La demande d’effacement de cicatrices cutanées

International audienceEn dermatologie, les progrès technologiques et leur médiatisation suscitent des demandes de plus en plus fréquentes d’effacement des cicatrices (cicatrices post–chirurgicales, cicatrices post-traumatiques, cicatrices d’acné, cicatrices auto-provoquées (excoriations, scarifications, automutilations) … Les attentes sont fortes et les demandes souvent pressantes chez ces patients qui ont une véritable souffrance avec sentiments de honte et culpabilité. Une réponse opératoire immédiate, sans entendre la demande latente derrière la demande d’effacement des cicatrices, risque d’aggraver la souffrance

La demande d’effacement de cicatrices cutanées

International audienceEn dermatologie, les progrès technologiques et leur médiatisation suscitent des demandes de plus en plus fréquentes d’effacement des cicatrices (cicatrices post–chirurgicales, cicatrices post-traumatiques, cicatrices d’acné, cicatrices auto-provoquées (excoriations, scarifications, automutilations) … Les attentes sont fortes et les demandes souvent pressantes chez ces patients qui ont une véritable souffrance avec sentiments de honte et culpabilité. Une réponse opératoire immédiate, sans entendre la demande latente derrière la demande d’effacement des cicatrices, risque d’aggraver la souffrance

Screening for Neuropathic Pain, Anxiety and Other Associated Chronic Pain Conditions in Vulvodynia: A Pilot Study

International audienceVulvodynia has been defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) as vulvar discomfort, which is most often described as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder (1). Much remains to be understood regarding the patho genesis, natural history, and management of this distressing condition. As postulated for many chronic pain syndromes, the involvement of both peripheral and central sensitization mechanisms in the pathogenesis of vulvodynia has been suggested (2, 3). The characteristics of the pain experienced by patients with vulvodynia suggests the involvement of a neuropathic component in vulvodynia; this includes: hyperalgesia, paraesthesia, dysesthesia and allodynia. In addition, the ineffectiveness of common pain-killers, the effectiveness of certain anticonvulsants (4), anti-depressants and transcutaneous electrical nerve stimulation (TENS) (5) are occasionally reported in association with vulvodynia. The primary objective of the present study was to generate further evidence in support of the existence of a neuropathic component underlying the pathogenesis of vulvodynia. An additional aim was to determine the presence of anxiety, depression and other chronic pain conditions in patients with vulvodynia

Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial.

International audienceHyperhidrosis is a disorder that can impair quality of life. Localized treatments may be cumbersome and ineffective, and no systemic treatments have proven to be significantly beneficial. To evaluate the effectiveness and tolerance of low-dose oxybutynin for hyperhidrosis. We conducted a prospective, randomized, placebo-controlled trial. From June 2013 to January 2014, 62 patients with localized or generalized hyperhidrosis were enrolled. Oxybutynin was started at a dose of 2·5 mg per day and increased gradually to 7·5 mg per day. The primary outcome was defined as improvement of at least one point on the Hyperhidrosis Disease Severity Scale (HDSS). Dermatology Life Quality Index (DLQI) and tolerance were also reported. Most patients (83%) in our study had generalized hyperhidrosis. Oxybutynin was superior to placebo in improving the HDSS: 60% of patients treated with oxybutynin, compared with 27% of patients treated with placebo, improved at least one point on the HDSS (P = 0·009). The mean improvement in quality of life measured by DLQI was significantly better in the oxybutynin arm (6·9) than in the placebo arm (2·3). The most frequent side-effect was dry mouth, which was observed in 43% of the patients in the oxybutynin arm, compared with 11% in the placebo arm. Treatment with low-dose oxybutynin is effective in reducing symptoms of hyperhidrosis in generalized or localized forms. Side-effects were frequent but minor and mainly involved dry mouth