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1.
Artigo em Inglês | MEDLINE | ID: mdl-37042810

RESUMO

BACKGROUND: Checkpoint inhibitors provide an effective approach for the melanoma treatment. They prolong lymphocyte effects, which explains the cytotoxicity underlying immune-related adverse events (IrAEs). Cutaneous IrAEs affect nearly 40% of PD-1i and 50% of CTLA4i-treated patients. Severe cutaneous irAE do not often occur but could be life-threatening and may persist despite treatment discontinuation. METHODS: We aimed to investigate cutaneous IrAEs in a cohort of patients treated with ICI across Europe in an effort to characterize the reactions in a real-world, phase IV, post-marketing study using a follow-up questionnaire. Data since November 2016 until March 2021 were obtained from the Melskintox database, a European multicentric biobank dedicated to the follow-up of melanoma and cutaneous adverse events, supported by EADO. The dermatoses reported were pooled into four categories: inflammatory dermatosis, bullous diseases, drug-related eruptions and pigmentary diseases. RESULTS: Inflammatory benign dermatoses (n = 63) represented the most common group of reactions (52.5%), followed by drug-related eruptions (n = 24, 20%), pigmentary diseases (n = 23, 19.2%) and bullous diseases (n = 10, 8.3%). Grade II (n = 41, 34.2%) are represented by bullous pemphigoid, eczema, hypodermitis, lichenoid eruption, maculopapular rash, pruritus, psoriasis-like rash, urticarial eruption and vitiligo. Grade III (n = 18, 15.0%) are represented by bullous pemphigoid, lichenoid eruption and rashes. Grade IV (n = 2, 1.7%) is only represented by bullous disease. Most cutaneous IrAEs led to immunotherapy continuation (n = 95, 88.0%). CR is associated with more severe the cutaneous irAEs. We report an average time-to-onset of 208 days and some late-onset events. CONCLUSION: Our study has characterized the clinical spectrum of cutaneous irAEs, their timing and severity and their relationship with tumour response. Grade I-II cutaneous IrAE are easily managed allowing ongoing anticancer treatment. Severe late-onset cutaneous irAE are not uncommon. A dermatological follow-up helps mitigate the risk of life-threatening adverse events. These findings highlight the importance of oncodermatological involvement in management of patients with melanoma receiving immunotherapy.

2.
J Cosmet Laser Ther ; 25(5-8): 77-85, 2023 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-38373440

RESUMO

Facial and neckline telangiectasias have an underestimated yet important impact on quality of life of patients with systemic scleroderma (SSc). This monocentric, prospective, open-label, intra-patient comparative study was conducted in 21 consecutive patients with SSc. Patients underwent 4 sessions of PDL 8 weeks apart. A final quadruple assessment was performed by several raters 2 months after the last session, based on the following criteria: change in telangiectasia number; subjective improvement score (LINKERT scale); impact on the quality of life (QoL; SKINDEX score); visual analog pain scale; adverse effects (AEs), including treatment discontinuation for PDL-induced purpura and patient satisfaction. The mean telangiectasia number decreased by 5 (32%) at the end of the protocol. Eighteen patients (85.7%) reported an improvement or a strong improvement, versus 73.81% for the expert committee. Immediate session pain (mean = 3.4/10) was slightly less than overall pain (mean = 4.6/10). Ten patients (47%) experienced at least one AE (oozing/crusts, edema, epidermal blistering), including PDL-induced purpura in 3 patients (14%). AEs were mostly transient (<1 week) and mild (CTCAE grade 1). All QoL parameters improved after treatment, and 85% of patients were satisfied.


Assuntos
Lasers de Corante , Púrpura , Escleroderma Sistêmico , Telangiectasia , Humanos , Lasers de Corante/efeitos adversos , Dor , Estudos Prospectivos , Qualidade de Vida , Escleroderma Sistêmico/complicações , Telangiectasia/etiologia , Telangiectasia/terapia , Resultado do Tratamento
3.
Ann Dermatol Venereol ; 150(3): 173-179, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37263865

RESUMO

AIMS: The primary objective was to study long-term outcomes in children with idiopathic facial aseptic granuloma (IFAG). The secondary objectives were to describe the clinical polymorphism of this entity, the different therapeutic options, and the occurrence of rosacea in this population. METHODS: We selected patients with a clinical diagnosis of IFAG seen in two different hospitals in Normandy between March 2016 and February 2021, and we collected clinical and therapeutic data from computerized medical records. A remote consultation based on recent photographs was performed to collect new data, and the children's parents were asked to complete a questionnaire between February and August 2021. RESULTS: Ten children were included in this study. Nine patients presented with a single red to purplish nodule. One patient presented multiple papulopustular plaques. IFAG healed spontaneously without major sequelae, and this outcome was not influenced by any treatments. During follow-up, two patients developed childhood rosacea. CONCLUSION: Although some clinical heterogeneity exists, early diagnosis and follow-up of IFAG is necessary to avoid unnecessary topical or systemic antibiotic treatments that do not shorten the disease course. IFAG appears to be a possible mode of entry for infantile rosacea.


