[Assessing the wearing of jewellery by French healthcare professionals]. / Évaluation du port de bijou chez des professionnels de la santé français.

OBJECTIVE: A prospective observation study was undertaken in seven medical centers, in the French region Alpes-Maritime, to assess nail hygiene of healthcare professionals and how often they wear hand jewellery. METHOD: Seven hundred and six healthcare workers in seven medical centers were interviewed from March to April 2008. RESULTS: Among the 706 professionals, 306 (43%) were wearing one or several pieces of jewellery. The nails of 81 (11.5%) were non-standard according to guidelines. Three hundred and forty-four health care professionals (49%) were wearing one or several pieces of jewellery and/or presented with non-standard nails. In univariate analysis, the wearing of jewellery was linked to the medical centre (P<0.001), to the professional category (p<0.001), to the number of times people washed their hands or used hand gel per day (ABHR) by categories (<10 times per day or ≥10 times per day) (P<0.017). In the multivariate analysis, the risk factors linked to the wearing of jewellery were the medical centers, the professional category, and the age. CONCLUSION: There are still too many healthcare professionals who do not comply to French recommendations on hand hygiene concerning the wearing of jewellery and nail hygiene standards.

[Risk factors for dryness or irritation of staff hands in nine healthcare institutions]. / Étude des facteurs de risque de sécheresse et d'irritation des mains du personnel dans neuf établissements de soins.

OBJECTIVE: We performed a prospective multicenter study to assess dryness and irritation of hands of staff in care facilities, and to show that disinfection with alcohol-based hand rub is better tolerated than classic hand washing with mild soap. METHOD: Dryness and irritation were self-evaluated by volunteers and hetero-evaluated by a team of investigators. The study took into account most of the individual and environmental risk factors of dryness and irritation (season, age, gender, use of protective agent, constitutional, personal and external factors, institution, function, number of consecutive working days). RESULTS: The results from the 1932 assessments collected showed that traditional hand washing was a risk factor for dryness or irritation, while alcohol-based hand rubs caused no skin deterioration and had a protective effect even when used intensively. COMMENT: These results should help to fight non-adherence to the use of alcohol-based hand rubs.

[Polylactic acid injections (Newfill) in the treatment of facial lipodystrophy in HIV-positive patients]. / Traitement par injections d'acide polylactique (Newfill) des lipoatrophies faciales chez les malades infectés par le VIH.

BACKGROUND: Lipodystrophy is a side-effect associated with treatment for human immunodeficiency virus (HIV) and is found chiefly on the face (disappearance of buccal fat pads) and is detrimental to self-esteem. PATIENTS AND METHODS: This was a retrospective study in HIV-positive patients with facial lipoatrophy treated between 1999 and 2004 by means of subcutaneous injections of polylactic acid (Newfill). We assessed the efficacy of treatment, the number of injections given, treatment methods and adverse effects. RESULTS: Eighty-three patients were treated between 1999 and 2004. Each patient received a mean of between 3 and 4 treatment sessions comprising subdermal injection of 1 ampoule of Newfill into each cheek. Ultrasound assessment of the dermis over the cheekbone was performed in 45 patients and showed an increase in dermal thickness of between 3 and 7 mm. Following injection, edema was observed in all cases and lasted between 1 and 2 days. Five patients presented bruising at the injection sites. Two patients presented asymmetry lasting 4 months and requiring correction. Four patients had non-inflammatory granulomas, which were not visible but were palpable in 2 cases; all nodules regressed after 4 months. DISCUSSION: Treatment of facial lipoatrophy in HIV patients by injection of polylactic acid (Newfill) was shown to be efficacious in the majority of subjects. Training in the administration of this treatment is needed to ensure optimal efficacy and safety. A number of technical difficulties led to changes in treatment methods, i.e. routine adoption of a mask and protective glasses and use of a Luer-lock syringe due to blockage of syringes in more than 20% of cases, with splashing; increase in dilution volume from 3 to 5 ml; use of a centrifuge to ensure greater homogeneity of the solution; use of lidocaine in place of water for injections in order to reduce pain for patients.

The place of botulinum toxin type A in the treatment of focal hyperhidrosis.

