[Value of the light-test histological study in photodermatoses]. / Intérêt de l'étude histologique du phototest dans les photodermatoses.

Clinic and histologic analysis of 92 phototests of various photodermatosis (14 benign summer light eruption (BSLE), 47 polymorphous light eruption (PMLE) 20 persistent light reactor photodermatitis (PLRP), 11 drug induced photodermatitis (DIP) has been performed. Clinically, a phototoxic aspect was observed in 30 cases, it was photoallergic in 36 cases and uncertain in 26 cases. Histologically, a phototoxic picture was present in 32 cases, a photoallergic one in 48 cases, and 12 cases exhibited unclassified aspect. Only one case of BSLE was associated with photoallergic aspect, clinically and histologically. Photoallergic type was observed in 70 p. 100 of iterative exposure phototest (IEP) of PMLE; clinical and histological aspects were concordant; in contrast phototoxic aspects were constantly observed when single exposure phototest (SEP) were used. In PLRP histological aspect of IEP was constantly of photoallergic type; whereas clinical aspect was uncertain in 50 p. 100 of the cases; 7 of the 10 biopsies of SEP exhibited a photoallergic picture. In DIP histological aspect of IEP was constantly photoallergic, whereas 5 of the 6 cases exhibited uncertain clinical aspect; only one of the 5 SEP gave a photoallergic reaction both clinically and histologically. Comparison of histological features revealed a more typical photoallergic picture in PLRP than in PMLE. We conclude that: the reproducibility of clinical and histological lesions is better with the iterative exposure phototest than with single exposure phototest; histologic examination is more reliable than clinical findings in persistent light reactor photodermatitis and drug induced photodermatitis.

[Follicular tumidus retro-auricular lichen planus (author's transl)]. / Lichen plan folliculaire tumidus rétro-auriculaire

Referring to three comparable cases, a new form of lichen planus is described. This form is characterized by a prominent lesion, violaceus in color or pigmented, with white yellowish specks mimicking milia. The histologic picture of lichen follicularis, the presence of typical papules of lichen distant from the retro-auricular lesion make it possible to consider this clinical aspect as a variety of lichen planus.

[Benign adnexal tumors of late occurrence in verrucoid-sebaceous nevus (Jadassohn). Apropos of 7 cases]. / Tumeurs annexielles bénignes de survenue tardive sur naevus verruco-sébacé (Jadassohn). A propos de 7 cas.

Occurrence of basal cell epithelioma and syringocystadenoma papilliferum on sebaceous nevi is well known. But many other adnexal tumors, such as pilar or sweat gland tumours may also be associated with this dysembryoplasia. Out of 99 cases of verruco-sebaceous nevi we find 12 associated basal cell epitheliomas, 7 syringocystadenomas papilliferum and 6 benign adnexal tumors. Our report is about these 7 cases. All of these tumors appeared in adult-hood and were clinically suggesting the diagnostic of basal cell epithelioma. But, after histopathological examination was performed, they revealed to be 2 nodular hidradenomas, 1 chondroid syringoma, 1 trichilemmoma, 1 apocrine cystadenoma, 1 follicular poroma. Similar data are given by Mehregan and Pinkus in 1965 and Wilson Jones and Heyl in 1970, respectively out of 150 and 140 cases of verruco-sebaceous nevi.

[The difference forms of "parapsoriasis en plaques". A report of 90 cases (author's transl)]. / Les différentes formes du parapsoriasis en plaques. A propos de 90 cas

The term parapsoriasis was used by Brocq (1902) to group a number of conditions previously described under different names. This group has since then been modified, the same conditions being described under separate names and these have led to a great confusion especially between countries. In this study of 90 cases, three types of parapsoriasis en plaques are distinguished. The "parapsoriasis digitiforme" (40 cases) or benign type, or xanthoerythrodermia perstans, or chronic superficial dermatitis is characterized by small, oval or finger-like, yellow or pink patches. The histology is frequently not characteristic, but in a few cases, there is an exocytosis localized "en flammèches" in the epidermis. The condition is usually permanent but none of these cases has progressed to mycosis fongoides. The parapsoriasis "en grandes plaques simples" (25 cases) is characterized by few pink patches (3 to 5), larger than in benign type. In our cases the transformation to poikiloderma atrophicans vasculare is not observed. One of these cases progressed to mycosis fongoides. The "parapsoriasis en grandes plaques poïkilodermiques" (25 cas), or poikiloderma atrophicans vasculare, prereticulotic poikiloderma, atrophic parapsoriasis, parapsoriasis lichenoides, is characterized by large patches, in limited number, showing a reticulated pigmentation and slight atrophy with telangiectasia. Five cases changed into mycosis fongoides and 4 cases showed some symptoms of malignancy; The histologic features are the same in the two last types: sometimes they are non-specific, in numerous cases the picture is characteristic with micro-abscesses or "flammèches"; in some cases there is a dense infiltrate with a clearly defined lower limit: this histologic appearance can be seen in cases without transformation into mycosis fongoides.

[Wells' syndrome or eosinophilic cellulitis. Apropos of 2 cases. Review of the literature]. / Le syndrome de Wells ou cellulite à éosinophiles. A propos de 2 cas. Revue de la littérature.

In 1971, four cases of a new dermatosis were described by Wells, under the name of recurrent granulomatous dermatitis with eosinophilia. In 1978, eight additional cases were reported by Wells and Smith and three authors suggested a shorter title: eosinophilic cellulitis for this syndrome. Since then, four additional cases were published in the literature. We report here two additional cases. From these eighteen upto now published cases, there is no doubt that this dermatosis, as initially described by Wells, is a distinct entity. Clinical course is characterized by sudden eruption of large infiltrated, itchy and/or painful plaques. Blisters are often associated. During the two or three weeks following the initial rash, the inflammatory aspect disappears. Lesions become indurated, and may resemble morphea. Spontaneous resolution occurs after about six weeks. Recurrences are constantly observed. Histologic features are a striking eosinophilic infiltrate associated with eosinophilic deposits constituting flame figures. Blood eosinophilia is present in most cases. Etiology of this entity remains unknown.