Assuntos
Doenças do Tecido Conjuntivo , Rosácea , Humanos , Criança , Seguimentos , Administração Cutânea , Antibacterianos/uso terapêutico , Progressão da Doença , Rosácea/complicações , Rosácea/diagnóstico , Rosácea/terapia
4.
Clin Exp Dermatol ; 46(5): 874-879, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33639007

RESUMO

Although biofield therapy is unexplained by scientific evidence, it has been practised for many years in numerous cultures for a variety of medical conditions. This study aimed to determine whether one session of biofield therapy with an experienced practitioner could treat warts on the hands and feet in adults. A single-blind, assessor-blind, placebo-controlled, randomized trial was performed between April 2016 and November 2018. The enrolled participants had at least one wart on the hand or foot that had been present for at least 90 days and they were not using any other therapy for the wart. The primary outcome of this trial was the disappearance of the original wart 3 weeks after session of proximal nontouch biofield therapy vs. a sham session. No original wart had disappeared 3 weeks after intervention (0/64), which made the study impossible to conclude on the primary objective. There were no significant differences between the two groups concerning wart disappearance 3 weeks (P = 0.49) or 6 weeks (P = 0.40) after the intervention. Reduction in wart size at Week 3 tended towards a better result for biofield therapy but this was not significant (P = 0.27). No related adverse effects were observed. The major limitation of this trial was the short follow-up time for measurement of clinical outcome, which did not allow verification of the hypothesis. However, this study shows that 3 weeks after a session of proximal nontouch biofield therapy is an insufficient length of time to assess biofield therapy in comparison with a sham session. Based on this study, biofield therapy cannot be recommended to treat warts within 3 weeks.


Assuntos
Toque Terapêutico/efeitos adversos , Toque Terapêutico/estatística & dados numéricos , Verrugas/terapia , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Pé/patologia , Mãos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Efeito Placebo , Método Simples-Cego , Toque Terapêutico/métodos , Verrugas/diagnóstico
5.
Ann Dermatol Venereol ; 148(1): 40-44, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32819743

RESUMO

INTRODUCTION: Microfat grafting is a well-known technique that is underutilized in dermatology. Instead of removing sclerotic tissue, microfat grafting preserves the tissue and uses stem cells for remodeling its structure into normal tissue. We performed a retrospective study of patients treated with microfat grafting for sclerotic and atrophic skin lesions and scars. PATIENTS AND METHODS: Seventy-two microfat grafts were performed using the Magalon technique under general anaesthesia for the treatment of sclerotic and atrophic skin lesions. We performed grafts for different indications, such as scars (n=55) and sclerotic and atrophic skin lesions (n=17: Parry-Romberg syndrome, morphea). The main outcome was assessed for satisfaction during follow-up. In addition, an independent committee judged the results based on photographs. RESULTS: Satisfaction levels (e.g. results were judged to be "good") were almost 91% (n=50/55) for scars and 100% (n=17/17) for atrophic and sclerotic skin lesions. Satisfaction levels according to the independent committee were 94.1% for sclerotic and atrophic lesions and nearly 51% for scars. CONCLUSION: Satisfaction was high after microfat grafting for atrophic and sclerotic skin lesions. Microfat grafting enabled restoration of the skin texture by exploiting stem cell properties. It is an efficient dermatological therapy for sclerotic and atrophic lesions, for which there are few alternative treatments.