BACKGROUND: Hyperhidrosis (primary or secondary) is excessive sweating beyond that required to return body temperature to normal. It can be localized or generalized, commonly affecting the axillae, palms, soles or face, and can have a substantial negative effect on a patient's quality of life. IMPACT OF DISEASE: Objective evaluation comprising quantitative assessment (gravimetric and Minor's iodine starch test) and subjective evaluation (Dermatology Quality of Life Index and Hyperhidrosis Impact Questionnaire) allow accurate assessment of the impact of hyperhidrosis on patients. BOTULINUM TOXIN TYPE A: Botulinum toxin type A acts by inhibiting the release of acetylcholine at the presynaptic membrane of cholinergic neurones. It has proved useful in treating a number of diseases relating to muscular dystonia and is now proving beneficial in treating hyperhidrosis. Clinical trials investigating botulinum toxin type A use in axillary and palmar hyperhidrosis show significant benefits with few side-effects reported, with a favourable impact also being seen on patient quality of life. Botulinum toxin type A injections are generally well-tolerated with beneficial results lasting from 4 to 16 months. CONCLUSIONS: Botulinum toxin type A injections are an effective and well-tolerated treatment for hyperhidrosis. This paper proposes a positioning of this treatment along with current established treatments, and highlights the role of botulinum toxin type A as a valuable therapy for the treatment of hyperhidrosis.

Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris.

BACKGROUND: In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne. OBJECTIVE: To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris. METHODS: Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules). RESULTS: This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and were moderate (5 dropouts with zinc gluconate and 4 with minocycline). CONCLUSION: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.

[Descriptive epidemiological study of acne on scholar pupils in France during autumn 1996]. / Epidémiologie descriptive de l'acné dans la population scolarisée en France métropolitaine pendant l'automne 1996.

BACKGROUND: Acne is the most common symptom prompting patients to consult a dermatologist. No previous study has been conducted in France to determine the prevalence of acne and describe the main epidemiological features. SUBJECTS AND METHODS: A cross sectional study was conducted in November 1996 and included 913 school children aged 11 to 18 years. This sample was statistically representative of the entire secondary school population in France during the 1996-1997 school year. The subjects were stratified by 5 criteria: age, sex, rural or urban residence, sun exposure, type of school. RESULTS: Taking the clinical diagnosis made by the dermatologist investigator as the main criteria, the overall prevalence of acne was 72 p. 100. It was 76.1 p. 100 using the new ECLA grading system previously described. The prevalence of acne was sex and age dependent: highest scores were found for girls aged 14-16 years and for boys aged 16-17 years. Genetic factors were very important for the outcome of acne. Finally, 41 p. 100 of the acneic subjects were following a treatment, prescribed by a dermatologist in two-third of the cases. DISCUSSION: These results are in agreement with those previously published in the literature although some differences were disclosed. It would appear important to distinguish between minimal acne with a few retentional pimples occuring during adolescence and severe acne (more than 20 pimples on the face) requiring early medical care to avoid scarring.

[ECLA grading: a system of acne classification for every day dermatological practice]. / La grille ECLA: un système de cotation de l'acné pour la pratique quotidienne du dermatologue.

BACKGROUND: Different acne gradings have been proposed: global grading, semi-global grading, quantitative grading and photographic grading. They are mainly used in clinical studies for the evaluation of acne treatment. However, it would be important for physicians to have an acne grade which would be useful for assessing acne lesions prior to treatment and following treatment efficacy. METHODS: Six French dermatologists developed an acne grading scaled called "ECLA" which only takes 2 minutes to fill out and specifically designed for use by dermatologist practitioners. In addition, the intra- and inter-observer reliability of the grading scale was assessed. RESULTS: This analysis demonstrated the excellent reliability of the ECLA grading scale both in terms of intra- and inter-observer variability except for the retentional factor. The cross physician reliability decreased with time specificity for the retention factor, indicating that previous training prior to a multicentric clinical study would be necessary. CONCLUSION: ECLA grading appears to be an interesting and useful tool in dermatology for the follow-up of acne patients.

[Cutaneous sarcoidosis secondary to inhalation of wall insulating material particles]. / Sarcoïdose cutanée secondaire à l'inhalation de particules de flocage d'isolation.

BACKGROUND: Sarcoidosis is a systemic disease defined by multiple granulomas. We report a case of sarcoidosis which occur concomitantly or secondary to foreign body granuloma of the lung. CASE REPORT: A 50-year-old women presented with Lofgren syndrome, subcutaneous granulomatous nodular lesions on the arms and legs. Computed tomography revealed a foreign body granuloma of the lung centered on particles of mural isolation material that the patient had inhaled accidentally. Analysis of the foreign body particles showed non crystalline silica, calcite monohydrate and phenol resin. DISCUSSION: Recent studies support the hypothesis that sarcoidosis is an antigen-driven disease involving pulmonary T-cell activation. The antigen-mediated reaction may be caused by infectious agents, particularly mycobacteria, occupational and environmental agents (beryllium) or as in our observation following inhalation of mural isolation material particles.

Minocycline induces an increase in the number of excreting pilosebaceous follicles in acne vulgaris. A randomised study.

