M.C. Marguery

Photoprotection in teenagers

Background: It is very common to apply a ‘template photoprotection’ without taking into consideration the background of a specific population. In Lebanon, so far, no preliminary survey has been conducted before launching an educational photoprotection campaign, revealing the need of the people according to their background.

Prolonged Photosensitivity following Contact Photoallergy to Ketoprofen

We report the third case of prolonged photosensitivity secondary to contact photoallergy to topical ketoprofen, a 2-arylpropionic acid derivative. The patient suffered from persistent photosensitivity for more than 1 year after the withdrawal of ketoprofen with recurrent eruptions on sun-exposed skin areas. This photosensitivity was associated with a persistent decrease in polychromatic and UVA minimal erythemal doses. Photobiological testing revealed cross-reactivity with fenofibrate and benzophenones. Photoallergy to ketoprofen is due to the benzophenone structure or to the very similar thiophene phenylketone of tiaprofenic acid, but not to the arylpropionic function. Thus, fenofibrate, tiaprofenic acid and benzophenones should be avoided by patients with a positive history of photocontact dermatitis to ketoprofen.

Allergic and photoallergic contact dermatitis to Olaquindox in a pig breeder with prolonged photosensitivity.

To the editor, Olaquindox is an allergen and photoallergen specifically affecting pig breeders. Only a few cases of allergic and photoallergic contact dermatitis have been reported since 1985 (1–5). We report a new case which stresses the importance of Olaquindox as an allergen and photoallergen capable of inducing prolonged photosensitivity. A 53-year-old man presented in March 1999 with a photodistributed eczema on the face (sparing eyelids), neck and backs of the hands and fingers. He had been taking Rilmenidine (HyperiumA) and Diltiazem (MonotildiemA) for 4 years, Pravastatin (ElisorA) for 1 year withdrawn in March 1999. The patient was atopic. He had also worked as a pig breeder for 10 years and used azaperone (StresnilA), a sedative drug for pigs, oxytetracycline (DuphacyclineA) and Olaquindox, an antibiotic molecule which is added to the pigs food to avoid enteritis at the time of weaning. Olaquindox was included in a vitamin and mineral complex presented in powder form. The photobiological testing was performed with two sources of light: polychromatic irradiation (UVB, UVA, visible)

Photodistribution of blue-gray hyperpigmentation after amiodarone treatment: molecular characterization of amiodarone in the skin.

BACKGROUND For decades, the photodistributed blue-gray skin hyperpigmentation observed after amiodarone therapy was presumably attributed to dermal lipofuscinosis. Using electron microscopy and high-performance liquid chromatography, we identified amiodarone deposits in the hyperpigmented skin sample from a patient treated with this antiarrhythmic agent. Our findings therefore indicate that the hypothesis relating the blue-gray hyperpigmentation to lipofuscin should be challenged. OBSERVATIONS A 64-year-old man, skin phototype III, presented with asymptomatic skin hyperpigmentation that had been slowly developing on sun-exposed areas since April 2004. He had been taking amiodarone for 4 years (cumulative dose, 277 g). Electron microscopy did not show lipofuscin pigments in his skin. Conversely, abundant electron-dense membrane-bound granule deposits were observed in most of the dermal cells (fibroblasts, macrophages, pericytes, Schwann cells, and endothelial cells), especially in photoexposed skin. High-performance liquid chromatography confirmed that the skin deposits were composed of amiodarone. These results demonstrate that amiodarone hyperpigmentation is related to drug deposition on photoexposed skin. CONCLUSION Amiodarone-related hyperpigmentation should be considered a skin storage disease that is secondary to drug deposition.

Contact urticaria from formaldehyde in a root‐canal dental paste

A 37-year-old woman presented, a few hours after a dental appointment, with itchy urticaria of the lower jaw that rapidly cleared with oral corticosteroids. Questioning her dentist revealed that he usually used Spad® rootcanal filling material for the treatment of infected teeth. Root-filling or pulp chamber filling is obtained in 1 session as follows: the canal is first irrigated with sodium hypochlorite, acidified with sulfuric acid, dried with hot air and then controlled by absorbing paper points. The paste is prepared by mixing a drop of 2 liquids: liquid L, containing glycerin and 28% formaldehyde, and liquid LD, containing hydrochloric acid, resorcinol and

