[Cutaneovisceral leishmaniasis following severe nervous depression]. / Leishmaniose cutanéoviscérale au décours d'une dépression nerveuse sévère.

Leishmania is considered an opportunistic agent during cellular immunodeficiency. The authors report the case of a patient living in the south of France presenting visceral leishmaniasis with cutaneous manifestations in the course of a severe nervous depression. This case report illustrates the possible relationships between stress and immunity.

[Chronic urticaria: role of oxatomide]. / Urticaire chronique: place de l'oxatomide.

Oxatomide (Tinset) is a new, powerful, antiallergic agent. Pharmacological and morphological studies have shown that oxatomide is not only an antihistaminic agent but it also inhibits mast cells and basophils degranulation, and neoformed mediators synthesis and release. Open and comparative studies have shown oxatomide to be an effective agent in the treatment of chronic urticaria including physical urticaria and food allergy. All these studies confirm its constant efficacy, giving good to excellent results in 68 to 89 percent of cases. It compares favorably with the classic anti-H1, particularly in that the symptomatic response is much quicker. Moreover the drug is always well tolerated, even when used at higher doses than those presently recommended (30 mg twice daily).

[Role of endothelial activation in urticaria]. / Rôle de l'activation endothéliale dans l'urticaire.

The endothelial cells, because of their privileged situation between the tissues and the vessels, play an important role in the inflammatory reaction. Expression of adhesion molecules (ELAM 1 especially) allows adhesion of circulating neutrophils to the epithelial cell and thus initiates the reaction. During the reactions of immediate hypersensitivity, the flow of leucocytes observed in the late phase is dependent on mastocytes, the recruitment being under the positive or negative influence of several cytokines.

[Urticaria and angioedema caused by mastocytosis]. / Urticaire et angioedème des mastocytoses.

Mastocytosis in children are very polymorphic, most often remaining isolated, without an associated visceral lesion. Beside the phenomenon of "urtication" characteristic, papulo-nodular lesions of urticaria and angio-oedema during the mastocytosis are rarely met. In contrast, congestive signs with pruritus, dermographism, congestive erythema and general signs are frequent.

[Dermatological complications caused by oral contraceptives]. / Complications dermatologiques des contraceptifs oraux.

PIP: The incidence of cutaneous effects of oral contraceptives (OCs) is estimated at 2.7-5%. Secondary effects directly attributable to the hormonal action of OCs include melasma, acne and hyperseborrhea, alopecia, and cutaneous lesions of vascular origin. Melasma or chloasma accounts for about 2/3 of all cutaneous side effects of OCs. It appears from 1 month-3 years after the start of OC use, its frequency increasing with dose and duration of use. Pigmentation appears to accentuate the symptoms in brunettes rather than predisposing them to melasma. Exposure to the sun plays a certain role, but use of a low dose OC and effective sun protection are not enough to reverse the pigmentation. These melasmas regress more slowly than after pregnancy and many remain definitive. The influence of OCs on acne is variable, with some OCs provoking sebaceous hypersecretion and some improving acne enough to be used for treatment. For the therapeutic effect to be observed, the estrogen dose must be sufficient to offset the androgenic effect of the progestin. Combined pills containing the strong antiandrogen cyproterone acetate should control acne if other, less androgenic progestins fail. Alopecia is a very rare effect of OCs and its appearance may even reflect simple coincidence. Vascular complications of combined OCs are dependent on estrogens and may include such manifestations as telangiectasias, angiomas, and livedo reticularis. Some secondary cutaneous effects are probably not due to a hormonal influence. They are less well known than the direct hormonal effects, and publications concerning the often detail isolated observations that are difficult to interpret. Reactions of hypersensitivity or allergy to combined OCs may include urticaria and eczema. A history of OC use should be sought in all women presenting with erythema nodosum and the OCs should be discontinued. Pruritus and jaundice may be observed in 1 OC user in 100,000. They indicate a cholestatic hepatitis for which estrogens are responsible. Most patients developing the condition have already had pruritus or jaundice during pregnancy; such a history contraindicates OC use. Several dermatological and systemic disorders are aggravated by OC use. Hereditary angioedema, herpes gestationis, porphyries, and systemic lupus erythematosus are exacerbated by OC use. The role of OCs in malignant melanomas remains controversial.^ieng

[Histologic signs of cutaneous aging]. / Signes histologiques du vieillissement cutané.

The changes induced by ageing of the skin are particularly visible in photo-exposed areas, indicating the interaction between actinic factors and factors specific to the ageing process itself. The corresponding histological signs affect various structures: epidermis (thinning of the epidermis, reduced cell proliferation...), dermis-epidermis junction (disappearance of the microvilli with defective adhesion of the epidermis to the dermis), dermis (degeneration of elastin and collagen, which is photoinduced, and a moth-eaten appearance with loss of microfibrils as a result of time-related ageing), microcirculation (reduced vascularization, particularly visible in photo-exposed areas...) appendages.

Secondary pancreatic involvement of mycosis fungoides detected by a clinically palpable mass.

A patient with a 4-year history of mycosis fungoides, who presented a pancreatic spreading of the disease, detected by a clinically palpable mass, is reported and discussed with a review of the literature. Mycosis fungoides (MF) is a T cell lymphoma primarily localized to the skin. Laparoscopic staging and autopsy studies, however, have shown that lymph node involvement or visceral spreading is common in the course of the disease [1-3]. Among visceral manifestations of MF, pancreas infiltration is found in 20-40% of autopsied cases [1, 2, 4]. Occurrence of a palpable pancreatic mass has never been described. We report a patient with a long-standing MF, and a secondary pancreatic extension detected by a palpable mass.