Assuntos
Procedimentos de Cirurgia Plástica , Esclerodermia Localizada , Tecido Adiposo , Cicatriz/cirurgia , Humanos , Estudos Retrospectivos , Esclerodermia Localizada/cirurgia , Resultado do Tratamento
6.
Ann Dermatol Venereol ; 147(8-9): 535-541, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32653219

RESUMO

BACKGROUND: Retinoids are widely used in dermatology. Adverse effects are frequent and require clinical and laboratory monitoring. Herein we report the case of a patient with secondary capillary leak syndrome (SCLS) associated with acitretin. We then present a review of the literature on systemic retinoids and SFCS. PATIENTS AND METHODS: A 57-year-old patient consulted following the onset of severe type I pityriasis rubra pilaris. Treatment was initiated comprising topical corticosteroids combined with acitretin at a dose of 0.5mg/kg/day. On the eighth day, voluminous edema appeared, accompanied by weight gain of 8kg in 48h and hypotension. The laboratory assessment showed hypoalbuminemia and hemoconcentration. Acitretin-induced SCLS was diagnosed based on the triple signs of hemoconcentration, hypoalbuminemia and hypotension, as well as rapid improvement following discontinuation of acitretin. DISCUSSION: We collected 7 published clinical cases between 1981 and 2018, including our own case report. Retinoids were indicated only in severe cutaneous diseases. The mean time to onset of SLCS is 9.8 days, with a return to normal 17 days after discontinuation of retinoids. Capillary leak syndrome is a rare and under-diagnosed clinical-laboratory syndrome that must be recognized in order to avoid potentially fatal inappropriate management. It is a rare adverse effect of retinoids used in dermatology and the pathophysiology remains unclear.


Assuntos
Acitretina/efeitos adversos , Síndrome de Vazamento Capilar/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade
7.
Ann Dermatol Venereol ; 147(11): 769-774, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32466850

RESUMO

INTRODUCTION: Self-healing juvenile cutaneous mucinosis (SHJCM) is a stereotypical disease in children characterized by the acute onset of subcutaneous papules and nodules on the face, dorsum of the hands and peri-articular regions that disappear spontaneously within a few months or years. A few cases have been reported in adults, but these display more heterogeneous clinical and histopathological features. Herein we report a case with a juvenile clinical presentation in an adult woman. OBSERVATION: A 36-year-old patient with a history of Von Willebrand disease was referred to our dermatology department following the rapid development of subcutaneous nodules on her face, hands and large joints, together with periorbital edema. Three nodules were surgically removed and histology demonstrated mucin deposition in the dermis with dissociation of collagen fibers. Autoimmune disease, neoplasia, infection and dysthyroidism were ruled out. Bilateral carpal tunnel syndrome was confirmed by electromyogram in this patient carrying out manual work. Treatment with hydroxychloroquine proved unfruitful. After 1.5 years of follow-up, her lesions showed partial regression. CONCLUSION: The form of SHJCM described in pediatric populations may occur in rare cases in adults. Should the name of juvenile mucinosis still be used in this event?


Assuntos
Mucinoses , Neoplasias Cutâneas , Adulto , Criança , Feminino , Mãos , Humanos , Mucinoses/diagnóstico , Remissão Espontânea , Pele
8.
Ann Dermatol Venereol ; 146(8-9): 542-549, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31320185

RESUMO

INTRODUCTION: Genital intraepithelial neoplasias (IEN) are precursors of squamous cell carcinoma. The ideal treatment must be efficacious, conservative and well-tolerated. CO2 laser is one of the recommended therapies, but its efficacy and safety have not been extensively studied. PATIENTS AND METHODS: This was a retrospective single-center study. Sixteen patients (8 women and 8 men) treated with CO2 laser for genital IEN, whether high-grade or differentiated, were included. Surgical lateral margins of 3 to 5mm were taken macroscopically during treatment. The CO2 laser session, assessment of therapeutic response and follow-up were undertaken by a dermatologist at the University Hospital of Caen. RESULTS: The mean patient age was 68.1 years and mean follow-up was 52.7 months (5-130). Lesions were isolated in 87.5% of patients. The recurrence rates of genital intraepithelial neoplasia after CO2 laser treatment were 58% for women and 40% for men. No impact on quality of life or on sexual activity was reported in over 90% of patients. CONCLUSION: Whatever the treatment recommended for intraepithelial neoplasia, recurrence is frequent. CO2 laser is an effective and well-tolerated conservative therapeutic option. It enables rapid clinical remission, but as with all currently available treatments, long-term dermatologic follow-up remains necessary.


