C. Droitcourt

A Randomized, Investigator-Masked, Double-Blind, Placebo-Controlled Trial on Thalidomide in Severe Cutaneous Sarcoidosis

BACKGROUND Thalidomide use in cutaneous sarcoidosis is based on data from small case series or case reports. The objective of this study was to evaluate the efficacy and safety of thalidomide in severe cutaneous sarcoidosis. METHODS This study consisted of a randomized, double-bind, parallel, placebo-controlled, investigator-masked, multicenter trial lasting 3 months and an open-label study from month 3 to month 6. Adults with a clinical and histologic diagnosis of cutaneous sarcoidosis were included in nine hospital centers in France. Patients were randomized 1:1 to oral thalidomide (100 mg once daily) or to a matching oral placebo for 3 months. In the course of an open-label follow-up from month 3 to month 6, all patients received thalidomide, 100 mg to 200 mg daily. The proportions of patients with a partial or complete cutaneous response at month 3, based on at least a 50% improvement in three target lesions scored for area and infiltration, were compared across randomization groups. RESULTS The intent-to-treat population included 39 patients. None of them had a complete cutaneous response. Four out of 20 patients in the thalidomide group (20%) vs four out of 19 patients in the placebo group (21%) had a partial cutaneous response at month 3 (difference in proportion of -1% [95% CI, -26% to +24%] for thalidomide vs placebo, P = 1.0). Eight patients with side effects were recorded in the thalidomide group vs three in the placebo group. We observed a large number of adverse event-related discontinuations in patients taking thalidomide in the first 3 months (four patients with thalidomide, zero with placebo) and in the 3 following months (five patients). CONCLUSIONS At a dose of 100 mg daily for 3 months, our results do not encourage thalidomide use in cutaneous sarcoidosis. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT0030552; URL: www.clinicaltrials.gov.

Vemurafenib-Induced Eccrine Squamous Syringometaplasia

We report herein a patient treated with vemurafenib for a stage IV melanoma who developed an eruption related to eccrine squamous syringometaplasia (ESS). This entity is a well-described side effect of cytostatic therapies used for malignant neoplasia and is clinically characterized by a symmetric cutaneous eruption composed of papules and vesicles preferentially located on fold and intertriginous areas. It is histologically defined by a squamous metaplasia of eccrine ductal epithelium. ESS represents another skin eruption to be added to the list of cutaneous adverse events associated with vemurafenib, a selective BRAF inhibitor used to treat patients with metastatic melanoma harboring the V600E mutation. The discussion focuses on the pathogenesis of ESS secondary to vemurafenib and on alternative diagnoses.

Docetaxel-induced photo-recall phenomenon.

Photo‐recall phenomenon is a phototoxic eruption occurring on areas of previous ultraviolet‐induced solar erythema following a systemic administration of a drug. It has been mostly described with methotrexate but remains rare with other antineoplastic drugs. We describe a case of docetaxel‐induced photo‐recall skin rash in a woman treated for a non‐small‐cell lung cancer. Although the patient has refused to receive a second infusion, chemotherapy can be carried on with photoprotection and the use of topical and/or systemic corticosteroids. In contrast, radiation recall is a well‐known reaction by oncologists, most of them may not be aware of a similar phenomenon called photo‐recall phenomenon. Recognizing this entity may avoid misdiagnosing a drug allergy and should avoid inappropriate decisions of drug discontinuation.

Multifocal Lymphangioendotheliomatosis With Thrombocytopenia: Clinical Features and Response to Sirolimus

Multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT) is a recently described glucose transporter 1–negative multifocal vascular disorder with significant morbidity and mortality. However, data are lacking on the clinical spectrum, long-term prognosis, and treatment of MLT. It is often confused with multifocal infantile hemangioma, but the conditions must be differentiated for appropriate assessment and therapeutic management. Treatments for MLT have been disappointing, and the treatments classically used for infantile hemangioma are often ineffective. We report 3 newborn cases featuring various clinical and biological phenotypes of MLT: 1 patient had severe brain involvement and died early; another had no thrombocytopenia; and the third had nearly no skin involvement. Histologically, all were negative for glucose transporter 1 and positive for the lymphatic marker lymphatic vessel endothelial hyaluronan receptor 1 or D2-40 (∼38-kDa O-linked transmembrane sialoglycoprotein podoplanin). Two cases with severe gastrointestinal bleeding were treated with sirolimus 0.1 mg/k per day, which was efficient after the first month of treatment. MLT clinically presents in various forms, and when complicated by widespread or severe extracutaneous involvement, initial aggressive therapeutic intervention is justified. The pathogenesis of MLT remains unclear, but lymphatic differentiation is widely acknowledged. Because of its antiangiogenic properties, including anti-lymphangiogenesis, sirolimus offers an adequate and targeted therapeutic approach for MLT.

