Human papillomavirus 16-specific T cell responses in classic HPV-related vulvar intra-epithelial neoplasia. Determination of strongly immunogenic regions from E6 and E7 proteins.

Cell-mediated immunity directed against human papillomavirus 16 (HPV-16) antigens was studied in 16 patients affected with classic vulvar intra-epithelial neoplasia (VIN), also known as bowenoid papulosis (BP). Ten patients had blood lymphocyte proliferative T cell responses directed against E6/2 (14-34) and/or E6/4 (45-68) peptides, which were identified in the present study as immunodominant among HPV-16 E6 and E7 large peptides. Ex vivo enzyme-linked immunospot-interferon (IFN)-gamma assay was positive in three patients who had proliferative responses. Twelve months later, proliferative T cell responses remained detectable in only six women and the immunodominant antigens remained the E6/2 (14-34) and E6/4 (45-68) peptides. The latter large fragments of peptides contained many epitopes able to bind to at least seven human leucocyte antigen (HLA) class I molecules and were strong binders to seven HLA-DR class II molecules. In order to build a therapeutic anti-HPV-16 vaccine, E6/2 (14-34) and E6/4 (45-68) fragments thus appear to be good candidates to increase HPV-specific effector T lymphocyte responses and clear classic VIN (BP) disease lesions.

[Presenting skin disorders in black Afro-Caribbean patients: a multicentre study conducted in the Paris region]. / Motifs de consultation en dermatologie des sujets de peau noire d'origine africaine et antillaise: enquête multicentrique en région parisienne.

BACKGROUND: There have been few studies in France concerning the specific features of dermatological practice regarding dark skin (Fitzpatrick's phototype V and VI) or the special requirements of black African and Afro-Caribbean patients. AIM: To determine the principal reasons for dermatological consultation among black patients of African or Afro-Caribbean descent in the Paris region. METHODS: This was a prospective clinical study conducted between 15 February and 15 May 2004. The diagnoses of cutaneous conditions leading to dermatological consultation for all black patients of phototype V to VI were recorded by 10 dermatologists practicing in 14 centres within the Paris region. LIMITS: The method used did not allow any conclusions to be drawn regarding the incidence of the presenting conditions among the global population nor did it allow comparison between populations of different phototypes. The absence of any preset list of diagnoses or of precise inclusion criteria regarding evaluation of skin colour left individual investigators with a broad margin of interpretation. RESULTS: In 836 adults and 228 children (half of whom were from Africa and half from the West Indies), diagnoses were as follows: acne in 29.2% of adults and 13.2% in children, and eczema in 6.8% of adults and 27.2% of children. Among dermatoses more specific to black subjects, scalp conditions were frequently seen in both adults (alopecia 7% of diagnoses) and children (tinea capitis 9.6% and alopecia 3.6% of diagnoses). In at least 25% of cases, consultation was associated with dyschromia. Clinical signs suggesting the use of skin lightening products were seen in 95 patients. CONCLUSION: In France, as in other industrialized countries, black patients consult dermatologists essentially for common benign dermatoses also seen amongst white people. Nevertheless, it is important to emphasise the presence of skin problems specific to black patients such as dyschromia and pigmentary disorders, hair and scalp dermatoses, and side effects associated with the use of skin lightening products.

[Unusual cutaneous lesions of familial Mediterranean fever]. / Manifestations cutanées rares de la maladie périodique.

BACKGROUND: Familial mediterranean fever belongs to the periodic fever syndromes. During the attacks, fever is associated with abdominal pain, arthralgia, or both. Cutaneous involvement occurs in 7 to 46 p. 100 of cases and mainly consists in erysipelas-like erythema. We report on three patients treated for familial Mediterranean fever who developed unusual cutaneous lesions. OBSERVATIONS: All the patients had long past history of familial mediterranean fever without cutaneous involvement except, for the third patient who had pseudo-erysipela. The first patient had diffuse Sweet's syndrome-like lesions, the second developed long lasting panniculitis of the thigh and the third had a persistent and lichenified erysipela-like plaque. In two patients, skin histology revealed an inflammatory infiltrate with neutrophils. In all cases, an increase in the colchicine dose led to the rapid resolution of the lesions. DISCUSSION: In our 3 case reports, the lesions were particular because of their atypical clinical appearance, their long duration, and they differed from the usual pseudo-erysipela aspect. Histopathologically, the lesions were similar to pseudo-erysipela, which has led some authors to hypothesize that cutaneous lesions of familial mediterranean fever belong to neutrophilic dermatoses. This hypothesis is supported by the response to the increase in colchicine doses.

Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests.