Assuntos
Carcinoma in Situ/cirurgia , Neoplasias dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Masculinos/cirurgia , Lasers de Gás/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
9.
Ann Dermatol Venereol ; 146(12): 793-800, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31648848

RESUMO

BACKGROUND: Drug addiction causes chronic wounds (CW) responsible for severe complications. Very few studies are available on this topic. The aim of our study was to describe the demographic, clinical and etiological characteristics as well as the course of CW in drug addicts. PATIENTS AND METHODS: This was a retrospective and prospective multicenter study including all drug addicts with CW. RESULTS: We included 58 patients (17 prospectively), 84.5% of whom were male, of median age 43 years, presenting multiple CW as a result of intravenous (78.2%), inhaled (41.1%) and/or snorted (20%) drug abuse. Addiction to opioids (68.4%), cocaine (47.4%) and/or cannabis (40.4%) was ended and/or treated through substitution in 79.3% of patients. CW were fibrinous and necrotic (42.9 to 53.6%), recurrent (54.2%), and in some cases had been present for more than 1 year (61.5%). Intravenous drug addiction was associated with large, fibrinous, ulcers in a setting of venous and lymphatic insufficiency (74%). Only 23% of these wounds involved the upper limbs. Necrotic ulcers associated with clinical arteriopathy were described mainly with inhaled addiction. Abscesses (50%) and erysipelas (29.3%) were the most common cutaneous complications. After 3 months, 50% of CW were improved and 29.2% of patients were lost to follow-up. DISCUSSION: Drug abuse-related CW occurred preferentially in young men with history of intravenous abuse. For the most part, CW were seen on the legs and were associated with venous and lymphatic insufficiency, and the resulting major risk for cutaneous infection increased morbidity and mortality in this population in whom medical follow-up is inherently complicated.


Assuntos
Abscesso/etiologia , Erisipela/etiologia , Úlcera Cutânea/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Insuficiência Venosa/etiologia
10.
Ann Dermatol Venereol ; 145(10): 593-597, 2018 Oct.
Artigo em Francês | MEDLINE | ID: mdl-30093076

RESUMO

BACKGROUND: Contiguous skin inflammation is a poorly described entity. It constitutes a cutaneous manifestation of an underlying ongoing process (infectious, inflammatory or neoplastic). Sinusitis is a known cause. PATIENTS AND METHODS: We report the case of a 70-year-old patient consulting for an ongoing centrofacial inflammatory plaque. Cutaneous biopsy revealed a polymorphic inflammatory infiltrate, and cutaneous microbiological specimens were negative. A facial CT-scan showed left maxillary sinusitis. Intra-sinus samples obtained at surgery showed aspergillus. Voriconazole combined with maxillary sinus surgery resulted in healing of the facial plaque. DISCUSSION: There have been only two published cases of contiguous skin inflammation related to sinusitis but no reported cases caused by aspergillus sinusitis. Herein we report the third case of contiguous skin inflammation associated with sinusitis, which is also the first related to aspergillus sinusitis.


Assuntos
Aspergilose/complicações , Eritema/etiologia , Dermatoses Faciais/etiologia , Sinusite Maxilar/complicações , Idoso , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/patologia , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/patologia , Humanos , Inflamação , Linfoma/diagnóstico , Masculino , Sinusite Maxilar/tratamento farmacológico , Sinusite Maxilar/cirurgia , Sarcoidose/diagnóstico , Dermatopatias Infecciosas/diagnóstico , Voriconazol/uso terapêutico
11.
Dermatology ; 233(2-3): 234-241, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28746927

RESUMO

BACKGROUND: Adipose tissue is an abundant source of mesenchymal stem cells, called adipose-derived stem cells, which have anti-inflammatory and trophic effects to enhance overall tissue repair. OBJECTIVE: To determine the healing effects of autologous adipose tissue graft on hypertensive leg ulcers. METHODS: Prospective pilot study in 1 French dermatology department. Ten patients with a hypertensive leg ulcer were enrolled from April 2013 to June 2015. The primary end point was the wound closure rate at each follow-up visit. The secondary end points were wound characteristics, pain assessment and adverse events. RESULTS: One patient, the only smoker, was lost to follow-up at month 5 (M5). For the 9 non-smokers, wound surfaces constantly and significantly decreased: the median wound closure rate was 73.2% at M3 and 93.1% at M6, p < 0.001. The median wound closure rate of the 10 patients was 63.2% at M3, p < 0.001. Percentages of fibrin and necrosis decreased, granulation tissue increased significantly. Pain rapidly and significantly decreased. No recurrence or adverse event was observed. CONCLUSION: Our data suggest that autologous adipose tissue grafting induces pain relief and promotes wound healing with a good skin quality. Large prospective controlled randomized studies are required to confirm these results.


