Le Pandalao ou la dépigmentation volontaire à Mayotte

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

Intérêt de l'échographie de contraste pour la détection des métastases hépatiques dans le suivi des patients porteurs d'un mélanome stade III et IV de l'AJCC (étude prospective à Besançon, de 68 patients sur deux ans)

BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Pandalao and skin whitening in Mayotte]

International audienceINTRODUCTION: Skin whitening (SW) is very common in dark-skinned populations and the practice is often named after a popular local brand of product and such is the case in Mayotte where this practice is called "pandalao". PATIENTS AND METHODS: We carried out a descriptive epidemiological study in a sample of black Mahoran women aged 15 and over. The survey comprised a questionnaire completed by 163 women between 12 November 2007 and 24 January 2008. The aim of our study was to investigate the practice of SW in Mayotte and to determine its prevalence. RESULTS: Hundred percent of the subjects were aware of SW and 95% knew people practicing this procedure. The prevalence of users of whitening products was 33%, although 74% of these subjects did not use such products on a regular basis and 89% of the women limited application to exposed areas (visible to others). Sixty-three percent simultaneously applied Diproson (betamethasone dipropionate) and Pandalao, the main component of which is salicylic acid. Fifty-four percent of users had presented one or more adverse effects after application of these products and 28% had stopped this practice due to such adverse effects (chiefly acne and dyschromia). DISCUSSION: Although illegal, the trade in skin whitening products continues to grow because it is profitable and takes full advantage of the success of ethnic cosmetics. In Mayotte, as in metropolitan France and Africa, the existence of SW is acknowledged but is still taboo. However, a number of specific characteristics are seen in Mayotte: SW is rarely performed on the whole body, salicylic acid is added to a topical corticosteroid, and the traditional Mahoran mask, the "mzindzano", is still worn for photoprotection

[Sweet's syndrome and phenylbutazone-induced sialadenitis]

International audienceBACKGROUND: Phenylbutazone frequently induces a range of potentially dangerous adverse reactions. We report a case of Sweet's syndrome with sialadenitis induced by phenylbutazone. CASE-REPORT: A 54-year-old woman presented lumbar pains treated with phenylbutazone for three days. Six days later, she exhibited inflammation of the submaxillary and parotid salivary glands, followed by an erythematous, oedematous, pustular and febrile eruption, with failure of antibiotic therapy. Laboratory data showed leukocytosis and neutrophilia, anaemia, an elevated platelet count and liver dysfunction. The infectious and autoimmune tests were negative. The skin biopsy confirmed Sweet's syndrome. Clinical and biological abnormalities resolved on administration of systemic steroids. DISCUSSION: Phenylbutazone-induced sialadenitis is rare and presents unrecognized adverse effects that may be associated with a systemic reaction. In the present case report, Sweet's syndrome met the criteria for drug-induced Sweet's syndrome. There appears to have been a systemic reaction caused by a hypersensitivity mechanism, in the same way as sialadenitis

[Chromomycosis in Guadeloupe]

International audienceBACKGROUND: Chromomycosis is a widespread subcutaneous fungal infection seen essentially in tropical and subtropical regions and transmitted via skin injury caused by the prickles of plants or infected wood splinters. It is prevalent throughout the West Indies including Guadeloupe, where its incidence is not well known. PATIENTS AND METHODS: This retrospective and descriptive study concerns five histologically established cases of chromomycosis in Guadeloupe between 1995 and 2005. The five patients were diagnosed and treated at Pointe-à-Pitre University Teaching Hospital. RESULTS: The study concerned four male patients and one female patient with an average age of 78 years; four were from the Basse-Terre district and one was from the Grande-Terre district. The most frequent clinical aspect was nodular or verrucous. The most common initial topography was the upper limbs. Fonsecaea pedrosoi was the only species identified. Diagnosis was confirmed by histopathology, which in all cases revealed sclerotic cells. Three patients underwent surgical treatment and two received medical treatment; only two patients were cured by 2005. DISCUSSION: Our study confirms the presence of a source of chromomycosis in Guadeloupe, where Fonsecaea pedrosoi is clearly the best adapted species. It also highlights the difficulties of therapeutic care in tropical areas

Sequential therapy in plaque psoriasis using the " Hit and Run " approach: infliximab followed by efalizumab.

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Rare skin cancer: a population-based cancer registry descriptive study of 151 consecutive cases diagnosed between 1980 and 2004.

International audienceBACKGROUND: There are few epidemiological data available on rare skin cancer, including Merkel cell carcinoma, Paget's disease, adnexal carcinoma, and sarcoma. We conducted this study to investigate the epidemiology of rare skin cancer diagnosed in the department of Doubs from 1980 to 2004. METHODS: Data were collected from a population-based cancer registry from 1980 to 2004. Diagnosis was based on the 3(rd) edition of the International Classification of Diseases for Oncology. The incidence rates were standardized on world population. RESULTS: One hundred and fifty one patients were investigated (88 women and 63 men). Median age for the diagnosed disease was 63 years. The standardized incidence rate was 0.82/100 000 person-year (95% CI = 0.68-0.96) and increased from 0.25 in 1980-1984 to 1.50 in 2000-2004. Fifty nine cases (39%) were sarcomas, 35 (23%) adnexal carcinomas, 27 (18%) Merkel cell carcinoma and 27 (18%) Paget's disease. The standardized incidence rates were 0.37/100 000 (0.27-0.47) for sarcomas, 0.16 (0.10-0.22) for adnexal tumors, 0.13 (0.08-0.18) for Merkel cell carcinoma, and 0.15 (0.09-0.21) for Paget's disease. CONCLUSIONS: Our results based on a population-based cancer registry showed an increase of the standardized incidence rate for all types of rare skin tumors. These results may be useful when considering the growing interest in rare diseases in identifying risk factors and planning scientific research programmes

A SUMOylation-defective MITF germline mutation predisposes to melanoma and renal carcinoma.

International audienceSo far, no common environmental and/or phenotypic factor has been associated with melanoma and renal cell carcinoma (RCC). The known risk factors for melanoma include sun exposure, pigmentation and nevus phenotypes; risk factors associated with RCC include smoking, obesity and hypertension. A recent study of coexisting melanoma and RCC in the same patients supports a genetic predisposition underlying the association between these two cancers. The microphthalmia-associated transcription factor (MITF) has been proposed to act as a melanoma oncogene; it also stimulates the transcription of hypoxia inducible factor (HIF1A), the pathway of which is targeted by kidney cancer susceptibility genes. We therefore proposed that MITF might have a role in conferring a genetic predisposition to co-occurring melanoma and RCC. Here we identify a germline missense substitution in MITF (Mi-E318K) that occurred at a significantly higher frequency in genetically enriched patients affected with melanoma, RCC or both cancers, when compared with controls. Overall, Mi-E318K carriers had a higher than fivefold increased risk of developing melanoma, RCC or both cancers. Codon 318 is located in a small-ubiquitin-like modifier (SUMO) consensus site (ΨKXE) and Mi-E318K severely impaired SUMOylation of MITF. Mi-E318K enhanced MITF protein binding to the HIF1A promoter and increased its transcriptional activity compared to wild-type MITF. Further, we observed a global increase in Mi-E318K-occupied loci. In an RCC cell line, gene expression profiling identified a Mi-E318K signature related to cell growth, proliferation and inflammation. Lastly, the mutant protein enhanced melanocytic and renal cell clonogenicity, migration and invasion, consistent with a gain-of-function role in tumorigenesis. Our data provide insights into the link between SUMOylation, transcription and cancer

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial

International audienceAbstract Background Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 )