Evaluation of drug-induced photosensitivity by UVB photopatch testing

Case Report A 70-year-old white woman (phototype III), who had been treated for 15 years with AldactazineA (Altizide, spironolactone) because of arterial hypertension, was admitted in February 1998 with a photodistributed erythematous, papulosquamous eruption involving the face (eyelids, cheeks), lateral neck, dorsum of both hands and proximal phalanges. The accompanying symptoms were those of burning and itching. Although she reported protection of her eyes by regularly wearing sunglasses, the erythematous eruption occurred on both eyelids. On withdrawal of AldactazineA, lesions disappeared and she recovered within 4 weeks. Photobiological testing was performed with polychromatic irradiation (1.000 W Xenon light, Dermolum UM-WA, Muller, Moosinning, Germany) filtered with a Schott WG 305 filter, and a high-pressure metal halide UVA lamp (2.000 W, SunlabA). The UVB radiant energy was 3.0 mW/cm2 and that of UVA, 40 mW/cm2. Patch and photopatch tests were performed in triplicate with the French Society of Photodermatology standard series (1), AldactazineA 10% aq. and 10% pet. The patches were removed after 1 day (D). 1 set was irradiated with 5 J/cm2 of UVA and a 2nd set with a suberythemal UVB dose (0.75 UVB-MED). The 3rd, non-irradiated set served as the patch test control. Reading was made at D1 and D2 after irradiation.

Aggravation d'un lupus érythémateux subaigu sous infliximab

Resume Introduction L’infliximab (Remicade®) est un medicament, ayant une action anti-TNF alpha, indique dans le traitement de fond des rhumatismes inflammatoires, notamment de la polyarthrite rhumatoide. Observation Nous rapportons le cas d’une femme de 56 ans ayant eu une aggravation d’un lupus erythemateux subaigu, SSA positif, lors de la mise en route d’un traitement de fond par infliximab pour une polyarthrite rhumatoide. Discussion Une revue de la litterature a permis de colliger 30 cas de lupus induits et de lister les modifications auto-immunes induites par les anti-TNF alpha. Ce premier cas de lupus erythemateux subaigu, preexistant a l’introduction d’un tel traitement et aggrave par celui-ci, souligne le risque de developper une poussee severe d’une maladie auto-immune lors d’un traitement par anti-TNF alpha. Il fait discuter la contre-indication relative des anti-TNF alpha chez les malades atteints de lupus erythemateux.

Fixed solar urticaria to visible light successfully treated with fexofenadine

Fixed solar urticaria (FSU) represents an uncommon form of urticaria related mostly to radiation from the ultraviolet (UVB, UVA) and visible spectrum. The exact pathomechanism has so far remained unknown. A 52‐year‐old woman with a 3‐year history of urticated eruptions limited to certain skin areas is presented. Photobiological testing revealed positive reactions limited to the visible light range. The induced lesions appeared only in originally affected skin sites. The particular distribution of whealing supports the concept of specific alteration of mast cells in well defined areas. The clinical findings and the results of phototesting lead to the diagnosis of FSU to visible light. It is recommended to carry out phototesting in patients with FSU in the originally affected skin areas, usually covered and protected by the patient, to avoid false‐negative results. Fexofenadine given in the conventional dosage can prevent recurrences and represents a successful treatment measure when dealing with this peculiar form of solar urticaria.

Urticarial manifestations due to Raphanus niger

Discussion The reaction to Bactroban® ointment previously reported was due to allergy to polyethylene glycol in the ointment base. In contrast, this patient was allergic to calcium mupirocin free base itself. It is most likely that his sensitivity to Bactroban® occurred through its application to his leg ulcers, a situation notorious for the induction of allergic contact hypersensitivities. Increased systemic absorption of mupirocin may thus have occurred, as well as of its principle metabolite monic acid, detected in the urine in those with skin conditions and amounting to 0.4--0.6% of the applied dose (6). It is necessary to consider the possibility of sensitivity to mupirocin, especially when applied to broken skin over protracted periods. Contact Dermatitis 1995: 32: 241

Incidence and risk factors for treatment failure with infliximab in psoriasis

G.U. Sawatkar, A.J. Kanwar,* S. Dogra, S.K. Bhadada, D. Dayal Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India *Correspondence: Prof. A. J. Kanwar. E-mail: ajkanwar1948@gmail.com