Assuntos
Tecido Adiposo/transplante , Úlcera da Perna/cirurgia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipertensão/complicações , Úlcera da Perna/etiologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Projetos Piloto , Estudos Prospectivos , Transplante Autólogo/efeitos adversos
12.
J Wound Care ; 26(7): 368-379, 2017 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-28704156

RESUMO

OBJECTIVE: We recently showed the superiority of a matrix metalloproteinase (MMP) modulating dressing (foam impregnated with NOSF, nano-oligosaccharide factor) compared with a lipidocolloid matrix (TLC) control dressing in median wound area reduction (WAR). Here we report the results from the same study assessing the performance and safety of TLC-NOSF in the local management of venous leg ulcers (VLUs) or mixed leg ulcers and determining its impact on the patient's health-related quality of life (HRQoL). METHOD: A superiority randomised double-blind controlled trial was conducted on patients presenting with a non-infected leg ulcer (VLUs or mixed leg ulcers) of predominantly venous origin (ABPI >0.8), with a surface area ranging from 5 to 50cm2 and a duration of 6 to 36 months. Patients were randomly allocated to either the TLC-NOSF matrix foam (UrgoStart) dressing group or to the neutral TLC foam dressing group (UrgoTul Absorb). All received appropriate compression therapy and the wounds were assessed blindly (clinical examination, wound area tracing and photographic record) every 2 weeks for a period of 8 weeks, or until complete closure. A secondary endpoint, described here, was the patient's HRQoL, documented by the patient, through the EuroQol 5D tool (EQ-5D) questionnaire and visual analogue scale (VAS). RESULTS: In total, 187 patients were randomised to either the TLC-NOSF group (n=94) or the control dressing group (n=93). The two groups were well balanced at baseline with regard to wound and patient characteristics. In the HRQoL questionnaire (EQ-5D), the pain/discomfort and anxiety/depression dimensions were significantly improved in the TLC-NOSF group versus the control one (pain/discomfort: 1.53±0.53 versus 1.74±0.65; p=0.022, and anxiety/depression: 1.35±0.53 versus 1.54±0.60, p=0.037). The VAS score was better in the test group compared with the control group (72.1±17.5 versus 67.3±18.7, respectively), without reaching significance (p=0.072). Acceptability and tolerance of the two products were similar in both groups. CONCLUSION: The double-blind clinical trial has demonstrated that the TLC-NOSF matrix dressing promotes faster healing of VLUs and mixed leg ulcers and significantly reduces the pain/discomfort and anxiety/depression experienced by the patients. These results suggest that acceleration of VLU healing could improve the HRQoL of the patients and reduced the emotional and social burden of these chronic wounds.


Assuntos
Bandagens , Nível de Saúde , Qualidade de Vida , Úlcera Varicosa/terapia , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Úlcera da Perna/metabolismo , Úlcera da Perna/terapia , Masculino , Metaloproteinases da Matriz/metabolismo , Pessoa de Meia-Idade , Úlcera Varicosa/metabolismo , Cicatrização
14.
Ann Dermatol Venereol ; 144(11): 700-704, 2017 Nov.
Artigo em Francês | MEDLINE | ID: mdl-28760502

RESUMO

BACKGROUND: Connective tissue nevus (CTN) is a rare condition of the extracellular matrix components that generally presents as papulae of normal skin colour. This condition may be syndromic or sporadic. PATIENTS AND METHODS: We report herein two isolated cases of extensive and infiltrative CTN in children at risk for subsequent joint stiffening. The pathology samples displayed respectively mixed hamartoma and a collagenoma. DISCUSSION: The onset of these lesions is often difficult to establish, since they are usually unnoticeable at first. When confronted with extensive CTN, the main differential diagnoses are eosinophilic fasciitis and morphea, and these must be ruled out by skin biopsy. CTN is associated with osteopoikilosis in Buschke-Ollendorf syndrome. Skeletal lesions are asymptomatic and are detected by means of iterative X-ray. Their management comprises symptomatic care.