The effects of treatment with minocycline 100 mg per day on sebaceous excretion in acne vulgaris using lipometry and Sebutape were studied in 45 patients in an open study as well as in a randomised placebo-controlled study. In both studies a subclinical increase in sebaceous excretion was noted from the 28th day of treatment. This effect continued for 1 month after the end of treatment. The increase in sebaceous excretion was concomitant with an increase in the number of excreting pilosebaceous follicles. Minocycline may cause the follicles to become unblocked by acting on the factors responsible for ostial hyperkeratosis, in addition to an antibacterial effect on retentional acne lesions.

[Treatment of keloid with intralesional bleomycin]. / Traitement des chéloïdes par infiltrations de bléomycine.

INTRODUCTION: Treatment of keloids is often disappointing and sometime quite difficult to manage. In addition to unpleasant esthetic effects, treatment may also produce functional impairment due to pruritus and contraction of the scar tissue. PATIENTS AND METHODS: We proposed a new treatment scheme using intralesional infiltrations of bleomycin. RESULTS: We treated 31 keloids and 5 hypertrophic scars with 3 to 5 infiltrations with a 1-month period. Total regression was obtained in 25 keloids and hypertrophic scars. Important regression was obtained in 6 keloids (86% good results). Treatment was effective in all cases within the first 2 infiltrations evidenced by a reduction in the volume of the keloid and clear reduction of functional impairment in most patients. CONCLUSION: Effective well-tolerated treatment without pain was achieved with infiltration suggesting that this treatment should be used as first line therapy for keloids.

[Paraneoplastic pemphigus: review of the literature, apropos of a case associated with chronic lymphoid leukemia]. / Le pemphigus paranéoplasique: revue de la littérature, à propos d'un cas associé à une leucémie lymphoïde chronique.

In 1990, Anhalt et al described a newly autoimmune bullous disease: paraneoplastic pemphigus, in five patients. It was characterized by a distinct set of circulating autoantibodies from those in the sera of patients with pemphigus vulgaris and superficial pemphigus. We report a 71 year-old man with chronic lymphocytic leukemia of 4 years duration who developed a severe mucocutaneous eruption with clinical and immunofluorescence findings of pemphigus vulgaris evolving into an oral bullous lichen planus presentation. Evaluation of his serum confirmed the presence of autoantibodies specific for paraneoplastic pemphigus by indirect immunofluorescence on rat-bladder and immunoprecipitation. Subsequently, additional cases have been reported in the literature. All occurred in patients with various neoplastic conditions. These patients present with polymorphous skin lesions and severe erosive oral disease. Histologic examination shows interface dermatitis and keratinocyte necrosis in addition to acantolysis. Direct immunofluorescence may reveal deposition of immunoglobulin and/or complement at the basement membrane as well as deposition on epithelial cell surfaces. Circulating IgG anti-cell-surface antibodies are detectable with both stratified and stratified epithelia as substrates. These antibodies immunoprecipitate a complex of four desmosomal proteins, including desmoplakin I (250 kDa), the bullous pemphigoid antigen (230 kDa), desmoplakin II (210 kDa) and a 190 kDa antigen.

Papular eruption in AIDS: role of demodectic mites?

We report 3 cases of pruriginous papular eruption of HIV disease, in which demodectic mites were found in the pilosebaceous follicles which were surrounded by a granulomatous inflammatory infiltrate. Papular eruption of HIV disease is a distinctive clinicopathological entity, whose pathogenicity is not known. Our observations suggest that demodectic mites might be sometimes the etiologic agents of this eruption.

Malignant lymphoma and dermatitis herpetiformis.

We report 2 cases of dermatitis herpetiformis (DH) with lymphoma: a non-Hodgkin's malignant histiocytic lymphoma and a rare phenotype of Hodgkin's disease. With these 2 cases, 32 cases of DH complicated by lymphoma have now been documented. Reviewing the literature we show that the majority of lymphomas (78.1%) arises from the gastro-intestinal tract and that almost all cases of DH with lymphoma are associated with coeliac disease. The possible preventive role of a gluten-free diet is discussed.

Porphyria cutanea tarda and antibodies to hepatitis C virus.

We have studied the prevalence of hepatitis C virus antibodies (anti-HCV) in 13 patients suffering from sporadic porphyria cutanea tarda. The sera were tested by Abbott second-generation enzyme immunoassay; seropositivity was confirmed by Ortho second-generation recombinant immunoblot assay. Ten cases (76.1%) were anti-HCV positive; one patient was also seropositive for HIV. This preliminary study suggests that HCV could be a frequent triggering factor for sporadic porphyria cutanea tarda.

[Focal epithelial hyperplasia. An unusual clinical aspect]. / Hyperplasie épithéliale focale. Aspect clinique inhabituel.

We report a case of focal epithelial hyperplasia in a child born in France of Algerian parents. The clinical appearance was unusual in that certain lesions were verrucous and pediculate. A virological study revealed the presence of papillomavirus 32, one of the two types of HPV specifically associated with this entity.