It is not always chlorhexidine: Identification of benzoxonium chloride and lauramine oxide as culprit allergens in a popular antiseptic in Switzerland.

BACKGROUND: A popular antiseptic spray in Switzerland (Merfen spray), containing chlorhexidine digluconate, benzoxonium chloride and lauramine oxide, is frequently used to treat skin wounds. However, it is also increasingly reported as a major cause of adverse skin reactions, including allergic contact dermatitis (ACD). OBJECTIVES: To investigate the contact allergens responsible for ACD from this antiseptic. PATIENTS/METHODS: Patch tests were performed on seven patients with a clinical history compatible with contact dermatitis from this antiseptic mixture. RESULTS: All patients presented with acute eczematous reactions following contact with either Merfen spray alone, or with multiple products including this spray. Patients showed positive reactions to this product in both patch tests and repeated open application tests (ROATs). Four patients showed dose-dependent reactions to both benzoxonium chloride and lauramine oxide. One patient showed a dose-dependent reaction to the former and a non-dose-dependent reaction to the latter. Finally, two subjects showed responses only to lauramine oxide. One patient reacted to chlorhexidine digluconate 0.5% aq. in addition to both other allergens. CONCLUSIONS: Two commercially unavailable allergens, that is, benzoxonium chloride and/or lauramine oxide were identified as major causes of ACD from Merfen antiseptic spray, whereas chlorhexidine digluconate was a contributing culprit in only one patient.

[Cutaneous visualization by different non-invasive skin imaging methods]. / La peau vue par différentes méthodes d'imagerie cutanée non invasive.

The development of in vivo skin imaging technologies has been booming for several decades. Their advantages are indisputable, especially as they are non-invasive. Their place is already well established in onco-dermatology and it is just a question of time for them to be used with success in other fields of dermatology, including pediatric dermatology. In this paper we will discuss 3 of these skin imaging techniques used in dermatology at the CHUV, including Optical Coherence Tomography (OCT), Reflectance Confocal Microscopy (RCM) and the most recent: Line-field Confocal Optical Coherence Tomography (LC-OCT).

Le développement de technologies d'imagerie cutanée in vivo est en plein essor depuis plusieurs dizaines d'années. Leurs avantages sont indéniables compte tenu notamment de leur caractère non invasif. Leur place est déjà bien établie en onco-dermatologie et leur utilité est également prometteuse dans beaucoup de domaines en dermatologie, y compris en dermatologie pédiatrique. Nous allons détailler ici trois de ces techniques utilisées en dermatologie au CHUV, à savoir la tomographie en cohérence optique (OCT), la microscopie confocale par réflectance (MCR) et la plus récente: la tomographie en cohérence optique confocale en champ linéaire (LC-OCT).

Case Report: Pansclerotic Morphea-Clinical Features, Differential Diagnoses and Modern Treatment Concepts.

Pansclerotic morphea (PSM) is a rare skin disease characterized by progressive stiffening of the skin with or without the typical superficial skin changes usually seen in morphea (localized scleroderma). Standard therapy, consisting of a combination of systemic glucocorticoids and methotrexate or mycophenolate mofetil, does rarely stop disease progression, which may lead to severe cutaneous sclerosis and secondary contractures. Little is known about the efficacy of newer biologicals such as abatacept, a fusion protein antibody against CTLA-4, or tocilizumab, a fully humanized IL-6R antibody, in the treatment of this pathology. We present the case of an 8 years old girl with an unusual, progressive stiffening of the skin, which was eventually diagnosed as pansclerotic morphea. A treatment with systemic glucocorticoids and methotrexate combined with tocilizumab led to a good clinical response within 2 months after initiation. In this paper, we discuss differential diagnoses to be considered and this new promising treatment option based on a case review of the literature.

[Telemedicine in pediatric dermatology:focus on current practices]. / Télémédecine en dermatologie pédiatrique†: mise au point sur les pratiques actuelles.

Pediatric teledermatology (PTD) allows offering long distance health care advice in pediatric dermatology trough telecommunication technologies. Due to the lack of pediatric dermatologists, the frequency of dermatological questions in general pediatrics, the visual nature of the specialty, and the rare occurrence of vital emergencies in dermatology, PTD appears to be a good option for giving long distance advice in a certain number of skin conditions. In this article, we will discuss benefits and limitations of PTD. We will also talk about diagnostic and therapeutic concordance between PTD and traditional consultations, as well as the most frequent advices asked.

La télédermatologie pédiatrique (TDP) correspond à l'utilisation des technologies de télécommunication pour offrir à distance des conseils de prise en charge spécialisés de l'atteinte cutanée chez l'enfant. La TDP semble adaptée pour un grand nombre de pathologies cutanées, étant donné le caractère visuel de la spécialité, l'occurrence rare d'urgence vitale en dermatologie, le faible nombre de spécialistes en dermatologie pédiatrique et la fréquence des motifs dermatologiques en consultation de pédiatrie. Nous discuterons, dans cet article, des avantages et limites de la TDP. Nous aborderons également les concordances diagnostique et thérapeutique entre la TDP et la consultation traditionnelle, ainsi que les demandes d'avis les plus fréquentes.

Correction to: Hormonal receptors in cutaneous vascular malformations: 51 cases.

The original version of this article contained error. Table 2 was shown in the wrong version, thus corrected table is shown in this article.

Hormonal receptors in cutaneous vascular malformations: 51 cases.

Vascular malformations (VMs) are rare congenital anomalies that develop during embryogenesis in different types of vessels. Several triggering factors of cutaneous VMs include trauma, infections, or hormonal changes. We investigated the expression of hormonal receptors (androgen, estrogen, progesterone) in tissue samples of well-characterized VMs. A secondary objective was to identify self-reported triggering factors for these VMs, including hormonal changes, in the cohort of patients. We included patients with VM samples obtained in the tertiary center for vascular anomalies of the University Hospital Center of Tours, France, from January 1, 2007, to August 1, 2018. Immunohistochemistry was used to detect the expression of hormonal receptors (estrogen, progesterone, androgens). We obtained 51 samples from 51 patients: 13 cystic lymphatic malformations (CLMs), 16 venous malformations (VeMs), 11 arteriovenous malformations (AVMs), 4 combined VMs, 4 PIK3CA-related overgrowth spectrum, 1 Parkes-Weber syndrome, 1 Gorham syndrome, and 1 multiple lymphangioendotheliomatosis with thrombopenia. In total, 38 (74.5%) samples were positive for androgen receptor: 11 (84.6%) CLMs, 12 (75.0%) VeMs, 8 (72.2%) AVMs, and 7/11 (63.5%) other samples. All samples were negative for estrogen and progesterone receptors. Triggering factors were self-reported in 7 cases and were most frequently hormonal changes (n = 6, 18.2%). Hormonal triggers were frequent in AVMs (n = 4). Among patients with identified hormonal triggers, VM samples were positive for androgen receptor in 3 and negative in 3. Three-quarters of our VM samples expressed androgen receptor, and most CLM, VeM, and AVM samples were positive. Hormonal triggers were identified in 6/33 patients, mostly with AVMs.