[Alcohol and the skin]. / L'alcool et la peau.

Cutaneous manifestations related to alcohol intake and abuse are various. Most frequently, there are vascular lesions and cutaneous alterations secondary to hepatic dysfunction. Alcohol consumption represents also a risk factor for many cutaneous diseases, such as psoriasis, where its prevalence is high. Other cutaneous complications associated with alcohol are also discussed.

Les manifestations cutanées en relation avec la consommation et l'abus d'alcool sont multiples. Il s'agit essentiellement de manifestations vasculaires et de signes cutanés en relation avec l'atteinte hépatique. La consommation d'alcool constitue, par ailleurs, un facteur aggravant de plusieurs maladies cutanées. C'est notamment le cas pour le psoriasis, dont la prévalence est plus élevée. D'autres répercussions cutanées, en relation avec la prise d'alcool, sont également discutées.

[The major SCAR syndromes]. / Les syndromes SCAR majeurs.

Some drug eruptions are frequent and follow an indolent course, while others prove to be life-threatening. By contrast, SCAR syndromes are serious skin drug reactions that are rare but their vital prognosis is affected. The three distinct entities of importance are the former Lyell's syndrome, now identified as SJS-TEN syndrome (Stevens-Johnson syndrome/toxic epidermal necrolysis), the DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), and the AGEP syndrome (acute generalized exanthematous pustulosis).

Certaines toxidermies sont fréquentes et ont un décours indolent, alors que d'autres grèvent de manière sévère le pronostic vital. En revanche, les syndromes SCAR sont des toxidermies médicamenteuses graves qui sont rares, mais dont le pronostic vital est réservé. Ils concernent trois entités distinctes qui sont l'ancien syndrome de Lyell, actuellement identifié comme SJS-NET (syndrome de Stevens-Johnson/nécrolyse épidermique toxique), le syndrome DRESS (drug reaction with eosinophilia and systemic symptoms) et le syndrome AGEP (acute generalized exanthematous pustulosis).

[The Mosan Study Group of Pigmented Tumours facing toward the oligometastatic cutaneous melanoma]. / Le Groupe Mosan d'étude des Tumeurs Pigmentaires face au mélanome cutané oligométastatique.

The oligometastatic melanoma is a peculiar stage of cancer progression which is initially restricted to the initial body area. In most instances, only a small number of metastases are simultaneously present. The oligometastatic stage is synchronous when metastases are disclosed at the time of initial diagnosis of the primary cancer. Metastases are metachronous when they are detected after the initial treatment of the primary neoplasm. A variant of the disease is called the smouldering disease when cutaneous metastases grow or regress in unison. The smouldering disease is granted to a condition when some metastases keep grooving when other metastases regress.

Le mélanome oligométastatique est un mode particulier de progression cancéreuse qui se cantonne initialement au territoire de drainage lymphatique du site du cancer primitif. Dans la majorité des cas, un très petit nombre de métastases seraient présentes simultanément. Le stade oligométastatique est synchrone lorsque les métastases sont découvertes au moment du diagnostic initial du cancer primitif. Les métastases sont dites métachrones lorsqu'elles surviennent après traitement initial. Une variante de ce processus, décrite sous le nom de maladie couveuse ou «smouldering disease¼, concerne des lésions métastatiques cutanées qui grandissent et régressent de concert sur ce même territoire.

[Erythema nodosum : a panniculitis of diverse origins]. / L'érythème noueux, une hypodermite aux origines diverses.

Erythema nodosum is an acute nodular panniculitis, mainly affecting young women. Diverse etiologies are evoked, but the most frequent are sarcoidosis (Löfgren syndrome), streptococcal infections, yersiniosis and inflammatory enteropathies. Antalgic drugs and rest are usually adequate in this condition, which is spontaneously of favourable evolution. Treatment of the cause is open to discussion, considering their lack of effect on the evolution of erythema nodosum.

L'érythème noueux est une hypodermite nodulaire aiguë atteignant principalement la femme jeune. Ses racines biologiques sont diverses, mais le tableau étiologique est dominé par la sarcoïdose (syndrome de Löfgren), des infections streptococciques, la yersiniose digestive et des entéropathies inflammatoires. Antalgiques et repos au lit sont habituellement suffisants pour contrôler cette affection d'évolution spontanément favorable. Le traitement de la cause est à discuter en fonction de chaque cas, en sachant qu'il sera sans effet sur l'évolution de l'érythème noueux.

