Antoine Petit

The Clinical Spectrum and Therapeutic Management of Hypocomplementemic Urticarial Vasculitis: Data From a French Nationwide Study of Fifty‐Seven Patients

Hypocomplementemic urticarial vasculitis (HUV) is an uncommon vasculitis of unknown etiology that is rarely described in the literature. We undertook this study to analyze the clinical spectrum and the therapeutic management of patients with HUV.

Clinical efficacy of intravenous immunoglobulins for the treatment of dermatomyositis skin lesions without muscle disease

Treating dermatomyositis (DM) with isolated skin involvement is difficult and inconsistently performed. Intravenous immunoglobulins (IVIg) are recommended for corticoresistant or corticodependant DM, but only a few cases of IVIg use in DM with isolated skin involvement have been reported.

Syringotropic mycosis fungoides: Clinical and histologic features, response to treatment, and outcome in 19 patients

BACKGROUNDnA rare variant of mycosis fungoides (MF), syringotropic MF (STMF) is characterized by a particular tropism of the lymphocytic infiltrate for the eccrine structures, and included in the follicular subtype of MF in the World Health Organization-European Organization for Research and Treatment of Cancer classification of cutaneous lymphomas.nnnOBJECTIVEnWe sought to determine the clinicopathologic features and disease course of patients with STMF.nnnMETHODSnA retrospective study was conducted to identify patients with STMF from 1998 to 2013.nnnRESULTSnNineteen patients were included: 15 men and 4 women, mean age 55 years (range, 24-86). Most had multiple lesions (n=16, 84%) with associated alopecia (n=12, 63%) and/or punctuated aspect (n=12, 63%). Palms or soles were involved in 10 cases (53%). Folliculotropism was found in 13 cases (68%). After a median follow-up of 70 months (range, 2-140), 3 patients died, 1 from disease-related death. The 5-year overall and disease-specific survival were 100%. The disease-specific survival was significantly higher than in 54 patients with folliculotropic MF without syringotropism (5-year disease-specific survival, 74%; 95% confidence interval, 58%-94%, P=.02).nnnLIMITATIONSnRetrospective setting is a limitation.nnnCONCLUSIONSnIn the spectrum of adnexotropic MF, STMF appears as a distinct entity from follicular MF, with peculiar clinical characteristics and natural history.

Maladie de Rosai-Dorfman à révélation cutanée : 7 observations

BACKGROUNDnRosai-Dorfman disease (RDD) is a benign form of non-Langerhans-cell histiocytosis. It is identified by a particular histological profile first observed in febrile lymph nodes. Extranodal sites are frequent. The most common site is the skin, which can reveal the disease despite a difficult and delayed diagnosis. Seven cases of cutaneous revelation of RDD were studied retrospectively in order to delineate the clinical characteristics and facilitate diagnosis and treatment of this extremely rare disease.nnnPATIENTS AND METHODSnSix cases of RDD from 1990 to 2011 were identified in the photographic and histopathological records of the Saint-Louis Hospital and one case came from a Bichat Hospital consultation. The diagnosis was based in all cases on histopathology results.nnnRESULTSnPatients consisted of four men and three women aged between 31 and 69 years. Cutaneous lesions (3 to 20) revealed the disease in all of them and the time from disease onset to diagnosis ranged from six months to five years. The clinical presentation was erythematous or orange popular nodules or plaques, usually on the face. Microscopically, a dense dermal infiltration was observed, in some cases extending into the subcutaneous tissue, with pale histiocytic cells characterised by emperipolesis, plasma cells, lymphocytes, some neutrophils and variable fibrosis. The diagnosis, initially erroneous in 4 cases, was rectified by a second reading of histopathology slides, and immunohistochemical studies showed expression of S-100 protein in histiocytes but not CD1a. Three patients had pure cutaneous RDD. Two neurological sites and one nasal site were also found, with one ENT site and sequelae of previous uveitis in one patient. All extra-cutaneous sites were identified by clinical examination. Different treatments were proposed according to the sites and impact of the disease. In one case, the lesions regressed spontaneously after 18 months.nnnCOMMENTSnFew RDD series have been published and they mainly concern Asian patients. The ethnic origin of our patients was varied. The main findings were: 1) common clinical findings (orange or erythematous papules or nodules, mostly on the upper body), which should alert the dermatologist and histopathologist to the possible diagnosis of RRD; 2) the possibility, already mentioned in the literature, of spontaneous regression and a good prognosis; 3) the need for thorough evaluation by thoracic, abdominal and cerebral CT (computed tomography) or more a PET (positron emission tomography) scan to screen for potentially dangerous visceral sites, and also clinical follow up.

Continuous increase of Trichophyton tonsurans as a cause of tinea capitis in the urban area of Paris, France: a 5-year-long study.

&NA; Tinea capitis (TC) is a highly contagious fungal infection of the scalp due to dermatophytes in children. To obtain information on the epidemiology of TC in the urban area of Paris, we analysed the microbiological results of 3090 patients seen with suspected TC from October 2010 to September 2015 at Saint Louis hospital, Paris, France. A peak of TC was observed in 3‐6 year‐old children, followed by a progressive decrease until 16 years of age. Of the 1311 positive cultures, 95% (1246) yielded one of the three anthropophilic species [Trichophyton tonsurans (33.5%), Trichophyton soudanense (38.3%), or Microsporum audouinii (28.2%)]. When considering one TC case per family, we observed a significant increase of T. tonsurans (P = .018) during these 5 years. The increase was more pronounced (P = .0047) in patients of West‐African descent (n = 666), and was at the expense of M. audouinii and T. soudanense. On the other hand, the Caribbean patients (n = 85) remained predominantly (72.9%) infected by T. tonsurans. Our results show a better virulence of T. tonsurans over other species as already reported. Since T. tonsurans has not been reported in Africa, the infection of patients of West‐African descent probably took place in the Paris area by exchanges with Caribbean patients. This increase of TC due to T. tonsurans was observed in the context of griseofulvin being the only licensed paediatric treatment for TC in France, which should deserve reappraisal because terbinafine may be more efficacious.

