Application en médecine générale des recommandations pour l’acné élaborées par le Centre de preuves de la Société française de dermatologie

National audienc

Association of psychiatric history with delay in the isotretinoin introduction among patients with severe acne. A French population-cohort study

International audienceNo abstract availabl

Dermo-hypodermite bactérienne « à bascule » chez un patient atteint d’hypogammaglobulinémie liée à l’X [Shifting cellulitis in a patient with X-linked hypogammaglobulinemia]

National audienceIntroduction Dans une situation d’immunodépression, une infection systémique peut se révéler par des manifestations atypiques, notamment dermatologiques. Observation Nous décrivons le cas d’un homme de 19 ans suivi pour une hypogammaglobulinémie liée à l’X, ou maladie de Bruton, substituée par immunoglobulines intraveineuses. Durant 6 semaines, le patient développait des placards inflammatoires récurrents des deux jambes, d’un côté puis de l’autre, sans fièvre. La cinquième paire d’hémocultures révélait une bactériémie à Campylobacter jejuni. Une tomodensitométrie abdominale trouvait un foyer infectieux appendiculaire, sans manifestation clinique digestive associée. Une antibiothérapie par azithromycine pendant deux semaines permettait une résolution complète. Discussion Les bactériémies à Campylobacter sont des infections sévères, à l’origine d’un décès dans les 30 jours chez 15 % des patients. Elles sont plus fréquentes en cas d’immunodépression humorale. C. jejuni a été rapporté comme responsable de bactériémies à l’origine de dermo-hypodermites dans dix cas, dont six sur un terrain d’hypogammaglobulinémie. Nous avançons l’hypothèse d’emboles septiques à l’origine des manifestations cutanées. Le déficit immunitaire du patient était supplémenté par une préparation à base d’immunoglobulines G ; le rôle des IgA et des IgM semble essentiel dans la lutte contre C. jejuni et leur défaut pourrait expliquer la susceptibilité à l’infection observée chez notre patient. Selon les recommandations américaines, il faut chercher des germes inhabituels en répétant les prélèvements bactériologiques sanguins et cutanés en cas de dermo-hypodermite bactérienne dans un contexte d’immunodépression cellulaire. Nous proposons d’étendre cette attitude aux patients atteints d’immunodépression humorale

Frequency and characteristics of pruritus in patients with monoclonal gammopathy: a case-control study

International audienceChronic pruritus (CP) is a frequent symptom in many skin and systemic diseases(1), including haematological malignancies. It is described in 30% of Hodgkin lymphoma patients and in patients with myeloproliferative disorders, particularly in polycythaemia vera(2,3). Serum protein electrophoresis (SPEP) is recommended in laboratory screening for CP(4). However, the literature about pruritus in monoclonal gammapathies (MGs) is scarce(5-7). The aim of this study was to determine the frequency and clinical characteristics of pruritus in patients with MGs in comparison to controls with normal SPEP results

Early major adverse cardiovascular events following the initiation of the anti-interleukin 12/23 antibody ustekinumab. A population-based case-time-control study

International audienceUstekinumab, a monoclonal antibody that targets interleukin (IL)-12/23, is used to treat psoriasis, psoriatic arthritis and Crohn disease. In 2011, a meta-analysis of randomized trials alerted on a potential risk of major adverse cardiovascular events (MACE) within the first months after the initiation of anti-IL-12/23 antibodies. Our objective was to assess if ustekinumab initiation may trigger MACE. Using the French National Health Insurance database, covering 66 million subjects, we included all patients exposed to ustekinumab between 2010 and 2016, classified according to their cardiovascular risk level (high vs. low risk). We conducted a case-time-control study. We defined the ‘risk’ period as the 6 months before MACE, defined as myocardial infarctions and strokes, and the ‘reference’ period as the 6 months before the risk period. The initiation of ustekinumab was screened in both periods, enabling to assess the odds-ratio (OR) between the initiation of ustekinumab and MACE. Among the 9290 patients exposed to ustekinumab, 179 displayed MACE: 65 myocardial infarctions, 68 unstable anginas and 46 strokes. Among patients at high-level cardiovascular risk, a significant association between ustekinumab initiation and MACE occurrence was identified (OR, 4.17; 95% CI, 1.19-14.59). Conversely, no association was found in patients at low-level cardiovascular risk (OR, 0.30; 95% CI, 0.03-3.13). From real-world data, we suggest that ustekinumab initiation could trigger MACE in patients at high cardiovascular risk, in line with current immunologic models of atherosclerotic disease. These results should call for caution regarding the prescription of ustekinumab in patients at high cardiovascular risk

Mycoplasma genitalium screening in a specialized French unit: A retrospective study

International audienceOBJECTIVE: Mycoplasma genitalium (MG) infection accounts for 10-35% of non-gonococcal non-chlamydial (NGNC) urethritis. However, given that most people infected with MG do not develop symptoms and that antimicrobial resistance is increasing worldwide, there is no evidence of any benefits of screening asymptomatic individuals. We conducted this study to describe MG screening practices and outcomes at a French Sexually Transmitted Infections (STI) center in which MG testing was performed selectively and multiplex assays were not carried out [i.e., simultaneous screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and MG]. METHODS: A retrospective, observational, single-center study was conducted at the STI unit of Saint-Louis Hospital in Paris. The records of all patients undergoing MG testing from January 1st, 2017, to December 31st, 2018, were reviewed. The primary aim of the study was to describe and evaluate the proportion of MG-positive (MG+) patients among those tested. Secondary objectives were determination of the prevalence of MG+ status among symptomatic patients, risk factors associated with MG infection, and therapeutic modalities and efficacy. RESULTS: Two hundred and forty-nine patients underwent MG testing, 28 (11%) of whom were positive (MG+). The prevalence of MG+ status among symptomatic NGNC patients was 12%. HIV-positive (HIV+) status was significantly associated with MG+ status in univariate and multivariate analyses (Odds Ratio=7.3, 95% Confidence Interval 1.3-41.7; P=0.02). Twenty-three patients (85%) received antibiotics. Eighteen (67%) received azithromycin for 5 days, but 7 had clinical resistance. No quinolone resistance was reported. CONCLUSION: Despite unavailability of multiplex testing at our facility, which led to targeted-only screening for MG, its relatively high local prevalence is in keeping with what is generally observed at similar facilities across the world, where use of multiplex tests enables systematic screening for MG alongside NG and CT. This reinforces the current recommendations in Europe, France and the US against systematic MG testing or treatment in asymptomatic patients