[Skin carcinogenesis in renal transplant recipients]. / La cancérogenèse dans la peau de patients transplantés rénaux.

Organ transplants are bound to the induction and upkeep of immunosuppression. The immunomodulatory regimen modalities have changed over time with an improvement of the overage graft survival. The effects are also present on the skin and its cancerogenesis which is particularly activated for the squamous cell carcinoma. A review of the recent medical literature reveals the importance of searching squamous cell carcinomas, actinic keratoses, seborrheic keratoses and keratocanthomas before and after organ transplants. The severity of the carcinomas is due to their multiplicity and to the progressive occurrence of more aggressive lesions. Prevention relies on a strict adherence to sun protection after transplantation and on refined immunosuppressive strategies.

Toute greffe d'organe s'accompagne de l'induction et de l'entretien d'un état d'immunosuppression. Les modalités des traitements immunosuppresseurs ont évolué au cours du temps avec une amélioration de la survie des greffons. Les effets se marquent aussi au niveau de la peau et de sa cancérogenèse qui est particulièrement active pour le carcinome spinocellulaire. Un survol de la littérature médicale récente semble indiquer l'importance de répertorier les carcinomes spinocellulaires, les kératoses actiniques, les kératoses séborrhéiques et les kératoacanthomes avant et dans le suivi d'une greffe. La gravité des carcinomes tient à leur multiplicité et à la survenue progressive de lésions biologiquement plus agressives. La prévention des lésions repose sur une protection solaire stricte dès la transplantation et sur l'adoption de stratégies immunosuppressives adaptées.

[How I treat... minor superficial wounds]. / COMMENT JE TRAITE ... des plaies mineures superficielles.

Superficial minor wounds represent frequent events in daily practice. Their evolution is often favourable and without any mishap. However, they possibly evolve to some serious episodes. Normal healing develops in three successive phases. They correspond to the inflammatory, proliferative and remodeling phases, respectively. Their treatments are distinct. The major active agents are cleaning products, antiseptics, corticosteroids and silicone gels. By contrast products claiming some healing properties are disappointing in most cases, and in some instances, they are of no use.

[INABILITY TO TOLERATE COSMETICS]. / INTOLÉRANCE AUX COSMÉTIQUES.

Inability to tolerate cosmetics can result from distinct mechanisms which appear as the so-called sensitive skin corresponding to one aspect of invisible dermatosis, or which corresponds to manifestations of a contact allergic or irritation dermatitis.

[How I treat... psoriasis using step procedures]. / COMMENT JE TRAITE ... un psoriasis par paliers progressifs.

Psoriasis is a multifactorial disease characterized by a cutaneous involvement possibly associated with various comorbidities. The disease associates some qualitative abnormal epidermal proliferation and immune alterations expressed by the presence of a dermal inflammatory infiltrate with neutrophil exocytosis. The hereditary aspect is well-documented and various susceptibility loci have been described on several chromosomes. The treatment relies on an eventual identifiable cause, and on the severity of the cutaneous involvement, as well as the presence of various comorbidities. The disease associates some qualitative abnormal epidermal proliferation, and an inflammatory cell infiltrate with neutrophil exocytosis. The treatment relies on a possible identifiable cause, and on the severity of the cutaneous involvement, as well as on a set of various comorbidities. Since some decades, psoriasis treatment follows a progressive step procedure. Liminar procedures rely on emollient applications. The next topical treatments concern dermocorticoids, vitamine D derivatives, calcineurin inhibitors and tars. The next step turns to photo(chemo)therapy using PUVA or UVB. In a further step, systemic treatments following oral intake include metharexate and ciclosporin. In severe cases resistant to treatments, biotherapies represent a hope for improving or even clearing the lesions. The stream of the current treatments has considerably reformed the psoriatic management over the long age.

[HOW I EXPLORE... SKIN COMPLEXION BY ANALYTICAL APPROACH]. / COMMENT J'EXPLORE ... la carnation de la peau par une approche analytique.

