were collected regarding demographics, type of cancer, delay of onset after chemotherapy, Dermatology Life Quality Index (DLQI), clinical description of the lesions, scalp biopsies, laboratory explorations investigating steroid hormonal, iron, zinc and thyroid status, therapy and outcome. RESULTS: Twenty white Caucasian females were included. Hair loss presented with a moderate or intense androgenetic-like pattern of scalp alopecia. Biopsy specimen examinations were normal or displayed the androgenetic-like pattern. Laboratory explorations ruled out iron or zinc deficiency and thyroid disorders and confirmed hormonal menopause without hyperandrogenism. The overall mean DLQI score reflected the distressing psychological consequences in the patients' lives. No spontaneous regrowth of the scalp hair was noted. Treatment including vitamins, minoxidil, psoralen and ultraviolet A therapy and spironolactone proved to be ineffective. CONCLUSION: Permanent and severe alopecia is a newly reported complication of the FEC 100-docetaxel breast cancer regimen.

[Treatment of connective tissue disorder-related acral syndromes using UVA-1 phototherapy. An open study of 11 cases]. / Traitement des acrosyndromes des connectivites par photothérapie UVA-1. Etude ouverte de 11 cas.

BACKGROUND: UVA-1 phototherapy is used to treat various connective tissues disorders including systemic lupus erythematosus (SLE) and systemic sclerosis (SS). We conducted an open study to investigate the efficacy of this therapy on connective tissue disorder-related acrosyndrome. MATERIAL AND METHODS: Eleven patients with Raynaud's phenomenon refractory to the standard therapy (six SLE and five SS) were treated with UVA-1 in an open study. Whole-body phototherapy was given in seven cases but was restricted to the hands in four cases. The results were evaluated by comparing status before and after treatment using semi-quantitative tools in terms of daily frequency and intensity of spastic phenomena, pain, overall patient satisfaction, improvement of cutaneous lesions, trophic disorders and distal cutaneous flexibility for patients with ScS. RESULTS: After treatment, Raynaud's phenomenon improved in terms of both frequency and severity in 9/11 patients (82%: 4/6 SS and 5/5 SLE). Likewise, pain decreased in 8/11 cases (73%: 3/6 SS and 5/5 SLE). 7/12 patients felt their condition had improved (64%: 3/6 SS and 4/5 SLE). Cutaneous lesions improved in 5/11 patients (45%: 2/6 SS and 3/5 SLE), especially for lupus-related lesions including chilblains and in idiopathic chilblains that totally subsided within one month. Digital ulcers improved in all cases, with complete healing in 3/4 patients (75%). In SS, cutaneous flexibility significantly improved in 2/6 cases (33%). No major adverse effects were seen in patients treated with hand-only phototherapy but a slight and spontaneously reversible cutaneous rash, reminiscent of lupus lesions, occurred in one female patient receiving whole-body phototherapy. DISCUSSION: This study is the first to provide a precise evaluation of the efficiency of UVA-1 phototherapy on connective tissue disorder-related acrosyndrome. This therapeutic effect is not necessarily restricted to the laboratory effects of UVA-1 since the favourable impact of infrared radiation and a placebo effect cannot be ruled out. Although its methodological limitations are obvious, our study also confirms dare data in the recent literature data by demonstrating significant improvement in cutaneous lesions, trophic ulcers and Raynaud's phenomenon in patients presenting connective tissue disorders, including SS, without any major adverse effects. CONCLUSION: Although these preliminary results remain to be confirmed by large-scale, randomized studies, UVA-1 phototherapy clearly offers a new and valuable therapeutic option in connective tissue disorders associated with acral manifestations and/or lesions, including SLE and SS.

A randomized, prospective study using the LPG technique in treating radiation-induced skin fibrosis: clinical and profilometric analysis.

