[Keratosis lichenoides chronica and prolonged exposure to infrared radiation]. / Kératose lichénoïde striée et exposition prolongée aux infrarouges.

BACKGROUND: We report a case of keratosis lichenoides chronica and prolonged exposure to a source of heat (infrared radiation). CASE REPORT: A 35 year-old man was examined for a symmetric and reticulate dermatosis on the abdomen, the interior of arms and lower extremities. The lesions had progressed over several months. They were characterized by hyperpigmentation, erythematous, bullous and squamous papules. These lesions were associated with those of the scalp, evoking seborrheic dermatitis. The patient was exposed to a source of heat with an electric radiator on his bare chest everyday. The skin biopsy showed a lichenoid reaction. All these elements allowed to put the diagnosis of keratosis lichenoides chronica, probably actived by the infrared light. DISCUSSION: Keratosis lichenoides chronica is a rare acquired dermatosis of the young adult. Its physiopathology remains elusive. This dermatosis is characterized by keratosic violaceous lichenoid papules distributed symmetrically. The eruption is usually asymptomatic. The histological examination indicates a lichenoid reaction. The progression is chronic and the disease is very resistant to therapy. Keratosis lichenoides chronica has never been described as being able to be induced by Koebner's phenomenon. In the literature, two cases of erythema ab igne were associated with lichen planus. For some authors, keratosis lichenoides chronica is an entity itself, for others it would be related to lichen planus. These arguments enabled us to diagnose keratosis lichenoides chronica probably activated by the infrared light.

[Contact dermatitis from polyacrylate in TENS electrode]. / Eczéma de contact aux polyacrylates du gel conducteur des électrodes de neurostimulation.

INTRODUCTION: Transcutaneous electric nerve stimulation (TENS) is useful for many chronic pains. It induces few serious side effects, but skin reactions are not rare. We report on two cases of contact dermatitis due to TENS electrodes by sensitization to the acrylate in TENS conductive gel. CASE REPORTS: A 50 year-old man suffered from post-traumatic lumbar pair. He developed eczematous lesions on the sites where the TENS electrodes were applied. Patch tests were positive with the TENS gel, with ethylene glycol dimethylacrylate (2 p. 100 petrolatum) and ethyl-acrylate (2 p. 100 petrolatum) on day 2 and 4 readings. A 54 Year-old man had a paralysis of the foot elevator following rupture of an aneurysm. After 2 months, he had an eczema on the sites where the TENS electrodes were applied. Patch tests were negative with the TENS electrodes but positive with 2-hydroxyethyl acrylate (0.1 p. 100 petrolatum), triethyleneglycol diacrylate (0.1 p. 100 petrolatum), 2-hydroxyethyl methacrylate (2 p. 100 petrolatum) and 2-hydroxypropyl methacrylate (2 p. 100 petrolatum) on day 2 and 4 readings. DISCUSSION: TENS transmits small electrical currents through the skin that induce the depolarization of the affected sensory nerve endings. They have few serious side effects but skin reactions such as irritation, burns or allergy to propylene glycol in the electrode gel, to the rubber of the electrodes (mercaptobenzothiazole) or to the metallic part of the electrodes, i.e. nickel, are not uncommon. To our knowledge, only one case of an allergy to the polyacrylates of TENS electrode gel has been previously reported in the literature. We emphasize that acrylate could be the main sensitizer in the more recently commercialized TENS electrodes and will propose alternative ways of treating patients sensitized to acrylate and who require treatment with TENS.

Epidemiology of dermatophytoses in children living in northeast France: a 5-year study.

Dermatologic fungal infections are thought to occur less frequently in children than in adults. This study, performed over a 5-year period, emphasizes the interregional variability of dermatophytes that cause skin and cutaneous apprendageal diseases in children. In northeast France, two-thirds of dermatophytoses are due to zoophilic fungi, while they are most commonly caused by anthropophilic agents in the Paris region and in other countries. The clinical features of pediatric dermatophytoses vary with the age of the child: tinea capitis and tinea corporis are far more frequent before the age of 12 years. After the age of 12, even if these are still quite frequent, tinea pedis and onychomycosis become more common.

Relevance of skin tests with drugs in investigating cutaneous adverse drug reactions.

Skin tests with drugs can be of value in investigating patients who have developed cutaneous adverse drug reactions (CADR), but their specificity and relevance remain to be determined. A false-positive result on skin testing can happen if it is not compared to results in control subjects. When performing intradermal tests (IDT), we have determined the lowest concentrations that induce false-positive results for many drugs, including betalactam antibiotics, cephalosporins, other antibiotics or non-steroidal anti-inflammatory drugs. Some drugs in their commercialized form contain sodium lauryl sulfate and can induce irritation when patch tested as such. When patch tested with colchicine at 10% in pet. or with a Cytotec pill (containing misoprostol) at 30% in pet., respectively, 80% of the 29 and 9 of the 10 negative controls developed false-positive results. Lastly, positive results of patch tests with drugs can be related to contact allergy to one of the components of the commercialized form of the drug, without any relevance to the investigation of a CADR, as observed in 2 cases with iodine or avocado oil.