Skin colour is important for interindividual relationships considerations, as well as for the assessment of some physiopathological aspects. Its subjective assessments varies among observers and according to light. By contrast, an objective approach, both qualitative and quantitative by analytical measurements, has been available for some years. Its application in routine clinical settings is possible. The aspects are dependent on the incident light wavelengths. Accordingly, a series of skin diseases, but also ictera, uremia, anemia and hemochromatosis are possibly assessed in the field of internal medecine according to variations of skin colors.

[Toxic epidermal necrolysis (Lyell syndrome), a lifethreatening emergency of introgenic origin]. / La nécrolyse épidermique toxique (syndrome de Lyell). Une urgence dramatique d'origine médicamenteuse.

Cutaneous drug eruptions are frequently encoun¬tered. Their putative diagnosis is based on a set of imputability arguments. The histopathological aspect is often suggestive of the dermatosis nature, and varies according to the type of drug reaction. Some drug eruptions follow a benign course, but others including the toxic epidermal necrolysis are severe and life-threatening. It corresponds to a dermatological emer¬gency to be managed in a specialized burn unit.

Les toxidermies sont des réactions médicamenteuses cutanées indésirables. Elles représentent des pathologies fré¬quentes dont le diagnostic de présomption est fondé sur un faisceau d'arguments structurés. L'aspect histopathologique est souvent évocateur, et il est diversifié en fonction de la nature de la toxidermie. Certaines toxidermies ont un décours indolent et d'autres, comme la nécrolyse épidermique toxique, grèvent de manière sévère le pronostic vital. Il s'agit d'une urgence dermatologique à prendre en charge dans une unité de soins spécialisée pour les grands brûlés.

[How I explore scalp and hairin erythemato-squamous disorders]. / Comment j'explore le scalp et la chevelure au cours de dermatoses érythémato-squameuses.

In their early stages, some dermatoses of the scalp such as psoriasis seborrheic dermatitis, tinea capitis and discoid lupus erythematosus are often hardly noticeable to others. However, the eruptions are occasionally severe and extensive. Reaching an adequate diagnosis is of utmost impor¬tance for an adequate healthcare.

A leurs débuts, certaines dermatoses du cuir chevelu telles que le psoriasis, la dermite séborrhéique, une teigne ou le lupus érythémateux discoïde, sont souvent peu discernables par l'entourage. Cependant, ces éruptions sont occasionnelle¬ment sévères et extensives. Obtenir un diagnostic de certitude est un objectif majeur pour une prise en charge adéquate.

[How I explore . HLA class II by ultrastructure in toxic epidermal necrolysis]. / Comment j'explore les HLA de classe II par ultrastructure dans la nécrolyse épidermique toxique.

Toxic epidermal necrolysis (TEN, Lyell syndrome) is a severe paroxystic drug reaction whose inductive mechanisms remain poorly understood. The HLA glycoproteins are possibly involved in the disease process. Such investigations rely on biomolecular methods, and suggest specific interactions between some drugs or their metabolites and some HLA groups according to ethnicity of the TEN patients. Electron microscopy following the immunogold method for revealing HLA-DR did not disclose any evidence for distinguishing distinct patterns on Langerhans cell membrane between the initial and the resolution phases of TEN.

La nécrolyse épidermique toxique (NET, syndrome de Lyell) est une toxidermie paroxystique grave dont les mécanismes inducteurs restent mal élucidés. Les glycoprotéines HLA ont été potentiellement impliquées dans ce processus. Leur étude a bénéficié des méthodes biomoléculaires qui suggèrent des interactions spécifiques entre certains médicaments ou leurs métabolites et certains HLA en fonction du groupe ethnique du patient atteint de NET. La microscopie électronique, par la méthode «immunogold¼ afin d'évaluer les HLA-DR, n'a pas révélé de différences notoires dans leur distribution sur la paroi de cellules de Langerhans entre la phase initiale et celle de résolution de 5 cas de NET.

[GAZING INTO A CRYSTAL BALL AND DETECTING SUBJECTS AT RISK FOR DEVELOPING CUTANEOUS MELANOMA]. / REGARDER DANS UNE BOULE DE CRISTAL ET DÉPISTER DES SUJETS À RISQUE POUR LE MÉLANOME CUTANÉ.

