Alain Taïeb

Clinical Validation and Guidelines for the SCORAD Index: Consensus Report of the European Task Force on Atopic Dermatitis

BACKGROUND We have previously reported how the SCORAD index was designed. This cumulative index combines objective (extent and intensity of lesions) and subjective (daytime pruritus and sleep loss) criteria. AIMS To study interobserver variability in scoring for objective SCORAD criteria and to optimize the scoring guidelines. MATERIAL AND METHODS Three scoring sessions were organized in 1993-1994 in Hamburg, Bordeaux and Rotterdam totalizing 19 patients (14 children and 5 adults) and 23 physicians, among whom 12 participated in at least 2 scoring sessions; 169 evaluation sheets have been processed using the SCORAD File Marker Pro software. At each session, total body photographs and close-up views were taken of each patient, and this material was reviewed at the final evaluation. RESULTS The extent of lesions according to the rule of nines showed interobserver variability mostly for patients with lesions of moderate intensity involving 20-60% of body surface. Intensity items were scored with more consistency overall, but variations subsided especially for oozing/crusts and lichenifications. Low and high scorer profiles and the benefit of training were noted. CONCLUSIONS This study has allowed to optimize clinical scoring using the SCORAD system. A proposal has been made to grade the severity of atopic dermatitis according to objective criteria in three groups for inclusion in clinical trials. The SCORAD index remains the major criterion for follow-up in trials.

Nail matrix arrest in the course of hand, foot and mouth disease

Abstract. Onychomadesis describes complete nail shedding from the proximal portion; it is consecutive to a nail matrix arrest and can affect both fingernails and toenails. It is a rare disorder in children. Except for serious generalised diseases or inherited forms, most cases are considered to be idiopathic. Few reports in literature concern common triggering phenomena. We present four patients in whom the same benign viral condition in childhood appeared as a stressful event preceding onychomadesis. In each case, spontaneous complete healing of the nails was achieved within a few weeks. Conclusion: onychomadesis and/or onycholysis is a newly recognised complication in the course of viral infections presenting clinically as hand, foot and mouth disease, and because of mild forms, is probably underestimated.

Vitiligo as an inflammatory skin disorder: a therapeutic perspective.

From a therapeutic standpoint, vitiligo is still regarded by many physicians as a simple problem of regenerative medicine, with the main aim to repopulate the depigmented skin with functional melanocytes from the margins of the lesions or from intact progenitors in hair follicles. However, recent research in vitiligo suggests that various local triggers alert the skin immune innate system and may precede adaptive immune responses targeting melanocytes. This scenario is close to that of other common skin inflammatory disorders like psoriasis and atopic, and suggests to target as a priority this clinically silent inflammatory component of he disease. This perspective highlights possible targets for intervention.

Epidemiology, Definitions and Classification

› Vitiligo occurs worldwide with an estimated overall prevalence of less than 0.5% in population-based studies. › Vitiligo vulgaris/NSV (non-segmental vitiligo) is an acquired chronic pigmentation disorder characterized by white patches, often symmetrical, which usually increase in size with time, corresponding to a substantial loss of functioning epidermal, and sometimes hair follicle melanocytes. › Segmental vitiligo (SV) is defined descriptively as for NSV, except for a unilateral distribution (“asymmetric vitiligo”) that may totally or partially match a cutaneous segment such as a dermatome, but not necessarily. › NSV and SV may coexist, and in this case SV lesions are usually more refractory to treatment.

IFAG and Childhood Rosacea: A Possible Link?

Idiopathic facial aseptic granuloma (IFAG) is a disorder that usually occurs during early childhood. Its pathogenesis remains poorly understood. The objective of this study was to investigate possible relationships between IFAG and childhood rosacea. This was a retrospective multicenter study of patients attending four French dermatologic centers diagnosed with IFAG between October 2000 and July 2007. Patients and their parents were asked to come for a follow‐up visit or to make an appointment for a telephone interview. Clinical symptoms of childhood rosacea were recorded: flushing, permanent or recurrent erythema; facial telangiectasia; papules and pustules on the face without comedones or microcysts; preferential location of the lesions on the convexity of the face; and ophthalmologic involvement of rosacea (recurrent chalazions, conjunctival hyperemia, keratitis). Thirty‐eight patients, 20 girls and 18 boys, were included in the study. The median age at the time of diagnosis of IFAG was 43 months, with a median follow‐up of 3.9 years. Sixteen patients (42.1%) had at least two criteria of childhood rosacea, 11 of 32 (34.4%) with a single lesion and 5 of 6 (83.3%) with multiple lesions. Children with IFAG are at risk for childhood rosacea, and follow‐up is advised, including periodic ophthalmologic assessment.