Prevalence of Nail Scabies: A French Prospective Multicenter Study

Introduction To assess the prevalence of nail involvement in children <16 years old with a confirmed diagnosis of scabies. Study design Observational, prospective study in 7 French dermatology departments between June 2015 and January 2017. Children were included if they had scabies confirmed by dermoscopy and/or microscopy and if nails could be sampled. The first toenails and thumbnails as well as clinically affected nails were systematically sampled for microscopic examination. Individual data were recorded via a standardized questionnaire. Results A total of 47 children with scabies were included (26 females [55.3%], mean age 3.6 ± 4.0 years). Pruritus was present in 42 children (89.3%); the relapse rate was 38.3% (n = 18). In 3 infants (6.4%), Sarcoptes mites were revealed by dermoscopy or microscopy of the first toenails (2 cases) and a thumbnail (1 case), but nails were normal in 2 children. Two of the 3 infants had already received treatment for scabies in the previous weeks. Conclusion Prevalence of nail involvement in children with confirmed scabies was 6.4%. Nails should not be overlooked during scabies treatment.

Safety of Oral Propranolol for Infantile Hemangioma

In this study on a large nationwide database based on health reimbursements, we confirm the overall good safety profile of oral propranolol in children with IH. OBJECTIVES: The safety of oral propranolol for infantile hemangioma has not yet been studied at population level since the pediatric use marketing authorization was obtained in Europe. METHODS: A survey of a nationwide, claim-based observational cohort of children <3 years old, with at least 1 delivery of oral propranolol between July 2014 and June 2016, was performed by using the database of the French National Health Insurance system. Standardized morbidity ratios (SMRs) were calculated by using, from the same database, a representative random sample of nonexposed subjects. The main outcomes were hospitalizations for cardiovascular (conduction disorders, bradycardia, and hypotension), respiratory (bronchial hyperactivity and bronchospasm), or metabolic events (hypoglycemia and hyperkalaemia), identified through the hospitalization diagnostic codes of the International Classification of Diseases, 10th Revision. The main analysis was conducted separately on “healthy” children (N = 1484), that is, free from of any prespecified underlying disease and on children with 1 of these underlying diseases (N = 269). RESULTS: In all, 1753 patients <3 years of age had at least 2 deliveries of oral propranolol. In the healthy population, we observed 2 cardiovascular events (SMR = 2.8 [0–6.7]), 51 respiratory events (SMR = 1.7 [1.2–2.1]), and 3 metabolic events (SMR = 5.1 [0–10.9]). In the population with an underlying disease (mainly congenital heart disease), we observed 11 cardiovascular events leading to an SMR of 6.0 (2.5–9.6). SMRs were not significantly raised for respiratory or metabolic events in this “nonhealthy” population. CONCLUSIONS: In this study on a large continuous nationwide claims database, we confirm the safety profile of oral propranolol in healthy children to be good.

Successful treatment of severe anti-p200 pemphigoid in a heart transplant recipient with a single cycle of rituximab

Anti-p200 pemphigoid is a rare autoimmune subepidermal blistering disease, first described in 1996.1 This disorder was initially considered as a more benign condition compared with bullous pemphigoid and epidermolysis bullosa acquisita, but in a recent series of patients, heterogeneous clinical presentations have been described, including cases with a more severe course than previously reported.2 We describe a case with a highly active disease in a heart transplant patient who experienced a dramatic and complete remission after 1 cycle of rituximab.

Trial Designs and Characteristics in Laser Studies in Dermatology: A Systematic Review.

BACKGROUND Lasers are increasingly used in Dermatology. Clinical studies are among the best means to assess their efficacy. OBJECTIVE To obtain an overview of therapeutic laser studies in the field of Dermatology, the authors conducted a systematic review to describe the types of study published over the past 25 years, and their reporting in the abstracts. METHODS The authors selected interventional studies that evaluated laser treatment on human subjects with skin diseases. Reviews or single-case reports were excluded. Journal characteristics, study design, and trial characteristics were recorded and analyzed according to trends over time and journal impact factor ratings. RESULTS Of the 681 studies included, 57% were comparative, of which 46% were randomized, controlled studies. Trial duration was clearly mentioned in 63% of the abstracts. Trial duration was generally under 6 months (78%). Some parameters were rarely mentioned as follows: the number of patients lost to follow-up (only 12%), blinding (21%), and a clearly stated main outcome (36%). Over the 25 years, there was a significant trend toward an increased proportion of randomized, controlled trials, from 15% between 1990 and 2000 to 41% between 2010 and 2015 (p < .001). CONCLUSION This systematic review highlights areas for improvement in laser studies in Dermatology.

Syndrome d’hypersensibilité médicamenteuse induit par l’ibuprofène

pose le problème du rôle des virus dans la pathogénie du DRESS. Ce rôle a déjà été démontré pour certains virus comme HHV6, HHV7, EBV et CMV, mais il n’a pas encore été rapporté de cas associé au virus de l’hépatite virale B. Dans notre observation, nous pensons que le syndrome d’hypersensibilité dû à l’isoniazide a réactivé le virus de l’hépatite virale B chez notre patiente. Conclusion.— La recherche d’une réactivation virale au cours du DRESS syndrome devrait être systématique. Déclaration d’intérêt.— Aucun.