Benoit Catteau

Imatinib mesylate as salvage therapy for refractory sclerotic chronic graft-versus-host disease

Imatinib is a promising candidate for the treatment of fibrotic diseases. This retrospective study evaluated the use of imatinib for the treatment of refractory sclerotic chronic graft-versus-host disease in 14 patients with different hematologic malignancies. Imatinib was started at a median of 44 months after transplantation (range, 16-119 months after transplantation) and was administered for a median of 5.9 months from time of initiation (range, 2.1-74 months from time of initiation). With a median overall follow-up of 11.6 months from time of initiation (range, 4.1-74 months from time of initiation) of imatinib, 4 patients (29%) had to stop imatinib because of drug intolerance. All other adverse reactions were of mild-to-moderate grade and could be managed symptomatically. Overall, 7 patients responded to imatinib (50%; 95% confidence interval, 24%-76%) with 4 patients improving their Rodman score more than or equal to 90%. In addition, imatinib therapy allowed for a significant reduction of corticosteroid dosage. Despite its limited size, this cohort suggests some beneficial activity of imatinib in sclerotic chronic graft-versus-host disease, warranting further prospective investigations.

Paediatric skin disorders encountered in an emergency hospital facility: a prospective study.

To determine the frequency of skin disorders encountered in a paediatric emergency care unit and to evaluate the benefits of advice from a dermatologist, we prospectively recorded data of children admitted with skin disorders to the emergency care unit during a 5-month period. Diagnostic agreement between paediatricians and dermatologists evaluating the patients separately was assessed. Three hundred and ninety-five children (median age 3 years; interquartile 1-6) were included. Skin disorders represented 4% of all paediatric emergency care unit visits. Visits were considered as appropriate in 19-30% of cases according to different criteria. Six diseases accounted for 57% of cases: viral exanthema, urticaria, atopic dermatitis, varicella, diaper dermatitis and herpetic gingivostomatitis. The dermatologist modified the diagnosis in 42% of cases and the treatment in 30%. Greater emphasis on teaching the skin disorders encountered in this setting and efforts to provide easy access to advice from dermatologist would improve the quality of care.

Conversion to sirolimus: A useful strategy for recalcitrant cutaneous viral warts in liver transplant recipient

Dermatological complications following transplantation are very common and the majority of immunosuppressed transplant recipients develop some to many warts due to human papillomavirus (HPV) infection. In the setting of immunosuppression, therapeutic management may be disappointing because of the extent of the lesions in patients unable to develop a sufficient immune response directed against HPV. We report here a case of a young liver transplant recipient who developed diffuse recalcitrant HPV‐induced warts leading to an impairment of her quality of life. Taking into account the antiproliferative and cytostatic properties of the target‐of‐rapamycin (TOR) inhibitors, a new class of immunosuppressive drug, we significantly modified the immunosuppressive regimen. Conversion to sirolimus was followed by a rapid improvement of cutaneous state suggesting that this strategy may be useful for recalcitrant cutaneous viral warts in transplant recipient. Liver Transpl 12: 1883–1887, 2006.

Bacterial Skin Infections in Children Hospitalized with Varicella: A Possible Negative Impact of Non-steroidal Anti-inflammatory Drugs?

This 1-year multicentre prospective study in northern France sought to evaluate the incidence of secondary bacterial skin complications related to varicella, describe these superinfections, and analyse risk factors for their onset. The study included every child admitted to a district paediatric unit with a varicella infection. Patients with varicella infection, with and without secondary bacterial skin complication, were compared. The study included 159 children, 43 of whom had a secondary bacterial skin complication on admission, 21 of them had a severe secondary bacterial skin complication (respective incidence: 7.5 and 3.7/100,000 children younger than 16 years old). Persistence or recurrence of fever > or =38.5 degrees C for > or =3 days after the beginning of varicella infection (adjusted odds ratio (aOR)=8.1; 95% confidence interval (CI): 2.3-28.4) and the use of non-steroidal anti-inflammatory drugs (aOR=4.8; 95% CI: 1.6-14.4) were independent factors associated with severe secondary bacterial skin complication.

Atypical varicella with palm and sole involvement

Varicella is a common disease characterized by a typical presentation. We report a case of an atypical presentation of varicella with a centrifugal distribution, eruption with many vesicles, no pustular stage in evolution and distal involvement. There were none of the known modifying factors (immunosuppression, skin disease, injury or sun exposure). To explain the distal involvement, we suggest intraepidermic lesions caused by a pre‐existing B1 coxsackie infection.

A four-year history of pruriginous erythroderma leading to the diagnosis of idiopathic hypereosinophilic syndrome.

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Chronic graft-versus-host disease revealed by lichenoid vulvar lesions successfully treated with thalidomide

Sir, Chronic graft-versus-host disease (GVHD) occurs in approximately 60 – 80% of patients who survive for 100 days after allogeneic bone marrow transplantation (BMT) (1). The skin is affected in almost all cases of chronic GVHD, with two distinct phases: the early chronic phase, characterized by lichenoid lesions similar to lichen planus, and the late chronic phase, with sclerodermatous lesions. During the early course, the clinical spectrum of lichen planus may be reproduced, and the initial lesions are usually in the buccal mucosa. Rarely has genital mucosa been reported during chronic GVHD. We describe a case of chronic GVHD in a 40-year-old woman successfully treated with thalidomide at a dose of 100 mg per day. GVHD manifested in erosive lichen-planus-like lesions of the vulva following allogeneic BMT for chronic myeloid leukaemia.