OBJECTIVE: To assess, by means of meta-analysis techniques for diagnostic tests, the accuracy of dermoscopic (also known as dermatoscopy and epiluminescence microscopy) diagnosis of melanoma performed by experienced observers vs. naked-eye clinical examination. DATA SOURCES: MEDLINE, EMBASE, PASCAL-BIOMED, and BIUM databases were screened through May 31, 2000, without any language restrictions. STUDY SELECTION: Original studies were selected when the following criteria were met: spectrum of lesions well described, histologic findings as standard criterion, and calculated or calculable sensitivity and specificity. Eight of 672 retrieved references were retained. DATA EXTRACTION: Three investigators extracted data. In case of disagreement, consensus was obtained. Summary receiver operating characteristic curve analysis was used to describe the central tendency of the studies, and to compare dermoscopy and clinical examination. DATA SYNTHESIS: Selected studies represented 328 melanomas, mostly less than 0.76 mm thick, and 1865 mostly melanocytic benign pigmented skin lesions. For dermoscopic diagnosis of melanoma, the sensitivity and specificity ranges were 0.75 to 0.96 and 0.79 to 0.98, respectively. Dermoscopy had significantly higher discriminating power than clinical examination, with respective estimated odds ratios of 76 (95% confidence interval, 25-223) and 16 (95% confidence interval, 9-31) (P =.008), and respective estimated positive likelihood ratios of 9 (95% confidence interval, 5.6-19.0) and 3.7 (95% confidence interval, 2.8-5.3). The roles of the number of lesions analyzed, the percentage of melanoma lesions, the instrument used, and dermoscopic criteria used in each study could not be proved. CONCLUSION: For experienced users, dermoscopy is more accurate than clinical examination for the diagnosis of melanoma in a pigmented skin lesion.

[Impact of French consensus conference concerning the follow-up of patients surgically treated for stage I melanoma among French dermatologists and oncologists]. / Impact de la conférence de consensus sur le suivi des malades opérés de mélanome de stade I chez les dermatologues et cancérologues français.

INTRODUCTION: Our aim was to assess the impact of the 1995 French Consensus Conference (CC) on the follow up of patients surgically treated for WHO stage I (AJCC/UICC stages IA to IIB) melanoma, two years after the recommendations had been provided to French dermatologists and oncologists by direct mailing and literature. Prior to this CC, a study of French dematologists' intentions of practice and dermatologists and oncologists effective practices had revealed a lack of homogeneity and the prescription of many paraclinical tests. MATERIAL AND METHODS: In 1997, we sent a questionnaire similar to 1995's one to French dermatologists (3585 practitioners) and oncologists (686), with a pre-paid envelop for the response. The statistical analysis compared these results with those of 1995 for dermatologists, and the results for dermatologists and oncologists using chi(2) test. RESULTS: The response rate was 29 p. 100 for dermatologists, 15 p. 100 for oncologists. Only the number of dermatologists following patients in private practice was increased. Prescriptions of paraclinical tests by dermatologists during initial investigation as well as during follow up dramatically decreased (-30 p. 100 to -50 p. 100), mainly for thoracoabdominal and brain computerized tomography scans and biological tests, to a lesser extent for chest X-rays and abdominal ultrasonographies. Prescriptions of paraclinical tests were higher among oncologists. The frequency of clinical surveillance in 1997 was more often as recommended. Detection of a second melanoma in the patients and their family had improved. However, oncologists' intentions of practice complied less to the CC as compared to dermatologists. DISCUSSION: This study clearly showed an impact of the CC in French dermatologists' intentions of practice leading to both an improvement of patient follow up and a reduction in its cost. This impact was not as great among oncologists.

[Implication of French general practitioners in the follow-up of patients surgically treated for stage I melanoma]. / Implication des médecins généralistes dans le suivi des malades opérés de mélanome de stade I.

INTRODUCTION: Our aim was to assess the implication of French general practitioners in the follow up of patients surgically treated for stage I melanoma 2 years after the publication of the 1995 French consensus conference recommendations. MATERIAL AND METHODS: In 1997, we sent a questionnaire to all the general practitioners of Hauts-de-Seine department (n = 1000). In that department, specific training on this topic had been conducted in 1996. RESULTS: The response rate was 12.4 p. 100. Follow up was performed in association with a dermatologist or a oncologist by 97 p. 100. There was a high rate of non-response for questions concerning follow up which reached 30.4 p. 100 for thick melanomas. DISCUSSION: Because of the low response rate, the interpretation of these results must be interpreted with precaution. Dermatologists seem to be the general practitioners' preferred correspondents for patients with melanoma.

[Group A beta-hemolytic Streptococcus: an unusual etiology of perianal dermatitis in an adult?]. / Le streptocoque beta-hémolytique du groupe a: une étiologie exceptionnelle de dermite péri-anale chez l'adulte?

BACKGROUND: Perianal dermatitis usually occurs in children between 1 and 8 years of age. We report a sixth case in an adult. CASE REPORT: A 33 year-old woman complained of perianal itching which quickly extended to the vulva and persisted in spite of anti-hemorrhoid and anti-fungal treatments. After 12 days, she had painful defecation, a well demarcated perianal and vulvar erythema and anal collection. Culture from a perianal swab isolated group A beta-hemolytic Streptococcus (ABHS). After surgical treatment of the collection and a 7 days oral amoxicillin regimen, the patient recovered with no recurrence. DISCUSSION: Symptoms of perianal dermatitis are unspecific, leading to delayed diagnosis and underestimated frequency. Symptoms consist in perianal erythema. Swab culture shows ABHS. The mechanism of colonization of perianal area is not well defined. Although treatment with oral penicillin is usually effective, failures and relapses have also been reported. Complications such as deep infection or abcess formation are infrequent. A bacterial swab should be made in patients with persisting perianal erythma.