BACKGROUND/PURPOSE: Cutaneous fibrosis is the quite mandatory sequela after a breast cancer treated by radiotherapy and it induces more or less important functional troubles. The LPG technique is a technique of mechanical massage that allows skin mobilization by folding/unfolding. The aim of this study was to evaluate the changes on irradiated skin before and after LPG treatment by clinical and skin replica analysis. METHODS: Twenty women, 43-55 years old, who had been treated from 6 to 16 months before, for breast cancer with a conservative surgery and radiotherapy, had been enrolled in the trial. They were divided into two groups after randomization: the first group was LPG treated three times a week for 1 month; the second group was only placed under medical supervision. The clinical criteria studied were systematically studied before (T0), at the end of treatment (T1) and 1 month after the end of treatment (T2): pain, itching, skin dryness, erythema, skin infiltration, feeling of tightness and of induration of the skin. Softening of the skin was assessed at T1 and T2. Cutaneous replica was performed on the internal upper 1/4 of each breast with silicone material before, after and 1 month later after the end of the treatment. After polymerization, the replica was stored and then blindly analyzed by image analysis software. The following parameters were systematically measured: average skin roughness, average of wrinkles' depth and residual length, wrinkle number and the space between them. RESULTS: Clinically, the LPG treatment induced a decrease of erythema (10% of the patients vs. 40% before treatment), a decrease of pain and pruritus (10% vs. 20% and 40%, respectively) and a decrease of the feeling of induration of the skin (10% of the patients vs. 70% before treatment). Furthermore, a skin-softening sensation was noted by seven patients vs. one in the control group. Replica shows an increase of roughness and of furrow depth without any change in the residual length and an increase in the space between the wrinkles, whose number decreases. CONCLUSION: This study confirms the impact of the clinical sequelae induced on skin after radiotherapy and shows improvement of the clinical signs after treatment by the LPG technique. The latter induces changes of micro relief, suggesting a softening effect on the skin. These preliminary results have to be confirmed on a more important group of patients.

[Pharmacovigilance off the beaten track: herbal surveillance or pharmacovigilance of medicinal plants]. / Une pharmacovigilance hors des sentiers battus: la phytovigilance où la pharmacovigilance des plantes médicinales.

For several years, herbal medicines have been increasingly consumed by patients without prescription. They are traditionally innocuous but as medicinal products they require drug surveillance in order to identify their risks. However, the first concern is to give them a legal status, to evaluate their efficacy and to control their safety. Published data show that the risk is due either to a contaminant or to an added drug or falsification. Since 1985, the Regional Pharmacovigilance Centres have received about 341 reports of undesirable effects due to herbal medicines: among them 30 cases of hepatitis were reported associated with germander which has been now withdrawn from the French market. This example well illustrates the role of the national system and its responsibility for collecting and evaluating ADRs due to herbal medicines.

Vitamin D metabolism in psoriasis before and after phototherapy.

Epidermis plays a major role in vitamin D synthesis and is a target tissue for 1,25 (OH)2 vitamin D, which could be involved in abnormal proliferation and differentiation of psoriatic keratinocytes. We investigated plasma calcium, phosphorus, alkaline phosphatases, parathyroid hormone, 25 (OH) D, 24,25 (OH)2 D and 1,25 (OH)2 D in 15 control subjects and 20 psoriatic patients before and after 3 weeks of phototherapy (UVB or PUVA). Before irradiation, all parameters were similar in psoriatics and controls, except for serum phosphorus (lower in psoriasis p less than 0.01). After phototherapy, P rose to normal values in psoriatic patients; 25 (OH) D and 24,25 (OH)2 D were dramatically increased by UVB (but not by PUVA) in psoriatic patients as well as in controls; 1,25 (OH)2 D was unmodified in controls but was significantly increased in psoriasis. Since 1,25 (OH)2 D has been reported to be an effective treatment for psoriasis, the UV-induced increase in 1,25 (OH)2 D could account for the beneficial effect of phototherapy in psoriasis.

Neutrophil chemotaxis in psoriasis before and after PUVA therapy.

Chemokinesis and chemotaxis of neutrophil leucocytes were studied by migration under agarose in 35 patients with psoriasis and compared with 35 healthy controls. Eschericheae coli filtrate and lipopolysaccharide were used as chemo-attractants. Of these patients, 14 were tested before and after photochemotherapy. The chemotactic capacities of psoriatic serum before and after PUVA therapy were also investigated. The increase in the chemotactic activity of psoriatic polymorphonuclear leucocytes (PMNs) was not significant and remained unchanged after PUVA therapy. The activated psoriatic serum showed a slight increase in chemotactic activity when compared with normal activated serum. These results do not support an intrinsic abnormality of psoriatic PMNs, and their migration into psoriatic lesions could be chiefly due to the presence of chemotactic factors in involved epidermis.

[Further observations on the presence of iron in the articuler synovial membrane]. / Secondes vues sur la présence de fer dans la synoviale articulaire

In 1971, a study of 66 synovial biopsy samples indicated that the presence of ferric deposits in the subintimal synovial tissue was of real semiological value in the diagnosis of rheumatoid synovitis. In 1975, a study of 228 synovial biopsy samples led the authors to reconsider this finding: the presence of ferric deposits in the subintimal synovial tissue was far from being a constant feature in rheumatoid synovitis and it was seen with similar frequency in other forms of chronic inflammatory rheumatism and also in several other joint conditions. The origin of the synovial iron and the influence it may have on the development of the rheumatoid processes remain obscure.