Relapse of severe forms of adult morphea after oral corticosteroid treatment

common aetiological agent (69%). This corroborates the results of most studies worldwide. In our study, the degree of correlation between the sampling techniques was satisfactory according to the results of DM (j = 0.7368; P < 0.0001) and culture (j = 0.5986; P = 0.0001). However, our results do not support the routine use of VP, considering we did not obtain a higher PP in DM and in culture with the use of this sampling technique. VP, as Qureshi et al. also noted, is technically more complicated and time-consuming. If not properly performed, VP can be associated to an increase risk of pain to the patient or transmission of infectious diseases.

Arterial aneurysm with distal ischemia in a renal allografted patient: beware of angiosarcoma

ejd.2013.2020 Auteur(s) : Barouyr Baroudjian1 bbarouyr@hotmail.com, Maxime Battistella2, Samia Mourah3, Geoffroy Hickman1, Cecile Pages1, Isabelle Moulonguet1, Fabien Koskas4, Julien Gaudric4, Christine Le Maignan5, Jacques Dantal6, Martine Bagot1, Antoine Petit1, Celeste Lebbe1 1 Department of Dermatology, 2 Department of Pathology, 3 Laboratoire de Pharmacologie-Genetique, 4 Department of vascular surgery, Pitie Salpetriere Hospital, Paris, France 5 Department of Oncology, Saint Louis Hospital, Avenue [...]

Increased Severity and Epidermal Alterations in Persistent versus Evanescent Skin lesions in Adult Onset Still’s disease

REFERENCES 1. Wolner ZJ, Yelamos O, Liopyris K, Rogers T, Marchetti MA, Marghoob AA. Enhancing skin cancer diagnosis with dermoscopy. Dermatol Clin. 2017;35(4):417-437. 2. Haliasos EC, Kerner M, Jaimes-Lopez N, et al. Dermoscopy for the pediatric dermatologist part I: dermoscopy of pediatric infectious and inflammatory skin lesions and hair disorders. Pediatr Dermatol. 2013;30(2):163-171. 3. Haliasos EC, Kerner M, Jaimes N, et al. Dermoscopy for the pediatric dermatologist, part II: dermoscopy of genetic syndromes with cutaneous manifestations and pediatric vascular lesions. Pediatr Dermatol. 2013;30(2):172-181. 4. Haliasos EC, Kerner M, Jaimes N, et al. Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions. Pediatr Dermatol. 2013;30(3):281-293. 5. Streicher JL, Kini SP, Stoff BK. Innovative dermatopathology teaching in a resource-limited environment. J Am Acad Dermatol. 2016;74(5):1024-1025.

Catastrophic cryofibrinogenaemia associated with chronic lymphocytic leukaemia and salvage therapy using plasmapheresis and cyclophosphamide

(Table 1). The ages vary from 18 to 89 years (mean: 46.5 years). The ratio of men to women is 8–4. CC was found to range in diameter from 2 to 30 mm (mean: 11.2 mm). There seems to be no correlation between trauma and the occurrence of CC. CC has been recognized on the face (four cases), sole (three cases), palm (two cases), neck (two cases) and thigh (one case). Humphreys et al. reported familial cases with multiple CCs (No. 2–4) and suggested that the phenomenon is associated with the incomplete expression of the tuberous sclerosis gene. CC can be clinically mistaken for verruca vulgaris, dermatofibroma, glomus tumour, eccrine poroma and pyogenic granuloma. Our review of the literature found that no cases were diagnosed as CC before surgical and histopathological examination. In fact, we clinically misdiagnosed the present case as callus. Regarding the pathogenesis of the callus-like feature, we speculated that chronic endogenic pressure might have thickened the surface and chronic exogenic pressure from the ground might have been what made the surface scaly. As CC can occur at any age and site and can have various clinical features, it is quite difficult to diagnose without histopathological examination. In conclusion, when dealing with callus-like subcutaneous nodules, we should consider CC as a differential diagnosis.

Cytokine levels in persistent skin lesions of adult-onset Still disease

To the Editor: Adult-onset Still disease (AOSD) is an inflammatory disease characterized by fever, polyarthritis, and skin inflammation, with increased serum levels of interferon(IFN), interleukin 1 (IL-1 ), IL-18, IL-6, tumor necrosis factor, IL-8, IL-2 receptor, C-X-C motif chemokine 10, and C-X-C motif chemokine 13 (CXCL13). The cutaneous manifestations of AOSD include the classic evanescent skin eruption (ESE) and atypical persistent skin eruptions (APSEs), the latter possibly being related to more severe AOSD forms. The aim of this study was to analyze the expression of key cytokines that are possibly involved in the skin inflammation of AOSD. A total of 13 patients with AOSD (according to the Yamaguchi and/or Fautrel criteria) with skin lesions (7 ESEs and 6 APSEs) and 9 healthy donors were included. Hematoxylin-eosinestained slides from all the patients were blindly examined by 2 pathologists (M.B. and M.D.V.P.). Total RNA was extracted from five 20m-thick paraffin tissue sections. Quantitative polymerase chain reaction