Assuntos
Doenças do Colágeno/patologia , Síndromes Neoplásicas Hereditárias/patologia , Nevo/patologia , Neoplasias Cutâneas/patologia , Dorso , Pré-Escolar , Doenças do Colágeno/diagnóstico , Contratura/etiologia , Contratura/prevenção & controle , Diagnóstico Diferencial , Tecido Elástico/patologia , Eosinofilia/diagnóstico , Fasciite/diagnóstico , Feminino , Humanos , Joelho , Síndromes Neoplásicas Hereditárias/diagnóstico , Nevo/diagnóstico , Oxazinas , Esclerodermia Localizada/diagnóstico , Ombro , Neoplasias Cutâneas/diagnóstico , Coloração e Rotulagem
16.
Br J Dermatol ; 173(5): 1266-70, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26148205

RESUMO

Chronic active Epstein-Barr virus infection (CAEBV) is characterized by chronic infectious mononucleosis-like symptoms associated with very high viral load, as assessed by quantitative polymerase chain reaction. We present an unusual case in a French woman who was followed up over 25 years with cutaneous and sinus lymphoproliferation. This white woman presented with a long history of recurrent cutaneous necrotic papules of the skin, which started during childhood and healed spontaneously with depressed scars. The lesions spread to the left maxillary sinus and were associated with hepatomegaly and splenomegaly with no other visceral locations. Pathological examination of the skin and sinus revealed a dermal monoclonal T-cell lymphoproliferative disorder, CD7(+) and CD20(-) , with no epidermotropism. T-cell receptor rearrangement was positive, showing the monoclonality from the first biopsy. This T-cell proliferation was positive for EBV-encoded small RNA and was associated with a high EBV viral load. Since then, the patient has been in good health, despite a permanently high EBV viral load. Hydroa vacciniforme (HV)-like lymphoma and natural killer/T-cell lymphoma were discussed, but none really fit our case. Natural killer cell lymphoma was ruled out because of the indolent course, but sinus lesions do not exist in HV-like lymphoma. A therapeutic approach is difficult because of the coexistence of viral infection and monoclonal T-cell proliferation. Chemotherapy is not efficient and induces immunosuppression, which may worsen the prognosis. Although rituximab may have an immunomodulatory function, it was not effective in our case.


Assuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Transtornos Linfoproliferativos/diagnóstico , Neoplasias do Seio Maxilar/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Dermatopatias Virais/diagnóstico , Adulto , Doença Crônica , DNA Viral/metabolismo , Diagnóstico Diferencial , Doenças Palpebrais/diagnóstico , Dermatoses Faciais/diagnóstico , Feminino , Seguimentos , Dermatoses da Mão/diagnóstico , Humanos , Doenças Labiais/diagnóstico , Linfoma de Células T/diagnóstico , Necrose , Gravidez , Remissão Espontânea , Carga Viral/fisiologia , Latência Viral/fisiologia
20.
Ann Dermatol Venereol ; 142(2): 85-93, 2015 Feb.
Artigo em Francês | MEDLINE | ID: mdl-25596132

RESUMO

BACKGROUND: General practitioners and specialists often seek advice from dermatologists based on digital pictures. This time-consuming activity is currently not valued nor well-established. We therefore conducted a survey to assess the extent and nature of such requests. PATIENTS AND METHODS: A questionnaire was sent to dermatologists working either at university hospitals or in private practice in three regions of France (Loire Atlantique, Rhone Alpes and Normandy). For two months, the dermatologists completed the same questionnaire for each specialized request. The following items were recorded: status of the dermatologist asked to provide a specialized opinion, region in which the request was made, status of the requesting practitioner, mode of request, type of disease, question asked, time taken to answer the request and result of the specialized advice. RESULTS: Thirty dermatologists, including 11 in private practice, participated in this study. We identified 287 requests. The majority of these requests came from general practitioners (30%) and dermatologists working in private practice (29%). These requests were sent by e-mail using a non-secure professional e-mail address in 49% of cases or via smartphone in 29% of cases. The purpose of the requests was either diagnostic/therapeutic (36%) or solely therapeutic (39%). Relevant requests concerned dermatological manifestations in paediatric or cancer patients (23% and 21% respectively), general dermatological diseases (21%) and wound management (14%). Nearly half of the specialized advice was provided in under 5minutes, and in 60% of cases a consultation with a dermatologist was avoided. CONCLUSION: Despite the small number of physicians taking part in the study, this non-exhaustive survey confirms the usefulness of remote dermatological reviews and consultations, and identifies the main intervening physicians involved in this type of procedure. The study also raises potential medico-legal issues regarding the lack of data security covering medical information. There is thus a need for dermatologists to organize their activity in order to respond to such requests without exposing themselves to medico-legal consequences.


Assuntos
Dermatologia , Padrões de Prática Médica , Consulta Remota/estatística & dados numéricos , França , Humanos , Inquéritos e Questionários
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