Prise en charge thérapeutique du psoriasis en plaques chronique de l'adulte en 2007

Le psoriasis en plaques chronique est une dermatose érythémato-squameuse fréquente qui évolue par poussées entrecoupées de rémissions et qui peut atteindre gravement la qualité de vie des patients. L'arsenal thérapeutique est large avec des traitements locaux, en particulier les corticoïdes, les dérivés de la vitamine D, les rétinoïdes, mais aussi les traitements généraux comprenant les photothérapies, l'acitrétine, le méthotrexate et la ciclosporine. La physiopathologie du psoriasis est encore incomplètement comprise mais les découvertes récentes ont conduit à l'utilisation de nouveaux traitements immunologiques avec trois molécules disponibles : l'étanercept, l'infliximab et l'éfalizumab. Ces traitements réservés aux psoriasis sévères amènent un espoir aux patients arrivés en impasse thérapeutique. Le choix du traitement basé sur la clinique et sur le retentissement sur la qualité de vie du malade sera fait après une information du patient et une négociation patient/médecin.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Photodermatitis from topical phenothiazines A case series

International audienceBackground - In Europe, contact photosensitivity to phenothiazines is well-known, particularly in southern countries. Topical phenothiazines are widely used and sold over-the-counter (OTC) for the treatment of mosquito bites and pruritus in France. Objective - To report a series of cases with photodermatitis following use of topical phenothiazines. Method - A retrospective study of cases of contact dermatitis from phenothiazines seen in French photodermatology centers was performed. Results - In all, 14 patients with a diagnosis of contact dermatitis from phenothiazines were included. These patients developed eczema on the application sites, and in 13 the eruption spread to photodistributed sites. Topical products containing isothipendyl were the most common cause of photodermatitis. One patient had photoaggravated eczema due to promethazine cream. All patients stopped using topical phenothiazines and were treated successfully with topical corticosteroids. One patient relapsed and developed persistent light eruption. In all of the nine cases tested, photopatch testing to the topical phenothiazine used "as is" was positive. Isothipendyl, chlorproethazine, and the excipients were not tested. Photopatch tests to chlorpromazine and promethazine were positive in 8 of 12 and 7 of 13 tested, respectively. Conclusion - Use of isothipendyl and promethazine as OTC (or even prescribed) drugs needs to be limited due to severe reactions and sensitization to other phenothiazines that consequently will have to be avoided

Omalizumab in patients with severe and refractory solar urticaria: A phase II multicentric study

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Comparison of histopathologic-clinical characteristics of Jessner's lymphocytic infiltration of the skin and lupus erythematosus tumidus: Multicenter study of 46 cases.

International audienceOBJECTIVE: We sought to identify criteria able to distinguish between Jessner's lymphocytic infiltration of the skin (JLIS) and lupus erythematosus tumidus (LET). METHODS: The following characteristics were recorded in a retrospective, multicenter analysis of patients with JLIS and LET: clinical features (number, size, type, and localization of lesions; photosensitivity; extracutaneous signs), histologic findings, phototesting, lupus serology, treatment, and outcome. Available histologic slides were reviewed blinded to the initial diagnosis using a pre-established grid. RESULTS: Univariate analysis of data from patients with JLIS (15 women, 17 men; mean age: 35 years) and LET (13 women, one man; mean age: 31 years) showed the following significant (P < .05) differences: more frequent back involvement and annular lesions in JLIS, as opposed to female predominance, more frequent face involvement, and plaques in LET. Phototesting, especially ultraviolet B, induced lesions in 18 of 26 patients with JLIS and all 4 with LET. The blinded histologic review (33 samples) only found slight epidermal atrophy and focal thickened dermoepidermal junction more frequent and perivascular lymphocyte infiltrations less dense in LET. The two groups of patients reclassified according histopathologic features (18 LET and 11 JLIS) showed only slight clinical differences (more frequent nasal bridge lesions in LET and annular lesions in JLIS). LIMITATION: The retrospective nature of the study is a limitation. CONCLUSION: JLIS and LET in this population showed more similarities than differences, supporting a continuous spectrum covering these two entities

Photo-induced graft-versus-host disease

International audienceOverlap chronic graft-versus-host disease (GVHD) associates both features of acute and chronic GVHD. Trigger factors for chronic GVHD are unclear. We describe two patients who received allogenic haematopoietic stem-cell transplantation, and who later developed overlap chronic GVHD after sun exposure. Available data from in vivo investigations suggest ultraviolet B radiation (UVB) has a beneficial effect on acute and chronic GVHD. The role of sun irradiation as a trigger for isomorphic cutaneous GVHD has been rarely reported in the literature. Herein, we demonstrate for the first time, using repetitive broadband phototesting, that UVB triggers chronic GVHD