Factors associated with the relapse of infantile haemangiomas in children treated with oral propranolol

Although propranolol has become the first‐line therapy for infantile haemangiomas (IHs), no study has yet investigated factors associated with the risk of relapse in children with IH treated with propranolol after cessation of treatment.

Living with vitiligo: results from a national survey indicate differences between skin phototypes

DEAR EDITOR, Vitiligo, an acquired, idiopathic skin disease characterized by a generally progressive loss of inherited skin colour, has an estimated worldwide prevalence of 0 5–1%. Although vitiligo is more noticeable in individuals with dark skin, the prevalence is similar to that in the overall population. Despite not being life threatening, vitiligo is a serious skin disorder and the overall disease burden in individuals with vitiligo is often underestimated. The current study determined the burden, in the broadest sense (including impact on quality of life, self-perceived stress and self-image) of vitiligo on daily life and, in particular, assessed differences in the perception of vitiligo and its management in fair vs. dark skin phototypes. We conducted a cross-sectional monocentric study in 300 patients with vitiligo, within the framework of developing a new specific vitiligo burden questionnaire. Consulting dermatologists recorded patient demographic/clinical characteristics, and classified patients as having ‘fair skin’ (phototype I–III) or ‘dark skin’ (phototype IV–VI). This study was approved by the Commission Nationale Informatique et Libert es and by the local ethics committee of the University Hospital of Bordeaux. The burden of vitiligo was evaluated via a conceptual vitiligo-burden-specific questionnaire (developed by the authors) and several validated assessment tools: Short Form-12, Dermatology Life Quality Index (DLQI), PCV-Metra (Pr evention Cardio-Vasculaire en M edecine du Travail) and Body Image States Scale. The conceptual vitiligo questionnaire, created after conducting face-to-face interviews between patients with vitiligo (n = 25), experts in questionnaire design and psychology, and physicians involved in vitiligo, consisted of 35 questions, each with seven possible responses: ‘all the time’, ‘very often’, ‘often’ (collectively ‘yes’), ‘sometimes’, ‘rarely’, ‘never’ and ‘not applicable’ (collectively ‘no’). Three hundred individuals with vitiligo (72% female; mean age 48 9 16 2 years, range 15–87) were classified as having fair (n = 234) or dark (n = 66) skin. The majority of patients classified with dark skin were of Middle Eastern, Caribbean or Indian ethnicity. Vitiligo most commonly affected the hands (85% of patients), wrists (69%), armpits (62%), feet (62%), elbows (61%) and mouth (59%). The face (76%) and hands (54%) were the most troublesome body areas affected by vitiligo. Overall, respectively 29%, 42%, 22%, 6% and 2% of patients reported < 5%, 5–10%, 10–25%, 25–50% and > 50% of their body area affected by vitiligo. There were no between-group differences for these parameters. More patients with dark skin than fair skin reported being satisfied with their support/management (34% vs. 20%, P = 0 046). However, 47% of fair-skinned patients replied ‘undecided/don’t know’ in response to ‘are you satisfied with your treatment?’; 73% of all patients were ‘undecided/not treated’, with < 10% of respondents answering ‘yes’. The majority (91%) of patients reported following their physician’s prescription ‘most often/occasionally’, with < 20% of patients self-medicating. Patients in both groups demonstrated impaired quality of life, self-perceived stress levels and self-image (Table 1). Patients with dark skin reported higher DLQI scores than those with fair skin (Table 1; P = 0 049). The responses obtained with the conceptual vitiligo questionnaire are shown by skin phototype in Table S1 (see Supporting Information). Twenty-two of 42 factors assessed by univariate analysis were retained at the predetermined P < 0 15 level (Table S2; see Supporting Information). Multivariate analysis demonstrated three factors that were significantly associated with skin phototype (Table 2). For patients with dark skin, significant factors were ‘my vitiligo has repercussions on my physical appearance’ [odds ratio (OR) 3 41, 95% confidence interval (CI) 1 04–11 13; P = 0 042] and ‘managing my vitiligo on a daily basis is a burden’ (OR 3 09, 95% CI 1 07–8 95; P = 0 037). In contrast, ‘my vitiligo puts me at greater risk for skin cancer’ (OR 0 37, 95% CI 0 15–0 95; P = 0 039) was significantly associated with a higher burden in fairskinned individuals. The latter perception is interesting in light of studies indicating that patients with vitiligo have a decreased risk of melanoma and nonmelanoma skin cancer; improved patient education by physicians may be warranted in this area. This study demonstrates that, regardless of skin phototype, patients with vitiligo experience significant disease-related burden and self-perceived stress. Furthermore, although patients with dark skin phototypes perceived some significant differences in the burden of vitiligo on daily life compared with their fair-skinned counterparts, and vice versa, overall self-perceived stress associated with vitiligo was generally similar in patients regardless of skin type. The current study reinforces outcomes from previous studies, while providing new insights into differences in the