Cutaneous melanoma is the deadliest skin cancer showing an increasingly growing incidence in white populations of Europe and United States. Intensive research in recent years has begun to unlock its molecular pathogenesis. Screening the neoplasm at an early stage remains primordial. Hence, targeting populations at risk is likely efficient. In such an attempt, the regular clinical examination benefits from a series of non invasive procedures such as skin surface biopsies, in vivo confocal microscopy, dermoscopy and specular fluorescent light reflectance.

[SPORADIC SKIN MELANOMA BEYOND ITS NORMATIVE CLASSIFICATION. PLEA CONSIDERING ITS EVOLUTIVE CHARACTERISTICS]. / LE MÉLANOME CUTANÉ SPORADIQUE AU-DELÀ DE SA CLASSIFICATION NORMATIVE. Plaidoyer prenant en compte son particularisme évolutif.

For aeons, cutaneous sporadic melanoma, exhibiting either a slow or rapid growth rate, is identified using a set of well defined histopathological criteria. Such diagnostic step is greatly appreciated, and it brings a rough estimate of the probable evolution of the cancer. Some additional assessments try to improve the progressive prognosis of cutaneous melanoma. In this scope, fractals and spectral analyses expect to better perceive the individual progressive characteristics of each tumor. The extent in the tumoral germinative compartment and the peritumoral microvascular network are explored and should in a near future make clear the progressive potential of cutaneous melanoma. The posible tumoral regression and the immune reaction should be better perceived.

[EHLERS-DANLOS SYNDROME OF THE HYPERMOBILE TYPE: A MULTISYSTEMIC DISORDER. CONTRIBUTION OF SKIN ULTRASTRUCTURE TO INDIVIDUAL MANAGEMENT]. / SYNDROME D'EHLERS-DANLOS DE TYPE HYPERMOBILE : UNE ATTEINTE MULTI-SYSTÉMIQUE. Apport de l'ultrastructure cutanée pour une prise en charge personnalisée.

Ehlers-Danlos syndrome (EDS) represents a heterogeneous group of disorders of the connective tissue structure. Currently, several types are distinguished following a limited set of clinical signs and genetic mutations. However, there is a lack of specificity of most recognized genetic alterations with the current clinical typing. In addition, the criteria from dermatopathology, ultrastructure and biomechanics are not considered. In addition, the established EDS frontiers are hazardous because a series of anatomo-clinical signs are not considered in the classical EDS concept. The hypermobile type EDS represents an example of the diagnostic uncertainties. It results that guidelines based on evidence-based medicine cannot be established. Only an individual management can be offered to the concerned patients.

[How I explore ... the cheetah-look of the skin under selected light wavelengths]. / Comment j'explore ... le "cheetah-look". Regard sur la peau sous des longueurs d'ondes particulières de la lumière.

The melanotic facial pigmentation of each individual is frequently heterogeneous, even when this condition remains imperceptible under natural ambient light. However, with aging, this aspect may appear to everybody. The melanin heterochromia has various origins including ethnicity, the hormonal impact, the influence of various inflammatory, toxic and drug-induced disorders, as well as the impact of photoaging. The cheetah-look aspect is thus established and well identified under ultraviolet light or using an ingenious trick selecting some wavelengths of visible light.

[Hair and their environment]. / Les cheveux et leur environnement.

Hair is influenced by the effects of the daily environment. Some toxic xenobiotics slow down or block the cell renewal of the hair matrix, thus inhibiting hair growth. The ultraviolet light obviously influences the physical structure and physiology of the hair follicle. Tobacco is similarly responsible for negative influences on the evolution of various alopecias. Several cosmetic procedures for maintaining and making hair more attractive are not always harmless, and they occasionally represent a possible origin for alopecia.

[How I treat... onychomycosis by topical therapy]. / Comment je traite... une onychomycose par voie topique.

Onychomycosis is a frequent and challenging disease to treat. Well conducted oral therapies are commonly quite effective for a short term period. However, recurrences are frequent. Topical therapies appear globally less active. Studies in this field are rare, although the promotional advertisements to the general public abound nowadays. Various microscopic fungi (dermatophytes, yeasts, molds) should be targeted by the treatment, In addition, the distinct activity conditions of both growth and quiescence of the pathogen fungi should be influenced by the treatments. This is not frequently considered by drug companies and encountered in practice. The antifungal drug penetration inside all the nail layers is important to be performed.