Grégory Szepetiuk

The therapeutic potential of TNF-alpha antagonists for skin psoriasis comorbidities.

Importance of the field: Alopecia, psoriatic arthritis, the metabolic syndrome, inflammatory bowel diseases and cardiovascular diseases may occur as skin psoriatic comorbidities. TNF-α antagonists are used to treat psoriasis. Adalimumab is one of the recognized active agents for this indication. Areas covered in this review: The current peer-reviewed publications and presentation of original findings. What the reader will gain: Adalimumab is active on recalcitrant psoriasis and some of its comorbidities, particularly arthropathies and Crohns disease. However, the progression of the radiological alterations is limited with regression of the bony erosions. Psoriatic enthesopathy also regresses. Mortality associated with psoriasis arthropathy is on the decline. Crohns disease, the most frequent inflammatory bowel comorbidity of psoriasis, is responsive to adalimumab. The effect of adalimumab on the metabolic syndrome and cardiovascular involvement is more erratic. The spectacular effects of adalimumab may be associated with some adverse effects. In particular, despite a marked reduction in the psoriasis area-and-severity index (PASI) score some new acute lesions of cutaneous psoriasis may develop corresponding to paradoxical psoriasis. Other potential adverse effects include infections, granulomas, rapid growth of cancers and occurrence of lymphomas. Take home message: Adalimumab frequently controls moderate-to-severe forms of cutaneous psoriasis and some of its comorbidities.

Recent trends in specular light reflectance beyond clinical fluorescence diagnosis.

Under specific light illumination, particularly ultraviolet (UV) and near-UV light stimulation, the skin produces both specular light reflectance and, possibly, specific fluorescent emission. These properties offer diagnostic clues and disclose some peculiar functions of the skin. A series of superficial infections (erythrasma, some tinea capitis types, tinea/pityriasis versicolor, dermatophytoses, etc.) and pilosebaceous follicles enriched in Propionibacterium spp show fluorescence. This latter characteristic is downgraded or lost while on some anti-acne treatments. A quenching effect of fluorescence is observed following the application of sunscreens. The (pre)neoplastic areas prepared for methylaminolevulinate photodynamic therapy (MAL-PDT) show reddish fluorescence following drug metabolisation producing porphyrins by the abnormal activated cells. Of note, when using a recording sensitive CCD camera instead of casual visual observation, skin fluorescence may be superimposed on the specular reflectance of the incident light. With the current technology, these situations are not distinguished with confidence. Any harsh and scaly lesion appears brighter following yellowish specular light reflectance. Stratum corneum samplings collected on clear self-adhesive discs or cyanoacrylate skin surface strippings are conveniently examined ex vivo, taking advantage of the same optical properties.

Chronic interdigital dermatophytic infection: A common lesion associated with potentially severe consequences

Interdigital intertrigo and onychomycosis has the potential cause of severe bacterial infectious complications with pain, mobility problems, abscess, erysipelas, cellulitis, fasciitis and osteomyelitis. In another hand, diabetic neuropathy, which affects 60-70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes. These people are high suspecting to be infected by dermatophytic infections in interdigital spaces or onychomycosis witch are frequently induce damage to the stratum corneum, leading to bacterial proliferation and secondary infection. A patient presented with an asymptomatic warm, painless, erythematous swelling of the second left toe, which had been present for a few weeks. Clinically, the lesion was categorized as erysipelas upon an insidious abscess formation. Further investigation was undertaken to confirm the presence of diabetes. Leg erysipelas is a common affection which, according to various studies, has both local concomitants (interdigital intertrigo, lymphoedema, surgical antecedents) and/or general causes (immune suppression, diabetes, alcoholism, etc). Interdigital intertrigo, tinea pedis, and onychomycosis present as public health problems that could trigger serious deterioration in patient quality of life, due to complications induced by secondary bacterial infections.

Hypomelanosis of Ito: pigmentary mosaicism with immature melanosome in keratinocytes.

Background  Hypomelanosis of Ito is a rare genetic disorder characterized by whorled areas of hypomelanosis. The purpose of the present study was to revisit some aspects of Ito’s hypomelanosis.

Fungal chitin-glucan scaffold for managing diabetic xerosis of the feet in menopausal women

Background: Corneocyte accumulation (hyperkeratosis, xerosis) commonly occurs in the stratum corneum (SC) of the feet of diabetic patients, as well as menopausal women. Objective: To compare the effects of a 1.5% chitin-glucan formulation with its placebo, and commercially available glycerol formulations. Methods: This two-step controlled double-blind, randomized, intra-individual study was performed in 30 type 1 and 2 diabetic menopausal women suffering from xerosis of the feet. The formulations were applied once daily for 3 weeks. Electrometric assessments were performed on three sites of the feet at entry in the study, at weekly intervals during the treatment phase, and in a 2-week follow-up out of treatment. Positive controls consisted in two commercially available formulations enriched in glycerol. Results: Data revealed an unequivocal benefit provided by the 1.5% chitin-glucan formulation compared with placebo. The electrometric values were significantly higher at each evaluation time during both treatment and follow-up phases. The two glycerol-enriched formulations showed slightly different kinetics of SC moisturization. A steep increase was followed by a plateau level and a rapid decline after stopping the treatments. Conclusion: The increased moisturization of the SC of the sole probably improves the desquamation process and reduces xerosis of the soles.

Autoimmunity-related granulomatous dermatitis in association with hepatitis.

Aim: Both interstitial granulomatous dermatitis (IGD) and palisaded neutrophilic granulomatous dermatitis (PNGD) are rare disorders typically associated with systemic autoimmune conditions. They probably represent different aspects of a disease spectrum encompassing the concept of autoimmunity-related granulomatous dermatitis (ARGD). Case Report: A 61-year-old woman presented with ARGD and autoimmune hepatitis. The clinical presentation suggested PNGD, while histopathology was consistent with IGD. Discussion: The association of ARGD with autoimmune hepatitis is apparently a rare event. The present case shows that the clinicopathological correlation in ARGD does not always clearly fit with the classical presentations of IGD or PNGD.

Fondements physico-biologiques de la fluorescence cutanée – Revue

Fluorescence is a peculiar aspect of photoluminescence. Some intrinsic components of the skin are fluorophores. Other synthetic components are metabolized into fluorophores. These characteristics may be used for identifying some specific aspects of skin physiopathology. Recent technological evolution has provided new devices bringing sensitive and specific information from the skin. This review presents a synthesis of the progress made in the field of fluorescence and specular reflexion of incident UV light on the skin.

About a Rare and Specific Clinical Entity: The Alopecic and Aseptic Nodules of the Scalp. A Case Report and a Literature Review

Alopecic and Aseptic Nodules of the Scalp, first described as pseudo cyst of the scalp, represent a new clinical entity. The nodules are glistening and non fluctuating and the rest of the scalp remains normal. Their surface is rounded and domed and is the seat of an inflammatory cicatricial alopecia. We report one case of AANS and discuss about clinical features, histology, aetiology and treatment.