Bita Dezfoulian

Seasonal variations in vitamin D levels in melanoma patients: a single-centre prospective pilot comparative study

Backgroundu2002 More than 90% of vitamin D synthesis is dependent on UV exposure. Photosensitive disorders such as lupus erythematosus, protoporphyria and xeroderma require strict sun avoidance, and vitamin D deficiency has been demonstrated in these patients. Melanoma patients are also instructed to avoid sun exposure and may hence be expected to be vitamin D deficient.

HERPES ZOSTER IN PSORIASIS PATIENTS UNDERGOING TREATMENT WITH BIOLOGICAL AGENTS: PREVALENCE, IMPACT, AND MANAGEMENT CHALLENGES

As TNF-α is a major factor in the immune defense against herpes zoster (HZ); an increased incidence and severity of HZ cases were suspected in patients undergoing treatment with TNF antagonists. Several studies and clinical experience provided evidence that the incidence of HZ increases by twofold to threefold in this patient category. The number of severe cases of HZ, with multisegmental, disseminated cutaneous, and/or systemic involvement, is also increased. Concerning psoriasis patients under biologicals, the clinician should be more alert for an eventual HZ event, in particular during the first year of biological treatment, and be aware of the possibility of more severe HZ cases. HZ may also undergo an age-shift toward younger patients. Rapid identification of risk factors for severe HZ, such as severe prodromal pains and/or the presence of satellite lesions, is recommended. The treatment recommendations of HZ in this patient group are identical to the recently published guidelines for the management of HZ. The live attenuated viral vaccine OKA/Merck strain anti-HZ vaccination is recommended before initiating biological treatment in psoriasis patients. The new adjuvanted anti-HZ vaccine will probably also benefit patients while on biological treatment.

Non-dermatophyte Dermatoses Mimicking Dermatophytoses in Humans.

Human dermatophytic cutaneous infections usually present as single or multiple slowly progressing annular erythemato-squamous lesions with a tendency to central healing on the hairless skin. In the intertriginous regions (feet, inguinal, axillar, submammary), dermatophytic colonisations and infections manifest as whitish, slightly hyperkeratotic, pruritic and sometimes fissurated lesions. On the scalp, dermatophytic infections commonly lead to single or multiple more or less inflammatory and alopecic lesions. On the plantar and palmar aspects of the feet and hand, dermatophytosis presents as an eczema-like chronic dermatosis. Abscess-like lesions may occur due to zoophilic dermatomycosis. Dermatophytic infections of the nails reveal ill-defined whitish-yellowish colorations of the distal end or the lateral aspects of the nails, sometimes combined with partial nail embrittlement or even complete destruction. Despite the ubiquity of dermatophytic skin infections and their usually highly typical clinical features, a differential diagnosis has to be considered, in particular when treatment is not efficient or when treatment resistance occurs. This review presents the differential diagnosis in terms of frequency as well as the diagnostic methods permitting the distinction of annular, intertriginous, alopecic, palmoplantar, abscess-like and onychodystrophic lesions.

Sensibilisation immédiate aux moisissures et aux levures chez les patients souffrant de maladies respiratoires allergiques (AR) par rapport à ceux atteints de dermatite atopique de la tête et du cou (DA)

Introduction Les moisissures et/ou les levures peuvent jouer un role important dans l’induction des poussees et de la persistance de la DA et de l’AR. Nous avons voulu determiner les taux de sensibilisation aux moisissures et aux levures chez les patients atteints d’AR par rapport a ceux atteints de DA, qui ont consulte notre service, durant une annee. Methodes Des prick-tests ont ete effectues chez 267xa0patients (172xa0femmes et 95xa0hommes, âge median 38 ans, de 25–50 ans). Les patients ont ete classes en 4xa0groupesxa0: dermatite atopique de la tete et du cou (DA) (nxa0=xa064), eczema du tronc (eczema) (nxa0=xa052), allergies respiratoires (AR) (nxa0=xa064xa0: rhinite, conjonctivite, asthme) et groupe temoin (nxa0=xa087xa0: dermatite seborrheique, sebopsoriasis, urticaire, allergie alimentaire et sujets sains). Les extraits aqueux commerciaux standardises suivants ont ete utilises dans des conditions standardiseesxa0: Alternaria, Penicillium, Aspergillus, Cladosporium, Candida albicans, Malassezia et Saccharomyces cerevisiae. Resultats Le taux de sensibilisation aux moisissures etait significativement plus eleve dans la DA et l’AR. Il etait presque equivalent dans l’eczema et dans le groupe temoin. Le taux de sensibilisation a l’Alternaria et au Penicillium etait significativement plus eleve dans la DA (25xa0%) que dans l’AR (15xa0%). Celui axa0l’Aspergillus et au Cladosporium etait similaire dans la DA et l’AR. Dans la DA, le taux de sensibilisation aux levures etait significativement plus eleve. Il etait similaire dans l’eczema, l’AR et le groupe temoin. Celui a Malassezia etait significativement plus eleve dans la DA que dans le groupe temoin. Discussion Les taux de sensibilisation aux moisissures etaient eleves dans la DA etxa0l’AR. La sensibilisation maximale etait observee a l’Alternaria et au Penicillium dans la DA. Les memesxa0moisissures etaient souvent isolees dans l’echantillon d’air ambiantxa0preleve au domicile du patient en cas de test cutane positif. Dans la DA, les taux de sensibilisation aux levures surtout au Malasseziaxa0etaient les plus eleves. Conclusion Les taux eleves de sensibilisation a ces allergenes dans la DA et l’AR confirment l’interet de leur recherche pour adapter les mesures d’eviction et les orientations therapeutiques.