[Non-drug toxicoderma by a respiratory or probable percutaneous route (fluorocarbons, butane, phenyl-azo-beta-naphthol)]. / Toxidermies non médicamenteuses par voie respiratoire ou percutanée probable (fluorocarbures, butane, phényl-azo-bêta-naphtol).

Four cases of cutaneous rash, clinically more or less similar to erythema multiforme have been observed in patient who either stayed in a room with an accidentally high content of fluorocarbons, or had a skin contact with butane or phenyl-azo-beta-naphthol. The cutaneous lesions appear to be secondary to absorption of the toxic product, and probably induced by inhalation rather than by percutaneous penetration. Arguments for the responsibility of the substances rely on anamnestic data.

[Erosive lichen of the scalp]. / Lichen érosif du cuir chevelu.

BACKGROUND: We report an exceptional clinical presentation of erosive lichen planus of the scalp associated with hepatitis C and idiopathic CD4 lymphocytopenia. CASE REPORT: A 90-year-old woman was hospitalized in May 1995 for erosive dermatosis of the scalp and alopecia, associated with ungual lesions. Histology of the scalp lesions demonstrated lichen and the serology tests were positive for hepatitis C. The patient also had severe CD4 lymphocytopenia (290/mm3). The lesions regressed with clobetasol and occlusion and growth of scalp hair turned. DISCUSSION: Erosive lichen planus of the scalp has, to our knowledge, not been reported previously. The causal effect of drugs taken by this patient (tetrazepam and clorazepam) was not retained. Seropositivity for hepatitis C (with no evidence of active disease) was however probably not fortuitous. The association with CD4 lymphocytopenia merits discussion.

[BCG-induced mycobacterium infection induced by alternative medicine]. / Bécégite du visage après mésothérapie.

INTRODUCTION: Mesotherapy is an alternative medical process defined by the intradermal injection of small amounts of pharmacological substances. It has been associated with the development of mycobacterial infections. CASE REPORT: A 80-year-old woman presented with a Mycobacterium bovis infection of the face following mesotherapy. Genome analysis of the mycobacterial strain isolated from a skin lesion using pulse-field gel electrophoresis demonstrated the presence of a vaccinal strain identical to the one employed by the same physician to vaccinate a child two hours before. DISCUSSION: Given the severity of mycobacterial infections following mesotherapy and given the lack of evidence about its efficacy, mesotherapy should not be performed on the face. Standardisation of aseptic measures in the daily medical practice could prevent such infectious complications.

[Atypical urticaria disclosing acute basophilic leukemia. Apropos of a case associated with hyperhistaminemia]. / Urticaire atypique révélatrice d'une leucémie aiguë à basophiles. A propos d'un cas associé à une hyperhistaminémie.

Acute basophilic leukaemia (ABL) is a rare disease characterized by high fever, anaemia and haemorrhagic diathesis. Its prognosis is somber and its response to therapy mediocre. Death is mainly due to cerebral or digestive hemorrhage and coronary disease. In a very small number of cases ABL, like all diseases accompanied by an increase in basophils, may be associated with hyperhistaminemia responsible for cutaneous and gastric symptoms.

[Lichen planus in children: 12 cases]. / Lichen plan de l'enfant. 12 cas.

OBJECTIVE: Lichen planus is in children uncommon and poorly understood. The classical description is comparable to lichen planus in adults. We conducted a retrospective analysis of 12 cases in children. PATIENTS AND METHODS: Twelve children with lichen planus consulted the Saint-Louis or Robert-Debré hospitals between February 1994 and March 1996. Data collected included: age, sex, ethnic origin, drug use, anti-hepatitis vaccination status, disease history, physical examination, skin histology, liver tests, hepatitis B and C serology, treatment and outcome. Histological proof was obtained in all cases but one (a child with isolated ungueal involvement whose sister had histologically proven ungueal lichen planus). RESULTS AND DISCUSSION: The clinical features classically described in adults were atypical in all our childhood cases. A rapidly extensive eruption was the main sign in 6 cases. The localizations were unusual with lesions involving all four limbs and the trunk as well as the face in 5 cases and the scalp in 1. Mucosal involvement, observed in 65 p. 100 of adult cases was only found in one of our children. Unguel involvement also appears to be uncommon in children. The etiological pattern was also unusual since we did not observe a single case related to drugs or hepatitis B or C infection. Three children developed a lichen eruption after anti-hepatitis B infection. Four other cases of lichen planus after anti-hepatitis B vaccination have been reported in the literature. Mean delay between the booster vaccination and onset of eruption is reported to be 40 days. The increased incidence of childhood lichen planus in tropical zones suggests ethnic, genetic and climatic factors may be involved. Prognosis is poorly defined in the literature. Certain authors emphasize the long duration of the disease and resistance to treatment in cases of childhood lichen planus. Currently, there is no consensus on treatment. Dermocorticoids in combination with antihistaminics are usually prescribed. General corticosteroid therapy would appear to be warranted in extensive progressive forms with important functional and esthetic impact (scalp involvement with cicatricial alopecia, pigmentation sequellae). The role of other drugs, particularly retinoids, remains to be defined. This retrospective series was not statistically significant. Data in the literature are rather discordant, emphasizing the need for a prospective analysis to acquire a better understanding of the real incidence of childhood lichen planus and better define the therapeutic strategy.