Comparison of ADVIA Centaur® and Pharmacia UniCAP® tests in the diagnosis of food allergy in children with atopic dermatitis

In a study comprising 63 children diagnosed with atopic dermatitis, the results of the ADVIA Centaur system was compared with the results obtained with the Pharmacia UniCAP100 system, which has been widely considered as a reference method for seric specific IgE (sIgE) measurements. The individual immunization against the most common food allergens [egg (f1), cow milk (f2), cod (f3), wheat (f4), peanut (f13) and soy bean (f14)] was determined by in vitro serum IgE testing and skin prick test (SPT). The comparison of the sIgE titers revealed a good concordance between the Centaur and the UniCAP tests for f1, f3, and f13 (94 %, 91 %, and 96 % respectively). However, the concordance was lower for f2, f4, and f14 (76 %, 77 %, and 77 % respectively) because of discrepancies between the two techniques. When compared with SPT and clinical diagnosis, on the 40 discordant cases found between the Centaur and the UniCAP, the Centaur showed concordance with the patients food reaction and SPT in 34/40 cases, and UniCAP in only 6/40 cases. Accordingly, the Centaur test displayed a statistically significantly better performance on specificity and concordance with SPT for f2, f4, and f14 (concordance/specificity = 70%/71%, 76%/75% and 90%/88% respectively), than the CAP test (49%/54%, 51%/52% and 67%/65% respectively).

Association of Immunologically Confirmed Delayed Drug Reaction and Human Herpesvirus 6 Viremia in a Pediatric Case of Drug-Induced Hypersensitivity Syndrome

child was seen for febrile lower back pain. An epiduritis was suspected on clinical signs, biology and spine MRI. No bacteria were isolated from blood culture and lumbar puncture. Antibiotics were initiated with cefotaxime and rifampicin for 2 weeks. Then the child received oral rifampin and trimethoprim/sulfamethoxazole. The child had never received these antibiotics before. Four weeks later, he presented a progressive generalized rash associated with hyperthermia and severe asthenia and was referred to our unit. Exanthematous eruption, diffuse edema ( fig. 1 ) and severe pruritus were observed on examination; in addition, polyadenitis and splenohepatomegaly were noted. The laboratory results revealed leukocytosis (WBC: 68,000/mm 3 , absolute eosinophil count: 1,800/mm 3 ) with mononucleosis, cholestasis and hepatic cytolysis (alkaline phosphatase: 623 IU/l, aspartate transaminase: 430 IU/l, alanine transaminase: 265 IU/l). Polymerase chain reaction for HHV-6 performed on day 3 after the onset of the rash was positive in blood (65,000 copies/ml). Cytomegalovirus and Epstein-Barr virus serologies were negative. The diagnosis of DIHS was made, and all drugs were discontinued. Corticosteroid therapy was started (prednisone 1 mg/kg/day) resulting in a rapid resolution of DIHS symptoms without epiduritis recurrence. Corticoids were stopped within 2 weeks without relapse. Two months later, drug patch tests were performed with the commercialized forms and with the purified active agent of all suspected antibiotics (drugs series, Chemotechnique , Sweden) in accordance with the guidelines for drug patch testing [1] . The patch tests were ap

Halo Nevi and Vitiligo

The halo nevus (HN) is a common lesion, with a suspected prevalence of 1% in the general population. The HN incidence is apparently equally increased in both segmental (SV) and nonseg-mental (NSV) vitiligo. There is a trend toward less extensive NSV in the case of association with HN. The usual explanation of the depigmented ring is that the immunologic response, first directed against the nevus melanocytic antigen(s), outgrows its first target to cause the loss of normal melanocytes of the surrounding skin. HN and vitiligo involve two independent pathways leading to depigmentation, but a possible overlap exists in a subset of patients, and there is an overall increased proneness to HN in both SV and NSV patients.