[Sensitization to resorcinol in a prescription verrucide preparation: unusual systemic clinical features and prevalence]. / Sensibilisation à la résorcine due à une préparation magistrale verrucide: manifestations cliniques systémiques et prévalence inhabituelles.

BACKGROUND: Resorcinol is a rare sensitizer. In Lorraine, where it is used in high concentrations in an anti-wart ointment, this molecule has induced many cases of allergy. The purpose of this study was to describe clinical features in patients sensitized to resorcinol, to determine the incidence of sensitization in Lorraine and ascertain the occurrence of cross reactions with other phenolic pro-haptens. PATIENTS AND METHODS: The files of all patients sensitized to resorcinol were studied from 1992 to 1999. Over a 20-month period, 983 consecutive patients underwent our standard patch tests where we included resorcinol (1 p. 100 in petrolatum). Co-sensitization with other pro-haptens was studied in all sensitized patients. RESULTS: Sensitization to resorcinol was observed in 0.5 p. 100 of the 983 consecutively tested patients. Contact sensitization was found in 24 patients, who all but one had previously used the anti-wart ointment containing resorcinol. All developed contact eczema on the site of application of the ointment, with generalized urticaria (4 cases), pompholyx (1 case), and generalized papulo-vesicular rash with pompholyx (6 cases). Positive patch tests were observed with resorcinol monobenzoate (15/19 cases), pyrocatechol (7/14 cases), pyrogallol (9/19 cases), salicylaldehyde (2/17 cases), and hydroquinone (6/17 cases). Negative patch tests were observed with phenysalicylate, hexylresorcinol, or fluoresceine. CONCLUSION: Resorcinol should not be applied in high concentrations as it can provoke generalized sensitization and co-sensitization with other pro-haptens.

[Cutaneous delayed hypersensitivity reactions to heparins and heparinoids]. / Réaction cutanée d'hypersensibilité retardée avec polysensibilisation aux héparines et héparinoïdes.

INTRODUCTION: Due to cross-reactions between unfractionated heparins, low-molecular-weight heparins and sometimes heparinoids, cutaneous delayed hypersensitivity reactions might be a problem for the choice of therapeutic alternative. We report on two cases of sensitization to heparins and heparinoids. OBSERVATIONS: One woman developed localized skin reaction to a low-molecular-weight heparin, then a generalized maculopapular rash when an intravenous injection of unfractionated heparins was performed. The second patient had a localized then extended reaction to a low-molecular-weight heparin and was referred for the choice of a well tolerated method to obtain anticoagulation during a pulmonary surgery. METHODS: Patch tests, prick tests, intradermal and subcutaneous tests were performed with several unfractionated heparins, low-molecular-weight heparins, danaparoid and lepirudin in both cases. RESULTS: In the first case, tests performed with both heparins and heparinoid were positive and the use of lepirudin was proposed if anticoagulation was necessary. In the second case the subcutaneous danaparoid injection induced a localized reaction on the injection site. Danaparoid injections were continued associated with localized applications of dermocorticoids without any side effect. DISCUSSION: Cutaneous delayed hypersensitivity reactions occur on the injection site but can also be generalised. Cross reactions might be unexpected therefore skin-tests are necessary to guide the choice of a therapeutic alternative. In case of intolerance to both heparins and heparinoids various solutions may be proposed such as the application of topical corticosteroids on the injection site or the administration of hirudins. There is no cross sensitization between heparins and hirudins, but the use of hirudins is restricted and requires specific monitoring.

[Lymphoma presenting as Sister Mary-Joseph's nodule]. / Nodule de soeur Marie-Joseph révélant un lymphome.

BACKGROUND: Cutaneous metastasis of the umbilicus is generally associated with intra-abdominal adenocarcinoma, rarely with a malignant hemopathy. CASE REPORT: We report a case of lymphoma presenting as Sister Mary-Joseph's nodule, in a 79-year-old man. Histology evidenced small-cell lymphoma. DISCUSSION: Umbilical metastasis is uncommon, most of these lesions arising from gastric adenocarcinoma. Only two cases of lymphoma, associated with an umbilical metastasis have been reported. This case opens the discussion on the fact that the umbilicus is generally not a site of metastatic spread of lymphomas.

An unusual form of Stevens-Johnson syndrome with subcorneal pustules associated with Mycoplasma pneumoniae infection.

We report a 10-year-old girl in whom Stevens-Johnson syndrome (SJS) (with acute gingivostomatitis and conjunctivitis) was associated with a pustular eruption clinically and histologically similar to Sneddon-Wilkinson subcorneal pustulosis. This is a very rare form of SJS, the true incidence of which is probably underestimated.

