M. Delage

Efficacy of Infliximab for Hidradenitis Suppurativa: Assessment of Clinical and Biological Inflammatory Markers

Treatment of hidradenitis suppurativa (HS) is often unsatisfactory. The efficacy of infliximab for treatment of the disease has been suggested. The main objective of this study was to evaluate the efficacy and side-effects of infliximab in the treatment of moderate to severe HS, resistant to local and systemic treatments. The secondary objective was to determine whether inflammation blood test results were changed. A retrospective monocentric study of all the patients seen consecutively for HS and treated with infliximab was performed. A median of six intravenous infusions (range 3-19) were performed. The end-points were self-improvement of HS (globally and in terms of pain, seeping and quality of life). The condition of six of seven patients improved (by nearly 50%) and none was aggravated. Adverse effects occurred in two patients; eczematous eruption in one case and cervical abscess in another case. We found no significant changes in inflammatory blood marker values. In conclusion, infliximab therapy was shown to be efficient and well tolerated in six of seven patients with HS resistant to previous therapy in our series. This was in agreement with pre-existing literature showing that 52 of 60 patients (87%) were improved after infliximab therapy.

Effect of physician dress style on patient confidence

Background  We lack data on how physicians can instill confidence in patients.

Lasers CO2 fractionnés : suites normales et complications post-interventionnelles

BACKGROUND Fractional resurfacing is a new concept in laser treatment designed to divide radiation into multiple evenly spaced microspots. The aim of our study was to analyze side effects and complications following fractional CO₂ laser therapy. PATIENTS AND METHODS This retrospective study involved the analysis of records of patients treated with ablative fractional CO₂ laser. Pain, type and duration of usual side effects, and immediate complications were analysed. RESULTS Forty-six treatments were studied. The average duration of erythema was 5.2 (±2) days while that of scabs was 4.1 (±1.9) days. Average pain was 3.3/10 (±2.5) for nine patients premedicated with Emla® and 4.1/10 (±2) for the other 14 non-premedicated patients. Complications were reported for 21.7% of the 46 treatments, as follows: 10.6% facial herpes, some of which occurred despite antiviral prophylaxis (valacyclovir 500 mg/day p.o.), 8.7% inflammatory reactions, including severe facial swelling, and 2.2% acne. All complications resolved quickly. DISCUSSION Our study specifically examined the safety of CO₂ fractional lasers and showed an acceptable per interventional pain and simple follow-ups. The frequency of complications was high compared to that described with the Fraxel®, but no severe complications were reported. Given the extent of herpes complications, our study encourages the prescription of valacyclovir prophylaxis 500 mg twice a day for all patients. Patients should also be informed of the high risk of severe inflammatory reaction.

Extensive, erosive congenital self‐healing cell histiocytosis

Case 1 A newborn full-term male, with no family history of skin disease, presented multiple erosive lesions on 40% of the cutaneous surface, predominantly on the face and scalp. He showed discrete erosions in the oral and nasal mucosal membranes. The suspected diagnoses were congenital bullous epidermolysis, diffuse impetigo, staphylococcal scaled-skin syndrome or neonatal pemphigus. Histopathology examination revealed, underlying a slightly acanthosic epidermis, a massive infiltration of Langerhans histiocytosis cells (large cells with kidney-shaped nuclei) intermixed with infiltrates of eosinophils. Sporadic ulceration was observed, with a disruption of the basal membrane. Immunohistochemical staining of cells revealed positivity for S-100 and CD1a protein. Electron microscopy examination of a skin sample showed lobulated nuclei inside the histiocytes, with Birbeck granules. The skin erosions resolved spontaneously (Fig. 1). After 3 months, the crusted lesions had completely disappeared, leaving non-inflammatory scars with numerous small epidermal cysts (Fig. 2).