A multicenter, randomized, open-label, controlled study comparing the efficacy, safety and cost-effectiveness of a sequential therapy with RV4104A ointment, ciclopiroxolamine cream and ciclopirox film-forming solution with amorolfine nail lacquer alone in dermatophytic onychomycosis.

BACKGROUND: The efficacy of topical antifungals is controversial. OBJECTIVE: To compare the efficacy and safety of a sequential(SEQ) treatment with chemical nail avulsion and topical antifungals to amorolfine nail lacquer in dermatophytic onychomycosis. METHODS: This was a randomized,parallel-group, controlled study comparing a 36-week SEQ treatment with chemical nail avulsion with RV4104A ointment(class I medical device containing 40% urea) followed by ciclopirox cream for 8 weeks and ciclopirox nail lacquer for 25 weeks (SEQ group) to amorolfine nail lacquer for 36 weeks (AMO group). Patients had to have a big toenail onychomycosis,sparing the matrix. The primary efficacy criterion was complete cure at week 48. A cost-effectiveness analysis was performed. RESULTS: A total of 142 patients were randomized. The complete cure rate at week 48 was significantly higher in the SEQ group than in the AMO group (36.6 vs. 12.7%, p = 0.001). Clinical cure at week 48 was observed in 53.5% of patients in the SEQ group versus 17% in the AMO group (p < 0.01). The cost of cure per patient was 50% lower with SEQ treatment (EUR 33) compared with amorolfine(EUR 76). CONCLUSION: A treatment of onychomycosis comprising chemical avulsion of the pathological nail, ciclopirox cream and nail lacquer is significantly more effective than amorolfine nail lacquer.

High frequency of the V548A fs X572 XPC mutation in Tunisia: implication for molecular diagnosis.

Xeroderma pigmentosum (XP, OMIM 278700-278780) is a group of autosomal recessive diseases characterized by hypersensitivity to UV rays. There are seven complementation groups of XP (XPA to XPG) and XPV. Among them, the XP group C (XP-C) is the most prevalent type in Western Europe and in the United States. We report here on the clinical and genetic investigation of XP-C patients in 14 Tunisian families. As the XPC V548A fs X572 mutation has been identified in Algerian and Moroccan populations, Tunisian patients were first screened for this mutation by a direct sequencing of exon 9 of the XPC gene. All patients with a severe clinical form had this mutation, thus showing the homogeneity of the mutational spectrum of XPC in Tunisia. A potential founder effect was searched and confirmed by haplotype analysis. Taking into account the similarity of the genetic background, we propose a direct screening of this mutation as a rapid and cost-effective tool for the diagnosis of XP-C in North Africa.

[Obstetrical prognosis of gestational pemphigoid. Study of a series of 13 cases and review of the literature]. / Pronostic obstétrical de la pemphigoïde gestationnelle. Etude d'une série de 13 cas et revue de la littérature.

Pemphigoid gestationis (PG) Herpes Gestationis (HG) is an auto-immune bullous dermatosis which usually occurs in pregnancy. We have studied the maternal and fetal prognosis of this pathological condition. Thirteen cases were reported at the same time by the departments of dermatology and obstetrics of the Charles-Nicolle Hospital between 1980 and 1990. Two women were not followed up. In the remaining eleven there was one intrauterine fetal death and one intrauterine fetal growth retardation (IUGR). One case was delivered prematurely because of obstetric indications. Four infants were delivered by Caesarean section on purely obstetrical indications. The other cases were delivered normally. There were no dermatological lesions or other malformations in the infants. Immediately after delivery ten women showed exacerbation of the skin lesions and most of these were treated by general corticotherapy. Our results were compared with those found in the literature. The prognosis differs according to different authors but in order to avoid any risks the condition must be followed carefully by obstetricians and dermatologists and laboratories working together.