[Contact dermatitis due to ethyl alcohol: how to perform patch tests?]. / Eczéma de contact à l'alcool éthylique: comment réaliser les tests?

INTRODUCTION: Ethyl alcohol sensitization is rare and can induce immediate contact urticaria or delayed eczema. Patch tests performed with ethanol can provoke an irritative reaction and are not well codified. CASE-REPORTS: We report on 4 cases of contact dermatitis due to alcohol in 4 women. Eczema was due to alcohol contained in the reservoir of a transdermal transfer system with estrogens in 2 cases and related to the application of alcoholized antiseptic lotions in the other 2 cases. In 2/4 cases we observed a co-sensitization with corticosteroids. METHODS: Patch tests were performed with alcohol at 95 degrees diluted at 70 p. 100 and at 10 p. 100 in water and read after 20 minutes then on day 2 and day 4. RESULTS: Positive results were obtained in 4/4 cases when alcohol was tested diluted at 70 p. 100 in water and in 3/4 cases when diluted at 10 p. 100 in water. No irritant reaction was observed in 140 negative controls. DISCUSSION: Immediate after 20 minutes and delayed readings of patch tests performed with ethyl alcohol diluted at 70 p. 100 seem to be convenient in diagnosing cutaneous delayed hypersensitivity to alcohol. Co-sensitization between corticosteroids and alcohol could be due to an aldehyde deshydrogenase deficiency.

[Ultra-late metastasis of melanoma with secondary dissemination along the venous stripping line]. / Métastase ultra-tardive d'un mélanome avec dissémination secondaire le long du trajet d'un éveinage.

BACKGROUND: A woman was cured of a melanoma of the leg. She presented an ultra late recurrence 17 years later, then rapid and extensive recurrence immediately after venous stripping. CASE REPORT: In 1977, a 38-year-old woman was operated for a SSM melanoma of the calf. She was then given chemotherapy and BCGtherapy for 2 years. In 1994, she presented a nodular recurrence which was treated surgically. In March 1997, she underwent a stripping of the leg. One month later, a nodular recurrence was discovered along the stripping line. DISCUSSION: The ultra late recurrence (> 15 years) in this case is highly exceptional and, to our knowledge, this is the first case of a recurrence along a vascular course. We discuss metastatic dissemination of SSM melanoma and the role played by stripping in this case of recurrence.

[Leg ulcers. Allergologic studies of 359 cases]. / Ulcères de jambe. Explorations allergologiques dans 359 cas.

INTRODUCTION: Leg ulcers are a common disease in dermatology. Their social and economic implications are important, especially when contact dermatitis complicates these wounds. PATIENTS AND METHODS: In this study a total of 359 patients had contact dermatitis investigations over a period of 5 years. Patch-tests were performed on 116 men and 243 women hospitalized with venous and/or arterial leg ulcers, with or without clinical appearance of periulcerous contact dermatitis. Standard patch-tests of the ICDRG (International Contact Dermatitis Research Group) were systematically performed as well as a specific series of 40 tests. RESULTS AND DISCUSSION: Positive patch tests were observed in 82.5 p. 100 of the patients, indicating a very high rate of contact allergy in patients with leg ulcers. Peru balsam, lanolin and neomycin were the most frequent culprits of positive patch-tests in this population. Five percent of patch-tests with eosin were positive in our study. This is not common in the literature. Moreover, we highlight the high rate of contact sensitization to corticosteroids in this population. According to these results and to the literature, a new series of patch-tests for leg ulcers is suggested. CONCLUSION: Polysensitization in patients with chronic wounds is very frequent. A series of patch-tests in leg ulcers may lead to some interesting conclusions but a good questioning of the patient is always necessary to complete this series.

[Radiodermatitis afer heart catheterization]. / Radiodermites après cathétérisme cardiaque.

INCREASING INCIDENCE: The development of new interventional techniques in radiology, particularly angioplasty of the coronary arteries, has lead to a rise in the incidence of radioderimitis. Clinical presentations vary from skin rash to necrosis and chronic ulceration. Telangiectasic atrophy and poikilodermitis are also observed. CASE REPORTS IN THE LITERATURE: Twenty-three cases of radiodermitis after cardiac catheterism have been reported in the literature. Mean delay to onset after the first radiology examination varies from 15 days to 10 years. TO REDUCE THE RISK: The main risk factor is a long duration of scopy using the same incidence. Use of older non-digitalized radiology machines also increases the risk. Physicians performing endovascular procedures should be aware of the risk of radiodermitis after angioplasy and implement radioprotective measures. RETROSPECTIVE DIAGNOSIS: Patients who develop localized pigmentation disorders and/or telangiectasies should be questioned concerning prior, often forgotten, radiology examinations.